• Users Online: 95
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 27-31

Behavioral brain systems activation with postpartum blue: According revised reinforcement sensivity theory


1 Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
2 Department of Psychology, Quchan Branch, Islamic Azad University, Quchan, Iran

Date of Submission07-Dec-2018
Date of Acceptance31-Dec-2018
Date of Web Publication1-Apr-2019

Correspondence Address:
Dr. Hamid Nejat
Department of Psychology, Quchan Branch, Islamic Azad University, Quchan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNMS.JNMS_58_18

Get Permissions

  Abstract 

Context: Mood disorders such as postpartum blue are very prevalent in the postnatal period, while the underlying mechanism of postpartum blue is not well known.
Aim: This research aimed to investigates the role of brain-behavioral systems activation in postpartum blue according to revised reinforcement sensitivity theory in mothers referring to Mashhad health-care centers.
Settings and Design: This correlational study has been conducted during February–March 2018, on 172 cases who diagnosed with postpartum blue were chosen through the purposive sampling method.
Materials and Methods: Participants completed demographic questionnaire, Jackson five-factor questionnaire, and the Edinburgh depression scale.
Statistical Analysis Used: The normality of data distribution examined using the Kolmogorov–Smirnov test. After, data were analyzed using descriptive methods (mean and standard deviation), Pearson confiscation, and stepwise regression method.
Results: The results showed that brain-behavioral systems, including behavioral inhibition system (BIS) (P < 0.001; R = 0.31) and behavioral activation system (BAS), had a significant correlation with postpartum blue (P < 0.05; R = 0.39), while there was no significant relationship between fight-flight systems with postpartum blue. BAS (R2 = 0.15,P < 0.05) and BIS (|R2 = 0.08,P < 0.001), the predictive potential of BIS and BAS was equal to 21% of variance of postpartum blue.
Conclusion: The findings suggest that behavioral-brain systems play a role in mothers' “postpartum psychological disorders such as postpartum blue and in the conception of mothers” distress after maternal delivery, the effects of these systems can be used in short-term interventions.

Keywords: Behavioral-brain systems activation, Postpartum blue, Revised reinforcement sensitivity theory


How to cite this article:
Alimoradi B, Nejat H. Behavioral brain systems activation with postpartum blue: According revised reinforcement sensivity theory. J Nurs Midwifery Sci 2019;6:27-31

How to cite this URL:
Alimoradi B, Nejat H. Behavioral brain systems activation with postpartum blue: According revised reinforcement sensivity theory. J Nurs Midwifery Sci [serial online] 2019 [cited 2019 Dec 10];6:27-31. Available from: http://www.jnmsjournal.org/text.asp?2019/6/1/27/255333


  Introduction Top


Mothers face many challenges during pregnancy and postpartum. Although the majority of mothers overcome the challenges in these stages, some mothers experience problem and could not pass postpartum normally situations.[1] Postpartum blue after childbirth is one of the complications that may affect mothers in postpartum period.[2] Higher degree of postpartum blue with clinical signs called postpartum depression.[3] The following can be pointed out about possible causes: feeling disappointed, fear and early birth discomfort, fatigue due to lack of sleep during labor and pregnancy, anxiety about the inability to care of the baby, and fear of reducing postpartum charm, as well as the involvement of hormonal agents such as endorphin, estrogen, and progesterone levels have also been reported.[4],[5] Although these hormonal changes are fast, transient, and only observed in the first few days after childbirth,[6] in some cases, grief in this period is the beginning of postpartum depression.[7] Emotions such as depression have biological, social, and psychological dimensions.[8],[9] According to a reinforcement sensitivity theory, behavioral-brain systems play a key role in creating emotions.[10],[11] Reinforcement sensitivity theory is one of the most widely accepted theories in terms of biological models in psychology, which has been proposed by Gray et al. in 1970. According to this model, Gray hypothesized brain-behavioral included two systems of behavioral inhibition system (BIS) and the behavioral activation system (BAS). These systems control the behavioral activity.[12] The BIS is thought to be related to sensitivity to punishment as well as avoidance motivation, while the BAS is thought to be related to sensitivity to reward as well as approach motivation. This theory supported animal studies.[13] The BIS, as proposed by Gray, is a neuropsychological system that predicts an individual's response to anxiety-relevant cues in a given environment. This system is activated in times of punishment, boring things, or negative events.[14]

