Proefschrift

192 Chapter 7 that were also part of the RE-PAIR study, may potentially disentangle differences in objective assessments versus subjective experiences of parenting behavior between depressed and nondepressed adolescents (Wentholt et al., In prep.). Disentangling whether parenting behavior itself or only the perception of the parenting behavior in the eyes of the adolescent is nonoptimal is important for interventions for adolescents with depression and whether and how their parents need to be involved. Parents with a history of CEM and depressed adolescents did not differ in their neural responses to making eye contact with familiar versus unfamiliar others, nor did they show altered neural responses to the different gaze directions. This suggests that their perceived lower mood in response to the videos of direct and averted gaze was not reflected in their neural responses. Instead, depressed adolescents exhibited overall blunted BOLD-responses in the secondary visual cortex and IFG throughout the task (i.e., in response to all task conditions). This part of the secondary visual cortex has been consistently found in relation to experiences of social exclusion in 7-10 year old children in a meta-analysis of three distinct samples (van der Meulen et al., 2017). The IFG, in addition, has been linked to emotion-regulation and resonating with another’s mental state and emotions (Feldman, 2017). Given the involvement of these brain regions in the processing of social information, the blunted neural responses might reflect a lack of social engagement characteristic of adolescent depression, and even a feeling of being excluded whilst making eye contact (Arce et al., 2009; Jankowski et al., 2018; Joiner et al., 2002). This finding corroborates with the difficulties in the social domain of adolescents with depression, although the precise psychological processes remain to be investigated. In contrast to altered responses to making eye contact with others, parents with a history of CEM and depressed adolescents also reported a lower mood in response to gazing into their own eyes when compared to parents with no CEM and non-depressed adolescents. Moreover, parents with more experienced CEM showed enhanced BOLD-activation in vmPFC, a brain consistently found in self-referential processing, in response to gazing into one’s own, but not others’, eyes. These findings suggest that both parents with a history of CEM and depressed adolescents might experience a certain discomfort when looking at themselves. This converges with studies showing, in addition to negative views about others, increased negative self-views, which is common in both people with experienced CEM and depression (Hammond & Romney, 1995). Lastly, parents with a history of CEM and depressed adolescents did not make less eye contact with the each other, unfamiliar others or with themselves in the task, which was assessed by measuring their gaze responses during the eye contact task. This suggests that they did not avoid eye contact more and that the differences that were found are not attributable to differences in how well they adhered to the task instruction to make eye contact with the targets throughout

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