Gender differences in the sensitivity to negative stimuli: Cross-modal affective priming study

European Psychiatry 28 (2013) 74–80

Original article

Gender differences in the sensitivity to negative stimuli: Cross-modal affective priming study§ B. Gohier a,*, C. Senior b, P.J. Brittain c, N. Lounes c, W. El-Hage d, V. Law c, M.L. Phillips e,f, S.A. Surguladze c,g a

De´partement de psychiatrie, UPRES EA 2646, CHU d’Angers, 49033 Angers, France School of Life & Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK Department of Psychosis, King’s College, London Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK d Inserm U-930, FRE CNRS 2448, universite´ Franc¸ois-Rabelais, clinique psychiatrique universitaire, CHRU de Tours, Tours, France e Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, USA f Department of Psychological Medicine, Cardiff University School of Medicine, UK g Cygnet Health Care, UK b c

A R T I C L E I N F O

A B S T R A C T

Article history: Received 15 January 2011 Received in revised form 26 May 2011 Accepted 22 June 2011 Available online 9 September 2011

Background. – There is evidence showing that men and women differ with regard to the processing of emotional information. However, the mechanisms behind these differences are not fully understood. Method. – The sample comprised of 275 (167 female) right-handed, healthy participants, recruited from the community. We employed a customized affective priming task, which consisted of three subtests, differing in the modality of the prime (face, written word, and sound). The targets were always written words of either positive or negative valence. The priming effect was measured as reaction time facilitation in conditions where both prime and target were emotional (of the same positive or negative valence) compared with conditions where the emotional targets were preceded by neutral primes. Results. – The priming effect was observed across all three modalities, with an interaction of gender by valence: the priming effect in the emotionally negative condition in male participants was stronger compared with females. This was accounted for by the differential priming effect within the female group where priming was significantly smaller in the emotionally negative conditions compared with the positive conditions. The male participants revealed a comparable priming effect across both the emotionally negative and positive conditions. Conclusion. – Reduced priming in negative conditions in women may reflect interference processes due to greater sensitivity to negative valence of stimuli. This in turn could underlie the gender-related differences in susceptibility to emotional disorders. ß 2011 Elsevier Masson SAS. All rights reserved.

Keywords: Gender Priming Emotion Cross-modal

1. Introduction Differences in emotional processing between men and women have been consistently reported. Healthy women were found to perform better in tasks requiring emotional face categorization [40], exhibited more intense responses to aversive stimuli, e.g. faces expressing fear and disgust [38], or to pictures of disgusting content [35], were faster than men in recognizing facial expressions of fear or distress [9] and performed better across different modalities (auditory, visual and audiovisual) in discriminating fearful and disgusting stimuli [12]. These gender differences are of potential importance as they may translate into differences in social behaviour as well as susceptibility to emotional disorders. § The study was conducted at the Department of Psychosis Studies, Institute of Psychiatry, King’s college, London. * Corresponding author. E-mail address: [email protected] (B. Gohier).

0924-9338/$ – see front matter ß 2011 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2011.06.007

Mood and anxiety disorders occur more frequently in women [21], with major depressive disorder being twice as common as compared to men (10–25% vs 5–12%) [1]. It could be important therefore to explore whether healthy women have any signs of ‘‘cognitive vulnerability’’ [3] that are similar to those found in depressed individuals of either gender. Since the cognitive vulnerability concept implies the existence of an automatic processing bias for negative information, it has been suggested that the most efficient way of examining this is by employing priming paradigms that are based on implicit rather than explicit processing [37]. In particular, the affective priming effect is defined by a facilitation of a target’s categorization when the prime and target have the same emotional valence (for review [22]). There have been several studies of depressive conditions employing the affective priming paradigms. Emotionally primed lexical decision tasks [7] and experiments requiring endorsement of trait adjectives [33] have shown facilitation of reaction time, i.e., greater priming effects in negative conditions in depressed subjects, compared with healthy controls.