The BAS, in contrast to the BIS, is based on a model of appetitive motivation in anxiety validation. The BAS is aroused when it receives cues corresponding to rewards and controls actions that are not related to punishment, rather actions regulating behaviors.[14] According to Gray's theory, the BAS is sensitive to conditioned attractive stimuli and is associated with impulsivity.[15] Gray and McNaughton (2002) made some changes and presented revised reinforcement theory. Accordingly, fight/flight/freeze system (FFFS) added, which in this revised theory, freezing refers to the response to real threats that are not avoidable.[11] The sensitivity of this system is to respond to all unpleasant stimuli (whether conditional, nonconditional, or internal), and the consequence of avoidable behaviors and escape from immediate threats and fears, including fear and hat but not anxiety.[16],[17]

The theory of sensitivity to reinforcement, as a biological basis personality, is a basis for explaining mood disorders such as depression.[18],[19],[20],[21],[22] However, no investigation was found regarding the relationship between postdelivery blue and brain-behavioral systems. Therefore, this study was conducted to investigate the role of brain-behavioral systems activation in postpartum blue according to revised reinforcement sensitivity theory in mothers.


  Materials and Methods Top


This cross-sectional correlational study has been conducted during February–March 2018. The study included all selected main health center services of Mashhad city (1-2-3-5 and Samen). Accordingly, researcher asked from staffs to screen referred mothers during February–March 2018 through Edinburg scale and introduce to researcher if they were willing to participate in the study. Finally, 172 cases were selected using the purposive method. The inclusion criteria were as follows: Iranian, residence of Mashhad, educated at least up to high school, earning a score between 10 and 15 in the Edinburgh depression scale,[23] lack of psychiatric drugs, nonsmoking, nonalcohol and drugs, no medical or mental condition (according self-report of participants), no history of postpartum depression in previous births, and lack of experience of stressful events during pregnancy such as the death of loved ones or divorce. They have excluded if they do not like to cooperate in any stage, history of suicide, and uncompleted questionnaire. In order to collect data, in addition to demographic information, the following tools were used.

Edinburgh Depression Scale

These 10-item self-report measures symptoms of emotional distress were during pregnancy and the postnatal period. Each item offers four options to selection. When scores are between 1 and 9 may indicate the presence of some symptoms of distress that may be short lived and not serious. Scores between 10 and 15 are considered as postpartum blue and more than 15 scores are considered as postpartum depression.[24] Mosallanejad and Sobhanian reported sensitivity of scale (75.6) and reliability for the Iranian population of 65.8. The positive predictive value of the test was 62.2 and the negative predictive value of the test was 2.79, and the accuracy of the correct diagnosis of the test was 6.72 and the confidence limits for the test were 0.062.[25]

Jackson's Five-Factor Questionnaire

This 30-item scale is designed by Jackson (2009); the items equally distributed across five scales to each six items as follows: BAS, BIS, fight, flight, and freezing. The answer format is a 5-point Likert type scale (1 = completely disagree; 5 = completely agree). Higher score in each subscale indicated domination of that trait.[26] An Iranian study showed Cronbach's alphas range (0.72–0.88), test-retest coefficients (0.64–0.78), and test-retest correlations (0.28–0.68) suggested good reliability of the Persian version of Jackson's five-factor questionnaire. Confirmatory and explanatory factor analysis supported the original five-factor model of the questionnaire. The internal relationships between the subscales were appropriate (0.11–0.53).[27]

Ethical considerations

Written consent form signed by participants. The aims declared before giving questionnaire and they informed there is no obligation to leave the study at any stage. The research project approved the research committee of the Azad University of Neishabur with ethical code number of IR.IAU.NEYSHABUR.REC.1396.10.

