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Kautz MM, McArthur BA, Moriarity DP, Ellman LM, Klugman J, Coe CL, Abramson LY, Alloy LB. The Impact of Early and Recent Life Stress on Trajectories of Inflammatory Biomarkers in a Diverse Sample of Adolescents. Res Child Adolesc Psychopathol 2023; 51:1883-1894. [PMID: 36786893 PMCID: PMC10642298 DOI: 10.1007/s10802-023-01026-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/15/2023]
Abstract
Elevated inflammatory activity is one possible pathway through which exposure to childhood adversity engenders risk for physical and psychiatric illnesses. Limited research has investigated the compounding effects of childhood and adolescent stress exposure on changes in circulating levels of inflammatory biomarkers. This study assessed whether childhood adversity interacted with chronic or acute stress during adolescence to affect the temporal trajectories of five inflammatory biomarkers across at least three blood draws in a diverse sample of adolescents (N = 134; observations = 462). Using multilevel modeling, the interaction of childhood adversity, time, and within-person variance of acute stressors significantly predicted trajectories of higher interleukin-10 levels, controlling for demographics, medication use, and body mass index. Adolescents with high levels of childhood adversity who were exposed to a higher frequency of acute stressors compared to their own average rate of stress exposure consistently had higher levels of IL-10 as they got older, but those with average and below frequency of acute stressors had decreasing trajectories of log IL-10 as they matured. The results demonstrate how events early in life shape biological responses to the adolescent environment. This study also highlights the importance of developmental timing on the body's enhanced reactivity to acute and sustained stressors following childhood adversity.
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Affiliation(s)
- Marin M Kautz
- Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N. 13th St., Philadelphia, PA, 19122, USA
| | | | - Daniel P Moriarity
- Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N. 13th St., Philadelphia, PA, 19122, USA
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N. 13th St., Philadelphia, PA, 19122, USA
| | - Joshua Klugman
- Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N. 13th St., Philadelphia, PA, 19122, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, Wisconsin, USA
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, Wisconsin, USA
| | - Lauren B Alloy
- Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N. 13th St., Philadelphia, PA, 19122, USA.
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Palmer-Cooper EC, Woods C, Richardson T. The relationship between dysfunctional attitudes, maladaptive perfectionism, metacognition and symptoms of mania and depression in bipolar disorder: The role of self-compassion as a mediating factor. J Affect Disord 2023; 341:265-274. [PMID: 37633530 DOI: 10.1016/j.jad.2023.08.117] [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] [Received: 03/27/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Maladaptive cognitions appear to be associated with the severity of mood symptoms in bipolar disorder (BD), but findings are mixed and generally cross-sectional in design. METHOD This study (n = 331) explored the associations between maladaptive cognitions and mood symptoms in BD over time (3 months), and the potential mediating effect of self-compassion cross-sectionally. Dysfunctional attitudes, maladaptive perfectionism and maladaptive metacognitions were explored separately with depressive and manic symptoms, and with current mood state in BD. RESULTS The results showed maladaptive metacognitions to be the only significant predictor of depression at 3-month follow-up (β = 0.31, p < .001), with no relationship to mania over time. Cross-sectionally, self-compassion partially mediated the relationship between all maladaptive cognitions and depression, with higher dysfunctional cognitions and lower self-compassion predicting increased severity of depressive symptoms. Only the relationship between dysfunctional attitudes and mania was partially mediated by self-compassion, however, the relationship was weak and suggestive that higher self-compassion predicted increased mania. LIMITATIONS The study duration limited the possible analysis. Future longitudinal research is needed. Also, the study sample was not representative of the clinical population, making results less generalisable. Additionally, limited significant findings regarding manic symptoms supports the need for further research into active cognitions during this phase of BD. CONCLUSIONS Maladaptive metacognitions were predictive of future depression severity, therefore, further exploration of metacognitive therapy for BD should be explored. Furthermore, self-compassion was shown to partially mediate the relationship between negative cognitions and mood, therefore further exploration of compassion-based therapies for BD is needed.
