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Mood disorders (major depressive and bipolar spectrum disorders) have devastating effects on quality of life, with individuals who do not respond to pharmacological interventions showing a greater risk of impaired functioning, suicidality, and symptom relapse. Electroconvulsive therapy (ECT) has demonstrated consistent efficacy for treating mood disorders. However, there is a relative paucity of research examining the effectiveness of ECT in ambulatory settings and for patients who present with psychiatric comorbidities. This thesis sought to characterize the clinical, functional, and neuropsychological profile and outcomes (i.e., effectiveness and side effects) of a mixed mood disorders population undergoing ambulatory ECT with minimal research-related restrictions. In study one, we demonstrated that ambulatory ECT patients were clinically severe and complex, with frequent psychiatric multimorbidity, high symptom severity, and elevated functional impairment. ECT was effective at significantly reducing depressive symptoms in the short- and long-term; yet the rates of remission and response were lower than expected. In study two, we found that objective cognitive functioning remained largely unchanged following ECT, a finding that should be interpreted with caution given the use of a brief cognitive screening battery. Interestingly, whereas patients who responded to ECT reported a lessening of subjective memory complaints, those who did not respond showed an increase in memory complaints post-ECT. In study 3, we sought to identify clinical and cognitive predictors of ECT outcomes using machine learning methods; we were unable to predict remission status, response status, or percent change in depressive symptoms in our sample. Overall, this thesis advances our understanding of the clinical, cognitive, and functional characteristics and outcomes of ambulatory ECT delivered under naturalistic conditions. This work highlights the importance of considering clinical comorbidities and cognitive functioning in ECT research and delivery and encourages a collaborative approach to clinical care aimed at enhancing treatment of patients with severe mental illness. / Dissertation / Doctor of Philosophy (PhD) / Severe mood disorders, such as depression and bipolar disorder, are associated with significant difficulties in social, occupational, and personal functioning. Electroconvulsive therapy (ECT) has shown consistent efficacy in reducing depressive symptoms, even in patients who did not respond to pharmacotherapy. This thesis advances our understanding of the therapeutic and adverse side effects of ECT in two understudied areas, ECT delivered in an outpatient setting and under naturalistic conditions with minimal research-related restrictions. We found that patients undergoing ECT were clinically complex and severe. ECT was effective at reducing depressive symptoms, but remission and response rates were lower than expected. Although, cognitive functioning, following ECT, remained largely unchanged on a brief screening assessment that may have underestimated cognitive changes, patients continued to report memory concerns. This thesis highlights the importance of considering patients’ full clinical and cognitive presentation in ECT research and delivery and encourages a collaborative approach to clinical care to better treat patients with severe mental illness.

Exercise has been shown to improve mood (Stöhle, 2009). Research has explored how exercise instructors can affect class participants' mood (Edmunds, Ntoumanis, & Duda, 2008). One style of instruction that is less understood relates to task-oriented vs. person-oriented instruction. The primary aim of this research was to explore the impact of spin-class instruction style on mood among spin-class participants. In Study 1, research assistants (RAs) evaluated the instruction of spin-class instructors and administered mood surveys to spin-class participants and instructors. Overall, positive mood improved for all spin-class participants and instructors. Instruction style did not moderate this effect. In Study 2, a refined instruction evaluation form was used to better detect person-oriented vs. task-oriented instruction. Unlike in Study 1, RAs also completed mood surveys. Overall, positive mood improved as a function of the exercise class for spin-class members and instructors, but not for RAs. Instruction style did not moderate this mood effect. Overall, the results support prior research that exercise leads to mood improvement. However, an impact of instruction style on class participants' mood was not found. One novel approach of this study was that instruction style was not manipulated. This pragmatic approach allowed the research team to explore organic instructor-student dynamics in a spin-class, which may improve the generalizability of the findings. / Master of Science

