When treating stress and anxiety, our responsibility, as clinicians, is always to respect our scope of practice and the client’s welfare. We must consider

1) Medical evaluation for possible physical etiology and medication purposes

2) Assess for suicide. If you would like to refresh your knowledge of this subject and 5150 issues please visit this link.

3) Assess for substance abuse

Please visit the following sites if you have any questions regarding substance abuse.  These are great organizations and very helpful to professionals.

http://www.alcoholics-anonymous.org/

http://www.na.org/

4) Screen for anxiety disorders and any complicating symptoms

5) Understand and treat stress management and anxiety reduction

Having previously covered the issues 1-4,  we  will turn our attention to specific interventions and modalities for specific anxiety disorders.   First, attention will be focused on managing the stress that accompanies some anxiety disorders.

Stress management can include a variety of different techniques from different disciplines, including behavioral approaches, meditation and hypnosis.  Our first task is to help the client identify the source of their stress.  As was stated earlier in the course, being present with one’s concerns is essential to decreasing stress.  This means giving yourself time to think about the concerns, when you can be most effective at dealing with them.  If your client's way to deal with stress is to escape with drugs or alcohol, video, or other pursuits which only take you away from yourself but increase your anxiety when you return; then, it is time to look at and let go of those patterns. 

Identifying Stress
Why Good Health Leaks Away.
By Kevin Roberts

   Most of those who are open to the so-called alternative or complementary therapies are familiar with the many studies showing how stress is related to disease and dysfunction. Stress could be defined as a force that strains or deforms, in our case it hampers our ability to stay balanced and healthy.
   The causes of stress are often cited as pressure in the workplace, trouble in relationships and even rush hour traffic; all quite vague and widely ranging and, perhaps most importantly, never questioned sources of this drain on our health. Since stress is such a central theme in all illness, it is in our best interest to be exact and thorough in our investigation. While many therapies are aimed at reducing or relieving stress already accumulated, the purpose of this article is to stop stress at the source, before we are affected by it

Please read the entire article at http://www.pendulum.org/articles/identifying_stress.htm

  A stress self assessment tool may be helpful for some clients

http://www.pitt.edu/~studhlth/studenthealthed_wbpage/Stress_Management/stress/Stress_Assessment.html

OR find another stress assessment tool at

http://www.internethealthlibrary.com/sq/stress/stress-assess.htm

 Once you have discovered and identified the sources of stress with your client, you may want to help them develop a lifestyle plan that works for them, including attention to diet and exercise.  Certain foods increase anxiety symptoms in certain people particularly ones containing refined sugar or caffeine.  High levels of aerobic exercise can also increase some people’s experience of stress.  Again, a client may have developed habits over many years and only be beginning to experience negative side affects.  It happens.  Things change.

Interventions for Stressful Life Events

Stressful life events, even for those at the peak of mental health, erode quality of life and place people at risk for symptoms and signs of mental disorders. There is an ever-expanding list of formal and informal interventions to aid individuals coping with adversity. Sources of informal interventions include family and friends, education, community services, self-help groups, social support networks, religious and spiritual endeavors, complementary healers, and physical activities. As valuable as these activities may be for promoting mental health, they have received less research attention than have interventions for mental disorders. Nevertheless, there are selected interventions to help people cope with stressors, such as bereavement programs and programs for caregivers (see Chapter 5) as well as couples therapy and physical activity.

Couples therapy is the umbrella term applied to interventions that aid couples in distress. The best studied interventions are behavioral couples therapy, cognitive-behavioral couples therapy, and emotion-focused couples therapy. A recent review article evaluated the body of evidence on the effectiveness of couples therapy and programs to prevent marital discord (Christensen & Heavey, 1999). The review found that about 65 percent of couples in therapy did improve, whereas 35 percent of control couples also improved. Couples therapy ameliorates relationship distress and appears to alleviate depression. The gains from couples therapy generally last through 6 months, but there are few long-term assessments (Christensen & Heavey, 1999). Similarly, interventions to prevent marital discord yield short-term improvements in marital adjustment and stability, but there is insufficient study of long-term outcomes. The prevention programs receiving the most study are the Couple Communication Program, Relationship Enhancement, and the Prevention and Relationship Enhancement Program (Christensen & Heavey, 1999). Greater research is needed to overcome gaps in knowledge and to extend findings to a broader array of programs, to diverse populations of couples, and to a wider set of outcomes, including effects on children.

Physical activities are a means to enhance somatic health as well as to deal with stress. A recent Surgeon General’s Report on Physical Activity and Health evaluated the evidence for physical activities serving to enhance mental health (U.S. Department of Health and Human Services [DHHS], 1996). Aerobic physical activities, such as brisk walking and running, were found to improve mental health for people who report symptoms of anxiety and depression and for those who are diagnosed with some forms of depression. The mental health benefits of physical activity for individuals in relatively good physical and mental health were not as evident, but the studies did not have sufficient rigor from which to draw unequivocal conclusions (DHHS, 1996).