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Affiliation(s)
- Emma C Palmer-Cooper
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Chloe Woods
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Thomas Richardson
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
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Strawbridge R, Alexander L, Richardson T, Young AH, Cleare AJ. Is there a 'bipolar iceberg' in UK primary care psychological therapy services? Psychol Med 2023; 53:5385-5394. [PMID: 35920607 PMCID: PMC10482719 DOI: 10.1017/s0033291722002343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Improving Access to Psychological Therapies (IAPT) is a primary care therapy service commissioned by England's National Health Service (NHS) for people with unipolar depression and anxiety-related disorders. Its scope does not extend to 'severe mental illness', including bipolar disorders (BD), but evidence suggests there is a high BD prevalence in ostensibly unipolar major depressive disorder (uMDD) samples. This study aimed to indicate the prevalence and characteristics of people with BD in a naturalistic cohort of IAPT patients. METHODS 371 participants were assessed before initiating therapy. Participants were categorised by indicated diagnoses: BD type-I (BD-I) or type-II (BD-II) as defined using a DSM diagnostic interview, bipolar spectrum (BSp, not meeting diagnostic criteria but exceeding BD screening thresholds), lifetime uMDD or other. Information about psychiatric history and co-morbidities was examined, along with symptoms before and after therapy. RESULTS 368 patients provided sufficient data to enable classification. 10% of participants were grouped as having BD-I, 20% BD-II, 40% BSp, 25% uMDD and 5% other. BD and uMDD participants had similar demographic characteristics, but patients meeting criteria for BD-I/BD-II had more complex psychiatric presentations. All three 'bipolar' groups had particularly high rates of anxiety disorders. IAPT therapy receipt was comparable between groups, as was therapy response (F9704 = 1.113, p = 0.351). CONCLUSIONS Notwithstanding the possibility that bipolar diathesis was overestimated, findings illustrate a high prevalence of BD in groups of people notionally with uMDD or anxiety. As well as improving the detection of BD, further substantive investigation is required to establish whether individuals affected by BD should be eligible for primary care psychological intervention.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laith Alexander
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Anthony J. Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
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Alloy LB, Walsh RFL, Smith LT, Maddox MA, Olino TM, Zee PC, Nusslock R. Circadian, Reward, and Emotion Systems in Teens prospective longitudinal study: protocol overview of an integrative reward-circadian rhythm model of first onset of bipolar spectrum disorder in adolescence. BMC Psychiatry 2023; 23:602. [PMID: 37592214 PMCID: PMC10436678 DOI: 10.1186/s12888-023-05094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Bipolar spectrum disorders (BSDs) are associated with a heightened sensitivity to rewards and elevated reward-related brain function in cortico-striatal circuitry. A separate literature documents social and circadian rhythm disruption in BSDs. Recently, integrated reward-circadian models of BSDs have been proposed. These models draw on work indicating that the two systems influence each other and interact to affect mood functioning. When dysregulated, reward and circadian system signaling may combine to form a positive feedback loop, whereby dysregulation in one system exacerbates dysregulation in the other. Project CREST (Circadian, Reward, and Emotion Systems in Teens) provides a first systematic test of reward-circadian dysregulation as a synergistic and dynamic vulnerability for first onset of BSD and increases in bipolar symptoms during adolescence. METHODS This NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 320 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13-16 years old, fluent in English, and without a prior BSD or hypomanic episode. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the high tail of the dimension in order to increase the likelihood of BSD onsets. At Times 1-6, every 6 months, participants will complete assessments of reward-relevant and social rhythm disruption life events and self-report and diagnostic assessments of bipolar symptoms and episodes. Yearly, at Times 1, 3, and 5, participants also will complete self-report measures of circadian chronotype (morningness-eveningness) and social rhythm regularity, a salivary dim light melatonin onset (DLMO) procedure to assess circadian phase, self-report, behavioral, and neural (fMRI) assessments of monetary and social reward responsiveness, and a 7-day ecological momentary assessment (EMA) period. During each EMA period, participants will complete continuous measures of sleep/wake and activity (actigraphy), a daily sleep diary, and three within-day (morning, afternoon, evening) measures of life events coded for reward-relevance and social rhythm disruption, monetary and social reward responsiveness, positive and negative affect, and hypo/manic and depressive symptoms. The fMRI scan will occur on the day before and the DLMO procedure will occur on the first evening of the 7-day EMA period. DISCUSSION This study is an innovative integration of research on multi-organ systems involved in reward and circadian signaling in understanding first onset of BSD in adolescence. It has the potential to facilitate novel pharmacological, neural, and behavioral interventions to treat, and ideally prevent, bipolar conditions.
