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Emotion dysregulation is central to psychopathological conditions, including borderline personality disorder (BPD) and depression. However, the nature of emotion-regulation (ER) difficulties in the daily life of people with BPD or depressive features is still unclear. Therefore, in this study, we aimed to disentangle two different ER subprocesses in daily life, (a) selection of ER strategies and (b) the effectiveness of implementing strategies, in terms of their associations with subsequent emotional experience. We analyzed data from a three-wave, longitudinal, experience-sampling study of young adults with varying levels of psychopathological features (N= 202). BPD features were uniquely linked to the use but not altered effectiveness of several putatively adaptive and maladaptive ER strategies. Depressive features were uniquely associated with the use of putatively maladaptive strategies. These findings suggest that ER deficits in people with more BPD or depressive features may be primarily located in strategy selection rather than the implementation of those strategies.

The Rives–Stoppa (RS) procedure is a gold standard treatment of midline abdominal wall hernias. Comparability of pain control and outcomes to the enhanced-view totally extraperitoneal prosthetic (eTEP) repair remain unclear. A single-centre retrospective surgical cohort was selected including 30 RS repairs (January 2019–November 2021) and 30 consecutive eTEP procedures (September 2021–August 2022) for midline abdominal wall hernia(s) with rectus abdominis diastasis. Postoperative pain and outcomes were compared up to 1 month. Presence and median duration of patient-controlled analgesia were, respectively, 90% and 3 nights with RS, versus 30% and 0 nights with eTEP. Median switch to only oral analgesics occurred at postoperative day (POD) 3 after RS and at POD 2 after eTEP. Postoperative analgesics and opioid prescription at discharge were comparable. Median length of hospital stay was six nights after RS versus 3 nights after eTEP. Median duration of surgery was 110.5 and 164.5 min for RS and eTEP, respectively. After RS, 30 patients had postoperative drain(s) compared to 3 patients after eTEP. Conversion was needed in 3 eTEP procedures. Postoperative complications were comparable. No early recurrences were observed. Minimal residual diastasis was seen at postoperative consultation in 11 patients after eTEP. Compared to RS, eTEP is a minimally invasive alternative treatment of midline abdominal wall hernias with rectus abdominis diastasis and is associated with a shorter length of hospital stay, less postoperative pain and a comparable risk of short-term complications. At 1 month after eTEP, minimal residual diastasis can be present. ClinicalTrials.gov: NCT05446675. Secondary identifying number: EC/EH/220608-SK. Date of Registration: June 24, 2022.

AbstractBackgroundDiffuse large B-cell lymphoma (DLBCL) masquerading as a recurrent inguinal hernia is rare. We report the case of a 73-year-old male patient who presented with a symptomatic bulge in his left groin. Medical history revealed bilateral preperitoneal inguinal hernia repair, osteoporosis and atrial fibrillation. The patient’s further history was not significant.MethodsSonography revealed recurrence of an indirect inguinal hernia (4.5 cm × 2.3 cm) on the left, with bilateral subcutaneous lymph nodes that were deemed unremarkable. We planned an elective left-sided anterior inguinal repair. Apixaban was stopped two days prior to surgery.ResultsDuring surgery we identified the bulge as a lump attached to the spermatic cord. No hernial sac was present. Together with the consulting urologist, we concluded a possible malignant etiology and performed an orchiectomy along with resection of the lump.ConclusionMicroscopic and immunohistochemical analysis revealed a DLBCL with non-germinal center phenotype and c-MYC rearrangement. Further staging confirmed stage IE disease with extranodal paratesticular involvement. The patient was subsequently treated with rituximab in combination with cyclophosphamide, doxorubicin, vincristine, prednisone and showed complete metabolic remission after two cycles. This case illustrates the broad differential diagnosis of inguinal swelling and (para)testicular tumors.

