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Glas VFJ, Koenders MA, Kupka RW, Regeer EJ. How to study psychological mechanisms of mania? A systematic review on the methodology of experimental studies on manic mood dysregulation of leading theories on bipolar disorder. Bipolar Disord 2024; 26:646-660. [PMID: 39043623 DOI: 10.1111/bdi.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Although there are several psychological theories on bipolar disorders (BD), the empirical evidence on these theories through experimental studies is still limited. The current study systematically reviews experimental methods used in studies on the main theories of BD: Reward Hypersensitivity Theory (RST) or Behavioral Activation System (BAS), Integrative Cognitive Model (ICM), Positive Emotion Persistence (PEP), Manic Defense theory (MD), and Mental Imagery (MI). The primary aim is to provide an overview of the used methods and to identify limitations and suggest areas of improvement. METHODS A systematic search of six databases until October 2023 was conducted. Study selection involved two independent reviewers extracting data on experimental study design and methodology. RESULTS A total of 84 experimental studies were reviewed. BAS and RST were the most frequently studied theories. The majority of these experimental studies focus on mechanisms of reward sensitivity. Other important elements of the reviewed theories, such as goal setting and-attainment, situation selection (avoidance or approach), activation, affective/emotional reactivity, and regulatory strategies, are understudied. Self-report and neuropsychological tasks are most often used, while mood induction and physiological measures are rarely used. CONCLUSION There is a need for more consensus on the operationalization of psychological theories of mania. Standardization of test batteries could improve comparability among studies and foster a more systematic approach to experimental research. Research on affective (activated) states is still underrepresented in comparison with studies on trait vulnerabilities.
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Affiliation(s)
- V F J Glas
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - M A Koenders
- Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | - R W Kupka
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - E J Regeer
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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Woods C, Richardson T, Palmer-Cooper E. Are dysfunctional attitudes elevated and linked to mood in bipolar disorder? A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:16-53. [PMID: 37807389 DOI: 10.1111/bjc.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Dysfunctional attitudes (DA) are higher in depression; however, less is understood about their role in bipolar disorder (BD). This paper aimed to explore the presence of DA in BD in comparison to clinical and non-clinical groups. Also explored were the associations between DA and mood states of depression, mania or euthymia in BD. METHODS A systematic review and meta-analysis were conducted. A total of 47 articles were included in the systematic review of which 23 were included in the meta-analysis. The quality of each study was rated. RESULTS The meta-analysis showed significantly higher DA in BD than healthy controls (d = .70). However, no difference was observed between BD and unipolar participants (d = -.16). When reviewing mood state within BD, a significant mean difference was found between DA scores for euthymic and depressed participants (d = -.71), with those who were depressed scoring higher. Three studies found that psychological therapies significantly reduce DA in BD (d = -.38). CONCLUSIONS These findings imply not only that DA are both a characteristic of BD that is not as prevalent in healthy populations but also that a depressed mood state is associated with increased severity. This implies that DA could possibly go 'offline' when mood symptoms are not present. Psychological therapies appear to reduce DA in BD. Implications for future research as well as practice-based implications are expanded on in the discussion.
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Affiliation(s)
- Chloe Woods
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| | - Thomas Richardson
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| | - Emma Palmer-Cooper
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
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Tietz S, Wagner-Skacel J, Angel HF, Ratzenhofer M, Fellendorf FT, Fleischmann E, Körner C, Reininghaus EZ, Seitz RJ, Dalkner N. Believing processes during the COVID-19 pandemic in individuals with bipolar disorder: An exploratory study. World J Psychiatry 2022; 12:929-943. [PMID: 36051599 PMCID: PMC9331453 DOI: 10.5498/wjp.v12.i7.929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/27/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Believing or “credition” refers to psychological processes that integrate the cognitions and emotions that influence our behavior. In the credition model by Angel and Seitz, four parameters are postulated: proposition, certainty, emotion and mightiness. It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances. External or environmental circumstances can include threatening situations such as the ongoing pandemic. It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder (BD) and healthy controls (HC).
