Sleep deprivation adversely affects interpersonal responses to frustration

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Personality and Individual Differences 41 (2006) 1433–1443

Sleep deprivation adversely affects interpersonalresponses to frustration

Ellen T. Kahn-Greene, Erica L. Lipizzi, Amy K. Conrad,Gary H. Kamimori, William D.S. Killgore *

Division of Psychiatry and Neuroscience, Department of Behavioral Biology, Walter Reed Army Institute of

Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, United States

Received 22 December 2005; received in revised form 25 April 2006Available online 7 September 2006

Abstract

Sleep deprivation produces negative effects on mood and cognitive function, but existing data havealmost exclusively utilized objective rating scales, which do not permit evaluation of idiosyncratic andunstructured responses. In this study, we used a semi-projective measure, the Rosenzweig Picture-Frustra-tion (P-F) Study, to assess subjective responses to frustration following two nights without sleep. Twenty-six healthy volunteers completed the P-F at rested baseline and again following 55 h of continuouswakefulness. Participants provided written responses for an ambiguous cartoon character confronted withvarious frustrating situations. Relative to rested baseline, sleep deprivation was associated with alteredresponses on several indices, indicating a great number of uncommon types of responses, increased ten-dency to blame others for problems, and a reduced willingness to alleviate a conflict situation by acceptingblame. Individual differences in several aspects of emotional intelligence were predictive of the extent towhich responses to frustration changed with sleep loss. These findings suggest that sleep deprivation signif-icantly weakens the inhibition of aggression and willingness to behave in ways that facilitate effective socialinteraction, possibly through reduced metabolic activity in prefrontal regions of the brain important forpersonality, affect, and inhibitory behavior.� 2006 Elsevier Ltd. All rights reserved.

0191-8869/$ - see front matter � 2006 Elsevier Ltd. All rights reserved.doi:10.1016/j.paid.2006.06.002

* Corresponding author. Tel.: +1 301 319 9391; fax: +1 301 319 9979.E-mail address: [email protected] (W.D.S. Killgore).

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1434 E.T. Kahn-Greene et al. / Personality and Individual Differences 41 (2006) 1433–1443

Keywords: Sleep deprivation; Frustration; Aggression; Rosenzweig Picture-Frustration Study; Stress; Assertiveness;Emotional intelligence

1. Introduction

Frustration is a universal human experience, but individuals vary greatly in the manner inwhich they respond to the inevitable road-blocks of life. When a desired goal or objective isthwarted, a primitive aggressive response is usually evoked, with the fundamental aim of remov-ing the source of the frustration. Within a civilized society, however, individuals are not free tosimply dispose of frustrating people and obstacles without regard for the social, interpersonal,financial, legal, and myriad other consequences that may ensue. Instead, civilized people must re-spond to frustration with socially appropriate behaviors that take into consideration the immedi-ate and long term consequences of potential actions. The ability to consider future consequences,weigh probable outcomes, control emotions, and inhibit inappropriate behavior are all believed tobe mediated by the prefrontal regions of the neocortex (Damasio, 1994). Lesions to the prefrontalcortex often lead to alterations in personality, including disinhibited behavior and primitive dis-plays of emotion that are not appropriate to the social context (Berlin, Rolls, & Kischka, 2004).Thus, an intact prefrontal cortex appears to be necessary to provide socially appropriate re-sponses to frustrating circumstances.

Even in normal healthy individuals, the functioning of the prefrontal cortex can be altered tem-porarily by substances such as drugs, alcohol (Coull, Frith, & Dolan, 1999; Schreckenberger et al.,2004), or even transient changes in physical status such as hunger and satiation (Tataranni et al.,1999). Moreover, the prefrontal cortex may be particularly vulnerable to the detrimental effects ofprolonged sleep deprivation (Harrison & Horne, 2000; Horne, 1988). Glucose metabolism withinthe prefrontal cortex is significantly reduced with as little as 24 h of continuous wakefulness (Tho-mas et al., 2000), and the complex cognitive functions mediated by the prefrontal cortex can bedegraded by one to two nights of sleep loss (Harrison & Horne, 2000; Horne, 1988; Nilssonet al., 2005). For instance, sleep deprived individuals frequently show deficits in decision making(Killgore, Balkin, & Wesensten, 2006), inhibitory control (Heuer, Kohlisch, & Klein, 2005), andmood regulation (Dahl & Lewin, 2002).