Abstract:While youths in Africa are often portrayed as peace spoilers, this view largely overlooks youths who have not (yet) turned to (post-) conflict violence. In order to deepen our understanding of the risks of conflict recurrence and the ways to prevent these risks from materializing, Kuppens and Langer argue that it is crucial to study the perspectives of non-violent youths in post-conflict countries. Through an essay-based study with secondary school pupils in post-conflict Côte d'Ivoire, they show that youths are concerned about issues of security, employment, and reconciliation, and yet, they look generally favorably upon the peace process and their role in it.Résumé:Alors que les jeunes en Afrique sont souvent dépeints comme des fauteurs de paix, ce point de vue néglige largement les jeunes qui ne se sont pas (encore) tournés vers la violence (post-)conflit. Afin d'approfondir notre compréhension des risques de reprise des conflits et des moyens d'empêcher ces risques de se matérialiser, Kuppens et Langer affirment qu'il est crucial d'étudier les perspectives des jeunes non violents dans les pays sortant d'un conflit. Sur base d'une étude basée sur des rédactions d'élèves du secondaire en Côte d'Ivoire post-conflit, Ils montrent que les jeunes sont préoccupés par les questions de sécurité, d'emploi et de réconciliation, mais qu'ils voient le processus de paix et leur rôle dans celui-ci généralement favorablement.Resumo:Apesar de a juventude africana ser muitas vezes retratada como perturbadora da paz, esta perspetiva subvaloriza largamente os jovens que (ainda) não adotaram uma postura de violência (pós-)conflito. Para aprofundarmos a nossa compreensão dos riscos de reincidência dos conflitos e as formas de evitar que esses riscos se materializem, Kuppens e Langer defendem que é fundamental estudar as perspetivas dos jovens não violentos nos países em situação de pós-conflito. Através de um estudo ensaístico com alunos do ensino secundário na Costa do Marfim, os autores mostram que, no pós-conflito, as preocupações dos jovens giram em torno das questões de segurança, emprego e reconciliação; pelo contrário, veem de forma genericamente favorável o processo de paz e o papel lhes cabe nesse processo.

AbstractWhile youths in Africa are often portrayed as peace spoilers, this view largely overlooks youths who have not (yet) turned to (post-) conflict violence. In order to deepen our understanding of the risks of conflict recurrence and the ways to prevent these risks from materializing, Kuppens and Langer argue that it is crucial to study the perspectives of non-violent youths in post-conflict countries. Through an essay-based study with secondary school pupils in post-conflict Côte d’Ivoire, they show that youths are concerned about issues of security, employment, and reconciliation, and yet, they look generally favorably upon the peace process and their role in it.

Emotional granularity is the ability to create differentiated and nuanced emotional experiences and is associated with positive health outcomes. Individual differences in granularity are hypothesized to reflect differences in emotion concepts, which are informed by prior experience and impact current and future experience. Greater variation in experience, then, should be related to the rich and diverse emotion concepts that support higher granularity. Using natural language processing methods, we analyzed descriptions of everyday events to estimate the diversity of contexts and activities encountered by participants. Across three studies varying in language (English, Dutch) and modality (written, spoken), we found that participants who referred to a more varied and balanced set of contexts and activities reported more differentiated and nuanced negative emotions. Experiential diversity was not consistently associated with granularity for positive emotions. We discuss the contents of daily life as a potential source and outcome of individual differences in emotion.

During the Covid-19 pandemic, the global public has relied on their political leaders to guide them through the crisis. The current study investigated if and how political leader’s rhetoric would be associated with collective emotional responses. We used text analytical methods to investigate association between political leader speech and daily aggregates of expressed emotions on Twitter. We collected posts concerning Covid-19 and all speeches by the highest executive power from the USA, UK, Germany, and Switzerland. We applied cross-lagged time series analyses. Political leaders whose communication was more analytic and communal corresponded to increased positivity on Twitter. Collective communal focus, in turn, increased after speeches which were more analytic and negative. Processes of socio-affective dynamics between political leaders and the general public are apparent. Our findings demonstrate that political leaders who present public crises competently and with a sense of community are associated with more positive responses on Twitter.