Prevention of Mental Disorders

A promising development in prevention of a specific mental disorder in adults occurred with the publication of results from the San Francisco Depression Research Project (Munoz et al., 1995). This study investigated 150 primary care patients who did not meet diagnostic criteria for depression and who were being seen in a public clinic for other problems. They were randomized to either psychoeducation—an 8-week cognitive behavioral course to help them control and manage moods—or to a control condition. One year later, those who received psychoeducation were found to have developed significantly fewer depression symptoms than members of the control group. This trial is noteworthy in two major respects: it was a randomized controlled trial and its participants were low-income individuals, with high representation of all major minority groups. Low-income individuals are considered a high-risk population because of studies documenting their higher prevalence of mental disorders. This study demonstrated in a methodologically rigorous fashion that depression may be preventable in some cases. It serves as a model for extending the concept of prevention to many mental disorders. Prevention research is vitally important and needs to be enhanced.

The Counting Method works, theoretically, in several ways. First, the traumatic memory is connected to the therapist's voice and to the experience of therapy. A terrifying, lonely piece of personal history is associated with the security, dignity, and partnership of Post-Traumatic Therapy. Future recollection, spontaneous or deliberate, may evoke aspects of therapist and therapy and therefore be less frightening and degrading.
Please read the entire article by Dr. Ochberg http://www.sourcemaine.com/gift/Html/counting.html
 

Eye Movement Desensitization and repatterning, EMDR, is something I have been introduced to and have used with quite effective results.  Developed by Francine Shapiro of  MRI in Palo Alto, CA.,  the method involves having the client use eye movement to access and reprocess difficult memories.  The reader is encouraged to visit the following link http://www.emdr.com/

These methods may be accessing the brain in similar manners. In addition to the neurology behind the methods ,they may facilitate healing by allowing the experience of having their therapist present at the reliving of the trauma, enabling the client to not feel so alone.

BIOFEEDBACK

What is Biofeedback?

The word "biofeedback" was coined in the late 1969 to describe laboratory procedures (developed in the 1940's) that trained research subjects to alter brain activity, blood pressure, muscle tension, heart rate and other bodily functions that are not normally controlled voluntarily. Biofeedback is a training technique in which people are taught to improve their health and performance by using signals from their own bodies.

One commonly used device, for example, picks up electrical signals from the muscles and translates the signals into a form that people can detect. This device triggers a flashing light or activates a beeper every time muscles become more tense. If one wants to relax tense muscles, one must try to slow down the flashing or beeping. People learn to associate sensations from the muscle with actual levels of tension and develop a new, healthy habit of keeping muscles only as tense as is necessary for as long as necessary. After treatment, individuals are then able to repeat this response at will without being attached to the sensors.  Association for Applied Psychophysiology and Biofeedback

For a wealth of resources on Biofeedback please visit the Association for Applied psychophysiology and Biofeedback Association’s site at

http://www.aapb.org/public/articles/index.cfm?Cat=13

  Or the Biofeedback Network at

http://www.biofeedback.net/

For more information on a variety of  other Alternative Approaches please visit

  http://www.ahealthyme.com/topic/mindandbody;$sessionid$CPONVIQAAGS2OCTYAIUDEMQ

Meditative Exercises

Meditation or visualization techniques should be introduced and evaluated with regard to your client's individual values and beliefs.  I have found Tibetan Wisdom for the Western World to be one of the most user friendly and highly accessible texts on the subject.  The authors follow two very identifiable persons through their course of learning and understanding of the techniques.  A more esoteric tape, I have found most useful is by an Intuitive Healer Kay Taylor simply titled Meditation for Balance and Healing.   For a less esoteric approach,  there are numerous texts on self hypnosis and relaxation techniques.  Always test anything you would recommend before using it.  Not all things work for all people.  Nearly twenty years ago I settled down to listen to a stress reduction tape,  only to sit bolt upright at the sound of rain from the tape.  Although many people may find a gentle rain soothing, in my childhood, it was synonymous with a ready alert in case the pump stopped working and the basement flooded.

Another way to affect this type of rest and relaxation is through guided meditation. Work with your client to access a beautiful image of a place of rest and recuperation.  Anchor the image with sight, sound, smell and feel.  If you take your time to establish this place and feelings within you, it can be readily accessed in other highly pressured situations.  Encourage the client to access this place at will.   A great source for more information on Guided Imagery is the book of that title by Ellen Curran, ASN.

Exercises

1) PROTECTIVE CLOAK Have the client stand and imagine that they are wearing a head cloak that protects them from head to toe and is able to carry all their burdens. Have them start at the top of their head and unzip the coat to the floor.  Allow the coat to drop and step out. Pick the coat up. Shake it off vigorously, letting everything unnecessary fall and dissolve into the floor.  Step back into the coat and rezip.  This little exercise can do wonders for the silliness and state of mind.  A sense of humor is really important to recapture, when life is filled with so many challenges.

2) AHHHHHH Relaxing from the head to toe.  Imagine a gentle, golden sun descending from the top of you head; slowly melting the tension from your head, neck, shoulders, and back all the way to the soles of you feet into the Earth.

