Title: The Expression and Regulation of Sadness in Complicated Grief
Description: The current study examined the role of context sensitive emotional responding in normal and pathological adjustment to loss among conjugally bereaved persons later in bereavement. We specifically focused on investigating how participants with complicated grief (CG) emotionally responded in comparison to a non-pathological bereaved group. We comprehensively measured the emotional responding behaviors (i.e., facial displays of emotion and head movements) of participants as they watched an evocatively sad or neutral film and also examined their emotion experience via self-report. We anticipated that CG participants would show and report less emotional context-sensitivity (i.e., less sadness and more negative emotions other than sadness) than non-pathological bereaved participants in the sad condition. Our findings demonstrate differences in both the emotional expression and emotional experience of the CG group compared with the non-pathological bereaved group in the context of a sad film.

Our findings both support and extend our predictions. While overall participants more commonly expressed the prototypical sadness expressions in the sad condition than the neutral condition, a number of notable interaction effects emerged. Specifically, non-pathological bereaved participants were significantly more likely to express sadness expressions that involved the orbicular oculi muscles (i.e., AU 6 or the "cheek raiser"), the outer muscles that orbit the eyes, than CG participants in the sad condition. Research evidences how the orbicular oculi muscles are associated with "genuine" or more intense expressions of happiness and the current study suggests that the orbicular oculi muscles also distinguish between sadness expressions. In addition, while both groups were more likely to report feeling greater sadness in the sad condition than the neutral condition, CG participants were more likely to feel disgust and anger than non-pathological bereaved participants in the sad condition, pointing to unique pattern of context insensitive emotional responding.

We found that CG is "complicated" in part due to its high co-morbidity rates with Major Depressive Disorder (MDD) and Post-traumatic Stress Disorder (PTSD). While controlling for the effects of MDD and PTSD did not significantly change our results, the high co-morbidity rate of CG with MDD (74%) and PTSD (68%) begs us to consider the pan-diagnostic nature of chronic grief-related pathology. In sum, the current study highlights grief-related pathology as a distinct clinical problem and points to how emotion context-insensitivity importantly plays a role in the maintenance of grief-related problems.