AIM To investigate credition in individuals with BD during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS Psychiatrically stable individuals with BD (n = 52) and age- and sex matched HC (n = 52) participated in an online survey during the first lockdown of the COVID-19 pandemic. The survey took place between April 9th and June 4th, 2020, in Austria. Participants completed the Brief Symptom Inventory-18, the Beck Depression Inventory-II, the Altman Self-Rating Mania Scale, the Pittsburgh Sleep Quality Index and a dedicated Believing Questionnaire assessing four parameters of credition (proposition, certainty, emotion and mightiness). The MAXQDA software was used to analyze the qualitative data. Statistical analyses included analyses of variance, a multivariate analysis of variance and a multivariate analysis of co-variance.
RESULTS Individuals with BD reported significantly more negative propositions [F (1,102) = 8.89, P = 0.004, η2p = 0.08] and negative emotions [Welch´s F (1,82.46) = 18.23, P < 0.001, η2p = 0.18], while HC showed significantly more positive propositions [F (1,102) = 7.78, P = 0.006, η2p = 0.07] and emotions [F (1,102) = 14.31, P < 0.001, η2p = 0.12]. In addition, individuals with BD showed a higher incongruence between their propositions and their emotions [F (1,102) = 9.42, P = 0.003, η2p = 0.08] and showed strong correlations between the parameters of the Believing Questionnaire and their psychiatric symptoms (r = 0.51-0.77, all P < 0.001). Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression, anxiety and sleep quality.
CONCLUSION Believing parameters were associated with psychiatric symptoms in BD during the pandemic. Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.
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Affiliation(s)
- Sophie Tietz
- Institute of Psychology, University of Graz, Graz 8010, Austria
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz 8036, Austria
| | - Hans-Ferdinand Angel
- Department of Catechetics and Religious Education, University of Graz, Graz 8010, Austria
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
| | - Christof Körner
- Institute of Psychology, University of Graz, Graz 8010, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
| | - Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf D-40629, Germany
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
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Granger S, Pavlis A, Collett J, Hallam KT. Revisiting the “manic defence hypothesis”: assessing explicit and implicit cognitive biases in euthymic bipolar disorder. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1948303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shara Granger
- Psychology Discipline, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Alexia Pavlis
- Psychology Discipline, College of Health and Biomedicine, Victoria University, Melbourne, Australia
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - James Collett
- Department of Psychology, School of Science and Biomedicine, RMIT, Melbourne, Australia
| | - Karen T. Hallam
- Centre for Youth AOD Research and Practice, Youth Support and Advocacy Service (YSAS), Fitzroy, Australia
- Institute for Innovation in Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Australia
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Dysfunctional cognition in individuals with an increased risk for mania. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3733. [PMID: 36397786 PMCID: PMC9667121 DOI: 10.32872/cpe.3733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is still a lack of knowledge about attitudes and cognitions that are related to bipolar disorder. Theoretically, it was proposed that exaggerated beliefs about the self, relationships, the need for excitement, and goal-related activities might lead to mania in vulnerable individuals, however, the few studies that examined this hypothesis provided mixed results. One of the unresolved issues is if such a cognitive style is associated with current mood symptoms or with different stages of the illness, i.e. at-risk versus diagnosed bipolar disorder. Therefore, the present study aimed at evaluating depression and mania-related cognitive style in individuals at-risk for mania. Method In an online survey, we collected data of 255 students of the University of Klagenfurt, Austria. All participants completed the Hypomanic Personality Scale (HPS), the Cognition Checklist for Mania – Revised (CCL-M-R), the Dysfunctional Attitude Scale (DAS), the Beck Depression Inventory (BDI), and the Internal State Scale (ISS). Results In a hierarchical regression, HPS was positively related to scores of all subscales of the CCL-M-R. The HPS did not significantly predict scores of the DAS. Current manic and depressive symptoms significantly contributed to the models. Conclusion The present results suggest that a trait-like risk for mania is associated with mania-related but not depression-related cognitions.