3) The  Vacation. Maya Angelou spoke during an interview with Toni Morrison about her concept of a "day away".  This would be a day in which she would wander without a specific goal or set schedule, but just explore her world with curiosity and fresh eyes apart from her normal routine. Making  time for that sort of day on a regular basis can do wonders for stress.  Turn off the phone and be "on vacation."

  PRIORITIZE

This is often easier said than done, but there are hundreds of books available on getting organized.  If it is possible for the client to delegate some of their least favorite duties, this  may be of great benefit.  For the rest of us, helping organize a schedule or setting a value on which things need to get done in which order. may be a valuable adjunct to  stress management.  Simply looking at when things need to be done and putting it in a schedule can be remarkable for gaining a sense of control.  The next step is to let go worry unless you are directly engaged in the event.   Many effective techniques for accomplishing stress reduction are found in cognitive behavioral therapy.  

EXPRESS YOURSELF

Dance, sing, paint, draw, throw pots, pound clay, write, play, do something to let yourself out of your routine into a different way of being.  Put on favorite music, preferably upbeat ,and move.  Put color on paper and scribble.  Let yourself go and flow for a moment into a different place.  It can do wonders to change your perspective.  Listen to comedy. Escape into a favorite novel.  I highly recommend a read or re read of Anne of Green Gables to give a fresh perspective to life's challenges and an appreciation of the moment.

This therapeutic approach combines cognitive psychotherapy and behavioral therapy and is highly effective as an approach for both anxiety and depression.  The fundamental premises behind this work were developed by  Aaron Beck and Albert Ellis.  Since the 1980's there has been increased interest and study of this highly effective approach.  With the growing recognition that emotion impacts and is an integral part of the human being, we can gain further insight as to how to work with our emotions rather than deny them.  By accepting emotional responses within a rational framework it gives the person a much greater sense of control.  

David Burns book Feeling Good: You Can Beat Depression is highly recommended for clinician and client.  Her addresses "errors in thinking"

•  including black and white thinking, 

• global thinking, 

• dwelling on negative details, 

• disqualifying the positive, 

• jumping to negative conclusions not based upon facts, 

• operating from ‘shoulds’ rather than a self reference point. 

 It is purported that if we can help the client recognize and interrupt these patterns of cognition, the resultant feelings of anxiety or depression can dissipate.   Helping clients chart their thoughts and then dispute them, can help them identify the triggers and change harsh judgments and pessimism.  What I have seen when you are challenging these thoughts, the issues that this worldview may be protecting, whether that includes early childhood issues or inherent self questioning of self worth, emerges and can then be examined and evaluated.   Pleas visit the following site for a highly readable explanation of cognitive behavior therapy, its origins, concepts and uses.  http://www.cognitivetherapy.com/site_map.html

The following article speaks to the research with emotions and provides valuable information to share with clients when explaining these concepts or phenomena

Emotion and social judgments

Gordon H. Bower
A. R. Lang Professor of Psychology
Stanford University

The experimental setting

I will be discussing experiments in which normal volunteers, people like you or me, are induced to feel a mild emotion like happiness, sadness or anger for a brief time. We then look at how those feelings affect their memory or thinking. We make people happy, sad or angry by doing things like showing them happy or sad movies, playing happy or sad music, getting them to read or imagine happy or sad scenes, or arranging for them to succeed or fail at some task. The mood inductions are often subtle or mild, and their purpose is usually disguised. The memory or judgment tasks are then introduced as though they were a completely separate and unrelated study. We do it this way to prevent subjects from consciously biasing their responses according to their ideas about how emotion might relate to judgment. When I refer to happy or sad people in the following experiments, I will usually be referring to normal individuals (typically college students) who have been randomly assigned to experimental conditions in which they have experienced a happy or sad mood induction.

Emotion and memory

In 1976, while studying the impact of various emotional states on memory (Bower et al., 1978; Bower, 1981), I also became interested in mood effects on social judgment. Since the effects of mood on memory probably play a central role in biasing judgments, I will briefly tell you what we were learning from that research. We were finding two effects — one we called “mood-dependent retrieval,” and the other we called “mood-congruent processing.” Because they have some bearing on our discussion of emotion and social judgment, I will describe these two phenomena before taking up mood effects upon judgments.

Mood-dependent retrieval

Mood-dependent retrieval refers to the idea that a person's emotional state can become associated with ongoing events, so that the events and the emotion are stored in memory together. Later those memories can be best retrieved if the person returns to an emotional state similar to that experienced during the original event. Thus, when made happy, people should do better recalling events experienced earlier when they were happy. When sad, they should more easily recall events they experienced when they were sad.

Our early demonstrations of mood-dependent retrieval stimulated considerable research exploring the conditions contributing to the phenomenon. A relatively recent demonstration, for example, was reported by Eric Eich and Janet Metcalfe (1989). They induced their college-age subjects to feel happy or sad by having them think happy or sad thoughts while listening to happy or sad music for awhile. The subjects were then prompted to generate 16 words which they were to memorize. For example, to the prompt, “Name a flower that begins with R,” the subject might say “Rose.” Upon returning the next day, half the subjects listened to music that put them in the same mood as that experienced the day before. The other half listened to music that put them in the opposite mood to that experienced the day before. All subjects then tried to recall the words they had learned the day before.