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Theories of how individuals reason, and how they experience emotion abound in the psychological literature; yet, despite the common lay-theories of how emotions might affect a person’s reasoning, very little empirical work has been conducted on this relationship. The current thesis addresses this knowledge-gap by first distilling from the literature two classes of emotion theory; Information, and Load; and then systematically testing the explanatory power of these theories. A dual-process framework is employed in order to define low (Type One) and high effort (Type Two) strategies. Information theories predict that negative emotion cues more analytic processing relative to positive emotion, whereas load theories predict both positive and negative emotion to suppress use of high-effort strategies. Thus the two theories are compared by varying incidental and integral emotion across syllogistic reasoning, conditional reasoning, and the ratio-bias task, and assessing the engagement of Type One and Type Two processes across positive emotion, negative emotion, and control conditions. The findings suggest that emotion effects in syllogistic reasoning do not consistently support either Load or Information theories (Experiments 1-4). Emotion effects are found to be typically larger for integral than incidental emotion (Experiment 5), and most frequently serve as Information in verbal (Experiments 6 and 7) and visual conditional reasoning tasks (Experiment 8). Furthermore, these effects are to a large extent dependent on task properties such as the number of alternative antecedents (Experiments 9 and 10), and are greater on more difficult tasks (Experiments 11 and 12). These findings suggest that emotion has a greater impact on Type Two than Type One processes. A range of methodological and theoretical implications which will inform future work in this area are also discussed in the closing chapter.

The current work assesses the relationship between reinforcement sensitivity theory (RST) and Personality Traits for the DSM-5 (PID-5), to explore the degree to which they are associated with mood disorder symptoms. Participants (N = 138) from a large public university in the South were administered a semi-structured interview to assess for current mood disorder and anxiety symptoms. They were also administered self-report inventories, including the Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) scales and the Personality Inventory for DSM-5 (PID-5). Results indicate that both the BIS/BAS scales and the PID-5 scales were strongly associated with current mood symptoms. However, the maladaptive personality traits demonstrated significantly greater associations with symptoms compared to the BIS/BAS scales. Results also indicated support for using a 2-factor model of BIS as opposed to a single factor model. Personality models (such as the five factor model) are strongly associated with mood symptoms. Results from this study add to the literature by demonstrating credibility of an alternative five-factor model of personality focused on maladaptive traits. Knowledge of individual maladaptive personality profiles can be easily obtained and used to influence case conceptualizations and create treatment plans in clinical settings.

Linguistic mood is a grammatical term as well as a morphological category of the verb. Due to its often philosophical implications it is challenging to find a definition or a common understanding of the notion; it has been proven historically and linguistically difficult to analyze. In this essay I aim to cast new light upon and interpret the concept of mood in extended, philosophical manners. The argument of the essay is that the traditional approach to the notion is done in ways that omit fundamental aspects of it, as well as puts it into a framework that tries to explain it in ways through which it cannot fully be explained. Thus the thesis is that there is more to the notion than what meets the eye. The idea is to find this through the work of phenomenologists. Alongside a linguistic use, the word mood [Modus/mode] is also being used in philosophy, most notably within a phenomenological discourse. Edmund Husserl, Martin Heidegger and Maurice Merleau-Ponty all use the word. By going through a close-reading of the concept, I argue for the proximity between the linguistic and the phenomenological adaption of mood and show how they are ontologically related; the objective is to suggest that there is more common ground between them than the mere (English) name. By concentrating on this term I want to further examine in what way a phenomenological understanding of language can challenge an overly narrow, one-dimensional understanding, which I see as a fault shared by the linguists.

Cognitive theories propose that interpretive biases play an important role in the onset and maintenance of emotional disorders. To investigate the proposed causal role of interpretive biases, this study examined if it is possible to train interpretations of ambiguous situations, and if this training affects emotional vulnerability and memory. The results indicated that the interpretive training was effective in inducing the intended group differences in interpretive bias, but that the positive training was more effective than negative training. These findings also highlight the potential benefits of inducing positive interpretive biases on mood and emotional vulnerability for some individuals (i.e., individuals with high depression or rumination scores). Additionally, results from the current study demonstrate that manipulating interpretive biases can result in corresponding changes in memory. In sum, findings from the current study hold valuable implications for the effects of positively manipulating interpretive biases on mood, emotional vulnerability, and memory. Future research can further elucidate the relationship between interpretive biases and mood, as well as extend current findings to a clinical population.

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