Still-face and separation effects on depressed mother-infant interactions

STILL-FACE AND SEPARATION EFFECTS ON

DEPRESSED MOTHER-INFANT INTERACTIONS

TIFFANY FIELDUniversity of Miami School of Medicine, and Fielding Graduate University

MARIA HERNANDEZ-REIF, MIGUEL DIEGO, LARISSA FEIJO, YANEXY VERA,KARLA GIL, AND CHRIS SANDERS

University of Miami School of Medicine

ABSTRACT: Maternal emotional and physical unavailability have differential effects on infant interactionbehavior as noted in a study by Field, Vega-Lahr, Scafidi, and Goldstein �1986�. In that study, four-month-old infants experienced their mother’s still face and a brief separation from the mother. Sponta-neous interactions preceded and followed these to serve as baseline and reunion episodes. Although theinfants became more negative and agitated during both conditions, the still face elicited more stressfulbehaviors. The present study replicated the Field et al. �1986� study but also compared infants ofdepressed and infants of nondepressed mothers. The infants of depressed versus those of nondepressedmothers were less interactive during the spontaneous interactions, as were their mothers, and theyshowed less distress behaviors during the still-face condition. During the “return to spontaneous inter-action” following the still-face condition, they were also less interactive, as evidenced by fewer positiveas well as fewer negative behaviors. Their mothers were also less active. The nondepressed mothers andinfants were extremely active, as if trying to reinstate the initial spontaneous interaction. Minimalchange occurred during the separation condition except that both groups of infants vocalized less thanthey had during the spontaneous interaction. During the reunion following the separation period, theinfants of depressed versus nondepressed mothers were paradoxically more active, although their moth-ers continued to be less interactive.

RESUMEN: Tal como fue presentado en un estudio por Field et al. �1986�, la falta de disponibilidadmaternal, tanto emocional como física, tiene efectos diferenciales sobre la conducta interactiva delinfante. En dicho estudio, infantes de cuatro meses de nacidos experimentaron las duras caras de susmadres y una breve separación de ellas. Estas experiencias fueron precedidas y seguidas de interaccionesespontáneas que servían como línea de base y episodios de reunión. A pesar de que los infantes fueronmás negativos y se agitaban más en ambas situaciones, las caras duras de las madres produjeron másconductas estresantes. El presente estudio replicó el anterior estudio de Field et al. �1986�, pero tambiéncomparó a infantes de madres depresivas con infantes de madres no depresivas. Los infantes de madresdepresivas, en comparación con aquéllos de madres no depresivas, se mostraron menos interactivos

We would like to thank the mothers and infants who participated in this study. This research was supported by aMarch of Dime’s grant �#12-FYO 3-48�, an NIMH merit award �MH # 46586�, NIH Senior Research ScientistAwards �# MH 00331 and # ATO 1585� to Tiffany Field and funding by Johnson and Johnson Pediatric Institute.Direct correspondence to: Tiffany Field, Ph.D., Touch Research Institutes, University of Miami School of Medicine,Department of Pediatrics �D-820�, P. O. Box 016820, Miami, FL 33101; e-mail: [email protected]

A R T I C L E

INFANT MENTAL HEALTH JOURNAL, Vol. 28(3), 314–323 (2007)© 2007 Michigan Association for Infant Mental HealthPublished online in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/imhj.20138

314

durante las interacciones espontáneas, lo cual ocurrió con sus madres también, y mostraron menosconductas de aflicción en los momentos de la condición de la cara dura. Durante el “retorno a lainteracción espontánea” después de la condición de la cara dura, ellos también fueron menos interacti-vos, tal como lo demuestran sus menos conductas positivas y menos conductas negativas. Sus madresfueron también menos activas. Las madres no depresivas y sus infantes fueron extremadamente activas,como si estuvieran tratando de volver a establecer la interacción espontánea inicial. Durante la condiciónde separación ocurrieron cambios mínimos, excepto que ambos grupos de infantes vocalizaron menosque lo que habían vocalizado durante la interacción espontánea. Durante la reunión que siguió al períodode separación, los infantes de madres depresivas, en comparación con aquéllos de madres no depresivas,fueron paradójicamente más activos, aunque sus madres continuaron siendo menos interactivas.