The subjects who learned and recalled in the same mood (happy or sad both days) recalled more than those whose mood was shifted between learning and later testing. Mood during learning or mood during testing had little overall impact. What mattered for recall was the matching or mismatching of moods during learning and recall testing. Matching moods aids recall.

It appears that mood-dependent retrieval is at work in a variety of learning and recall situations beyond working with word lists in a laboratory. For example, it applies to people's recall of autobiographic events. When asked to recall an unselected sample of autobiographic events from their recent past, people will retrieve a biased set of events that agrees with their emotional state during recall. An experiment by Mark Snyder and Phyllis White (1982) illustrated this mood dependency in autobiographic reports. They first induced their college-student subjects to feel happy or sad by having them imagine themselves experiencing a series of either very happy feelings and thoughts or very sad feelings and thoughts. A few minutes later, as part of an apparently unrelated experiment, the subjects were asked to recall any autobiographic events from the past two weeks. Figure 2 shows that when they were happy, people retrieved relatively more happy episodes; when they were sad, they retrieved relatively more unpleasant or sad episodes from their lives.

Clinical psychologists have noted a similar bias when depressed patients recall events from their childhood. When depressed, they are more likely to recall an unhappy, deprived childhood; after their depression passes, they recall a far rosier childhood. These observations can be explained by the simple idea that the emotion a person is feeling becomes associated in memory with events that caused that emotion, so that later reinstatement of the emotion will aid retrieval of those memories.

Mood-congruent processing

I said that our early research turned up two mood-related effects on memory. The second phenomenon (Bower, 1981; 1983) we called mood-congruent processing, which means that a person's mood can sensitize the person to take in mainly information that agrees with that mood. Material that is congruent with the mood becomes salient so that the person attends to it more deeply than to other material. The person thinks about that material more deeply and associates it more richly with other information (an activity we call associative elaboration). The result is that the person learns this material better than non-mood-congruent material. Thus, when happy, people will attend and respond more to pleasant than unpleasant pars of their environment and learn more about them; when sad, they'll attend and respond more to its unpleasant than to its pleasant parts and learn more about them.

Such mood-congruent learning can be illustrated by an experiment done in my lab with a former student, Steve Gilligan (1982). Subjects were hypnotized and put into a happy, angry or sad mood. They were then read 36 three-line descriptions of hypothetical events in which they were to imagine themselves. A third of these were happy events, such as unexpectedly finding a $20 bill on the sidewalk; a third were sad events, such as experiencing the death of a pet; and a third were anger-provoking events, such as having someone cut in line in front of you, causing you to miss your bus. Each event was described and imagined for 10 seconds. After having imagined the 36 events, the subjects' hypnotically induced moods were removed. Five minutes later they were unexpectedly asked to free-recall as many of the 36 events as they could.

The results in Figure 3 show recall of the three types of events by the subjects who had been feeling happy, angry or sad during learning. There's a mood-congruent advantage: people who were happy during the initial experience learn the happy events better; angry people learn anger-provoking events better; and sad people learn sad events better. I remind you that these people are recalling when in a neutral mood. So, the differences in recall reflect differences in original learning. Of course, these differences would also be present, even exaggerated, if the same mood had been present during both initial registration and later retrieval. Although these results illustrate mood-congruent learning under laboratory-induced moods, available evidence suggests that such selective learning also happens with naturally occurring variations in everyday moods (Mayer et al., in press).

Emotional influences on associative and attentional biases

An implication of mood-congruent processing is that when an emotion is aroused, it brings to mind the words, concepts, themes and inferences that have been associated with that emotion; these are primed into readiness and made highly available for use. The easy availability of these emotionally-congruent associations, perceptual categories and themes leads people to perceive and interpret the social world in ways that confirm their feelings. Those interpretations, in turn, will perpetuate the person's emotional state — something we might call “mood perseverance.” Let me describe several ways in which this emotional priming manifests itself.

Bias in free word associations

As a first example, we found that people give word associations that are pleasant or unpleasant according to whether they are feeling happy or sad (Bower, 1981). Thus, to a word like LIFE, happy subjects will give associates such as freedom and love, whereas sad subjects will associate to LIFE with words such as death and struggle. As a second example, when asked to name the first kind of weather that comes to mind beginning with the letter S, happy subjects are likely to say sunny or springtime, whereas sad subjects are likely to say stormy or snowy (Mayer et al., 1992).

A further illustration of this associative bias is that when people in a particular emotional state daydream or make up stories about fictional characters on the Thematic Apperception Test, they make up stories congruent with their current feelings (Bower, 1981). Happy people often concoct stories about success and romance; sad people make up stories about failure and loss; and angry people make up stories about conflicts and fights. So people's feelings prompt associated themes that are then revealed in the stories they make up.