The collected data were analyzed using SPSS-20 software (SPSS 20, IBM, Armonk, NY, United States of America) after omitting invalid questionnaires. Mean and standard deviation used to describe data. Meanwhile, frequency and percentage employed for describing characters of participants. The Pearson statistical tests and multiple regressions used to find the correlation of variables. Durbin–Watson and inflation variance index were used to check the assumptions. Initially, the normal distribution of data was investigated using the Kolmogorov–Smirnov statistical method. A statistically significant level of 0.05 was considered.


  Results Top


Demographic characters of the participants reported as following [Table 1].
Table 1: Demographic characters of participants

Click here to view


The mean and standard deviation of brain-behavioral systems and postpartum blue as well as the correlation between these systems were presented [Table 2]. The results indicated a statistically significant correlation between BIS (r = 0.38, P < 0.001) and BAS with postpartum blue (r = −0.33 P < 0.05), while there was no significant relationship between FFFS components with postpartum blue.
Table 2: Mean, standard deviation, and correlation of brain-behavior systems and postpartum blue

Click here to view


The multivariate regression analysis was used to determine the role of brain-behavioral systems in postpartum blue. For this purpose, the basic assumptions of this test such as natural distribution, elimination of irregular data, linearity, homogeneity of variances, and the absence of multiple parallelism by the Durbin–Watson test and coefficients of variance inflation factor were investigated. As shown in [Table 3], the BAS (F = 29.93, P < 0.05, R2 = 15) and BIS (F = 26.15, P < 0.001, R2 = 0.08) and totally they could predict 23% of variance of postpartum blues.
Table 3: Statistical indexes of stepwise regression brain-behavior systems and postpartum blue

Click here to view



  Discussion Top


The results showed that the BIS/BAS had the potential for predicting mothers' postpartum blue. This result is in harmony with findings of other study which showed that depressed patients have a high level of BAS in comparison with normal people.[28] Previous findings acknowledged that neurotic depression and anxiety are the results of higher activity of BIS, while psychoactive depression arises from the low activity of the BAS.[11] Meanwhile, researchers found that the high scores of BAS predict lifelong depression and anxiety disorders.[29] However, high scores in BAS are positively correlated with a positive emotional experience such as optimism, psychological well-being, and conversely correlated with depression.[14]

The results of this study revealed that participants suffering from postpartum blue have higher BIS, and their BAS is limited. According to the theory of reinforcement sensitivity, the participants are more sensitive to the reward. It has been expected as BIS is the basis of neurotic depression.[5],[21] The findings of the research are also consistent with other results which indicated high activation and sensitivity of BAS is related to negative mood.[30] It is suggested that, regardless of the nature of the anxiety, the sensitivity of the BAS is associated to unpleasant emotions. People with high levels of BAS, in general, regardless of the situation, experience more unpleasant emotions and exhibit higher unpleasant emotions in distressed situations.[31],[32],[33]

As a cross-sectional study, this study has been subjected to some limitations. Since the present study has been conducted in the mothers with postpartum blue in a single city and limited participants, its generalizability should be taken with caution and it is suggested that a similar study be conducted among the clinical population of mothers suffering from postpartum blue. There is a need for further neurological research to understand the underlying mechanism of BIS/BAS and its relationship with postpartum blue. Regarding disease history, we were limited with self-report tools and could not conduct deep intervention or laboratory tests. Therefore, it is recommended that laboratory evaluations also included in future studies. On the other hand, this study is limited to single variable, while postpartum blue is associated with several factors. Future research should look at the role of these components, and especially their differences in postpartum depression and blue as a mood disorder, in correction with BIS/BAS. The responsibilities, father cooperation, social capital, and support suggested to be compared in future researches.