B. Gohier et al. / European Psychiatry 28 (2013) 74–80

Similarly, in a non-clinical population, the high negative affect group showed greater priming of depression-relevant than neutral control words compared with the low negative affect group [6]. In contrast, some investigators reported a reduced effect of negative primes in depressed patients – these, however, may be accounted for by differences in experimental paradigms. Dannlowski et al. [14], using an evaluative decision task, found no affective priming in depressed individuals that was explained by Stroop-like interference effects (e.g., emotional Stroop effect [42]), which in turn may result from inhibitory deficits. The studies specifically focusing on inhibitory processes with negative affective priming paradigms confirmed that depressive individuals had inefficiency of inhibition of emotionally negative information [13,18]. In our previous study [19], we have also found impaired cognitive inhibition in depressed individuals in a variety of tasks, including the Stroop. To summarize, there is a considerable literature on implicit emotional processing in depressed individuals as well as on explicit emotional processing in healthy men and women. It is much less is known – whether the healthy men and women differ in terms of implicit emotional processing. This needs further research since the implicit emotional processing mechanisms underlie the cognitive bias that may be implicated in vulnerability to depression. In addition, it would be important to investigate potential gender differences in implicit processing of both verbal and non-verbal emotional stimuli. This is necessary, since socially relevant stimuli are often represented by non-verbal cues of different modalities (e.g. facial expressions and emotional vocalizations) – to which females appeared to be more sensitive than males in explicit tasks [9,12]. On the other hand, there have been indications that vulnerability to depression was associated with impaired cross-modal integration of sensory stimuli [10,28]. Thus, it would be important to explore whether men and women differ in terms of cross-modal transfer during processing of emotional information. We employed a cross-modal affective priming task, similar to that of Caroll and Young [11] to investigate gender differences in the implicit processing of affective material. The task allows an exploration of affective priming effects across different modalities (facial expressions, words, non-verbal emotional vocalizations). In contrast to Caroll [11], where the participants were asked to name each emotional target, our task required the evaluation of the targets as pleasant or unpleasant. Hence, we have employed an evaluative decision paradigm analogous to the one used in Dannlowski et al. [14] study of depression. We were aiming at detecting any signs of cognitive vulnerability (negative processing bias) in females that would resemble those of people with depression, although likely presented to a milder degree. We also had a second, exploratory aim – to investigate gender differences in cross-modal transfer of emotional information. Based on the existing evidence of increased sensitivity to emotionally negative information in women, we hypothesized that females, compared with male participants, would demonstrate reduced priming in conditions comprising emotionally negative stimuli, due to the interference processes.

2. Methods 2.1. Participants Two hundred and seventy-five right-handed subjects (167 female: 108 male) participated in the study, which was approved by the local institutional ethical review boards. All participants were white Caucasians aged between 18 and 55 years whose first

75

Table 1 Demographic and clinical characteristics.

Number Agea MMSEa NARTa Years of education GHQ STAI-state STAI-trait BDI

All subjects Mean (SD)

Women Mean (SD)

Men Mean (SD)

275 29.2 (10.2) 28.9 (1.5) 113.6 (19.2) 15.2 (3.3) 9.3 (3.4) 36.6 (11.3) 39.3 (9.98) 5.4 (5.6)

167 26.9 (9.3) 28.8 (1.7) 116.6 (14.7) 15.0 (3.0) 9.1 (3.8) 36.8 (11.5) 39.5 (9.5) 5.5 (5.2)

108 32.8 (10.6) 29.2 (1.08) 108.9 (23.8) 15.7 (3.6) 9.4 (3.0) 36.4 (11.1) 39.0 (10.8) 5.25 (6.2)

SD: standard deviation; MMSE: Mini-Mental State Examination [17]; NART: National Adult Reading Task [31]; GHQ: General Health Questionnaire [20]; STAI: State-Trait Anxiety Inventory [39]; BDI: Beck Depression Inventory [4]. a P < 0.01.