Mood-congruent preferences

The mood-priming theory suggests that people will tend to dwell on, or even prefer, situations, people and things that confirm their current feelings. These preferences show up in several different behaviors:

What's interesting?

An early illustration of mood-congruent interest arose in an experiment by my student Colleen Kelley (1982). She induced happy or sad feelings in college students by having them write about some happy or sad experiences from their lives. Thereafter, as part of a second experiment, they were asked to examine a series of slides of scenes, going at their own pace, dwelling on each scene according to its intrinsic interest for them. The slides were a random mixture; half were happy scenes (people laughing, playing celebrating victories) and half were sad scenes (failures, rejections, funerals, and the aftermath of disasters).

Unknown to the subjects, Kelley recorded how much time they spent looking at different types of pictures. She found a mood-congruity effect in the average time subjects spent viewing the pictures. If viewers were happy, they spent  more time looking at happy rather than sad scenes; conversely, if they were sad, they spent more time looking at sad rather than happy scenes. Curiously, subjects were not aware that they were attending more to the pictures that matched their mood. This difference in exposure time also led to a difference in later recall of the pictures. Happy viewers recalled more happy scenes; sad viewers recalled more sad scenes.

Some unpublished experiments by Mark Snyder (personal communication, 1990) also found mood-congruent preferences. His subjects indicated their preferred selections from briefly-described movie film clips which they thought they would be reviewing as part of a consumer survey. Subjects made temporarily depressed chose to look at more somber, serious films than did subjects made temporarily happy. In another similar experiment, Snyder found that sad subjects also chose to listen to more sad, nostalgic music than did happy subjects.

Activity preferences

In line with such results, temporarily sad people cannot think of very many activities that they consider to be “pleasant”; they generally rate most activities as far less enjoyable than do happy people. Snyder also asked his subjects how much time they intended to spend in various activities in the coming weeks. Happy subjects said they planned to spend more time in light-hearted enjoyable activities than in weighty activities; on the other hand, sad subjects said they planned to spend more time in somber, serious and solitary activities than in joyful activities.

Socializing

Loss of interest in social activities is a familiar symptom of the depressed person. Similarly, several studies have found that when non-depressed people are made temporarily sad, they lose interest in socializing, finding other people far less rewarding or “attractive” than do people who  are not sad. We may explain this result by supposing that people's happy or sad mood alters their expectations gaining rewards versus punishments from interactions, and the balance of those expectations makes socializing with others more or less attractive.

Social preferences

Further evidence of mood perseverance is that people prefer to affiliate with and learn more about others who share their current mood. Most of us most of the time prefer the company of happy people and avoid the company of depressed people, but that may be because we're usually in a moderately good mood.

On the other hand, sad people have somewhat different preferences. As one illustration, Fred Gibbons (1986) observed that temporarily sad people seek out more information about sad, unfortunate people than about happy people. Moreover, when forced to socialize, depressed people prefer to meet and become better acquainted with unfortunate, unhappy people rather than with happy people (Wenzlaff & Prohaska, 1989).

Surprising as it seems, people who are feeling depresses get more satisfaction from socializing with others who are similarly depressed than with people who are not depressed. This result was shown in an experiment by Ken Locke and Len Horowitz (1990). They assigned college-student strangers to same-sex pairs, and asked them to take turns telling one another their opinions regarding a series of personal topics, and to privately rate their liking for the other person as the conversation proceeded. The two students of a pair had been pre-selected to be wither both dysphoric (mildly depressed), both nondysphoric, or only one member was dysphoric. As their conversational turns proceeded, the students whose moods matched one another reported progressively more liking for their partner and satisfaction with the interaction. But students in mixed-mood pairs reported progressively less satisfaction and less warmth for their partner. Moreover, as time went on, the mismatched pairs chose to talk about progressively more negative topics. The conclusion is that depressed people prefer to spend time with others who have similar concerns and are in a similar mood. This illustrates the old adage, “Misery loves company.”

A dramatic demonstration of this selective exposure to mood-congruent people was provided in experiments by Bill Swann and his associates (Swann, 1992; Swann et al., 1992a, 1992b). They studied college students who had been classified as depressed or non-depressed according to an earlier personality test. After being brought to the laboratory, these students read three different, brief evaluations supposedly written by clinical-psychology trainees who had examined different parts of the subject's answers to a personality test taken several days earlier. In fact, the experimenters composed bogus evaluations so that one was relatively positive, one neutral, and one relatively negative about the subject's personality. After reading these sample evaluations, subjects were asked to rate which of these three evaluators they would most like to meet and get acquainted with. 

Non-depressed subjects most wanted to meet and get acquainted with the positive evaluator who had the flattering opinion of them, and they wanted nothing to do with their negative evaluator. In contrast, depressed subjects said they most wanted to meet and get acquainted with their negative evaluator, the one person who had found the most faults in them and who they could be certain would have an unfavorable opinion about them. This behavior or depressives, of seeking out criticism of themselves, is guaranteed to maintain their depression.