Individuals at-risk for mania show mania-specific rather than depression-specific thinking patters. Current subclinical mood symptoms are related to mood-congruent attitudes and cognitions.
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Yang Y, Fletcher K, Murray G. A narrative review of cross-sectional and prospective associations between self-schemas and bipolar disorder. Clin Psychol Psychother 2021; 28:766-783. [PMID: 33386678 DOI: 10.1002/cpp.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 01/03/2023]
Abstract
The role of self-concept in bipolar disorder (BD) has not been well understood. The present review utilizes the notion of self-schema and interrogates existing research concerning evidence for cross-sectional and prospective associations between four schema-like constructs (i.e. trait self-esteem, dysfunctional beliefs concerning contingent self-worth, early maladaptive schemas and implicit self-esteem) and various facets of BD. Existing findings demonstrate various types of involvement of self-schemas in BD. Of particular clinical relevance, the present review suggests that low trait self-esteem and dysfunctional beliefs concerning contingent self-worth are risk factors for ongoing BD symptoms and mood episodes. The present review also yields important yet unaddressed questions with respect to the evaluative content of self-schemas associated with the hypo/manic phase of BD.
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Affiliation(s)
- Yan Yang
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
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Koenders M, Dodd A, Karl A, Green M, Elzinga B, Wright K. Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Meyer TD, Hautzinger M, Bauer IE. A mania-related memory bias is associated with risk for relapse in bipolar disorder<sup/>. J Affect Disord 2018; 235:557-564. [PMID: 29698917 DOI: 10.1016/j.jad.2018.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/31/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Previous work has shown that neuropsychological performance can predict outcome of psychotherapy. The present paper explores whether an affective bias in verbal memory is associated with recurrence of mood episodes in patients with Bipolar Disorder (BD). METHOD 76 euthymic adult patients with BD were randomly assigned to either 9 months of Cognitive Behavioral Therapy (CBT) or Support Therapy (ST), and followed up for 2 years after completing therapy. At baseline, affective learning memory (Emotional Auditory Verbal Learning Test; EMO-AVLT) and other measures were assessed. Recurrence of a mood episode was the primary outcome. RESULTS The survival analyses revealed that the interaction between therapy condition, more specifically ST, and a recognition bias in favor of mania-related, but not depression-related words predicted recurrence of mania. Recurrence of depression was predicted by neither affective memory bias nor their interaction with treatment. CONCLUSIONS A mania-related memory bias emerged as a predictor of mania recurrence, specifically in an unstructured setting such as ST. Perhaps mania-related schemata are more salient or more easily activated in those at high risk for recurrence. Interventions targeting patients' insight into their internal states as potential indicators of prodromal manic symptoms could be the key to improve the outcome of psychological interventions in BD. Additional research in the role of cognitive factors in relapse prevention is warranted.
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Affiliation(s)
- Thomas D Meyer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States.