Sleep loss can amplify negative emotions in response to unpleasant events and lessen positiveresponses to pleasant ones (Zohar, Tzischinsky, Epstein, & Lavie, 2005). Mood changes due tosleep loss have customarily been assessed using objective self-report measures, such as the Profileof Mood States (De Valck & Cluydts, 2001), which require participants to rate their current moodstatus using a numeric rating scale corresponding to a series of emotional adjectives. Although suchinstruments are highly reliable and provide a valid measure of current mood state, they are limitedbecause they do not permit the respondent to provide a unique and unstructured response. Con-sequently, subtle approaches to interpersonal dynamics and idiosyncratic patterns of respondingto stress may be missed when assessment is limited to a structured objective response format.

Projective techniques provide an alternative method for assessing responses to stress. Ratherthan asking about feelings directly, projective techniques involve an analysis of the responsesof an individual to an ambiguous stimulus, such as a picture, inkblot, or incomplete sentence, thuspermitting open ended and relatively unstructured responses (Cohen, Montague, Nathanson, &

E.T. Kahn-Greene et al. / Personality and Individual Differences 41 (2006) 1433–1443 1435

Swerdlik, 1988). Because projective techniques do not specifically query the examinee about his orher own feelings, they are considered to be indirect measures of personality, and have the potentialto detect subtle aspects of character traits or affective response styles that are not apparent fromobjective self-report measures (Exner, 1993). Viglione and Rivera (2003) suggest that projectivetests reveal a respondent’s cognitive processing and problem-solving styles, and thus, may reflecthow an individual might deal with problem situations in real-life. A projective measure may,therefore, potentially yield a more ecologically valid assessment of an individual’s style of emo-tional processing, response to frustration, and approach to interpersonal relationships. In contrastto the large number of studies that have utilized objective assessment techniques to assess the ef-fects of sleep deprivation on mood, there have been no controlled studies that have employed pro-jective techniques to explore the effect of sleep loss on the ability to cope with frustration.

In the present study, we examined the effect of sleep deprivation on responses to frustrating sit-uations as measured by a semi-projective measure of personality and affective functioning, theRosenzweig Picture-Frustration (P-F) Study (Rosenzweig, 1978). Volunteers completed the P-Fat rested baseline and again following 55 h of continuous wakefulness. It was hypothesized that,relative to baseline responses, sleep deprived individuals would show greater outward expressionof frustration and an increased tendency to avoid responsibility by fixing the blame on others.

2. Methods

2.1. Subjects

Twenty-six healthy volunteers participated. The study group included 21 men and 5 women,with a mean age of 25.3 years (SD = 4.1), and an average of 14.1 years of education(SD = 1.6). Participants were all native English speakers and were required to possess at least a6th grade reading level as assessed by the Wide Range Achievement Test-3rd Edition (WRAT-3). All were non-smokers and moderate daily caffeine users (i.e., less than 300 mg/day). Partici-pants were evaluated by a physician before entry and all were free of any significant history ofmedical, neurological, or psychiatric problems. Urine drug screens were collected upon entry toensure that all participants were free of illegal substances or stimulant medications. Volunteerswere all active duty military recruited through fliers posted at the Walter Reed Army Instituteof Research (WRAIR). Monetary compensation was provided upon completion of the study(or prorated for early withdrawal). Prior to participation, the study was fully described to all vol-unteers and written informed consent was obtained. This study was approved by the Walter ReedArmy Institute of Research Human Use Review Committee and the US Army Human SubjectsResearch Review Board.

2.2. Materials

2.2.1. Rosenzweig Picture-Frustration Study (P-F)The P-F contains a series of 24 cartoon-like scenarios each depicting two ambiguously drawn

characters experiencing a frustrating situation (Rosenzweig, 1978). One character in each scenariohas a caption bubble expressing some form of a frustrating situation. The caption bubble over the


second character is always blank. The examinee must fill in a written reply to the frustrating sit-uation for the second character with the first response that comes to mind. Because the examineewill potentially identify with the frustrated individual in each depicted situation, their projectedresponse may reflect how they would respond to similar real-life situations (Rosenzweig, 1978).The P-F responses are coded in two dimensions: (1) Direction of Aggression indicates whetheraggression is directed outward toward the environment, turned inward onto the self by the sub-ject, or evaded in an attempt to minimize the frustration; (2) Type of Aggression indicates whetherthe barrier leading to frustration is insistently pointed out, whether the subject attempts to defendthe ego by fixing blame or hostility, or whether a solution to the frustrating circumstance is soughtdespite the obstacle.