language was English. Participants with lifetime psychiatric or neurological disorders as well as substance dependence problems within the last twelve months were excluded from participation (see Table 1 for a full description of the participants). 2.2. Affective priming task The task was modified from Caroll and Young [11] and comprised three subtests – according to the primes, which could either be human faces, mechanical/human non-verbal sounds, or written words. The participants were asked to indicate whether the target written word was either ‘‘pleasant’’ or ‘‘unpleasant’’ (evaluative decision task [16]) by pressing a button of a game-pad. Each of the three priming subtests (with faces, sounds or words) was 60 trials long. In each of these subtests, 30 of the target words were positively valenced (happy words) and 30 were negatively valenced (15 denoting fear or 15 anger). Twenty of the primes were positively valenced (happy), 20 were negatively valenced (10 fearful and 10 angry) and 20 were neutral. Thus, with respect to the targets, primes could be emotionally congruent, incongruent or neutral. The order of the 60 trials within each subtest was pseudorandomised and adjusted manually so that no more than two primes of the same valence occurred after one another. The order of presentation of the three prime conditions was also pseudorandomised for each subject. For the ‘‘face-word’’ subtest, images were taken from the Facial Expressions of Emotions Test (FEEST) [42] and used as primes (four males and six females, Fig. 1). The faces subtended an average visual angle of 8.858 vertically by 4.778 horizontally. In the ‘‘sound-word’’ subtest, auditory stimuli consisting of non-verbal human emotional vocalizations such as a scream or laughter and mechanical emotionally neutral sounds were used [36]. The average word was six letters long and subtended a visual angle of 1.368 vertically by 4.288 horizontally. A list of potential test words was initially chosen from the Affective Norms for English Words (ANEW) database [5], that contains 1,040 words, with ratings of their valence, arousal and dominance. The 143 words for the initial list were chosen based on the requirement that there be enough of them to be matched on various criteria across the three conditions (face, sound, word) and emotional valence categories. The matching criteria included word length, imageability, frequency, and word type i.e. noun or adjective. Subsequently, we have conducted a pilot study involving 14 English speakers who rated the words from this candidate list of 143. The words were rated on a scale of 1 to 6 with regard to closeness to one of five emotions (happiness, sadness, anger, fear and disgust). Words had to score highly on their intended emotional category and score low on every other emotion. For example, ‘‘How related is the word ‘joyful’ to the emotion of

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comparing the following conditions: RT to emotional targets preceded by neutral primes vs RT to emotional targets preceded by emotional primes. 2.3. Instruments Cognitive abilities, mood and personality characteristics of all participants were assessed with rating scales and questionnaires as shown in Table 1. 2.4. Statistical analyses

Fig. 1. Schematic illustration of face/word subtest of the affective priming experiment. In other subtests, the PRIME stimuli are replaced by either vocalisations or words, respectively. The priming effect is calculated as the difference in response times to target words when primed with an emotionally neutral prime (trial 1 above) as compared to when primed with an emotional prime (trial 2 above).

‘happy’’’. From this study, the words chosen as being most related to the emotional categories employed in this task (happy, fearful or angry) were used and then allocated into the lists of emotionally pleasant vs. unpleasant. In the ‘‘word-word’’ condition, the words were carefully paired so as not to have any obvious semantic relationship. The protocols of the subtests were as follows. For the ‘‘faceword’’ and ‘‘word-word’’ conditions, a central fixation crossappeared for 500 ms, then there was a 250 ms interval. The prime was then displayed for 250ms followed by a further interval of 150 ms. Thus, the Stimulus-onset asynchrony (SOA) was 400 ms. The target word then appeared for 5000 ms, which was also the response window. If the subject did not respond within this time, the trial was not included in the analysis. The ‘‘sound-word’’ condition was different in one respect. Because the sounds varied in length between 400–1800 ms, the interstimulus interval (ISI) between the offset of the sound (prime) and the onset of the word (target) was varied so that the onset of the sound and the onset of the word (the stimulus-onset asynchrony) was always 2000 ms. Practice trials with six pairs of stimuli not used in the main task were completed for each condition. The investigators propose that the automatic and strategic processes are not mutually exclusive and evaluative decisions are based on the flexible blending of automatic and strategic components [24,26]. Thus, we are content that our evaluative decision affective priming task, although biased towards automatic processing, would still involve some strategic components. The priming effect was calculated as the difference in response – either in terms of the number of correct responses or the reaction times (RT) to those correct responses. For example, we calculated the priming effects based on the RT facilitation by

