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Social Contagion and Mental Health

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Social contagion involves the transmission of attitudes, behaviours or emotions between individuals in close social networks, comparatively to the spread of infectious diseases [1]. Rather than how similar individuals connect, form friendships and consequently spend more time together through homophily, social contagion mediates similarity amongst social ties[2]. Research has shown that social contagion can occur at a psychological level through unconscious mimicry and emotional internalisation, as well as through social processes including communication and behavioural learning.[3] Understanding the mechanisms and extent of social contagion influence can help inform clinical treatment of mental health conditions and symptom management strategies, supporting psychological and physical wellbeing.

Social Contagion, Emotions and Behaviour

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Observing others' emotional expressions provides insight into their current emotional state by expressing internal processes as external signals.[4] Cues to predicting and understanding an expressers behavioural intentions are gained, providing social advantages evolutionarily.[5] For example, crying often encourages consolidation from observers, alongside congruency in emotions via empathy and afferent feedback mechanisms to aid understanding. Emotional contagion is thought to be influenced by both conscious and unconscious elements,[1] despite uncertainty in the precise underlying mechanisms. When emotion-related information is processed, embodiment theories [6] propose neural states implicated in past affective experiences are reactivated; when connected emotions and expressions are repeatedly experienced together (i.e. sadness and crying), they become internalised and can be evoked by related stimuli. Activation of similar emotion-specific neural systems has been demonstrated in observers of pain, fear, and anxiety during fMRI studies.[7] Not restricted to visual observation, automatic stimulation of congruent mood states in listeners is also prompted by vocalised emotional expressions.[8] Listening to an individual expressing their emotional state and experiences involve the same neural representations used to articulate personal emotion, leading to activation upon hearing, even without an intention to share emotion.[8]

Empathy processing through mirror neurons is important in social cognition to understand others' emotions, facilitating feedback between observing emotional expressions and the related neural activation.[9] Links between the mirror neuron system, limbic system and insula are involved in empathy and facial expression mimicry,[9] with subtle changes occurring almost instantaneously upon observation. Electromyographic (EMG) measurements demonstrate that facial expressions reflect changes in internal emotional experiences, with muscular regions corresponding to the same emotions being activated in individuals observing someone else's emotional expression.[3] Automatic mimicry of vocal utterances, postures and movements has also been found: directed by commands from the central nervous system. Individuals receive affective feedback from their expressions, causing interpretation and appraisal of their own emotional state.[3] Research indicates that an observer's drive and capability to process and understand others' emotions,[10] alongside their emotional regulation ability,[11] determines the degree social influence has on mood state contagion. Therefore, social contact and empathising with an individual experiencing negative mental health has been implicated with contagion of similar affective experiences.[12]

Mental Health Conditions

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Research has examined links between various psychopathologies and mental health diagnoses with the transmission of emotions via social contagion.

Depression

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Diagram of the limbic system; involved in an extensive neural network with the motor neuron system, implicated with emotional empathy.[13]

Co-existing with individuals exhibiting depressive symptoms has led to emotional contagion of similar states through mimicry and neuronal synchronisation. Social exposure to verbal expression of affective states, with the arousal inflicted from hearing such emotions, has shown a positive association with neural synchrony in multiple brain regions.[14] This includes attentional, emotional (e.g. amygdala and thalamus) and somatosensory areas, linked to emotional expressions and bodily responses: thought to facilitate understanding of others' emotional states and intentions, aiding communication ability and empathy.[14] In individuals with Major Depressive Disorder (MDD), individuals may find empathy, facial happiness recognition and social engagement difficult, which has been linked to defective activation patterns in the mirror neuron system.[9] Synchrony of neuronal activation, including the mirror neuron system, therefore may facilitate contagion in depressive symptoms amongst individuals spending large proportions of time together.

In terms of socialisation, influence from individuals expressing depressive symptoms can occur directly and indirectly. Direct influence - the encouragement or discouragement of symptoms - may occur in cases where individuals with mood disorders cluster together. Mediated by social contagion, research has demonstrated that individuals with depression seek out others displaying similar symptoms, subsequently spending more time in contact and leading to mood convergence among those even at 3 degrees of separation.[15] The level of affiliation within a social tie determines the strength of contagion. Female participants exerted greater influence on mood spread over time, likely due to greater emotional expression (e.g. in non-verbal cues).[16] Research indicates that peer influence on depressive symptoms is facilitated by co-rumination in certain contexts: the excessive discussion of problems, centring on negative affect.[17] Individual factors determine vulnerability to symptom internalisation, such as increased susceptibility to influence or empathetic distress. The quality of friendship and characteristics of the peer also play a role, such as whether the depressed individual excessively seeks reassurance and involves others in their distress, compared to mere exposure to such symptoms.[17] Studies have shown links between maternal depression, interactions and consequent child depression, irrespective of genetic similarity.[18] The importance of environmental influence on a child's behaviour and wellbeing is demonstrated as children of mothers suffering from persistent depression displayed more emotional and behavioural difficulties, including intergenerational transmission of depressive symptoms.[18] However, according to Coyne's (1976) Interpersonal Theory of Depression,[19] stable relationships and interactions act as buffers against depression by providing support and validation. By facilitating positive interactions, a vulnerable individual may receive indirect benefits. Therefore, emotional contagion of depressive symptoms has been shown to occur socially within parent-child and peer relationship climates, alongside the influence of neuronal synchrony in close proximity relations. Understanding the role of social relationships in depressive symptom onset or exacerbation can enhance understanding of risk factors, contributing to therapeutic intervention development and improvement.