| | - Martin Hautzinger
- Department of Psychology and Psychotherapy, University of Tübingen, Germany
| | - Isabelle E Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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Haffner P, Quinlivan E, Fiebig J, Sondergeld LM, Strasser ES, Adli M, Moritz S, Stamm TJ. Improving functional outcome in bipolar disorder: A pilot study on metacognitive training. Clin Psychol Psychother 2017; 25:50-58. [PMID: 28857347 DOI: 10.1002/cpp.2124] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/08/2017] [Accepted: 07/16/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Effective group psychological interventions in bipolar disorder are rare. In this study, we present "metacognitive training (MCT) for bipolar disorder"-an adaption of a group intervention that has proven effective in other severe psychiatric disorders. MCT is a structured, interactive approach that addresses cognitive biases, social cognition, and self-esteem. In this pilot study, we investigated psychosocial functioning as primary outcome measure, as well as the feasibility of MCT and its acceptance among bipolar patients. METHODS Thirty-four outpatients with bipolar disorder were recruited. Inclusion criteria were euthymia and psychosocial functioning with a score >11 assessed by the Functional Assessment Short Test. The subjects received eight weekly MCT sessions. Before and after the intervention, psychosocial functioning, quality of life (QoL), and patient views were assessed. RESULTS Patients improved significantly in global psychosocial functioning, with a large effect size from baseline to post-treatment. Over the intervention period, patient QoL improved significantly in terms of their physical health, however not for other QoL subdomains. Treatment adherence was 80%, and patients' appraisal of the training was positive. LIMITATIONS As this study lacks a control group, it is not possible to ascertain whether the positive treatment effects are attributable to MCT. Additionally, it is unclear whether gains in psychosocial functioning would have been maintained long term. CONCLUSIONS This pilot trial conclusively shows that MCT is feasible and provides preliminary evidence for both the acceptance and efficacy of MCT. Further studies with larger samples and control condition will be necessary to build on these findings.
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Affiliation(s)
- Paula Haffner
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Quinlivan
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elisa Sophie Strasser
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Fliedner Klinik, Berlin, Germany
| | - Steffen Moritz
- Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Josef Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Dagani J, Signorini G, Nielssen O, Bani M, Pastore A, Girolamo GD, Large M. Meta-analysis of the Interval between the Onset and Management of Bipolar Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:247-258. [PMID: 27462036 PMCID: PMC5407546 DOI: 10.1177/0706743716656607] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD). METHOD We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta-regression. RESULTS Twenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5.8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity ( I2 = 92.6; Q = 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO. CONCLUSIONS There is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.
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Affiliation(s)
- Jessica Dagani
- 1 Saint John of God Clinical Research Centre, Brescia, Italy
| | | | - Olav Nielssen
- 2 St. Vincent's Hospital Sydney, University of Sydney, University of New South Wales, New South Wales, Australia
| | - Moira Bani
- 1 Saint John of God Clinical Research Centre, Brescia, Italy
| | - Adriana Pastore
- 3 Department of Basic Medical Sciences, Neuroscience and Sense Organs, Childhood and Adolescence Neuropsychiatry Unit, University of Bari "Aldo Moro," Bari, Italy
| | | | - Matthew Large
- 4 The School of Psychiatry, University of New South Wales, New South Wales, Australia
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Redhead A, Jordan G, Ferrier IN, Meyer TD. Automatic processing of emotional stimuli in euthymic patients with bipolar disorder. J Affect Disord 2016; 203:339-346. [PMID: 27318534 DOI: 10.1016/j.jad.2016.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Biased information processing styles are a core feature of cognitive models of unipolar depression (UD). The manic-defence hypothesis (MDH) posits that UD and Bipolar Disorder (BD) are subject partially to the same underlying cognitive processes, which may act as putative vulnerability factors. Previous studies have used experimental paradigms as a way of measuring automatic (non-intentional) processing of emotional information in order to test the MDH with some studies providing some evidence for a negatively biased automatic processing of emotionally-relevant information in BD. However, most prior studies used supraliminal stimuli (i.e. presented above perceptual threshold). Based on the MDH we predicted that subliminally presented negative stimuli will affect performance of patients with BD differently than non-clinical participants, but similarly to what has been observed in prior studies with currently depressed patients. METHODS The current study used an affective priming paradigm with both supraliminally and subliminally presented emotional images as primes to measure automatic processing. Seventeen euthymic individuals with a BD diagnosis were recruited along with seventeen non-clinical control participants (NCC) matched for age and gender. RESULTS We found interference (increased response times) due to masked, subliminally presented negative primes in patients with BD when negative prime images were followed by negative targets, but decreased response times (facilitation) in NCCs. LIMITATIONS We did not include a psychiatric control group and the sample size was small. CONCLUSION Our findings suggest that euthymic patients with BD do exhibit an affective bias suggesting an increased sensitivity to negative emotional information even when euthymic.