Social comparisons

Similar tactics of mood-perpetuation are also seen in the social comparisons that people choose to make — that is, folks with whom they choose to compare themselves. A common belief is that people will often compare themselves to others who are in worse circumstances, so they'll come off favorably, thus enhancing self-esteem. But people's comparisons turn out to be partly controlled by their mood state.

In a study by Ladd Wheeler and Kunitate Miyake (1992), college students recorded details of all their social comparisons over a two-week period. Whenever they noticed themselves comparing themselves to someone else, subjects were to record the details, including how they felt just before the thought of this comparison, who they were comparing themselves to, and how they felt after making the comparison. One interesting finding was that the more depressed the students were, according to their scores on the Beck Depression Inventory, the more frequently they compared themselves to people who they judged to be better than themselves. These cases are called “upward” comparisons and they increase significantly in depression. Moreover, regardless of their personality score, the sadder subjects were feeling at the moment a comparison was made, the more likely they were to make an upward comparison, to someone better off; the happier they were feeling, the more likely they were to make a downward comparison, to someone worse off than themselves. Thus the direction of a social comparison — whether to someone considered superior or inferior — was partly determined by momentary fluctuations in a person's mood.

Wheeler and Miyake also reported that the direction of a comparison caused the person's momentary mood to change in the opposite direction: that is, upward comparisons to someone perceived as better caused a worsening of one's mood, whereas downward comparisons to others worse off caused people to feel better. Such results suggest that people tend to think about those social comparisons that are likely to perpetuate or exacerbate their mood. In particular, momentarily sad people tend to ruminate on those very thoughts and comparisons thar are guaranteed to make them even more depressed. Moreover, people who score high on the Beck Depression scale may sometimes make a habit out of such depressing comparisons; in doing so, they have fashioned a cognitive lifestyle that is likely to keep them down in the dumps.

To summarize, the experiments I have been reviewing demonstrate that, depending on their mood, people tend to become interested in or attracted to activities, people, stories, movies and music that are “in tune” with their mood. This bias seems to occur with temporarily induced moods as well as with longer-term, dispositional disorders such as depression. Furthermore, people behave in accordance with their desire for more or less exposure to such situations. The congruity between the mood and the situations individuals choose to enter then causes their present mood to be sustained.

Persuasive impact of messages

These results on selective exposure are bolstered by further results showing that even when people are forced to be exposed to particular social information, its impact on them depends on whether it agrees with their mood. In 1987, Joe Forgas and I reported this congruence effect for subjects who had been induced to feel happy or sad before they read descriptions of a stranger and formed an impression on him. The subjects sat before a computer terminal and presented themselves with a series of statements, each statement describing some favorable or unfavorable behavior of the stranger.

Two conclusions are warranted. First, subjects in a sad mood took longer than those in a happy mood to read the information and then form impressions; this is a common finding. Second, subjects in a happy mood dwelt longer on positive aspects of the stranger; subjects in a sad mood dwelt longer on his negative aspects. As you might expect, subjects in a good mood ended up with a more favorable impression of the stranger. Moreover, subjects' late memory for the stranger's behaviors showed mood congruence: subjects in a good mood remembered more of his positive attributes; subjects in a sad mood remembered more of his negative attributes.

Job interviews

 In the experiment just described, subjects formed an impression based solely on verbal descriptions of a stranger who they never actually met. Robert Baron (1987) had his subjects develop an impression during a face-to-face interview with a person who was supposedly applying for a middle-management job, asking him a list of pre-arranged questions in a structured interview. In fact, the applicant was a confederate who gave the same canned answers to each interviewer — answers that were deliberately mixed and ambivalent. After the interview, the interviewer-subject rated the job applicant on several traits. As expected, compared to neutral interviewers, happy interviewers rated the candidate as more motivated, talented, likable, attractive, and having greater potential for the job. They also said they would hire him. In contract, the momentarily depressed interviewers rated the applicant considerably worse on all dimensions and were fairly sure they would not hire him.

Baron also tested his interviewers for their later recall of the confederate's canned answers. Recall showed mood congruity. Happy interviewers recalled more of the positive things the applicant had said about himself; depressed interviewers recalled more of the negative things he had said about himself. Such studies show that in a realistic setting, mood biases could significantly affect hiring decisions and the careers of the people and institutions involved.

The experiments just reviewed make the point that mood increases people's absorption of information that agrees with their mood. One implication of these studies is that the impact of a persuasive message in changing a person's opinion depends on how this information matches up with his or her mood. There are several demonstrations of that fact in the literature on attitude change, but I will not review them here.

Mood congruence in evaluations

Another implication of the mood-congruity idea is that people's mood will influence their momentary evaluation of their possessions and their opinions about all manner of things. Basically, a prevailing mood should prime and make more available those features of a topic (person, group, object) that agree with the mood.

Personal possessions

As an early demonstration of this bias, Alice Isen and her associates (Isen et al., 1978) found that pedestrians in a shopping mall who received a small gift that pleased them, such as a fingernail clipper, reported on an unrelated survey a few minutes later that their cars and television sets were working better than did people who had not received that small gift.