Biochar offers opportunities for improving soil carbon (C) sequestration and reducing CO2emissions to the atmosphere. It has emerged as a strategy for mitigating climate change and improving the soil carbon cycle (SCC). While previous review studies have primarily investigated the effects of biochar on greenhouse gas (GHG) emissions, a considerable research gap remains regarding its impact on the SCC. The present study aims to bridge this gap by examining the main SCC components: total CO2flux, total microbial respiration, and C sequestration. We conducted a global meta-analysis which included 75 studies and 250 observations. The results show an average 11% increase in soil total CO2flux from biochar, but the confidence interval (CI) slightly touches the no-effect line (CI [0%, 23%]). Total microbial respiration remains unchanged after the application (10%, CI [− 2%, 23%]). In contrast, soil C sequestration benefits from biochar by 61% (CI [36%, 90%]). Our analysis identified key predictors affecting SCC components: experimental design, continent, biochar application rate, feedstock type, and pyrolysis temperature. Incubation experiments reveal benefits for all SCC components. The Middle East, Europe, and Asia exhibit potential for enhancing C sequestration with biochar. Higher application rates amplify C sequestration and total microbial respiration. Manure biochar enhances total microbial respiration, while woody biochar influences total CO2flux. Furthermore, lower pyrolysis temperatures show promise for improving C sequestration and total microbial respiration. In conclusion, while biochar holds promise for C sequestration, its impact on total microbial respiration and total CO2flux remains inconclusive.

Real-world emotions are often more vivid, personally meaningful, and consequential than those evoked in the lab. Therefore, studying emotions in daily life is essential to test theories, discover new phenomena, and understand healthy emotional functioning; in short, to move affective science forward. The past decades have seen a surge of research using daily diary, experience sampling, or ecological momentary assessment methods to study emotional phenomena in daily life. In this paper, we will share some of the insights we have gained from our collective experience applying such daily life methods to study everyday affective processes. We highlight what we see as important considerations and caveats involved in using these methods and formulate recommendations to improve their use in future research. These insights focus on the importance of (i) theory and hypothesis-testing; (ii) measurement; (iii) timescale; and (iv) context, when studying emotions in their natural habitat.

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Current guidelines for smoldering multiple myeloma (SMM) recommend active monitoring until the onset of multiple myeloma (MM) before initiating treatment or enrollment in a clinical trial. Earlier intervention may delay progression to MM. In CENTAURUS, 123 patients with intermediate-risk or high-risk SMM were randomly assigned to daratumumab 16 mg/kg intravenously on extended intense (intense), extended intermediate (intermediate), or short dosing schedules. At the prespecified primary analysis (15.8-month median follow-up), the complete response (CR) rates (co-primary endpoint) were 2.4%, 4.9%, and 0% for intense, intermediate, and short dosing, respectively; the co-primary endpoint of CR rate >15% was not met. Progressive disease (PD)/death rates (number of patients who progressed or died divided by total duration of progression-free survival [PFS] in patient-years; co-primary endpoint) for intense, intermediate, and short dosing were 0.055 (80% confidence interval [CI], 0.014–0.096), 0.102 (80% CI, 0.044–0.160), and 0.206 (80% CI, 0.118–0.295), respectively, translating to a median PFS ≥24 months in all arms (P<0.0001, <0.0001, and =0.0213, respectively). With longer follow-up (median follow-up, 25.9 months), CR rates were 4.9%, 9.8%, and 0% for intense, intermediate, and short dosing, respectively. PD/death rates for intense, intermediate, and short dosing were 0.059 (80% CI, 0.025–0.092), 0.107 (80% CI, 0.058–0.155), and 0.150 (80% CI, 0.089–0.211), respectively, again translating to a median PFS ≥ 24 months in all arms (P<0.0001 for all arms). Twenty-four–month PFS rates were 89.9% (90% CI, 78.5–95.4%), 82.0% (90% CI, 69.0–89.9%), and 75.3% (90% CI, 61.1–85.0%) for intense, intermediate, and short dosing, respectively. Pharmacokinetic analyses indicated that intense dosing maintained target-saturating trough concentrations in most patients throughout weekly, every-2-week, and every-4-week dosing periods. No new safety signals were observed. These data provide the basis for an ongoing phase 3 study of daratumumab in SMM.

•Influence of social class on thought and behavior depends on specifics of social contex.•This is because people compare themselves with others on locally relevant dimensions.•Context shapes the relevance of social comparison dimensions (e.g., education, income, ethnicity) and also the outcomes of such comparisons.•Interventions that reduce educational inequalities among groups in one socio-ecological context may operate differently in other contexts.

