Emotional Reactivity in Severe Alcohol Use Disorder and Major Depressive Disorder Using Eye-tracking, Physiological, and Interoceptive Measures (ERAD) (ERAD)

Emotional Reactivity in Severe Alcohol Use Disorder and Major Depressive Disorder: a Multidimensional Approach Combining Dynamic Emotional Stimuli, Eye Tracking, Pupillometry, Electrodermal and Cardiac Activity, and Biological Measures of Stress and Interoception

The goal of this observational study is to investigate emotional recognition and emotional reactivity in individuals with severe Alcohol Use Disorder (sAUD), Major Depressive Disorder (MDD), comorbid sAUD and depressive symptoms (sAUD+DS), and healthy controls.

The main questions this study aims to answer are:

• Do individuals with sAUD, MDD, sAUD+DS, and healthy controls exhibit different patterns of emotional recognition and emotional reactivity in response to dynamic emotional stimuli?
• How are emotional recognition and emotional reactivity related to each other?
• How are these emotional processes associated with psycho-affective, socio-emotional, stress-related, interoceptive, and disorder-specific factors?
• Do emotional recognition and emotional reactivity predict clinical outcomes at 6- and 12-month follow-up assessments?

Participants will:

• Complete two experimental sessions involving dynamic emotional facial expression and emotional scene tasks
• Provide emotion identification, subjective emotional ratings (type, intensity, and valence), and and self-reported bodily sensations using an emotional body map (InteroMap)
• Undergo eye-tracking, pupillometry, electrodermal activity, and cardiac activity recordings during emotional tasks
• Complete questionnaires assessing psycho-affective, socio-emotional, stress-related, and disorder-specific factors
• Provide saliva and hair samples for cortisol assessment
• Participate in follow-up clinical assessments at 6 and 12 months

Researchers will compare emotional recognition and emotional reactivity profiles across the sAUD, MDD, sAUD+DS, and healthy control groups, and evaluate their predictive value for future clinical outcomes.

Study Overview

• Status: Recruiting
• Conditions: Alcohol Use Disorder; Major Depressive Disorder (MDD)
• Intervention / Treatment: Other: Emotional Reactivity Experimental Protocol

Detailed Description

Severe Alcohol Use Disorder (sAUD) and Major Depressive Disorder (MDD) are among the most prevalent and debilitating mental health disorders, often co-occurring and exacerbating each other's symptoms, which complicates the clinical course and increases the risk of relapse of both disorders. Although their comorbidity is well-established, the mechanisms linking these disorders remain unclear.

Impaired emotional processing is a crucial component of this understanding. Deficits in emotional recognition (i.e., the ability to accurately identify and interpret emotions expressed by others) and responses (i.e., self-report, behavioral, and physiological reactions to emotional stimuli) contribute to significant difficulties in daily functioning and social interactions, as well as to the risk of relapse in these two psychiatric conditions.

Despite they offered crucial insights on the understanding of emotional processing in sAUD and MDD, previous studies presented several key limits hampering the evolution of this research field as (1) they used non-ecological stimulations, namely static pictures or isolated auditory cues, neglecting the multimodal and complex nature of emotional stimuli in everyday life; (2) they predominantly focused on behavioral data or a single measurement modality, offering limited information regarding the physiological correlates of these deficits or the potential of multidimensional analyses; (3) none of them included a group of patients with comorbid sAUD and depressive symptoms, leaving the combined or additive effects of these conditions unexamined; (4) predictive approaches remain largely underexplored.

ERAD addresses these gaps by investigating emotional recognition and emotional reactivity in individuals with sAUD (n=70), MDD (n=70), and sAUD+DS (n=70) compared to healthy controls (n=70), using two complementary experimental paradigms: (1) a dynamic emotional facial expression recognition task with congruent emotional prosody, and (2) an emotional induction task based on dynamic emotional scenes. This multidimensional approach integrates: the identification of emotions expressed by others (basic emotions), self-reported emotional experiences (intensity and valence), measures of visual exploration (eye-tracking), autonomic nervous system responses (pupillometry, electrodermal activity, and cardiac activity), biological stress markers (cortisol), and interoceptive measures assessed through emotional body maps (InteroMap).

ERAD aims to provide a transdiagnostic understanding of emotional processes and their predictive value for future clinical outcomes in sAUD, MDD, and their comorbidity, with potential implications for targeted and personalized prevention and treatment strategies.