Coding of the P-F has been shown to produce reasonable inter-scorer reliability, ranging from79% to 85% inter-scorer accuracy, and demonstrates high test–retest reliability and stability acrosstime (Rosenzweig, Ludwig, & Adelman, 1975). Scores on the P-F correlate significantly with otherpsychometric measures of hostility and aggression (White, 1975) and are sensitive to experimen-tally induced frustration (Muehleman, Hollinden, & Batsel, 1981). Rosenzweig P-F scores alsocorrelate with self-reported verbal and physical aggression among children (Graybill, Williams,Bodmer, & Peterson, 1991) and successfully predict aggressive behaviors in adolescents at a fiveyear follow-up (Graybill & Blackwood, 1996).

2.2.2. Bar-On Emotional Quotient Inventory (EQ-i)The Bar-On EQ-i (Bar-On, 2002) was administered at baseline to determine whether certain

aspects of personality and emotional intelligence might prove useful in predicting changes inresponses to frustration with sleep deprivation. The Bar-On EQ-i is an objective self-reportinventory that assesses general emotional intelligence, a capacity that includes the ability tounderstand one’s own emotions as well as the emotions of others, effectiveness in dealing withinterpersonal relationships, and the capacity to cope with environmental demands. For thepresent study, we utilized only the 15 subscale scores of the EQ-i obtained at baseline as pre-dictors of change in frustration scores on the P-F following sleep deprivation. The 15 subscalesused in the present study included: Emotional Self-Awareness; Assertiveness; Self-Regard; Self-Actualization; Independence; Empathy; Interpersonal Relationship; Social Responsibility; Prob-lem Solving; Reality Testing; Flexibility; Stress Tolerance; Impulse Control; Happiness;Optimism.

2.3. Procedure

Participants arrived at the laboratory at 19:00 on the familiarization day (Day 0) and were pro-vided 8 h of uninterrupted time in bed from 23:00 until 07:00 the next morning. From 14:00 to14:30 on Day 1 (baseline), participants completed the P-F. The EQ-i was completed on the sameday between 17:00 and 17:30. Participants were administered the P-F again at the same time ofday following 55 h of continuous wakefulness (Day 3).

As part of a larger study, half of the participants were administered 200 mg of caffeine every 2 h(at 01:00, 03:00, 05:00, and 07:00) throughout each night (total 800 mg over 8 h) for three consec-utive nights. Caffeine was administered in a double blind manner using a chewing gum prepara-tion (Syed, Kamimori, Kelly, & Eddington, 2005). For the present study, we were not interested in


the effects of caffeine per se, but only the effects of sleep loss on frustration responses. Because thelast dose was administered at 07:00 (7 h prior to P-F testing), the psychostimulant effects of caf-feine were expected to have dissipated by the time of P-F administration on Day 3. However, toexamine potential residual stimulating or withdrawal effects, we included caffeine group as a be-tween groups factor in the initial analysis of variance.

Each P-F response was scored for the Direction of Aggression and the Type of Aggression(Rosenzweig, 1978) by two clinically trained doctoral candidates both of whom were naı̈ve tothe specific research hypotheses of the study. Inter-scorer agreement between evaluators was cal-culated at 85.7% for eight (15.4%) randomly selected protocols, and Cohen’s coefficient kappa wascalculated at 0.83, consistent with published findings (Rosenzweig, 1978). As a reliability check,we had all 54 protocols re-scored by an additional rater who was completely naı̈ve to the test con-ditions and research hypotheses. The correspondence between this new rater and the reporteddata was 78.5% for the total sample, which is similar to that found in other studies (e.g., 79%in a study by Graybill & Blackwood, 1996). Table 1 summarizes the response codes and descrip-tions for each of the P-F indices scored. The EQ-i was computer scored according to proceduresprovided by the test publisher (Bar-On, 2002).