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Affiliation(s)
- Lauren B Alloy
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA.
| | - Rachel F L Walsh
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Logan T Smith
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Mackenzie A Maddox
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, USA
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, USA
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Alloy LB, Chat IKY, Grehl MM, Stephenson AR, Adogli ZV, Olino TM, Ellman LM, Miller GE, Nusslock R. Reward and Immune Systems in Emotion (RISE) prospective longitudinal study: Protocol overview of an integrative reward-inflammation model of first onset of major depression in adolescence. Brain Behav Immun Health 2023; 30:100643. [PMID: 37304334 PMCID: PMC10250584 DOI: 10.1016/j.bbih.2023.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
Background Depression is associated with a reduced sensitivity to rewards and low reward-related brain function in cortico-striatal circuitry. A separate literature documents elevated peripheral inflammation in depression. Recently, integrated reward-inflammation models of depression have been proposed. These models draw on work indicating that peripheral inflammatory proteins access the brain, where they lower reward responsiveness. This blunted reward responsiveness is proposed to initiate unhealthy behaviors (substance use, poor diet), as well as sleep disruption and stress generation, which further heighten inflammation. Over time, dysregulation in reward responsiveness and immune signaling may synergize in a positive feedback loop, whereby dysregulation in each system exacerbates dysregulation in the other. Project RISE (Reward and Immune Systems in Emotion) provides a first systematic test of reward-immune dysregulation as a synergistic and dynamic vulnerability for first onset of major depressive disorder and increases in depressive symptoms during adolescence. Methods This NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 300 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13-16 years old, fluent in English, and without a prior major depressive disorder. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the low tail of the dimension in order to increase the likelihood of major depression onsets. At Time 1 (T1), T3, and T5, each a year apart, participants complete blood draws to quantify biomarkers of low-grade inflammation, self-report and behavioral measures of reward responsiveness, and fMRI scans of reward neural activity and functional connectivity. At T1-T5 (with T2 and T4 six months between the yearly sessions), participants also complete diagnostic interviews and measures of depressive symptoms, reward-relevant life events, and behaviors that increase inflammation. Adversity history is assessed at T1 only. Discussion This study is an innovative integration of research on multi-organ systems involved in reward and inflammatory signaling in understanding first onset of major depression in adolescence. It has the potential to facilitate novel neuroimmune and behavioral interventions to treat, and ideally prevent, depression.
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Affiliation(s)
- Lauren B. Alloy
- Department of Psychology and Neuroscience, Temple University, USA
| | - Iris K.-Y. Chat
- Department of Psychology and Neuroscience, Temple University, USA
| | - Mora M. Grehl
- Department of Psychology and Neuroscience, Temple University, USA
| | | | - Zoe V. Adogli
- Department of Psychology and Neuroscience, Temple University, USA
| | - Thomas M. Olino
- Department of Psychology and Neuroscience, Temple University, USA
| | - Lauren M. Ellman
- Department of Psychology and Neuroscience, Temple University, USA
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Fassett-Carman AN, Moser AD, Ruzic L, Neilson C, Jones J, Barnes-Horowitz S, Schneck CD, Kaiser RH. Amygdala and nucleus accumbens activation during reward anticipation moderates the association between life stressor frequency and depressive symptoms. J Affect Disord 2023; 330:309-318. [PMID: 36871909 PMCID: PMC10695433 DOI: 10.1016/j.jad.2023.02.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Life stressors confer risk for depressive symptoms, but individuals vary in the extent of their sensitivity to life stressors. One protective factor may be an individual's level of reward sensitivity, e.g., a stronger neurobiological response to environmental rewards may mitigate emotional responses to stressors. However, the nature of neurobiological reward sensitivity that corresponds with stress resilience is unknown. Further, this model is untested in adolescence, when life stressor frequency and depression increase. METHODS We tested the hypothesis that stronger reward-related activation in the left and right nucleus accumbens (NAc), amygdala, and medial prefrontal cortex (mPFC) attenuates the strength of the stress-depression relation. We measured BOLD activation throughout Win and Lose blocks of a monetary reward task, as well as during anticipation and outcome phases of the task. Participants (N = 151, ages 13-19) were recruited to be stratified on risk for mood disorders to enhance variance in depressive symptoms. RESULTS Activation during anticipation of rewards in the bilateral amygdala and NAc, but not mPFC, buffered the association between life stressors and depressive symptoms. This buffering effect was not found for reward outcome activation or activation across Win blocks. CONCLUSIONS Results highlight the importance of reward anticipation activation of subcortical structures in attenuating the stress-depression link, suggesting that reward motivation may be a cognitive mechanism through which this stress buffering occurs.