Outliers in the RT data, i.e. faster than 300 ms or slower than 3000 ms, were removed (resulting in approx 0.12% of the data being removed). The priming effects were determined by contrasting the reaction times (RT) and the correct response (CR) rates in emotionally congruent prime/target pairs vs the pairs where a neutral prime preceded an emotional target. The RT analysis included only the values where the participants’ responses were correct. The maximal correct score could be 10 in any condition, therefore, we have used the values of the mean CR per each condition (rather than per cent correct) as dependent variable in subsequent analyses. Thus, the CR values indicated a proportion of correct responses out of 10. The RT and CR values in congruent and incongruent trials were separately analysed with 2  3  2  2 ANOVAs with gender (female, male) as the betweensubjects variable, prime modality (face, sound, and word), valence (positive, negative) and relatedness (incongruent, congruent) as within-subjects factors. To adjust for multiple comparisons, Bonferroni correction was used as a standard procedure. Correlational and regression analyses were carried out to examine possible associations between the priming effects and the level of anxiety or the personality measures.

3. Results 3.1. Demographic and clinical measures The male participants were significantly older and had lower scores in NART-defined IQ. On the other hand, men had significantly higher scores on the MMSE. There were no significant differences between the men and women in terms of years of education, STAI trait and state measures, BDI and GHQ (Table 1). Mean STAI trait and state scores in both gender groups did not significantly differ from the normative data of working adults [39]. The mean levels of BDI were below the minimal scores attributed to mild depression [3]. 3.2. Priming An omnibus 2  3  2  2 ANOVA with gender (female, male) as a between-subjects variable, prime modality (face, sound, word), valence (positive, negative) and relatedness (incongruent, congruent) as within-subjects factors was performed. Since the male and female groups had different scores in NART and also differed in age, we have entered these variables as covariates. There was a main effect of relatedness: F(1,261) = 36.2; P < 0.03 indicating a priming effect across all conditions. The three-way interaction between valence, relatedness and gender was significant: F(1,261) = 6.2; P = 0.013, that indicated a gender-related differential priming effect in either emotionally positive or negative condition. To further explore this interaction, we have computed priming effects per each emotional condition and then compared them between female and male groups. Between-group t-test revealed that the males had a stronger

B. Gohier et al. / European Psychiatry 28 (2013) 74–80

3.3. Exploratory analysis To further explore the reasons underlying the differential priming effects in the word condition in females vs. males, the CR values across the groups were compared. In the congruent conditions with negative prime words (negative prime/negative target), females demonstrated a significant reduction in CR rates compared with the baseline condition (neutral prime/negative target): t(161) P = 2.5; P = 0.015. The analogous effect in men was not significant. The RT-based analysis showed a significant slowing down of RTs (‘‘inverse priming’’) in women in the emotionally congruent negatively primed word condition compared with the baseline

