Emotion regulation strategies in bipolar disorder: A systematic and critical review

Background Theoretical frameworks emphasise associations between interpretations and responses to affect and bipolar disorder (BD). This review (PROSPERO CRD42016043801) investigated which emotion regulation (ER) strategies have been applied to BD, are elevated in BD compared to clinical and non-clinical controls, and are associated with clinical and functional outcomes in BD Methods Search terms relating to emotion regulation, coping and bipolar disorder were entered into Embase, MedLine and PsycInfo. Quantitative studies investigating relationships between ER strategies and BD were eligible for this narrative synthesis Results A large volume of research (n = 47) investigated specific ER strategies in BD. Maladaptive strategies such as rumination and dampening were elevated in BD compared to controls and these particular strategies had a detrimental impact on outcomes such as mood symptoms. BD had a similar profile of ER strategies to unipolar depression, but there was limited comparison to other clinical groups. People with BD did not generally have deficits in using adaptive strategies, as evidenced by comparisons with controls and experimental studies Limitations Methodological heterogeneity and a lack of ecologically valid ER assessments Conclusions Empirical literature is critiqued in line with contemporary theories of BD and of emotion regulation more generally, in order to inform future research recommendations. This includes investigation of the importance of context in the impact of ER strategies, and discrepancies between trait and state use of ER strategies, particularly through experience sampling

The Cognitive Behavioural Processes Questionnaire: A Preliminary Analysis within Student, Mixed Clinical and Community Samples and the Identification of a Core Transdiagnostic Process

Theorists have highlighted the commonalities in cognitive and behavioural processes across multiple disorders i.e. transdiagnostic approach. We report two studies that tested the psychometric properties of a new scale to assess these processes. The Cognitive and Behavioural Processes Questionnaire (CBP-Q) was developed as a 15- item measure. In Study 1, the CBP-Q was administered to a student (n = 172) sample with a range of standardised measures of the processes and symptom measures. Study 2 repeated the evaluation in a mixed clinical group (n = 161) and a community control group (n = 57). An exploratory factor analysis resulted in a 12-item version of the CBPQ, consisting of a single factor. The measure demonstrated good internal consistency, test-retest stability and satisfactory convergent and divergent validity in both studies. Correlations with symptom-based measures showed increased engagement in these cognitive and behavioural processes to be associated with higher levels of symptomatology. The scale was elevated in the clinical relative to the community group and there were no differences in scores between broad diagnostic groupings (anxiety vs. mood vs. other). The CBP-Q has good psychometric properties. The findings are consistent with the transdiagnostic approach and indicate that a single, as yet unspecified factor may account for the shared variance across cognitive and behavioural maintenance processes

The relationship between internal conflict and well-being : a control theory perspective

This thesis explored the relevance of goal conflict for well-being and psychopathology. The thesis incorporates a comprehensive literature review, research into well-being, applied research concerning emotion- and behaviour- regulation difficulties including bipolar disorder, and two intervention studies. The literature review (Chapter 1) described four concepts related to goal conflict, clarified the state of the existing literature, and proposed a reconceptualisation of these four concepts within a hierarchical model. This review also highlighted important avenues for future research, and a number of these avenues were pursued in this thesis (Chapters 2-8). Study 1 tested the possibility that inconsistent findings in previous goal conflict studies might be due to interaction effects. The combination of high ambivalence and low goal conflict related to elevated depression symptoms in a student sample (Chapter 2). It was hypothesised that conflict between opposing goals might underlie a range of emotion- and behaviour-regulation difficulties, and two student studies supported this hypothesis. Individuals who held highly important, opposing goals for the regulation of six everyday emotions and behaviours reported more difficulties in managing these emotions and behaviours, in terms of self-ratings (Study 2) and scores on validated measures (Study 3). These difficulties related to general distress and lower well-being (Chapter 3). This form of conflict is potentially relevant in mood swings and bipolar disorder. An analogue study (Study 4) explored the relationship between mood symptoms and extreme positive and negative beliefs and appraisals of high, energetic states. Positive appraisals uniquely related to high, activated mood, whilst negative beliefs and appraisals of the same states uniquely related to depression (Chapter 4). It was hypothesised that conflict between these opposing appraisals might relate to bipolar disorder, which is characterised by both high and low mood. In Study 5, the combination of opposing extreme positive and extreme negative appraisals of the same internal states discriminated individuals with bipolar disorder from controls and from individuals with unipolar depression (Chapter 5). Tenacity in striving for one's goals and flexibility in disengaging from or adapting one's goals may enable the successful reorganisation of conflict when it arises, promoting long-term well-being. Study 6 examined these processes in a large, older adult sample. The combination of high tenacity in goal pursuit and high flexibility in goal adjustment predicted a number of aspects well-being at 10-year follow-up (Chapter 6). The final two studies involved investigations of therapeutic approaches to conflict. Study 7 found that an expressive writing intervention reduced the distress caused by ambivalent conflict in an analogue sample with varying levels of depression and anxiety symptoms (Chapter 7). In Study 8, individuals with various psychological difficulties received a form of cognitive therapy (Method of Levels) designed to facilitate awareness of higher-level goals and the resolution conflict. Therapist adherence, along with working alliance, predicted client readiness to change, and readiness predicted improvements in symptoms between therapy sessions (Chapter 8). Goal conflict seems to be important in determining distress and psychopathology, particularly in the context of emotion-regulation difficulties. Research would benefit from further exploration of therapeutic approaches which target internal goal conflict.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A guide to behavioural experiments in bipolar disorder