RESUME: Le manque de disponibilité émotionnelle et physique de la mère a des effets différentiels surle comportement interactif du nourrisson, comme le montre une étude de Field et al. �1986�. Dans cetteétude, des nourrissons de quatre mois ont fait l’expérience du visage impassible de leur mère et ont subiune brève séparation d’avec leur mère. Des interactions spontanées ont précédé et suivi ces expériencesafin de servir d’épisodes de base et de retrouvailles. Bien que les nourrissons aient été bien moins àl’aise et bien plus agités durant les deux expériences, le visage impassible est l’expérience ayant pro-voqué les comportements les plus stressants. Cette étude réplique l’étude de Field et al. �1986� maiscompare également des nourrissons de mères déprimées et des nourrissons de mères non-déprimées. Lesnourrissons de mères déprimées, comparés aux nourrissons de mères non-déprimées, étaient moinsinteractif durant les interactions spontanées, comme l’étaient leurs mères, et ils faisaient preuve demoins de comportements de détresse pendant l’expérience de visage impassible. Durant le “retour àl’interaction spontanée” après l’expérience de visage impassible, ces nourrissons étaient aussi moinsinteractifs, comme en ont fait preuve moins de comportements positifs et moins de comportementsnégatifs. Leurs mères étaient également moins actives. Les mères et les nourrisssons non-déprimésétaient extrêmement actifs, comme s’ils essayaient de rétablir l’interaction spontanée initiale. Deschangements minimaux ont eu lieu durant l’expérience de séparation, mis à part le fait que les deuxgroupes de nourrissons ont moins vocalisé qu’ils ne le faisaient durant l’interaction spontanée. Durantles retrouvailles après la période de séparation les nourrissons de mères déprimées �par rapport auxmères non-déprimées� étaient paradoxalement plus actifs, bien que leurs mères continuaient à être moinsinteractives.

ZUSAMMENFASSUNG: Die physische und emotionale Abwesenheit der Mutter hat unterschiedliche Ef-fekte auf das Verhalten des Kindes, wie in einer Studie von Field et al. �1986� gezeigt wurde. Bei derdamaligen Studie erlebten 14 Monate alte Kinder ein ausdrucksloses Gesicht und eine kurze Abwesen-heit von ihrer Mutter. Spontane Interaktionen wurden davor und danach erlebt, um einerseits einenAusgangswert zu haben und andererseits eine Episode der Wiedervereinigung. Obwohl die Kleinkinderin beiden Situationen negativer und agitierter waren als vorher, machte ihnen das ausdruckslose Gesichtmehr Stress. Die vorliegende Studie repliziert die Field Studie von 1986, vergleicht aber Kinder vondepressiven und nicht depressiven Müttern. Die Kinder depressiver Mütter waren weniger interaktiv beispontanen Interaktionen, genauso so wie ihre Mütter, litten aber weniger unter dem ausdruckslosenGesicht. Auch bei der spontanen Interaktion nach dem ausdruckslosen Gesicht waren sie weniger inter-aktiv, wie man an weniger positivem und negativem Verhalten sehen kann. Ihre Mütter waren auchweniger aktiv. Die nicht depressiven Mütter waren aktiver, so als wollten sie die spontane Interaktionvom Anfang wiederherstellen. Wenige Unterschiede zeigten sich bei der Trennung, wenngleich beideGruppen weniger als während der spontanen Interaktion vokalisierten. Während der Wiedervereinigungnach der Trennung waren die Kinder depressiver Mütter paradoxerweise aktiver, obwohl deren Mütterweiterhin weniger aktiv waren.

Still-Face and Separation Effects • 315

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

* * *

Physical separation from the mother has been considered the most stressful loss situationfor the infant �Field, 1986�. The continuing distress that typically follows reunions suggeststhat even when the mother is physically available, if she is emotionally unavailable, the infantremains distressed �Adamson & Frick, 2003; Field, 1986�. In these studies the mother re-turned with a newborn from the hospital after the delivery of that infant and was often tired,depressed, and preoccupied with the new infant, thus being less emotionally available to herolder infant.

Other experimental perturbations of mother-infant interactions have mimicked emotionalunavailability of the mother. For example, asking normal mothers to look depressed �Cohn &Tronick, 1983; Field, 1984� or to remain still-faced �Tronick, Als, Adamson, Wise, & Brazel-ton, 1978� mimics emotional unavailability of the mother. In both cases, the mother is unre-sponsive and the infant, after attempting to reinstate a normal interaction, becomes distressed�see Adamson & Frick, 2003, for a review of still-face studies�. Thus, both physical andemotional unavailability of the mother has appeared to be distressing to the young infant.