60.00

Priming effect to negative targets Priming effect to positive targets

_______p=0.003 _______

50.00

Mean RT facilitation, ms

priming effect compared with females in emotionally negative condition: t(163.3) = 3.0; P = 0.003, but not in positive condition (P = 0.64). The second three-way interaction between modality, relatedness and gender was significant: F(2,260) = 4.2; P = 0.02. Further interrogation of this interaction revealed that this was driven by a stronger priming effect in the word condition in males compared to females: t(265) = 8.2; P = 0.005. A within-group paired t-test showed that in the female group priming effect was significantly larger in emotionally positive condition compared with the negative (t[165] = 3.4; P = 0.001). In male participants, the priming effects between the positive and negative conditions did not differ statistically: P = 0.36 (Fig. 2). The 2  3  2  2 ANOVA was applied to the data reflecting the number of correct responses (CR) per each condition. This ANOVA with gender (male, female) as a between-subject variable, prime modality (faces, sounds, words), target valence (positive, negative) and relatedness (congruent, incongruent) as within-subjects variables demonstrated the following. There was no main effect of gender: F(1,265) = 0.31; P = 0.58 and no main effect of relatedness: F(1,265) = 0.085; P = 0.77. Thus, priming did not entail any change in correct response rates compared with the baseline. This could be explained by the high level of performance in all conditions: both men and women had a mean CR rate of 9.6 (out of possible 10) in response to neutral as well as congruent or incongruent primes. Correlational analyses between affective priming values (both RT and CR data) and mood, trait/state anxiety or IQ scores did not yield any significant results.

77

40.00

30.00

_p=0.001_

20.00

10.00

0.00 male

female Gender

Fig. 2. The males demonstrate significantly greater reaction time facilitation (priming effect) compared with females in emotionally negative conditions where the negative targets were preceded by negative primes of any modality. RT: reaction time. Error bars:  SEM.

(non-primed) word condition (t[160] = –2.4; P = 0.019), whereas in men there was a facilitation: t(104) = 2.2; P = 0.027. Thus, in the priming condition with negative words the women demonstrated a decline in performance and an increase in RT. In the positive word conditions, the priming effects manifested as RT facilitation in both women and men groups (Table 2). To explore the effects of non-verbal primes – we rerun the mixed ANOVA for the non-verbal conditions only, with two (male, female)  two (positive, negative)  two (relatedness)  two (face, sound) variables. The results replicated the main results as above – showing the greater priming effect in emotionally negative non-verbal conditions in men, compared with women: F(1,269) = 6.4; P = 0.012. There was a significant gender difference in RT in baseline neutral prime–negative target conditions in sound/word and word/word subtests with female participants having faster baseline RTs than males (Table 2). To control for these baseline differences, we have repeated the omnibus ANOVA covarying for

Table 2 Affective priming task: main results. Total (275)

Women (167)

Men (108)

CR

RT

CR

RT

CR

RT

Faces Prime Neutral Pleasant Neutral Unpleasant

Target Pleasant Pleasant Unpleasant Unpleasant

9.56 9.63 9.60 9.65

867.7 823.4 884.7 845.0

9.58 9.63 9.66 9.70

875.5 822.1 874.7 849.2

9.53 9.63 9.50 9.57

855.6 825.3 900.3 838.6

Sound Neutral Pleasant Neutral Unpleasant

Pleasant Pleasant Unpleasant Unpleasant

9.65 9.77 9.69 9.7

837.8 805.1 822.4 796.9

9.65 9.74 9.69 9.72

824.9 784.1 793.8a 772.8

9.64 9.81 9.70 9.69

857.8 837.6 866.6a 833.9

Words Neutral Pleasant Neutral Unpleasant

Pleasant Pleasant Unpleasant Unpleasant

9.75 9.70 9.28 9.08

857.5 828.6 887.5 888.9

9.72 9.66 9.30 9.11

835.8 807.6 847.1b 873.9

9.8 9.76 9.24 9.04

890.6 845.5 949.3b 911.8

CR: correct responses; RT: reaction time (ms). a Differences between women and men in neutral sound/unpleasant word condition: t(270) = 2.4; P = 0.019 b Differences between women and men in neutral word/unpleasant word condition t(264) = 3.1; P = 0.002.