Patterns of emotional change in daily life have been consistently linked to depressive and borderline personality disorder (BPD) features. However, dynamic measures and average affect show considerable statistical overlap, and depressive and BPD features are comorbid. Moreover, the prospective nature of these relationships is unclear. We used a measurement burst design in which 202 young adults with varying levels of psychopathological features participated in a week-long experience sampling at baseline and 1-year follow-up. Taking overlap into account, we found that BPD traits were uniquely and specifically linked to higher levels of variability in negative affect (NA). For depressive features, indications were found for a specific association with inertia of NA, but these results were not robust and consistent. In fact, overall, incremental predictive power of the dynamic measures above mean affect was limited, especially for depressive features. Prospective relationships showed that psychopathological features predicted stronger emotion dynamic patterns 1 year later rather than the other way around.

We used two experience sampling studies to examine whether close romantic partners’ feelings of love and perceived partner responsiveness are better predicted by their actual emotional similarity or by their perceived emotional similarity. Study 1 revealed that the more partners were emotionally similar, the more they perceived their partner as responsive. This effect was mediated by perceived similarity, indicating that emotional similarity had to be detected in order to exert an effect. Further, when people overperceived their emotional similarities, they also reported more perceived partner responsiveness. Study 2 replicated these findings, by revealing similar effects for actual and perceived similarity on the love people reported to feel toward their partner. Implications for understanding the factors that predict feelings of love and responsiveness in close relationships are discussed.

Previous studies of business economics education have highlighted differences regarding the role of businesses towards sustainability, as articulated by teachers, students and in textbooks. The roles differ from externally motivated (following law and customers) to internally driven (creating new routes) to address sustainability in the business context. Changes by students in their perspectives on the role of a business in relation to sustainability can be seen as examples of a transformative learning experience in the context of business economics education. This paper presents a measurement instrument of 12 items on a five-point Likert scale to measure the views of students regarding the role of a responsible businessperson. A mixed-methods approach was used to develop, test and validate the instrument. Data were gathered by business economics students at Hasselt University. The added value of the instrument is that it can be used in educational practice and in further research to indicate whether transformative learning is happening in the context of business education and to gain insight into students’ views on the role of a responsible businessperson. The instrument goes beyond existing attitude, knowledge and competence scales and contributes to assessing transformative learning for sustainable development.

Across 50 years of research, extensive efforts have been made to improve the effectiveness of psychotherapies for children and adolescents. Yet recent evidence shows no significant improvement in youth psychotherapy outcomes. In other words, efforts to improve the general quality of therapy models do not appear to have translated directly into improved outcomes. We used multilevel meta-analytic data from 502 randomized controlled trials to generate a bivariate copula model predicting effect size as therapy quality approaches infinity. Our results suggest that even with a therapy of perfect quality, achieved effect sizes may be modest. If therapy quality and therapy outcome share a correlation of .20 (a somewhat optimistic assumption given the evidence we review), a therapy of perfect quality would produce an effect size of Hedges’s g= 0.83. We suggest that youth psychotherapy researchers complement their efforts to improve psychotherapy quality by investigating additional strategies for improving outcomes.

Quantitative markers of extravasated iodine at dual-energy CT can be used to predict intracranial hematoma expansion with higher sensitivity and overall accuracy than the conventional spot sign.

(Acta Obstet Gynecol Scand. 2022;101:441–449)The national maternal mortality ratio (MMR-quantified maternal deaths during pregnancy through 42 days postpartum per 100,000 live births) is an important metric for evaluating health care trends and allows for learning to improve care and prevent further death. While 90% of maternal deaths occur in low- and middle-income countries, from 1990 to 2015 some high-income countries saw increased MMR over previous decades. In the Netherlands, the rise of known risk factors including chronic hypertension and obesity, changes in national demographics, and reduced underreporting are considered significant contributors to the MMR increased observed from 1982-1992 (9.7 per 100,000 live births) to 1993-2005 (12.1). Further inquiry is necessary to update MMR in the Netherlands and evaluate new trends.

•Reviews literature on emotion dynamics, the patterns of emotion change over time.•Proposes a set of basic principles involved in emotion dynamics.•Special attention goes to the role of emotion dynamics in psychological well-being.