  Conclusion Top


According to the findings of this study, research evidence suggests that the inherent tendencies of BIS and BAS that manifest themselves in their emotional styles are an important risk factor for emotional disturbances. In addition, the abnormal sensitivity of these systems is indicative of potential for different types of psychopathology,[9] so that the BIS/BAS can explain a wide range of disorders. As studies showed that BIS/BAS is relevant to treatment outcome.[34] It would be useful for future studies to utilize the measurement of BIS/BAS in treatment settings to design personal and effective protocols for the treatment of postpartum blue in mothers.

Conflicts of interest

There are no conflicts of interest.

Author contribution

All authors contributed to this research.

Financial support and sponsorship

Nil.

Acknowledgments

Thanks to all the mothers who participated in the study. In addition, the cooperation of the staffs at the health centers is appreciated.

 
  References Top

1.
Nagy E, Molnar P, Pal A, Orvos H. Prevalence rates and socioeconomic characteristics of post-partum depression in hungary. Psychiatry Res 2011;185:113-20.  Back to cited text no. 1
    
2.
Faisal-Cury A, Menezes PR, Tedesco JJ, Kahalle S, Zugaib M. Maternity “blues”: Prevalence and risk factors. Span J Psychol 2008;11:593-9.  Back to cited text no. 2
    
3.
Saduk B, Sadock V. Synopsis of psychiatry: Behavioral sciences and clinical psychiatry. J Urmia Univ Med Sci 2014;25:240-63.  Back to cited text no. 3
    
4.
Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL. Williams Obstetrics. 29th ed. NY: McGraw hill; 2014.  Back to cited text no. 4
    
5.
O'Keane V, Lightman S, Patrick K, Marsh M, Papadopoulos AS, Pawlby S, et al. Changes in the maternal hypothalamic-pituitary-adrenal axis during the early puerperium may be related to the postpartum 'blues'. J Neuroendocrinol 2011;23:1149-55.  Back to cited text no. 5
    
6.
Held L, Rutherford A. Can't a mother sing the blues? Postpartum depression and the construction of motherhood in late 20th-century America. Hist Psychol 2012;15:107-23.  Back to cited text no. 6
    
7.
Buttner MM, O'Hara MW, Watson D. The structure of women's mood in the early postpartum. Assessment 2012;19:247-56.  Back to cited text no. 7
    
8.
Bradbury TG. Tests Kills. Tehran: Savalan; 2005.  Back to cited text no. 8
    
9.
Dumitrescu AL, Toma C, Lascu V. Investigating the use of specific cognitive emotion regulation strategies in response to the experience of gingival bleeding. Rom J Intern Med 2011;49:207-15.  Back to cited text no. 9
    
10.
Gray JA. The neuropsychology of anxiety. Berlin, Heidelberg: Springer; 1984. p. 52-71.  Back to cited text no. 10
    
11.
Gray JA, McNaughton N. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal System (Oxford Psychology Series). NY: Oxford University Press; 2000.  Back to cited text no. 11
    
12.
Gray JA. A critique of Eysenck's theory of personality. A model for personality. Berlin, Heidelberg: Springer; 1981. p. 246-76.  Back to cited text no. 12
    
13.
Boksem MA, Tops M, Wester AE, Meijman TF, Lorist MM. Error-related ERP components and individual differences in punishment and reward sensitivity. Brain Res 2006;1101:92-101.  Back to cited text no. 13
    
14.
Gable SL, Reis HT, Elliot AJ. Behavioral activation and inhibition in everyday life. J Pers Soc Psychol 2000;78:1135-49.  Back to cited text no. 14
    
15.
Gray JA. The psychophysiological basis of introversion-extraversion. Behav Res Ther 1970;8:249-66.  Back to cited text no. 15
    
16.
Gray JA. Framework for a taxonomy of psychiatric disorder. In: Emotions. USA: Psychology Press; 2014. p. 43-74.  Back to cited text no. 16
    
17.
Corr P. Gray's reinforcement sensitivity theory: Tests of the joint subsystems hypothesis of anxiety and impulsivity. Pers Individ Dif 2002;33:511-32.  Back to cited text no. 17
    