Maternal emotional and physical unavailability effects on infant interaction behaviorwere compared in a study by Field et al. �1986�. In that study, four-month-old infants wereexposed to their mother’s still face and to a brief physical separation from their mother.Spontaneous interactions preceded and followed these to serve as baseline and reunion epi-sodes. Although the infants became more negative and agitated during both the still-face andseparation conditions, they appeared to be more distressed during the still-face condition. In asimilar study, but without the separation condition, depressed and nondepressed mothers wereasked to remain still-faced �Field, 1984�. The infants of depressed mothers versus the infants

316 • T. Field et al.


of nondepressed mothers appeared to be less distressed by their still-face mothers, possiblybecause they had become accustomed to their mothers’ relatively flat affect and less interac-tive behaviors. These data were consistent with those reported later by Stanley, Murray, andStein �2004� on infants of depressed mothers during the still-face condition.

The purpose of the present study was to compare the behaviors of infants of depressedand infants of nondepressed mothers as they experienced the still-face paradigm of Tronick etal. �1978� versus the separation condition of the Field et al. �1986� study. In this study, theinfants were videotaped during a spontaneous interaction followed by a brief segment of theirmothers’ still face or a brief separation �counterbalanced� followed by a “return to spontane-ous” or “reunion” interaction condition.

METHOD

Participants

The sample was comprised of 40 4-month-old �mean �M��17 weeks� infants. Infants wereexcluded due to excessive fussiness during the interaction procedure ��50% interactiontime�, yielding a final sample of 28 infants �16 females�. This relatively high rate of fussiness�30% of the original sample� may have related to the infants experiencing two stressfulconditions �still face and separation�, although this rate did not differ across groups. Themothers were low-middle-income �M�3.9 on the Hollingshead� and were 58% Hispanic,24% African American, and 18% Caucasian. The groups did not differ on these demographicvariables. One half of the sample was depressed �dysthymic� as determined by the CES-D�score�16� and a SCID diagnosis of dysthymia and one half of the sample was nonde-pressed.

Procedure

Assessments.

1. Center for Epidemiological Studies Depression Scale �CES-D; Radloff, 1977�. This20-item scale was included to assess depressed symptoms. To complete this scale,participants are asked to report on their feelings during the preceding week. The scalehas adequate test/retest reliability �.60 over several weeks�, internal consistency �.80–.90� and concurrent validity. A score of 16 on the CES-D is considered the cut pointfor depression �Radloff, 1977�.

2. Structured Clinical Interview for the DSM-IV �SCID�. The Structured Clinical Inter-view for the DSM-IV �SCID� was then used to determine whether subjects met criteriafor DSM-IV Axis I Disorders �American Psychiatric Association, 2000�. The SCID isa face-to-face, paper-and-pencil interview for major DSM-IV disorders administeredby a clinician and takes approximately 45–90 minutes to complete. For the currentstudy, the Affective Disorder Module was used to assess current dysthymia. Symptomsof depression �dysthymia� on the SCID include dysphoria, appetite and weightchanges, insomnia or hypersomnia, fatigue, irritability, psychomotor agitation or re-



tardation, anhedonia, feelings of worthlessness or guilt, cognitive dysfunction, suicidalideation or attempts, crying, and hopelessness.

Interactions. Mothers with both high CES-D scores ��16� and a SCID diagnosis of depres-sion were classified as depressed for this study. For the interactions, the infant was positionedin an upright infant seat placed on a table at eye level with the mother who was seated so herface was approximately 18 inches �46 centimeters� away from the infant. The room wasequipped with two cameras positioned approximately 6 feet from the mother and infant at anangle such that they were in the periphery of the subjects’ visual fields. A split-screen gen-erator enabled the viewing of the mother’s face and torso on one side of the screen and theentire body of the infant on the other.

Each mother-infant dyad engaged in five interactions of 1.5 minutes each for a total of 7.5minutes including a baseline, a separation, a still face, and two reunions �one for the separa-tion and one for the still face�. The conditions were shorter than the usual 3-minute conditionsbecause of the concern that infants might change state across the session if it were as long as15 minutes. The order of the separation and still-face conditions was counterbalanced acrossinfants to control for order and state effects, with a 3-minute interval separating the separationand still-face phases to give the infants a break from sitting in the infant seat and to providemore separation between the two conditions to potentially lessen any order effects.

For the baseline and reunion conditions �spontaneous interactions�, the mother was sim-ply asked to engage her infant in play as she would do at home. For the separation condition,the mother left the table and moved behind a curtained partition. For the still-face condition,the mother was instructed to remain silent while only looking at her infant with an immobileface and not to touch her infant. The mother was signaled to change conditions by a knockingsound made on the one-way mirror by the experimenter who was monitoring the videore-corder in the adjacent room.