Life satisfaction

A similar effect was reported by Joe Forgas and Stephanie Moylan (1987), who interviewed nearly a thousand patrons in cinema lobbies before or after their seeing films judged to arouse predominantly happy or sad feelings. In the guise of a public-opinion survey completed just before or just after the movie, patrons took about a minute to rate their mood and their satisfaction with several controversial political figures, the likelihood pf several future prospects, satisfaction with their personal and work situations, and their opinion about the severity of penalties handed out for various anti-social crimes such as drunk driving and heroin trafficking.

The results showed that happy films increased people's satisfaction with political figures, as well as with their own life, career, and their future prospects, whereas sad films lowered their satisfaction on all these issues. For example, people who had seen a comedy like  “Back to the Future” were more satisfied with their own life, more optimistic about their future, and more favorable to their politicians than were filmgoers who had just seen a profoundly saddening film such as “The Killing Fields” or “Terms of Endearment.” Also, people who had just seen a Rambo-type violent films were more likely to recommend very severe punishments for heroin traffickers and other such criminals.

Health evaluations

People's moods also affect their reports about their physical health and their medical history. A study by Peter Salovey and Deborah Birnbaum (1989) found that people made to feel temporarily sad as they filled out a medical history reported far more past illnesses, more frequent chronic symptoms and complaints, and poorer health than did subjects in a neutral mood. That bias may be reflecting how much a sad mood increases recall of times when one felt sick.

Beyond that, however, mood also influences people's perception or appraisal of their current health status, as indicated by the number of physical complaints from people who are slightly ill. Salovey and Birnbaum found such appraisal biases in a study of Yale students. Students who currently had a bad cold or the flu were first made to feel happy, sad or neutral by having them recall a happy, sad or neutral episode from their lives. They then rated the severity of aches, pains and discomfort from their current cold. As expected, compared to neutral controls, temporarily sad subjects rated their cold symptoms as considerably more painful and discomforting, whereas happy subjects rated their symptoms as less painful and discomforting. This bias could be significant in medical practice, since physicians' diagnoses depend to some extent upon patients' appraisal of the severity of the symptoms they report.

Salovey and Birnbaum also had subjects rate their vulnerability to future illnesses and whether they thought alleged health-promoting behaviors would be effective in preventing those illnesses. Here, too, subjects showed mood-congruent changes. For example, temporarily sad subjects felt they were destined to have many health problems in the future, and there was little they could do to prevent these illnesses or alleviate their severity once they happened. Such pessimism is significant for personal health practices since it spawns defeatist, fatalistic attitudes, such as that one gains no health benefits from quitting smoking, reducing alcohol consumption, losing weight, or reducing blood pressure and cholesterol levels. Such fatalistic attitudes also reduce sick patients' adherence to long-term medication or treatment plans. Such noncompliance just exacerbates the medical problem and increases patients' depression.

Forecasting the future

So we see that people's moods affect not only their evaluation of their past and present circumstances but also their judgments about the likelihood of future events. In a direct assessment of these effects, Bill Wright and I (1992) induced a happy or sad mood in subjects and then had them estimate the likelihood of a variety of future events: half were blessings such as world peace or finding a cure for cancer; half were disasters such as being injured in a car accident or there being a major melt-down at a nearby nuclear power plant. 

Relative to neutral-mood controls, people when happy raised their subjective probability estimates of future blessings and lowered their estimates of future disasters. On the other hand, sad subjects did just the reverse: they raised their probability estimates for disasters, and lowered their estimates of the likelihood of blessings.

Here, then, is the optimism of the happy person and the pessimism of the depressed person. We can explain such biases by noting that people estimate subjective probabilities by gauging the ease with which evidence supportive of an event comes to mind (the “availability heuristic” of Tversky and Kahnemann, 1974). According to the mood-congruity theory, then, people who are sad will think of more facts and ideas associated with a pessimistic outcome. So the ease with which positive versus negative evidence comes to mind would bias the judgments in an optimistic or pessimistic direction.

Evaluating oneself and others

Judging others

Just as people's mood affects their evaluations of their possessions, their lives, and their future prospects, so does their mood influence their judgments about other people's behavior toward them. Our social perceptions of what someone is doing, of what is happening around us, are heavily tinged with subjectivism and evaluation. The meaning of people's actions is not given to us objectively. Rather, we project meaning onto those actions. In other words, as we attempt to determine the intentions hidden behind someone's actions and words, our own feelings strongly influence our interpretation. Thus, we have to decide whether a Senator who argues for a position is expressing his actual views or is just posturing for his constituents; whether he is showing admirable persistence or pigheaded stubbornness; whether a soldier in combat who takes a risk is being courageous or irresponsibly reckless; whether a policeman's use of force is appropriate or excessive. Clearly, the judgments we make depend on how the actions impact on us and how we feel about the person. But those two things are very much mixed together with how we are currently feeling. And we may have acquired out current mood or feeling for reasons totally irrelevant to the judgment at hand. In general, our research shows that people who are temporarily happy tend to be charitable, loving and forgiving in their interpretations of others. Depressed people are quick to notice any signs of flagging friendship. They exaggerate the slightest criticism, and over-interpret remarks as critical of themselves.