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Affiliation(s)
- Anthony Redhead
- Easington Affective Disorders Team, Tees, Esk & Wear Valley NHS Trust, UK
| | | | | | - Thomas D Meyer
- Institute of Neuroscience, Newcastle University, UK; Department of Psychiatry and Behavioral Science, University of Texas Health Science Center at Houston, Houston, TX, USA.
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The Impact of Thought Speed and Variability on Psychological State and Threat Perception: Further Exploration of the Theory of Mental Motion. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9753-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The role of negative mood induction on working memory capacity in individuals putatively at risk for bipolar disorder: A pilot study. J Affect Disord 2015; 185:60-6. [PMID: 26143405 DOI: 10.1016/j.jad.2015.05.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) is characterized by cognitive deficits. Usually individuals at risk for BD do not exhibit such deficits but they might be evident under cognitive or emotionally stressful conditions. To our knowledge this is the first study examining working memory capacity under mood induction in individuals at risk for BD. METHODS Using the Hypomanic Personality Scale (HPS) 68 participants out of an initial pool of 148 students were divided into groups at high and low risk for BD. They completed twice a Dual Task Paradigm (DTP) task assessed under high and low cognitive load prior to and following a negative mood induction. RESULTS As expected stimuli incongruency, high cognitive load and mood induction increased response times. Contrary to our hypothesis the mood induction did not differentially affect at-risk individuals. However, they generally reacted faster to neutral stimuli compared to those at low risk. CONCLUSIONS While we replicated former results related to the DTP, we did not find evidence for the hypothesis that individuals putatively at risk for BD will be more affected by negative mood when doing such a cognitive task. Replication using a larger sample is needed which should also examine whether changes in positive mood might more relevant in the context of risk for mania.
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Fuhr K, Hautzinger M, Meyer TD. Are Social Comparisons Detrimental for the Mood and Self-Esteem of Individuals with an Affective Disorder? COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9656-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Poletti S, Colombo C, Benedetti F. Adverse childhood experiences worsen cognitive distortion during adult bipolar depression. Compr Psychiatry 2014; 55:1803-8. [PMID: 25194467 DOI: 10.1016/j.comppsych.2014.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cognitive distortion is a central feature of depression, encompassing negative thinking, dysfunctional personality styles and dysfunctional attitudes. It has been hypothesized that ACEs could increase the vulnerability to depression by contributing to the development of a stable negative cognitive style. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and cognitive distortion, and whether any gender differences exist. AIM The aim of this study was to examine the association between ACEs and cognitive distortions and possible differences between genders in a sample of patients affected by bipolar disorder. METHOD 130 patients with bipolar disorder (BD) (46 men and 84 females), completed the Risky Family Questionnaire to assess ACEs and the Cognition Questionnaire (CQ) to assess cognitive distortions. RESULTS A positive association was found between ACE and the CQ total score. Investigating the 5 dimensions assessed through the CQ, only the dimension "generalization across situations" was significantly associated to ACE. An interaction between ACE and gender was found for "generalization across situations", while no differential effect among females and males was found for CQ total score. CONCLUSION This is the first study to report a relationship between negative past experiences and depressive cognitive distortions in subjects affected by BD. Growing in a family environment affected by harsh parenting seems to a cognitive vulnerability to depression; this effect is especially strong in females.