2.4. Analyses

Data were first examined for atypical response biases on the EQ-i (i.e., a standard score exceed-ing 120 on either the Positive or Negative Impression Indices). Two participants were excludeddue to atypically high Negative Impression Index scores. On the remaining data, the effect of sleepdeprivation on frustration responses was analyzed using repeated measures analysis of variance.Second, to evaluate potential personality traits that might be associated with greater change infrustration responses as a result of sleep loss, a difference score was calculated for each Rosen-zweig P-F code-type score (i.e., sleep deprived – baseline). These frustration response changescores were then correlated with each of the 15 EQ-i subscales.

Table 1Rosenzweig Picture-Frustration Study scoring codes and descriptions

Code Name Description

E 0 Extrapeditive Insistently pointing out the presence of a frustrating obstacleE Extrapunitive Directing blame and/or hostility towards someone or somethinge Extrapersistive Requesting that someone else provide a solution to the frustrating situationI 0 Intropeditive Denying frustration and expressing embarrassment at being involved in

instigating another’s frustrationI Intropunitive Accepting the blame for the frustrating circumstancei Intropersistive Offering amends to solve the problem, usually out of a sense of guiltM 0 Impeditive Minimizing the frustrating situation to the point of denying its existenceM Impunitive Regarding the frustrating situation as unavoidable and not blaming anyonem Impersistive Hopefully expecting that a solution to the problem will occur over timeGCR Group conformity rating The percentage of responses which match typical responses

from the normative sample


3. Results

3.1. Drug effects

There were no significant main effects associated with the overnight administration of caffeineon any of the P-F indices when the task was administered on Day 3, despite the approximate 4–6 hhalf life of caffeine (Statland & Demas, 1980; Whitsett, Manion, & Christensen, 1984). One inter-action did emerge as significant. This interaction was between caffeine group and testing sessionfor Impeditive (M 0) responses, but further analysis revealed that this was due to a chance differ-ence between groups at baseline and not as a result of caffeine administration. Thus, all subse-quent analyses were collapsed across drug groups.

3.2. Sleep deprivation effects

As evident in Table 2, group conformity ratings (GCRs) declined significantly following sleepdeprivation, indicating that sleep loss was associated with fewer ‘‘common’’ types of responses onthe P-F relative to rested baseline. Sleep deprivation was also associated with significantly moreExtrapunitive (E) responses than observed at baseline, indicating an increase in the tendency todirect blame or hostility outward toward people or objects in the environment. Finally, the fre-quency of Intropersistive (i) responses decreased significantly when participants were sleep de-prived, indicating fewer responses where the main character apologizes or offers amends inorder to alleviate the problem. The other response types did not differ significantly between base-line and sleep deprivation.

3.3. Personality/emotional intelligence effects

Correlational analysis was conducted to determine whether trait personality/emotional intelli-gence factors, as measured by the EQ-i, were associated with a change in frustration responses asdefined by the difference score between baseline and sleep deprivation sessions for each responsecategory. The results of this analysis are presented in Table 3. Change from baseline for six of the

Table 2Means and standard deviations for the Rosenzweig Picture-Frustration Study variables at baseline and sleep deprivedtesting sessions

Variable Baseline mean (SD) Sleep deprived mean (SD) p

E 0 1.63 (1.48) 1.25 (1.17) .336E 5.83 (3.21) 7.10 (3.86) .042*

e 2.81 (1.85) 2.90 (1.51) .867I 0 0.88 (0.76) 0.96 (0.93) .684I 2.65 (1.14) 2.42 (1.06) .451i 3.54 (1.90) 2.85 (1.73) .027*

M 0 1.35 (1.15) 1.67 (1.06) .379M 3.17 (1.79) 2.81 (1.50) .348m 1.65 (1.75) 1.75 (1.46) .766GCR 51.97 (12.53) 44.60 (12.40) .025*

Table 3Results of the correlation analysis predicting change in frustration scores following sleep deprivation from baselinesubscale scores on the Bar-On EQ-i