The videotapes were then coded �using an event recorder� during a single pass throughthe videotapes for the duration of behaviors exhibited by the mothers and their infants.Duration rather than frequency was used as a dependent measure so that the data could beconverted to proportion of interaction time that behaviors occurred, thus enabling compari-sons across data sets derived from interactions of varying durations. The infant behaviorsincluded smiling, vocalizing, motor activity, gaze aversion, distress brow, and crying. Thebehaviors coded for the mother included smiling, exaggerated facial expressions, vocalizing,touching, and moving the infant’s limbs. Coders, naïve to the hypotheses of the study, weretrained to greater than 80% reliability. Interobserver reliabilities were calculated by Cohen’skappa, a chance-corrected statistic. Interobserver reliability was then assessed by the simul-taneous coding of 12 of the videotaped sessions and averaged .82 for the infants and .87 forthe mothers.

RESULTS

Analyses of variance were first performed to determine whether there was an order effect forthe separation and still-face conditions. Since the order in which the infants experienced theseconditions did not affect the infants’ behaviors, the data were collapsed across orders for eachcondition. Analyses of variance were then performed for each of the interaction phases withgroups as the between subjects factor.



For the baseline spontaneous interaction, the following significant effects were noted�see Table 1�: �a� the infants of depressed mothers versus those of nondepressed mothersshowed significantly less smiling, vocalizing, and gaze aversion and more motor activity; and�b� the depressed mothers showed significantly less smiling and less moving of the infants’limbs. During the still-face condition, the infants of depressed mothers versus those of non-depressed mothers showed significantly less motor activity and less distress behavior �lessgaze aversion, distress brow, and crying�. During the reunion or the “return to spontaneous”phase, the infants of depressed versus nondepressed mothers showed significantly less smil-ing, vocalizing, distress brow, and crying and more motor activity. Their mothers also showedsignificantly less smiling as well as less touching their infants and less moving their limbs.

During the separation phase �see Table 2�, the infants of depressed mothers versus theinfants of nondepressed mothers vocalized significantly less often. During the reunion, how-ever, they showed significantly more smiling, they vocalized more, and they showed less gazeaversion. Their mothers spent significantly less time smiling, showing exaggerated faces, andmoving their infants’ limbs.

DISCUSSION

The less frequent affective and interactive behaviors of the depressed mothers and theirinfants were not surprising based on many studies in the literature �see Field, 2004, for areview�. Also, not surprising was the finding that the still-face paradigm appeared to be lessdistressing to the infants of depressed versus nondepressed mothers, as manifested by lessmotor activity, gaze aversion, distress brow, and crying, consistent with other data on infantsof depressed mothers in the still-face conditions �Stanley et al., 2004�. The still face isreputedly more distressing than the silent voice during this paradigm �Striano & Bertin, 2004�,and the depressed mother’s face is often less expressive, as it was in this study. Thus, theinfants of depressed mothers may be more accustomed to a less expressive, still face. Thestill-face condition has typically resulted in continuing distress behavior �distress brow andcrying� during the subsequent reunion periods. Thus, the more frequent positive behavior�more smiling and vocalizing� that occurred during the reunions in this study was surprising.This could be interpreted as greater attempts by the infants of the nondepressed mothers toreinstate their spontaneous interactions. A similar interpretation could be made for the moreinteractive behavior of the nondepressed mothers during the reunion phase, as if they wereattempting to reinstate their more positive baseline interactions. This was a positive finding,inasmuch as infants might remember this more positive interaction as opposed to the still-faceinteraction. Other investigators, for example, have noted prolonged effects for some infants�Bornstein, Arterberry, & Mash, 2004�. In the Bornstein et al. �2004� study, infants who wereexposed to the still face of a stranger at 5 months remembered that stranger and looked at thatparticular stranger less often than the faces of other strangers as late as 20 months, highlight-ing the stressfulness of the still-face situation for young infants.

For the infants of nondepressed mothers, relatively little distress occurred during orfollowing the brief separation from the mother as compared to the still-face condition. Similardata have been reported for 3-month-old infants by Field �1984�. The violation of expectancyin the still-face situation �the mother being suddenly unresponsive in a typically interactivesituation� and her apparent emotional unavailability may be more distressing to the infant thansimply being left alone during the separation condition. In contrast, the infants of the de-



TAB

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Non

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dp

Dep

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Non

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Infa

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.68

�33.