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the mean baseline RT across all three conditions. The results of all main effects and interactions as described above remained significant. 4. Discussion To summarize, our study showed a cross-modal emotional priming effect that manifested in the facilitation of emotional labelling of target words when preceded by emotionally congruent faces, sounds or words. We found a gender by valence interaction where the male participants demonstrated significantly stronger priming effects in emotionally negative conditions, compared with females. We could not detect any gender difference in priming effect in cross-modal conditions. That suggests that the cross-modal integration of emotional information was not modulated by gender. What are the mechanisms of gender-related difference in priming effects in the emotionally negative conditions? Our data showed that whereas in the emotionally positive prime-target conditions both females and males demonstrated a facilitation of RT’s (compared with the baseline), the conditions with negative primes/negative targets produced little facilitation in RT in the females. Moreover, we observed an impediment of performance as represented by an increased error rate and significant slowing in the negative prime word/negative target word condition. We suggest that this decline in performance could be explained by a Stroop-like interference effect (emotional Stroop effect [41]). Investigators of affective priming [23,26], suggest that the Strooplike effect is the most plausible framework for the evaluative decision paradigms, whereas the spread of activation concept is more relevant to pure semantic priming paradigms with lexical decision or word pronunciation tasks. We suggest that in our experiments, the priming of negative targets by negative primes posed conflicting demands on cognitive-emotional processes in females but not males. The reduced priming effect in females compared with males was previously described in a study [8] employing a reading task with emotionally negative words. Importantly, depressed individuals performing evaluative decision affective priming task have also demonstrated reduced priming [14]. However, the gender differences detected in our study were more subtle than those between the depressed patients and controls in the above study: in our female participants the interference occurred only in conditions where both prime and target were of negative valence, whereas the depressed individuals in Dannlowski et al. study [14] had interference effects in response to any target (positive or negative) – as long as the prime was negative. We suggest that our healthy females had a higher threshold for the interference than the individuals with depression.Again, in our female participants, the significant interference effect was observed in the verbal

condition only (leading to ‘‘inverse priming’’) whereas the nonverbal conditions were characterized just by smaller priming – compared with the males. Findings from the neuroimaging literature shed some light on the nature of the male/female differences in emotion processing. There is much evidence which indicates that females and males engage different brain circuits when performing cognitive/ emotional tasks [15,25,29,27]. To summarize, the above studies show that when performing a wide variety of cognitive tasks, females differ from males in their tendency to engage emotional brain circuits, rather than those implicated in cognitive control. This is particularly evident within the context of negative emotional processing. We speculate that the above attributes of neural processing may possibly underlie interference processes and, subsequently, an inefficiency of cognitive inhibition in females. Our study has several limitations. First, we were unable to establish why the effect of inverse priming was uniquely observed in the word-word condition. Is this a characteristic of the verbal condition solely – or could this effect also take place with the faces or sounds as targets? To fully understand this – we would need the experimental conditions where the word primes precede the faces or emotional sounds targets. We are also cautious with the interpretation of our results. In order to prove that priming deficits occurring in females are similar to those observed in depressed individuals, one has to conduct a study assessing all groups (healthy males, females, and depressed individuals of both sex) under the same rigorously controlled experimental conditions. This issue warrants further investigation. We conclude that the priming paradigm provides a useful model that sheds light on the gender differences in emotional processing. Thus, whereas the processing of negative events per se may occur faster in females, sequential exposure to negative events does not facilitate the RT and may even result in a decline in performance as demonstrated in our priming experiments. These effects are similar, but are of a lesser degree to those found in depressed individuals performing analogous task. The clinically important question is – why do the gender differences occur in the negative and not positive emotional context. We suggest that this gender difference may be based on an over-responsiveness of emotional brain circuits to negative stimuli in females, as shown in neuroimaging studies. Thus, converging with the evidence from the neuroimaging literature, our results demonstrate inefficient processing of emotionally negative information in females that may underlie their susceptibility to emotional disorders.

Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.