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Affiliation(s)
- Sara Poletti
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy.
| | - Cristina Colombo
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Francesco Benedetti
- Scientific Institute and University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
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Park JY, Ryu V, Ha RY, Lee SJ, Choi WJ, Ha K, Cho HS. Assessment of implicit self-esteem in bipolar manic and euthymic patients using the implicit association test. Compr Psychiatry 2014; 55:557-64. [PMID: 24262123 DOI: 10.1016/j.comppsych.2013.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Although self-esteem is thought to be an important psychological factor in bipolar disorder, little is known about implicit and explicit self-esteem in manic patients. In this study, we investigated differences in implicit and explicit self-esteem among bipolar manic patients, bipolar euthymic patients, and healthy controls using the Implicit Association Test (IAT). METHODS Participants included 19 manic patients, 27 euthymic patients, and 27 healthy controls. Participants completed a self-esteem scale to evaluate explicit self-esteem and performed the self-esteem IAT to evaluate implicit self-esteem. RESULTS There were no differences among groups in explicit self-esteem. However, there were significant differences among groups in implicit self-esteem. Manic patients had higher IAT scores than euthymic patients and a trend toward higher IAT scores than healthy controls. CONCLUSIONS Our findings suggest that, on the latent level, a manic state is not simply the opposite of a depressed state. Furthermore, there may be a discontinuity of implicit self-esteem between manic and euthymic states. These unexpected results may be due to characteristics of the study participants or the methods used to assess implicit self-esteem. Nevertheless, they provide greater insights on the psychological status of manic patients.
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Affiliation(s)
- Jin Young Park
- Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Vin Ryu
- Department of Psychiatry, Konyang University College of Medicine, Daejon, South Korea
| | - Ra Yeon Ha
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Seoul Bukbu Hospital, Seoul, South Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Won-Jung Choi
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun-Sang Cho
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yonsei University College of Medicine, Severance Mental Health Hospital, Gwangju, South Korea.
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Implicit motives and cognitive variables: specific links to vulnerability for unipolar or bipolar disorder. Psychiatry Res 2014; 215:61-8. [PMID: 24182545 DOI: 10.1016/j.psychres.2013.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 08/29/2013] [Accepted: 10/10/2013] [Indexed: 11/21/2022]
Abstract
Cognitive variables contribute to the etiology of affective disorders. With the differentiation between explicit and implicit measures some studies have indicated underlying depressogenic schemata even in bipolar disorders. We tested for differences in implicit motives and cognitive variables between patients with remitted unipolar and bipolar disorder compared to controls and in a high-risk sample. Additionally we investigated whether affective symptoms relate to those variables. We cross-sectionally examined N=164 participants (53 with bipolar disorder, 58 with major depression, and 53 without affective disorders) and a high-risk sample (N=49) of adolescent children of either parents with unipolar or bipolar disorder or of healthy parents. The Multi-Motive-Grid was used to measure the implicit motives achievement, affiliation, and power, in addition to the cognitive measures of self-esteem, dysfunctional attitudes, and perfectionism. Unipolar and bipolar groups did not differ from healthy controls in implicit motives but showed higher scores in the cognitive factors. Adolescents at high risk for unipolar disorder showed lower scores in the power and achievement motives compared to adolescents at low risk. Subsyndromal depressive symptoms were related to the cognitive variables in both samples. Our results underline the importance of cognitive-behavioral treatment for both unipolar and bipolar disorder.
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Lex C, Meyer TD. Is there evidence for an emotion-related bias in verbal learning or memory in individuals putatively high at risk for mania? Psychiatry Res 2013; 210:891-5. [PMID: 23809462 DOI: 10.1016/j.psychres.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/24/2013] [Accepted: 05/04/2013] [Indexed: 11/19/2022]
Abstract
There is broad evidence that individuals with bipolar disorder show deficits in verbal memory and learning. Such deficits seem to be independent of acute mood episodes and to manifest after the onset of the disorder. Less research has been conducted in relation to more specific memory functions, particularly to verbal memory and learning for emotional information. Therefore, the objective of the present study is to investigate if there is evidence for an affective memory bias in at-risk individuals before the onset of affective disorder. We applied the Emotional Auditive Verbal Learning Test to individuals at risk for mania and at risk for depression, as well as to a control group. We hypothesized a mania-related memory bias for individuals at risk of mania. We found no evidence for an overall learning or memory deficit in the high-risk groups. All groups performed better learning and remembering neutral words compared to emotionally valenced words, however, contrary to our hypothesis there was no specific emotion-related learning or memory bias in the two high-risk groups. There was no evidence of impairments in verbal learning and memory overall and for emotional contents before the onset of affective disorders.