Behavioural experiments are an important component of cognitive-behavioural therapy. However, there exists little up-to-date guidance on how to conduct these in people with a diagnosis of bipolar disorder. This paper provides recommendations on how to conduct behavioural experiments in this population. The aim is to upskill and empower clinicians to conduct behavioural experiments. The paper combines the expertise of senior clinicians working in the United Kingdom. The article starts by providing general advice on conducting behavioural experiments in people with bipolar disorder. It then offers specific examples of behavioural experiments targeting cognitions around the uncontrollability and danger of affective states, and related behavioural strategies, which have been implicated in the maintenance of bipolar mood swings. The article finishes by providing examples of behavioural experiments for non-mood related difficulties that commonly occur with bipolar experiences including perfectionistic thinking, need for approval, and intrusive memories. Behavioural experiments offer a useful therapeutic technique for instigating cognitive and behavioural change in bipolar disorder. Conducted sensitively and collaboratively, in line with people's recovery-focused goals, behavioural experiments can be used to overcome mood- and non-mood related difficulties

Flexible and tenacious goal pursuit lead to improving well-being in an aging population: A ten-year cohort study

Background: Previous research has shown that tendencies to tenaciously pursue goals and flexibly adapt goals independently relate to well-being in adults in mid-to-late life, but research has not tested whether these tendencies interact. For example, tenacity may only predict well-being in combination with flexibility. This research tests whether these tendencies interact to predict changes in health-related outcomes. Methods: A large cohort of people (n=5,666), initially aged 55-56, completed measures of flexibility, tenacity, health-related outcomes (physical health, depression, hostility), as well as demographics. Participants provided follow-up data on all measures ten years later. Moderation analysis was used to test whether flexibility and tenacity interacted to predict changes in the health-related outcomes over the period. Results: The interaction between tenacity and flexibility significantly predicted changes in depression, hostility, and physical ill-health symptoms over ten years, such that highly flexible and tenacious individuals experienced the largest decreases in symptoms of depression, hostility, and physical ill-health. Conclusions: The interaction between flexibility and tenacity predicts greater well-being, such that one is most protective when an individual also scores highly on the other. The combination of flexibility and tenacity in the pursuit of personal goals may mean individuals can enjoy gains associated with goal pursuit without the detrimental effects of persevering in blocked goals

A test of the core process account of psychopathology in a heterogenous clinical sample of anxiety and depression: A case of the blind men and the elephant?