Appendix A. List of primes and targets Emotional Prime/Target I N C O N G R U E N T

+/– +/– +/– +/– +/– +/– +/– +/– +/– +/–

Prime Face

Target Word

Prime Sound

Target Word

Prime Word

Target Word

Happy Happy Happy Happy Happy Happy Happy Happy Happy Happy

Hostile Infuriated Outraged Terrified Panicky Jittery Cross Afraid Angry Frightened

Happy Happy Happy Happy Happy Happy Happy Happy Happy Happy

Irate Petrified Alarmed Furious Livid Fearful Nervous Enraged Dreading Seething

Rainbow Luxury Gold Peace Melody Puppy Sunlight Fame Holiday Paradise

Shark Python Scorpion Cruelty Grudge Tornado Fist Contempt Wrath Mask

B. Gohier et al. / European Psychiatry 28 (2013) 74–80

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Appendix A (Continued ) Emotional Prime/Target

Prime Face

Target Word

Prime Sound

Target Word

Prime Word

Target Word

I N C O N G R U E N T

–/+ –/+ –/+ –/+ –/+ –/+ –/+ –/+ –/+ –/+

Fear Fear Fear Fear Fear Angry Angry Angry Angry Angry

Jovial Joyful Blissful Merry Elation Fun Pleased Thrilled Carefree Exhilarated

Fear Fear Fear Fear Fear Angry Angry Angry Angry Angry

Radiant Peaceful Contented Delighted Happy Jolly Glad Euphoric Cheerful Ecstatic

Temper Riot Jealousy Height Flooding Hostage Fire Fight Quarrel Panic

Beauty Laughter Food Trophy Baby Honor Kindness Diamond Cheer Success

C O N G R U E N T

+/+ +/+ +/+ +/+ +/+ +/+ +/+ +/+ +/+ +/+

Happy Happy Happy Happy Happy Happy Happy Happy Happy Happy

Jovial Pleased Fun Carefree Elation Thrilled Merry Blissful Joyful Exhilarated

Happy Happy Happy Happy Happy Happy Happy Happy Happy Happy

Euphoric Peaceful Ecstatic Cheerful Radiant Happy Contented Glad Jolly Delighted

Holiday Sunlight Luxury Rainbow Gold Melody Puppy Paradise Peace Fame

Cheer Food Trophy Honor Kindness Beauty Success Baby Diamond Laughter

C O N G R U E N T

–/– –/– –/– –/– –/– –/– –/– –/– –/– –/–

Fear Fear Fear Fear Fear Angry Angry Angry Angry Angry

Terrified Jittery Panicky Frightened Afraid Angry Outraged Cross Hostile Infuriated

Fear Fear Fear Fear Fear Angry Angry Angry Angry Angry

Nervous Petrified Fearful Dreading Alarmed Irate Seething Livid Enraged Furious

Flooding Fire Quarrel Fight Temper Riot Panic Jealousy Height Hostage

Mask Scorpion Wrath Cruelty Grudge Contempt Tornado Fist Python Shark

Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral

/– /– /– /– /– /– /– /– /– /– /+ /+ /+ /+ /+ /+ /+ /+ /+ /+

Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral

Outraged Jittery Terrified Afraid Cross Angry Frightened Panicky Infuriated Hostile Pleased Jovial Elation Merry Carefree Joyful Blissful Exhilarated Thrilled Fun

Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral Neutral

Dreading Petrified Seething Nervous Irate Livid Fearful Furious Enraged Alarmed Cheerful Happy Delighted Contented Ecstatic Euphoric Jolly Glad Radiant Peaceful

Square Corridor Chair Umbrella Month Cork Journal Cabinet Lawn Locker Locker Umbrella Journal Month Chair Lawn Cabinet Corridor Square Cork

Grudge Mask Tornado Fist Cruelty Scorpion Wrath Shark Contempt Python Beauty Baby Honor Diamond Success Laughter Cheer Food Trophy Kindness

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