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Affiliation(s)
- Claudia Lex
- Department of Psychiatry, Villach General Hospital, Nikolaigasse 43, 9500 Villach, Austria.
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Batmaz S, Kaymak SU, Soygur AH, Ozalp E, Turkcapar MH. The distinction between unipolar and bipolar depression: A cognitive theory perspective. Compr Psychiatry 2013; 54:740-749. [PMID: 23608048 DOI: 10.1016/j.comppsych.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 01/20/2023] Open
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Cristea IA, Montgomery GH, Szamoskozi Ş, David D. Key Constructs in “Classical” and “New Wave” Cognitive Behavioral Psychotherapies: Relationships Among Each Other and With Emotional Distress. J Clin Psychol 2013; 69:584-99. [DOI: 10.1002/jclp.21976] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lahera G, Benito A, González-Barroso A, Guardiola R, Herrera S, Muchada B, Cojedor N, Fernández-Liria A. Social-cognitive bias and depressive symptoms in outpatients with bipolar disorder. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:670549. [PMID: 22312485 PMCID: PMC3270533 DOI: 10.1155/2012/670549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/29/2011] [Indexed: 11/17/2022]
Abstract
A deficit of social cognition in bipolar disorder has been shown, even when patients are stable. This study compares the attribution of intentions (social-cognitive bias) in a group of 37 outpatients with bipolar disorder with 32 matched control subjects. Bipolar patients scored significantly higher in the Ambiguous Intentions Hostility Questionnaire, showing an angry and intentionality bias (P = .001, P = .02). Differences in blame scale and hostility bias did not reach statistical significance, but a trend was found (P = .06). Bipolar patients with depressive symptoms presented a higher score in the angry bias scale (P = .03) and aggressivity bias scale (P = .004). The global functioning (GAF) correlates significantly with intentionality (P = .005), angry (P = .027), and aggressivity (P = .020) biases. Bipolar patients show a social-cognitive bias that may play a role in their functional outcome.
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Affiliation(s)
- Guillermo Lahera
- Department of Psychiatry, Príncipe de Asturias University Hospital, University of Alcalá, Carretera Alcalá-Meco s/n, 28805 Alcalá de Henares, Madrid, Spain
| | - Adolfo Benito
- Department of Psychiatry, Hospital Provincial de Toledo, Plaza de la Merced, 4, 45002 Toledo, Spain
| | - Ana González-Barroso
- Department of Psychiatry, Príncipe de Asturias University Hospital, University of Alcalá, Carretera Alcalá-Meco s/n, 28805 Alcalá de Henares, Madrid, Spain
| | - Rocío Guardiola
- Department of Psychiatry, Príncipe de Asturias University Hospital, University of Alcalá, Carretera Alcalá-Meco s/n, 28805 Alcalá de Henares, Madrid, Spain
| | - Sara Herrera
- Department of Psychiatry, Príncipe de Asturias University Hospital, University of Alcalá, Carretera Alcalá-Meco s/n, 28805 Alcalá de Henares, Madrid, Spain
| | - Beatriz Muchada
- Department of Psychiatry, Príncipe de Asturias University Hospital, University of Alcalá, Carretera Alcalá-Meco s/n, 28805 Alcalá de Henares, Madrid, Spain
| | - Noelia Cojedor
- Department of Psychiatry, Hospital Provincial de Toledo, Plaza de la Merced, 4, 45002 Toledo, Spain
| | - Alberto Fernández-Liria
- Department of Psychiatry, Príncipe de Asturias University Hospital, University of Alcalá, Carretera Alcalá-Meco s/n, 28805 Alcalá de Henares, Madrid, Spain
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