Many cognitive and behavioral processes, such as selective attention to threat, self-focused attention, safety-seeking behaviors, worry and thought suppression, have their foundations in research on anxiety disorders. Yet, they are now known to be transdiagnostic, i.e. shared across a wide range of psychological disorders. A more pertinent clinical and theoretical question is whether these processes are themselves distinct, or whether they reflect a shared 'core' process that maintains psychopathology. The current study utilized a treatment-seeking clinical adult sample of 313 individuals with a range of anxiety disorders and/or depression who had completed self-report measures of widely ranging processes: affect control, rumination, worry, escape/avoidance, and safety-seeking behaviors. We found that only the first factor extracted from a principal components analysis of the items of these measures was associated with symptoms of anxiety and depression. Our findings supported the 'core process' account that had its origins in the field of anxiety disorders, and we discuss the implications for theory, clinical practice and future research across psychological disorders

A novel cognitive behaviour therapy for bipolar disorders (Think Effectively About Mood Swings or TEAMS): study protocol for a randomized controlled trial

BACKGROUND: Existing psychological therapies for bipolar disorders have been found to have mixed results, with a consensus that they provide a significant, but modest, effect on clinical outcomes. Typically, these approaches have focused on promoting strategies to prevent future relapse. An alternative treatment approach, termed ‘Think Effectively About Mood Swings’ (TEAMS) addresses current symptoms, including subclinical hypomania, depression and anxiety, and promotes long-term recovery. Following the publication of a theoretical model, a range of research studies testing the model and a case series have demonstrated positive results. The current study reports the protocol of a feasibility randomized controlled trial to inform a future multi-centre trial. METHODS/DESIGN: A target number of 84 patients with a diagnosis of bipolar I or II disorder, or bipolar disorder not-otherwise-specified are screened, allocated to a baseline assessment and randomized to either 16 sessions of TEAMS therapy plus treatment-as-usual (TAU) or TAU. Patients complete self-report inventories of depression, anxiety, recovery status and bipolar cognitions targeted by TEAMS. Assessments of diagnosis, bipolar symptoms, medication, access to services and quality of life are conducted by assessors blind to treatment condition at 3, 6, 12 and 18 months post-randomization. The main aim is to evaluate recruitment and retention of participants into both arms of the study, as well as adherence to therapy, to determine feasibility and acceptability. It is predicted that TEAMS plus TAU will reduce self-reported depression in comparison to TAU alone at six months post-randomization. The secondary hypotheses are that TEAMS will reduce the severity of hypomanic symptoms and anxiety, reduce bipolar cognitions, improve social functioning and promote recovery compared to TAU alone at post-treatment and follow-up. The study also incorporates semi-structured interviews about the experiences of previous treatment and the experience of TEAMS therapy that will be subject to qualitative analyses to inform future developments of the approach. DISCUSSION: The design will provide preliminary evidence of efficacy, feasibility, acceptability, uptake, attrition and barriers to treatment to design a definitive trial of this novel intervention compared to treatment as usual. TRIAL REGISTRATION: This trial was registered with Current Controlled Trials (ISRCTN83928726) on registered 25 July 2014

Sensorimotor delays in tracking may be compensated by negative feedback control of motion-extrapolated position.

Funder: University of CambridgeSensorimotor delays dictate that humans act on outdated perceptual information. As a result, continuous manual tracking of an unpredictable target incurs significant response delays. However, no such delays are observed for repeating targets such as the sinusoids. Findings of this kind have led researchers to claim that the nervous system constructs predictive, probabilistic models of the world. However, a more parsimonious explanation is that visual perception of a moving target position is systematically biased by its velocity. The resultant extrapolated position could be compared with the cursor position and the difference canceled by negative feedback control, compensating sensorimotor delays. The current study tested whether a position extrapolation model fit human tracking of sinusoid (predictable) and pseudorandom (less predictable) targets better than the non-biased position control model, Twenty-eight participants tracked these targets and the two computational models were fit to the data at 60 fixed loop delay values (simulating sensorimotor delays). We observed that pseudorandom targets were tracked with a significantly greater phase delay than sinusoid targets. For sinusoid targets, the position extrapolation model simulated tracking results more accurately for loop delays longer than 120 ms, thereby confirming its ability to compensate for sensorimotor delays. However, for pseudorandom targets, this advantage arose only after 300 ms, indicating that velocity information is unlikely to be exploited in this way during the tracking of less predictable targets. We conclude that negative feedback control of position is a parsimonious model for tracking pseudorandom targets and that negative feedback control of extrapolated position is a parsimonious model for tracking sinusoidal targets