Dysfunctional beliefs in bipolar disorder: hypomanic vs. depressive attitudes.

BACKGROUND: To date the effect of cognitive behavioural therapy modified for bipolar disorder has been inconsistent and sometimes disappointing. However studies exploring cognitive style in bipolar disorder have not identified the unique patterns of beliefs specific to bipolar disorder. The current study examines whether Mansell's hypomania-related dysfunctional belief scale specifically identifies bipolar disorder patients. METHOD: Forty remitted bipolar patients, twenty remitted unipolar patients and twenty healthy controls completed the Hypomanic Attitudes and Positive Prediction Inventory (HAPPI) and the Dysfunctional Attitude Scale (DAS). RESULTS: The remitted bipolar group scored higher than the unipolar and healthy control groups on the HAPPI scale overall score and on three subscales that measured self-catastrophic beliefs, beliefs related to negative responses from other people when in elevated mood and beliefs related the response style to activation and elevation. CONCLUSION: The study finds evidence of unique dysfunctional beliefs elevated only in remitted bipolar patients. Such findings could be used to inform the development of a specific cognitive behavioural therapy for bipolar disorder

Self-discrepancy in students with bipolar disorder II or NOS.

BACKGROUND: Studies on self-representation in bipolar disorder have mainly focused on the single dimension of self-esteem and recruited patients either in episode or in remission. The aim of the study was to examine multi-dimensional aspects of the self (discrepancy between actual- and ideal-selves and between actual- and feared-selves) in a student sample with a history of significant experience of hypomania (with or without experience of major depression) as compared to healthy control students. METHODS: Bipolar students and healthy control students completed the Self-Discrepancy Questionnaire (SDQ: Carver, Lawrence, and Scheier, 1999). The degree of similarity to, and the perceived likelihood of ideal-self and feared-self characteristics were assessed. RESULTS: The difference between the groups in level of ideal-self similarity was at trend level. Students with prior hypomania but no history of depression showed higher similarity to their feared-self than healthy controls and also rated themselves as more likely to have these feared-self characteristics in the future. LIMITATION: The small sample size, especially in the bipolar group with no history of depression, limits the power of the study. CONCLUSIONS: The presence of ideal-self discrepancy was not convincingly demonstrated in this sample and it is possible that where it has been identified in previous studies it may, at least in part, represent a scar of previous episodes of depression or mania rather than a predisposing factor. However a sub-sample of students who had experienced hypomania in the absence of history of depression were distinguished from healthy controls in perceived closeness to the feared-self qualities. The feared-self concept warrants further investigation in bipolar patients

Self-Organization in Bipolar Disorder: Replication of Compartmentalization and Self-Complexity

Remitted bipolar patients were compared to remitted unipolar patients and healthy controls on a self concept task assessing degree of self- compartmentalization (clustering of self-aspects based on valence) and self-complexity (the degree of relatedness versus differentiation across self-aspects). Similar to the findings of Taylor et al. (Cognitive Therapy and Research, 31(1), 83-96, 2007) the bipolar and unipolar groups showed higher levels of self compartmentalization than healthy controls. No differences were found on the self complexity measure. © 2010 Springer Science+Business Media, LLC

Extreme and conflicting appraisals of activated internal states discriminate remitted bipolar disorder from remitted unipolar depression and non-clinical controls.

Background This research aimed to test whether positive, negative, or conflicting appraisals about activated mood states (e.g., energetic and high states) predicted bipolar disorder. Methods A sample of individuals from clinical and control groups (171 with bipolar disorder, 42 with unipolar depression, and 64 controls) completed a measure of appraisals of internal states. Results High negative appraisals related to a higher likelihood of bipolar disorder irrespective of positive appraisals. High positive appraisals related to a higher likelihood of bipolar disorder only when negative appraisals were also high. Individuals were most likely to have bipolar disorder, as opposed to unipolar depression or no diagnosis, when they endorsed both extremely positive and extremely negative appraisals of the same, activated states. Limitations Appraisals of internal states were based on self-report. Conclusions The results indicate that individuals with bipolar disorder tend to appraise activated, energetic internal states in opposing or conflicting ways, interpreting these states as both extremely positive and extremely negative. This may lead to contradictory attempts to regulate these states, which may in turn contribute to mood swing symptoms. Psychological therapy for mood swings and bipolar disorder should address extreme and conflicting appraisals of mood states

Mindfulness-based Cognitive Therapy (MBCT) in bipolar disorder: Preliminary evaluation of immediate effects on between-episode functioning

BACKGROUND: Bipolar disorder is highly recurrent and rates of comorbidity are high. Studies have pointed to anxiety comorbidity as one factor associated with risk of suicide attempts and poor overall outcome. This study aimed to explore the feasibility and potential benefits of a new psychological treatment (Mindfulness-based Cognitive Therapy: MBCT) for people with bipolar disorder focusing on between-episode anxiety and depressive symptoms. METHODS: The study used data from a pilot randomized trial of MBCT for people with bipolar disorder in remission, focusing on between-episode anxiety and depressive symptoms. Immediate effects of MBCT versus waitlist on levels of anxiety and depression were compared between unipolar and bipolar participants. RESULTS: The results suggest that MBCT led to improved immediate outcomes in terms of anxiety which were specific to the bipolar group. Both bipolar and unipolar participants allocated to MBCT showed reductions in residual depressive symptoms relative to those allocated to the waitlist condition. LIMITATIONS: Analyses were based on a small sample, limiting power. Additionally the study recruited participants with suicidal ideation or behaviour so the findings cannot immediately be generalized to individuals without these symptoms. CONCLUSIONS: The study, although preliminary, suggests an immediate effect of MBCT on anxiety and depressive symptoms among bipolar participants with suicidal ideation or behaviour, and indicates that further research into the use of MBCT with bipolar patients may be warranted