• Study Type: Observational
• Enrollment (Estimated): 280

Contacts and Locations

• Study Contact: Name: Edelweiss Touron, PhD; Phone Number: +32470052024; Email: edelweiss.touron@uclouvain.be
• Study Contact Backup: Name: Pierre Maurage, PhD; Phone Number: +3210474804; Email: pierre.maurage@uclouvain.be

Study Locations

• Belgium
  • Belgium
    • Brussels, Belgium, Belgium, 1200
      • Recruiting
      • Cliniques Universitaires Saint-Luc
      • Contact: Philippe De Timary, PhD; Phone Number: +3227642160; Email: philippe.detimary@uclouvain.be

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

For patients:

• Cliniques Universitaires Saint-Luc (gastro-hepatology unit and the Institute of Psychiatry (IPI)) Bruxelles
• Hôpital Psychiatrique du Beau-Vallon Namur
• Grand Hôpital de Charleroi
• Cliniques Saint-Pierre Ottignies

For healthy controls:

• Faculté de Psychologie de l'Université Catholique de Louvain

Description

Inclusion Criteria:

All participants must:

• Be aged 18 to 70 years, fluent in French, and able to provide written informed consent.
• Have normal or corrected-to-normal vision, without ocular conditions that could interfere with eye-tracking or pupillometry data quality.

Patients with severe Alcohol Use Disorder (sAUD)

• Meet DSM-5 criteria for severe Alcohol Use Disorder.
• Be tested during the third week of abstinence.
• Have no history of neurological, endocrinal, or infectious disease, diagnosed anxiety or depressive disorder, or other substance use disorder (except tobacco).

Patients with Major Depressive Disorder (MDD)

• Meet DSM-5 criteria for a current Major Depressive Episode.
• Have no history of neurological disease, severe alcohol use disorder, other substance use disorder (except tobacco), or other psychiatric disorders (e.g., bipolar disorder, schizophrenia).

Patients with severe Alcohol Use Disorder and Depressive Symptoms (sAUD+DS)

• Meet the same inclusion criteria as the sAUD group.
• Present moderate to severe depressive symptoms persisting after withdrawal, confirmed by a clinical diagnosis using the Mini International Neuropsychiatric Interview (MINI).

Healthy Controls (HC)

• Recruited from the general population, matched to patients for age, sex, and education.
• Have no current or past psychiatric or neurological disorder.
• Present subclinical levels of alcohol consumption (AUDIT score <7 for men, <6 for women) and depressive symptoms (BDI-II score <10).

Exclusion Criteria:

• Cognitive impairment, uncorrected visual deficits, or any condition preventing understanding of instructions or reliable task performance (e.g., major attention or comprehension difficulties);
• Ophthalmological conditions that could compromise eye-tracking or pupillometry data quality;
• Dermatological conditions or excessive sweating that may interfere with electrodermal and cardiac activity recording;
• Cardiac conditions or devices that could affect ECG recording (e.g., pacemaker, defibrillator, severe uncontrolled arrhythmias), or use of medications strongly influencing heart rate.
• Acute intoxication or withdrawal state at the time of testing;
• Current diagnosis of psychotic disorder, bipolar disorder, or neurological disease;
• Pregnancy;
• Ongoing participation in another interventional or clinical study that could interfere with behavioral or physiological measures;
• For healthy controls: use of psychotropic medication or history of substance use disorder.

Study Plan

How is the study designed?