Explaining one's successes and failures

People's moods also influence the way they explain their successes and failures. These influences were demonstrated in an experiment by Joe Forgas, Stephanie Moylan and me (1990). The subjects were students in an introductory psychology class who had recently received their exam score and ranking on an important examination they had taken earlier in the class. For the experiment, the students first watched one of two short films designed to evoke feelings of either happiness or sadness. They then rated their exam preference. Furthermore, they judged the extent to which their exam performance was attributable to their ability and effort versus the difficulty of the test or good or bad luck. We divided subjects into those who had scored well on the exam and felt satisfied with their success, versus those who had scored poorly and felt they had failed.

We found that when feeling happy, subjects who had done well attributed their success to their ability and effort in studying, whereas the happy ones who had failed explained their failures ad sue to bad luck or an unfair test. On the other hand, when students had been put in a sad mood, those who had done well attributed their success to an easy test or to simple dumb luck, whereas those who had failed the exam blamed their failure on their lack of ability and weak efforts. This, happy people take credit for their successes and slough off blame for their failures; in contrast, sad people do just the opposite, blaming themselves for their failures and denigrating their successes. Such attributions are guaranteed to maintain their current mood.

Marital blaming

Similar results were obtained by Forgas (1994) when people made temporarily happy or sad by a film at a cinema were asked in a survey to explain the cause of various serious conflicts in their marriage, such as fights over finances or extreme jealousy. Contrary to what you might think, after a happy movie people were not more likely to accept blame for their marriage problems. Quite the contrary: happy people judged themselves as relatively blameless, whereas people, who had just come out of a sad movie tended more to blame themselves, believing that they were more responsible for causing problems in their marriage. So again, sad people are blaming themselves in a manner that will unwittingly maintain their sad mood.

Projecting hostility

The idea that people's moods alter their perceptions and attributions of others is further confirmed by studies of anger and hostility. In laboratory studies, we find that when subjects are provoked to anger, they tend to be uncharitable, fault-finding, have a chip on their shoulder, and are ready to take offense (see also Bandura, 1973, and Zillmann, 1979). They may take out their anger on innocent bystanders in a manner reminiscent of scapegoating.

The idea that hostile people are primed to perceive hostility in their social environment has also been strongly supported in field research by Kenneth Dodge (1985). He studied the aggressive behavior of young bullies — boys between the ages of 7 and 11 — who were observed in peer groups of elementary school children, Dodge found that bullies have trained themselves to interpret their social interactions with very hostile biases, as providing evidence that their peers dislike them and are trying to do them in. So they believe that they are justified in beating up on those kids. But their aggressive actions are thus provoking from their social environment exactly the hostile reactions they expected.

Self-perception

The material I've just reviewed shows that people's moods influence their perception and evaluation of the behavior of others. We also have evidence that mood similarly influences people's observations and evaluations of their own behavior. In an experiment by Joe Forgas, Susan Krantz and me (1984), subjects who had been put into a good or bad mood rated their own behavior every 5 seconds for pro-social, neutral or anti-social aspects. They did this by viewing themselves on videotape in a social interaction recorded the previous day. The percentages of each type of observation of themselves are depicted in Figure 7.

People in a good mood judged themselves in the video to be emitting large numbers of positive, pro-social behaviors, appearing suave, friendly and competent. People in a bad mood saw themselves as emitting many negative, antisocial behaviors, appearing as withdrawn, socially unskilled and incompetent. These effects were all “in the eye of the beholder“ since objective judges rated the videotaped subjects as displaying about the same levels of positive and negative behaviors.

We can explain such results by supposing that the perceiver's mood primes into readiness mood-congruent concepts they then use to classify as positive or negative the ambiguous gestures, speeches and body language they view in the video tape — even when they're viewing themselves.

Self-confidence

In related research, David Kavanaugh and I (1985) studied how temporary moods influence people's sense of efficacy or competence in accomplishing a variety of tasks. Subjects induced to feel temporarily happy or sad rated the likelihood that they could successfully carry out diverse actions — such as attracting someone of the opposite sex, forming friendships, dealing assertively with others, or doing well in intellectual or athletic tasks. They were asked to ignore their current feelings and to make these judgments according to what they normally would be able to do.

We found that relative to control subjects in a neutral mood, happy subjects had an elevated sense of self-efficacy, confidence and competence, whereas sad people had a lowered sense of self-efficacy. These effects prevailed across all content domains. These mood influences are important since we know that self-efficacy judgments determine which activities people will attempt and how long they will persist in the face of difficulties. We may explain these effects in terms of mood-congruent availability of the subjects' memories for positive (versus negative) experiences in the questioned activity. Although people's average levels of achievement will differ greatly depending on their history, each of us has his or her private collection of “better“ versus “worse“ performances evaluated relative to our standards in a given domain. However, a temporary happy or sad mood can then shift the availability of these two sets of memories, thus temporarily biasing our estimate of our capabilities.

Habitual optimism or pessimism

The material reviewed illustrates that what people see and how they interpret a situation varies with how they're feeling.