P-F variable Significant EQ-i predictor r p

E 0 Self-actualization .501 .013E Self-regard �.475 .019e Empathy .433 .035

Social responsibility .429 .036I 0 – – nsI Assertiveness �.407 .048

Happiness .507 .011i Optimism .460 .024M 0 Independence �.424 .039

Problem solving �.682 .001Optimism �.508 .011

M – – nsm – – nsGCR – – ns


P-F indices was related to specific EQ-i scores measured at baseline. Specifically, sleep deprivedincreases in Extrapeditive (E 0) responses, which represent the frequency in which an examineepoints out the presence of a frustrating obstacle, were predicted by higher scores on the Self-Actu-alization subscale of the EQ-i at baseline. Similarly, individuals most likely to increase in their ten-dency to direct blame and/or hostility toward someone or something following sleep loss asevidenced by increased Extrapunative (E) responses were those with lower baseline scores ofSelf-Regard. Sleep deprived increases in Extrapersistive (e) responses, which involve a requestfor someone else to provide a solution to the frustrating situation, were predicted by higher scoreson Empathy and Social Responsibility. In contrast, increases in Intropunitive (I) responses, thetendency to direct blame inward toward the self following sleep loss, were predicted by lower base-line scores on the Assertiveness and Happiness subscales of the EQ-i. Increases in Intropersistive(i) responses following sleep loss, the tendency to offer amends to solve the problem, were pre-dicted by higher baseline scores on EQ-i Optimism. Finally, sleep deprived increases in the ten-dency to minimize frustrating situations to the point of overt denial, referred to as Impeditive(M 0) responses, were predicted by lower baseline scores on the Independence, Problem Solving,and Optimism subscales of the EQ-i. None of the other correlations were significant.

4. Discussion

Findings supported our hypothesis that sleep deprivation would be associated with increasedoutward expression of aggressive responses and a greater tendency to assign blame to others whenconfronted with frustrating situations. Relative to baseline assessment, sleep deprived volunteersshowed a significant increase in Extrapunative (E) responses on the Rosenzweig P-F (i.e., directingblame and aggression externally toward another person or object). This was accompanied by adecline in the number of Intropersistive (i) responses, suggesting fewer attempts to accept blame


for a frustrating circumstance and an unwillingness to offer restitution or amends to the otherparty. Finally, we found that sleep deprivation was also associated with a greater tendency to pro-vide unconventional responses to frustration, as evidenced by a significant decrease in GroupConformity Rating (GCR) scores. The GCR has been described as a global estimate of frustrationtolerance, in that it represents the examinee’s ability to inhibit or suppress impulsive responsesdespite strong urges to do otherwise (Rosenzweig, 1978). Thus, the present findings suggest thatat least two nights of sleep loss is associated with reduced capacity to inhibit impulses, particularlythose related to aggression and hostility in response to a frustrating obstacle.

The present findings are consistent with other studies showing increased depression, confusion,and anger (James & Gregg, 2004), and greater subjective feelings of frustration with sleep loss (Chel-ette, Albery, Esken, & Tripp, 1998). These results have clear implications for critical occupationswhere individuals may have to work closely with others in group settings under conditions of limitedsleep. For instance, medical staff and military personnel often operate for extended periods withoutadequate sleep, yet must function effectively as members of an integrated team. We found that sleeploss was associated with an alteration in the types of responses that individuals make within social orinterpersonal situations. Moreover, the trend was in the direction of antagonistic, self-serving, anduncooperative behavioral responses, such as increased blame and hostility, reduced willingness tomake concessions and restitutions, and a general increase in atypical or impulsive responses, all ofwhich are antithetical to harmonious interpersonal relations. These findings highlight the impor-tance of ensuring that workers obtain adequate sleep, particularly in occupational settings wherethe quality of the work or the outcome of the mission is heavily dependent on the effective cooper-ation and interdependence of several team members working in close proximity.