•Generalized hypersensitivity in post-cancer, sports-related and pediatric pain.•Rationale for pain education, stress management and cognition targeted exercises.•Need to change from a biomedical or psychosocial to an integrated approach.

Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called ‘swimmers’ shoulder’ has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers’ shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers’ shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers.

Context:Patients with Prader-Willi syndrome (PWS) are severely at risk to develop morbid obesity, diabetes mellitus type 2, and cardiovascular disease, leading to high mortality. They have an increased fat mass (FM) and decreased lean body mass (LBM). During childhood, GH treatment counteracts the natural course of increasing obesity. Discontinuation of GH treatment at attainment of adult height (AH) might deteriorate their improved clinical condition, whereas continuation might benefit them.Objective:To investigate the effects of GH versus placebo on body composition in young adults with PWS who were GH treated for many years during childhood and had attained AH.Design:Two-year, randomized, double-blind, placebo-controlled crossover study with stratification for gender and body mass index in 27 young adults with PWS.Setting:PWS Reference Center in The Netherlands.Intervention:Crossover intervention with GH (0.67 mg/m2· d) and placebo, both during 1 year.Main outcome measures:Body composition, measured by dual-energy x-ray absorptiometry.Results:During placebo, FM increased (relative change +21.5%; P< .001). Compared with placebo, GH treatment resulted in lower FM (−2.9 kg; P= .004) and higher LBM (+1.5 kg; P= .005), representing relative changes of −17.3% FM and +3.5% LBM. Both limb and trunk FM percentage were lower during GH versus placebo (relative change +17.3% and +15.6%; P< .001 and P= .007, respectively). No GH-related adverse events occurred.Conclusions:GH-treated young adults with PWS who have attained AH benefit from continuation of GH treatment. FM increases during placebo, whereas GH versus placebo results in lower FM and higher LBM. Thus, GH treatment maintains the improved body composition without safety concerns.

Interpersonal theories of depression postulate that depressed individuals’ experience of social isolation is attributable, in part, to their tendency to behave in ways that elicit rejection from others. Depression contagion has been implicated as a factor that may account for the rejection of depressed individuals. In the current study, we revisit this hypothesis by using a controlled, but realistically motivated, setting: speed dating. Approximately 2 weeks before the speed-dating event, participants’ depression levels were assessed. During the event, participants had 4-min “dates” with opposite-sex partners. After each date, they responded to items that measured their affect and romantic attraction. At the end of the evening, participants indicated which partners they wanted to see again. Our results did not support depression contagion: After 4 min of interaction with partners with high levels of depressive symptoms, participants did not experience increased negative affect; instead, they experienced reduced positive affect, which led to the rejection of these partners.

Does knowing your own emotions relate to knowing those of others? We argue that our ability to experience and label our own emotions in a differentiated and specific manner is related to the ability to accurately perceive the level of emotions in others. In an experience sampling study among romantic couples, we tested the hypothesis that individuals with higher levels of emotion differentiation are characterized by higher levels of empathic accuracy (i.e., judge others’ emotions more accurately). In line with expectations, results showed that individuals who differentiate highly between their negative emotions are more able to accurately infer how pleasant their partners are feeling across daily life. This finding establishes a link between perceptions of our own and others’ emotions and provides evidence that the skills we use to understand our own emotions are also relevant for understanding how others feel.

Prader–Willi syndrome (PWS) is characterized by a switch from failure to thrive to excessive weight gain and hyperphagia in early childhood. Hyperghrelinemia may be involved in the underlying mechanisms of the switch. The purpose of this study is to evaluate acylated ghrelin (AG) and unacylated ghrelin (UAG) levels in PWS and investigate their associations with hyperphagia. This is a cross-sectional clinical study conducted in three PWS expert centers in the Netherlands and France. Levels of AG and UAG and the AG/UAG ratio were determined in 138 patients with PWS (0.2–29.4 years) and compared with 50 age-matched obese subjects (4.3–16.9 years) and 39 healthy controls (0.8–28.6 years). AEBSF was used to inhibit deacylation of AG. As a group, PWS patients had higher AG but similar UAG levels as healthy controls (AG 129.1 vs 82.4 pg/ml, p= 0.016; UAG 135.3 vs 157.3 pg/ml, resp.), resulting in a significantly higher AG/UAG ratio (1.00 vs 0.61, p= 0.001, resp.). Obese subjects had significantly lower AG and UAG levels than PWS and controls (40.3 and 35.3 pg/ml, resp.), but also a high AG/UAG ratio (1.16). The reason for the higher AG/UAG ratio in PWS and obese was, however, completely different, as PWS had a high AG and obese a very low UAG. PWS patients without weight gain or hyperphagia had a similar AG/UAG ratio as age-matched controls, in contrast to those with weight gain and/or hyperphagia who had an elevated AG/UAG ratio. The switch to excessive weight gain in PWS seems to coincide with an increase in the AG/UAG ratio, even prior to the start of hyperphagia.