74�

54.6

7�3

9.14

�.0

52.

68�1

.69�

.87

�.76�

NS

6.67

�5.1

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�20.

29�

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37.2

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9�35

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Mot

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19�

5.42

�3.9

4�.0

148

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3.29

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06�

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48.1

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4.83

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�29.

67�

NS

Dis

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2.44

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6.01

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20.9

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54�2

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13.4

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2.91

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27�

.001

4.94

�3.7

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.05

Exa

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69�4

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7.51

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1



pressed mothers appeared to be less distressed by the still-face condition. As has been noted,the still face may be less stressful for the infant who has experienced the mother as typicallyunresponsive and emotionally unavailable �Field, 1984�.

During the reunion period following the still face, the infants of depressed mothersshowed less positive behavior than the infants of the nondepressed mothers. This finding wasconsistent with data from other studies in which infants of mothers who were more sensitive/responsive reengaged following the still face, whereas infants of mothers who were lesssensitive/responsive showed more negative behavior �Hayley & Stansbury, 2003; Kogan &Carter, 1996�. Following the separation, the infants of depressed versus those of nondepressedmothers engaged in more greeting behavior �smiling and vocalizing� than they did followingthe still-face situation, as if trying to reinstate the spontaneous interaction. This was surprisingbecause they had been relatively unperturbed during the separation phase. Their mothers, as inthe reunion following the still face, engaged in less smiling, touching, and moving theirinfants’ limbs. As was noted in the earlier comparison of still-face and separation conditions�Field et al., 1986�, more prolonged separations and still-face situations may be needed. Inaddition, microanalyses of behavior might be needed as well as more complex analyses of theinteraction patterns to elucidate the process and the effects of brief episodes of maternalphysical and emotional unavailability.

Some clinical implications of these data are that, as has been shown previously, asking

TABLE 2. Mean Percent Time That Behaviors Occurred (Standard Deviations in Parentheses)

Separation Reunion Reunion

Behaviors Depressed Nondepressed p Depressed Nondepressed p

Infant Smile .00�.00�

.00�.00�

NS 39.87�37.14�

11.88�10.33�

.005

Vocalize .00�.00�

15.73�14.34�

.01 43.17�40.96�

18.62�14.97�

.05

Motor Activity 61.89�46.85�

63.89�49.23�

NS 6.24�6.13�

9.28�8.96�

NS

Gaze Aversion 22.96�21.09�

23.67�22.38�

NS 35.81�32.05�

58.50�44.26�

.05

Distress Brow 29.79�20.67�

23.86�19.30�

NS 18.54�14.44�

32.44�27.45�

NS

Crying 10.09�9.01�

12.00�10.29�

NS 29.21�26.97�

20.61�16.88�

NS

Mother Smile 9.67�7.87�

20.11�19.49�

.05

Exaggerated Faces .54�.37�

4.80�3.54�

.05

Vocalize 92.70�10.24�

96.88�11.41�

NS

Touch 86.68�25.49�

84.56�30.99�

NS

MovingLimbs

17.99�14.68�

54.69�41.46�

.01



depressed mothers to touch their infants during the still face may enhance their interactions�Pelaez-Nogueras, Field, Hossain, & Pickens, 1996�. Inasmuch as depressed mothers oftenpresent a still face to their infants naturally �Field, 1984�, they might be taught to touch theirinfants more during their interactions to lessen the negative effects of their flat facial expres-sions. Their touching did not differ from the touching of the nondepressed mothers, suggest-ing that their depression does not limit their touching behavior. However, they might com-pensate for their flat facial expressions and vocalizations in part by providing more touching.Touching has, in fact, alleviated distress behaviors in both infants of depressed mothers�Pelaez-Nogueras et al., 1996� and infants of nondepressed mothers �Stack & LePage, 1996�.Depressed mothers might also be shown videotapes of their still-face interactions to help themnotice the effect of their still-face-like behaviors on their infants. Finally, they might be giveninterventions that stimulate vagal activity. The vagus is noted to innervate the face and voice.Flat intonation and affect in depressed mothers and infants may relate to their low vagal tone�Moore & Calkins, 2004�. Vagal tone has also been notably lower during the still-face �Wein-berg & Tronick, 1996�. Interventions that are known to increase vagal activity in mothers andinfants, such as massage therapy, may also help enliven their interaction behaviors.

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Still-face and separation effects on depressed mother-infant interactions