Anorexia Nervosa

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Social pressures stemming from the standards, values and desirability of 'thinness' in Western societies are continually reinforced, shaping ideals transmitted socially in-person and via media display.[20] Peer groups can act as reinforcers for similar habits, including disordered eating patterns supporting harmful practices, weight loss and/or demanding physical exercise.[20] Social learning and reinforcement as a mechanism for social contagion can occur through observing others partake in practices to meet a desirable goal. Daily social interactions with both parents and peers in adolescence can lead to the transmission of weight-related issues and dieting behaviour, regardless of gender, despite a greater presence of dieting behaviour and influence in female peer groups than males.[21] Yet again, susceptibility to social contagion of disordered behaviour through peer influence is dependent on individual traits,[20] including reward/praise sensitivity, perfectionism and a need for orderliness.[22] Co-rumination may also exert indirect influence, leading individuals to behave in line with the social norms of a valued social group and engage behaviourally [9]. Research examining specialised inpatient group therapy care has found a risk of peer contagion to interfere with recovery.[23] Despite the shared understanding and support advantages of group treatment settings, individuals recounting their treatment experiences have reported facilitation of a competitive environment involving the comparison of eating habits and weight among patients.[23] Concerns over vicarious learning and modelling of damaging habits, for both eating and other behaviours, are also prevalent.[23] Eating disorder prevention programmes implemented for female college students led to increased symptomology at follow-up compared to individuals who did not participate, despite a lack of differences before enrolment.[24] The awareness of potential factors that may hinder recovery offers valuable insight into treatment options; the interaction between individual susceptibility to social influence and the therapeutic climate can help determine the suitability of group treatment settings to individual needs.

Post-Traumatic Stress Disorder

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PTSD stems from exposure to traumatic events, inflicting subsequent chronic stress that surfaces as negative or dysfunctional cognitions (e.g. re-experiencing an event), mood and behavioural patterns.[25] A research topic of interest involving social and emotional contagion is the transmission of traumatic stress from the trauma survivor to close proximity relations.[25] Even without direct exposure, psychological and emotional distress can be shared: a process believed to be linked to interpersonal identification and empathy.[25] By providing emotional support to the survivor, an individual may attempt to understand their experience and empathise by gathering information about their suffering. As a result, memories, experiences, distress and overall affect may be taken on as their own.[25] This psychological depletion has been referred to as Compassion Fatigue,[26] often seen in caregivers and therapists. Transmission can occasionally surface directly connected to the individual's trauma, such as experiencing flashbacks of constructed memories that resemble the survivor's experiences or avoiding connected cues. Other times, more generalised psychological distress may be experienced by individuals closely connected to the trauma survivor.[25] Having emotional connectedness to an individual experiencing PTSD can increase susceptibility to social contagion of secondary traumatic stress, increasing the likelihood of adopting the behaviours and reactions observed.[27] Greater empathy and insecure attachment style, associated with self-differentiation difficulty and emotional sensitivity, emerged as other risk factors.[27]

Promoting Positive Mental Health

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Sociograms enable visual representations of an individual's social network, allowing them to identify positive, beneficial relationships and negative, potentially harmful relationships.

The knowledge of how behavioural and affective psychopathology symptoms can be transmitted through social contagion encourages utilisation in preventative or counteractive interventions. Such approaches aim to support individuals at risk of being affected or having their symptoms worsen. Understanding how emotional experiences can be transmitted and shared amongst interconnected individuals has positive implications for group therapy and community interventions. The importance of social support can be utilised in supporting individuals vulnerable to loneliness and low mood.[28] In clinical settings, recognising the biopsychosocial influences on emotional states can be done by examining a client's regular social contacts. From this understanding, clients can be advised on the best way to navigate their social network, encouraging contact with those most likely to have a positive influence, therefore mediating resilience and positive mental health.[1] Sociograms have been used in clinical settings to explore peer relationship quality, structures and interpersonal dynamics to examine how this affects an individual's own psychological well-being.[20] For individuals suffering from eating disorders, examining relationship networks in relation to exercise and dieting can support a client in understanding and navigating friendships to best benefit them during recovery, eliminating harmful influences.[20] Early intervention goals to maintain or reinstate existing friendships that don't revolve around dieting or body image can help improve mood and motivation to recovery.[20]

Recent research has implemented the role of mimicry in emotional contagion for supporting mood disorders. Exposure to positive facial expressions has had a positive impact on individuals displaying significant depressive mood symptoms, yet sub-threshold for diagnosis.[29] Happy facial expression exposure led to mimicry and an increase in mood, compared to a decrease in mood for those who were exposed to and mimicked negative expressions.[29] The prospect of individuals expressing positive mood as offering some protective support against symptom worsening or maintenance is encouraging for future intervention research. However, appropriate and realistic implementation is required to understand the extent of benefit an individual may receive by being exposed to positive support in this way.

There are growing concerns surrounding social media as a vehicle for negative influence on adolescent mental health. Social media content and online communication provides a medium for exposure to behaviours including substance abuse, disordered eating habits and self-injury.[30] Examining the implications of emotional propagation and contagion through social media has led to recent developments of early screening models for psychopathology by looking at vulnerable individuals' online social circles. [31] Who individuals interact with and under what contexts can support clinical healthcare interventions, contributing to more prospective and targeted treatment options that aim to minimise as much harm as possible.[31] This can include reducing depression onset risk, or symptom management to prevent other harmful behaviours from surfacing, including substance abuse, self-harm and suicide.[31] Insight into how large-scale social contagion can be successfully managed to reduce negative emotion and harmful behaviour pattern transmission is hopeful for developing interventions to tackle other conditions, opening doors for future research.

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