Ever since scholars started studying public opinion and political acting, they have reported substantial educational differences. Much debate remains, however, about how to interpret these differences. Recently a number of scholars using a variety of terms and theoretical reasoning have proposed interpretations that suggest education has become a source of (inter)group processes. Against this background, the objective of this paper is twofold. First, we reflect on this stream of thought, arguing that it provides a starting-point for the development of a new approach for studying educational differentials. This would be centred around the proposition that the central and highly institutionalised nature of education in contemporary societies paves the way for education-based (inter-)group acting and thinking. Starting from this, secondly, we attempt to take stock of existing research, propose a research agenda, and provide data that illustrates a starting-point for the research we propose.

Western culture has become obsessed with happiness, while treating negative emotions like sadness, depression, or anxiety as pathological and nonnormative. These salient cultural norms communicate social expectations that people should feel “happy” and not “sad.” Previous research has shown that these “social expectancies” can increase feelings of sadness and reduce well-being. In this study, we examined whether these perceived social pressures might also lead people to feel socially disconnected—lonely—when they doexperience negative emotions? Drawing on a large stratified sample prescreened for depressive symptoms and utilizing both trait measures and moment-to-moment “experience sampling” over a 7-day period, we found that people who felt more negative emotions and also believe that others in society disapprove of these emotions reported more loneliness. Our data suggest that social pressures to be happy and not sad can make people feel more socially isolated when they do feel sad.

AbstractObjective: Illness perceptions, i.e. how patients think about their illness in terms of identity, cause and consequences, are important, as negative illness perceptions are associated with maladaptive illness behavior, more dysfunctioning, poor treatment adherence and treatment outcome. As illness perceptions are influenced by cultural background, former experiences and provided information, the aim of this study was to compare illness perceptions of patients with fibromyalgia syndrome [FMS] living in different countries.Methods: Dutch speaking participants from two countries were recruited in this international comparative study. In total, 114 Belgian [Flemish] and 283 Dutch FMS patients completed the Illness Perception Questionnaire for Fibromyalgia-Dutch Language version [IPQ-R FM-Dlv]. The Mann–Whitney Utest for non-parametric data was used to compare data between the patient groups. Pearson’s chi-squared test was used to compare proportions.Results: Significant differences in illness perceptions were observed. Belgian patients reported a higher variety of symptoms and believed more strongly that these symptoms are related with their illness. They had more negative beliefs concerning the consequences of their illness and reported more external attributed factors to be the cause of their illness. Dutch patients demonstrated a better understanding and controllability. They indicated more internal attributed factors as a cause.Conclusions: These findings suggest that illness perceptions in patients with FMS are prone to local influences, including small differences in the health care system. Future studies are advised to measure mood, psychopathology, medical co-morbidity and socio-demographic factors and include them in a multivariate analysis.

Major depressive disorder (MDD) is a prevalent disorder involving disturbances in mood. There is still much to understand regarding precisely how emotions are disrupted in individuals with MDD. In this study, we used a network approach to examine the emotional disturbances underlying MDD. We hypothesized that compared with healthy control individuals, individuals diagnosed with MDD would be characterized by a denser emotion network, thereby indicating that their emotion system is more resistant to change. Indeed, results from a 7-day experience sampling study revealed that individuals with MDD had a denser overall emotion network than did healthy control individuals. Moreover, this difference was driven primarily by a denser negative, but not positive, network in MDD participants. These findings suggest that the disruption in emotions that characterizes depressed individuals stems from a negative emotion system that is resistant to change.