Design Details

• Observational Models: CASE_CONTROL
• Time Perspectives: PROSPECTIVE

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
severe Alcohol Use Disorder (sAUD)	Other: Emotional Reactivity Experimental Protocol; Standardized experimental protocol including: (1) completion of questionnaires assessing psycho-affective, socio-emotional, stress-related, and disorder-specific factors; (2) exposure to dynamic emotional facial expressions and emotional scenes to assess emotional recognition and reactivity; (3) recording of eye-tracking, pupillometry, electrodermal activity, and cardiac activity responses; (4) assessment of bodily sensations using an emotional body map; (5) salivary and hair cortisol collection; and (6) follow-up clinical assessments at 6 and 12 months. Procedures are identical across all study groups.
Major Depressive Disorder (MDD)	Other: Emotional Reactivity Experimental Protocol; Standardized experimental protocol including: (1) completion of questionnaires assessing psycho-affective, socio-emotional, stress-related, and disorder-specific factors; (2) exposure to dynamic emotional facial expressions and emotional scenes to assess emotional recognition and reactivity; (3) recording of eye-tracking, pupillometry, electrodermal activity, and cardiac activity responses; (4) assessment of bodily sensations using an emotional body map; (5) salivary and hair cortisol collection; and (6) follow-up clinical assessments at 6 and 12 months. Procedures are identical across all study groups.
Comorbid sAUD and Depressive Symptoms (sAUD+DS)	Other: Emotional Reactivity Experimental Protocol; Standardized experimental protocol including: (1) completion of questionnaires assessing psycho-affective, socio-emotional, stress-related, and disorder-specific factors; (2) exposure to dynamic emotional facial expressions and emotional scenes to assess emotional recognition and reactivity; (3) recording of eye-tracking, pupillometry, electrodermal activity, and cardiac activity responses; (4) assessment of bodily sensations using an emotional body map; (5) salivary and hair cortisol collection; and (6) follow-up clinical assessments at 6 and 12 months. Procedures are identical across all study groups.
Healthy Controls (HC)	Other: Emotional Reactivity Experimental Protocol; Standardized experimental protocol including: (1) completion of questionnaires assessing psycho-affective, socio-emotional, stress-related, and disorder-specific factors; (2) exposure to dynamic emotional facial expressions and emotional scenes to assess emotional recognition and reactivity; (3) recording of eye-tracking, pupillometry, electrodermal activity, and cardiac activity responses; (4) assessment of bodily sensations using an emotional body map; (5) salivary and hair cortisol collection; and (6) follow-up clinical assessments at 6 and 12 months. Procedures are identical across all study groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Multidimensional assessment of emotional recognition and emotional reactivity to dynamic emotional stimuli	Participants are exposed to dynamic emotional stimuli (facial expressions and emotional scenes). Five dimensions are measured: (1) Emotional recognition, facial expression task only: accuracy rate and reaction time ; (2) Self-report: ratings of emotion type, intensity and valence ; (3) Behavioral: eye-tracking indices such as gaze patterns, number and duration of fixations, and saccades within areas of interest ; (4) Physiology: pupillometry (pupil size variations), electrodermal activity (skin conductance responses), and cardiac activity (heart rate, heart rate variability, and cardiac deceleration) ; (5) Interoception, emotional scene task only: self-reported bodily sensations on a body map. All measures are compared between the four groups.	Throughout the entire study, during approximately 22 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Relationships between emotional recognition and emotional reactivity (self-reported, behavioral and physiological)	Within each group, associations are examined between emotional recognition (facial expression task: accuracy rate and reaction time) and measures of emotional reactivity to dynamic emotional stimuli (self-reported emotional ratings ; eye-tracking measures ; pupil size variations; skin conductance responses; and cardiac activity). The consistency between subjective ratings and objective responses is also assessed for each emotion, to identify congruence or discrepancy. Associations are compared between each patient group and healthy controls.	Throughout the entire study, during approximately 22 months
Associations of emotional recognition and reactivity with psycho-affective, socio-emotional, stress, interoceptive and disorder-specific factors	Within each group, associations are examined between emotional processing (emotional recognition and emotional reactivity, as defined in the primary outcome measures) and: (1) psycho-affective factors (depressive and anxiety symptoms, BDI/STAI; rumination, RSS); (2) socio-emotional abilities (emotion regulation strategies, DERS; interpersonal problems, IIP); (3) stress markers (salivary and hair cortisol levels); (4) interoceptive abilities; (5) disorder-specific characteristics (duration of current or past depressive or alcohol use disorder). The role of these factors as mediators or moderators is also tested in the relationships between emotional processing and depressive severity (BDI) or alcohol consumption (AUDIT). Associations are compared between each patient group and healthy controls.	Throughout the entire study, during approximately 22 months
Prediction of clinical status at 6 and 12 months by baseline emotional recognition and reactivity	Baseline emotional recognition and emotional reactivity (as defined in the primary outcome measures) are tested as predictors of clinical status at 6 and 12 months in participants with sAUD, MDD and sAUD+DS. Clinical status is assessed during follow-up phone calls and includes: (1) relapse; (2) alcohol consumption (AUDIT); (3) presence and severity of depressive symptoms (BDI).	Throughout the entire study, during approximately 22 months

Collaborators and Investigators

• Sponsor: Université Catholique de Louvain
• Collaborators: Fonds Spécial de Recherche (FSR), UCLouvain

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2026
• Primary Completion (Estimated): September 1, 2028
• Study Completion (Estimated): September 1, 2028

Study Registration Dates

• First Submitted: November 3, 2026
• First Submitted That Met QC Criteria: November 3, 2026
• First Posted (Actual): November 9, 2026

Study Record Updates

• Last Update Posted (Actual): November 9, 2026
• Last Update Submitted That Met QC Criteria: November 3, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Alcohol-Related Disorders; Mood Disorders; Depressive Disorder; Alcoholism; Depressive Disorder, Major
• Other Study ID Numbers: B4032025000122; 2025/11DEC/520 (Other Identifier: Comité d'éthique hospitalo-facultaire Saint-Luc - UCLouvain)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No