Individuals also appear to differ in their resilience to the detrimental effects of sleep deprivation.Van Dongen, Baynard, Maislin, and Dinges (2004) found that individual differences in neurobehav-ioral responses to sleep loss were primarily dependent upon a trait-like vulnerability, which includedan individual’s self-evaluation of fatigue and mood, and cognitive processing capability. We foundthat changes due to sleep loss for six of the ten P-F indices were significantly predicted by one ormore of the subscales of the EQ-i. Specifically, individuals higher in the trait of Self-Actualizationwere more likely to show an increase in Extrapeditive (E 0) responses (i.e., pointing out frustration)following sleep loss, while those with higher Self-Regard were least likely to direct blame towardothers. Higher traits of Empathy and/or Social Responsibility correlated with a tendency to makerequests for others to provide a solution to the frustrating situation (i.e., Extrapersistive [e] re-sponses). In contrast, sleep deprived volunteers with higher Assertiveness and/or lower Happinessscores were less accepting of blame, as evidenced by lower Intropunitive (I) scores. The most opti-mistic individuals were also those that tended to show the greatest increase in responses indicatingthe willingness to offer amends to solve the problem (i.e., Intropersistive [i] responses). Interestingly,individuals with the lowest scores on Problem Solving, Independence, and/or Optimism, were mostlikely to show an increase in Impeditive (M 0) responses, which involve severely minimizing or evenovertly denying the existence of a frustrating situation. These findings suggest that individual affec-tive responses to sleep deprivation are significantly related to stable characterologic traits.

The present findings suggest that sleep loss is often associated with decreased suppression ofaggressive and hostile impulses, and a reduced willingness to offer amends or provide commonsocially palliative responses in stressful situations. Furthermore, specific traits of emotional intel-ligence or personality appear to be predictive of the vulnerability of an individual to frustration


during sleep loss. Given that an individual’s capacity to inhibit socially inappropriate impulsesand direct affective processes toward constructive goals is mediated predominantly by the prefron-tal cortex, the present findings are consistent with a growing body of evidence that suggests thatthe regional blood flow (Thomas et al., 2000) and cognitive functioning (Harrison & Horne, 2000)of the prefrontal cortex may be particularly affected by prolonged wakefulness.

Some limitations should be kept in mind when interpreting these findings. First, because theRosenzweig Picture-Frustration Study was developed in the 1940s and the current version ofthe manual was published in 1978, the normative sample may not fully characterize contemporaryrespondents. Despite this potential drawback, the P-F was chosen because it uniquely capturesinterpersonal qualities that reveal how an individual is likely to respond to others when faced withfrustration. Furthermore, due to logistical constraints, we were only able to measure responses onthe P-F at baseline and after sleep deprivation, without a follow-up administration of the P-Fafter recovery sleep. Thus, it is unclear to what extent the observed patterns remain stable or re-verse following a period of recovery sleep or the extent to which the results could be due to anorder effect. Future research could examine whether sleep deprivation related changes return tobaseline levels after receiving sleep. It was also not possible to rule out the effects of test-familiarityon the pattern of responses during the second administration. Considerable evidence on the test–retest reliability of the P-F suggest that responses remain fairly stable between two repeatedadministrations (Rosenzweig et al., 1975). It should also be noted that the present results arebased on a final sample of only 24 participants. Conclusions should be considered cautiously untilthe results have been replicated. Finally, the validity of the construct of ‘‘emotional intelligence’’,as defined by the EQ-i, has been criticized because of the considerable overlap between traits mea-sured by this inventory and a number of major dimensions of personality, including at least fourof the ‘‘Big Five’’ (Dawda & Hart, 2000) and all but one of the factors of the Sixteen PersonalityFactor Questionnaire (Newsome, Day, & Catano, 2000). Although our data cannot directly ad-dress the issue of whether emotional intelligence is a distinct construct from other stable traitssuch as personality, the present findings do strongly suggest that there are measurable trait-likecharacteristics that are predictive of an individual’s affective response to sleep deprivation.

Despite these limitations, the present study provides preliminary evidence that sleep deprivationaffects individual responses to stress and frustration and provides further support for the hypoth-esis that functions mediated by the prefrontal cortex are particularly affected by sleep loss, includ-ing an increased tendency to respond to frustrating circumstances with unconventional, hostile,and blaming responses and a reduced willingness to direct blame inward in order to sustain, facil-itate, or protect interpersonal relationships. This could negatively affect interpersonal relation-ships in familial, occupational, and social settings. In light of previous findings regardingcognitive and mood changes that occur with sleep deprivation, these results further underscorethe importance of sleep in maintaining effective cognitive and interpersonal functioning.

Acknowledgments

The views expressed in this paper are those of the authors and do not reflect the official policyor position of the Department of the Army, the Department of Defense, the US Government, orany of the institutions with which the authors are affiliated.


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Sleep deprivation adversely affects interpersonal responses to frustration