18.
Corr PJ, Pickering AD, Gray JA. Personality and reinforcement in associative and instrumental learning. Pers Individ Dif 1995;19:47-71.  Back to cited text no. 18
    
19.
Meyer B, Johnson SL, Winters R. Responsiveness to threat and incentive in bipolar disorder: Relations of the BIS/BAS scales with symptoms. J Psychopathol Behav Assess 2001;23:133-43.  Back to cited text no. 19
    
20.
Vermeersch H, T'Sjoen G, Kaufman JM, Vincke J. The relationship between sex steroid hormones and behavioural inhibition (BIS) and behavioural activation (BAS) in adolescent boys and girls. Pers Individ Dif 2009;47:3-7.  Back to cited text no. 20
    
21.
Stoner R, Camilleri V, Calleja-Agius J, Schembri-Wismayer P. The cytokine-hormone axis-the link between premenstrual syndrome and postpartum depression. Gynecol Endocrinol 2017;33:588-92.  Back to cited text no. 21
    
22.
Kimbrel NA, Nelson-Gray RO, Mitchell JT. BIS, BAS, and bias: The role of personality and cognitive bias in social anxiety. Pers Individ Dif 2012;52:395-400.  Back to cited text no. 22
    
23.
Salari P. Relationship of fatigue and depression after delivery. JFMH 2009;11:302-11.  Back to cited text no. 23
    
24.
Bergink V, Kooistra L, Lambregtse-van den Berg MP, Wijnen H, Bunevicius R, van Baar A, et al. Validation of the Edinburgh depression scale during pregnancy. J Psychosom Res 2011;70:385-9.  Back to cited text no. 24
    
25.
Mosallanejad L, Sobhanian S. The accuracy of Edinburgh postpartum depression test. Jahrom Univ Med Sci 2010;2:14-20.  Back to cited text no. 25
    
26.
Krupić D, Corr PJ, Ručević S, Križanić V, Gračanin A. Five reinforcement sensitivity theory (RST) of personality questionnaires: Comparison, validity and generalization. Pers Individ Dif 2016;97:19-24.  Back to cited text no. 26
    
27.
Hasani J, Salehi S, Rasoli Azad M. Psychometric properties of Jackson's five factor questionnaire: Scales of revised reinforcement sensitivity theory (r-RST). JRPH 2012;6:60-73.  Back to cited text no. 27
    
28.
Kasch KL, Rottenberg J, Arnow BA, Gotlib IH. Behavioral activation and inhibition systems and the severity and course of depression. J Abnorm Psychol 2002;111:589-97.  Back to cited text no. 28
    
29.
Johnson JL, Kim LM, Giovannelli TS, Cagle T. Reinforcement sensitivity theory, vengeance, and forgiveness. Pers Individ Dif 2010;48:612-6.  Back to cited text no. 29
    
30.
Heponiemi T, Keltikangas-Järvinen L, Puttonen S, Ravaja N. BIS/BAS sensitivity and self-rated affects during experimentally induced stress. Pers Individ Dif 2003;34:943-57.  Back to cited text no. 30
    
31.
Smits DJ, Kuppens P. The relations between anger, coping with anger, and aggression, and the BIS/BAS system. Pers Individ Dif 2005;5:50-8.  Back to cited text no. 31
    
32.
Segarra P, Poy R, López R, Moltó J. Characterizing carver and white's BIS/BAS subscales using the five factor model of personality. Pers Individ Dif 2014;61:18-23.  Back to cited text no. 32
    
33.
Mellick W, Sharp C, Alfano C. The role of BIS/BAS in the vulnerability for depression in adolescent girls. Pers Individ Dif 2014;69:17-21.  Back to cited text no. 33
    
34.
Ly C. The Relevance of Reinforcement Sensitivity Theory to Social Anxiety and Response to Cognitive Behavioural Therapy for Social Anxiety Disorder. University of Tasmania; 2011.  Back to cited text no. 34
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed445    
    Printed48    
    Emailed0    
    PDF Downloaded84    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]