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Affiliation(s)
| | - Amelia D Moser
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States of America
| | - Luka Ruzic
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States of America
| | - Chiara Neilson
- University of Colorado Boulder, Department of Psychology and Neuroscience, United States of America
| | - Jenna Jones
- University of Colorado Boulder, Institute of Cognitive Science, United States of America
| | - Sofia Barnes-Horowitz
- University of Colorado Boulder, Renée Crown Wellness Institute, United States of America
| | - Christopher D Schneck
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States of America
| | - Roselinde H Kaiser
- University of Colorado Boulder, Institute of Cognitive Science, United States of America; University of Colorado Boulder, Department of Psychology and Neuroscience, United States of America
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Tiba AI, Trip S, Bora CH, Drugas M, Borz F, Miclăuş DC, Voss L, Iova SC, Pop S. Positive irrational beliefs are associated with hypomanic personality. Front Psychol 2023; 14:1053486. [PMID: 37020915 PMCID: PMC10067582 DOI: 10.3389/fpsyg.2023.1053486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/06/2023] [Indexed: 03/22/2023] Open
Abstract
Primary irrational beliefs, such as demanding about attaining personal goals, are a common trans-diagnostic factor involved in many emotional disorders. Although Bipolar Disorder (BPD) is a severe emotional disorder, little is known about the role of primary irrational beliefs in the risk of BPD. Given that the risk for mania is related to responses to positive rather than adverse events, we developed a measure of irrational beliefs in response to cues of positive events. This is the first study that examines the relationship between positive primary irrational beliefs and the risk of BPD. 119 participants completed an online survey including measures for the risk of BPD, irrational beliefs, positive irrational beliefs, mania-related cognitions, and mood measures (depressive and manic mood). Results revealed significant associations between the risk of BPD and positive primary irrational beliefs, irrational beliefs, positive generalization, and mood. Regression analyses revealed that positive primary irrational beliefs, such as demanding to attain significant goals in response to cues for positive events, uniquely predict the risk for BPD independently of mood, mania-related cognitions and irrational beliefs. These findings encourage the treatment approaches focused on restructuring primary irrational beliefs in response to positive situations to reduce the risk of BPD.
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Affiliation(s)
| | - Simona Trip
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Carmen H. Bora
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Marius Drugas
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Feliciana Borz
- Department of Psychology, University of Oradea, Oradea, Romania
| | | | - Laura Voss
- Hull York Medical School, Hull, United Kingdom
| | - Sorin C. Iova
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Simona Pop
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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Moriarity DP, Kautz MM, Ghias K, Pennypacker K, Harmon-Jones E, Alloy LB. Protocol for project MIME: Motivation, inflammation, and Mood in Emerging Adults. Brain Behav Immun Health 2022; 26:100520. [PMID: 36187406 PMCID: PMC9523276 DOI: 10.1016/j.bbih.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background Atypical inflammatory biology is gaining evidence as a risk factor for mood psychopathology; however, little work has attempted to integrate inflammation into extant psychosocial frameworks of risk. Recent work using secondary data analysis has investigated the possibility of an immunocognitive model of mood disorders, in which cognitive vulnerabilities (i.e., rumination on positive or negative affect) increase the effect that arousal-related characteristics (e.g., reward sensitivity) have on inflammatory biology in ways that may confer risk for depression and hypo/mania symptoms. Project MIME (Motivation, Inflammation, and Mood in Emerging Adults) was designed to test this model in the context of a novel, reward-salient stressor (the Anger Incentive Delay Task, AIDT). Methods This NIMH-funded study will result in a dataset of approximately 100 college undergraduates from a large university in Pennsylvania, United States of America. Eligible participants are recruited from an online screener, have to be 18–22 years old, fluent in English, and successfully answer several items designed to test whether participants randomly answer questions on the screener. Eligible participants are invited to an in-person visit in which they completed the AIDT, blood draws pre- and 50 minutes post-AIDT, and self-report questionnaires. Participants also complete a set of online questionnaires two weeks after the in-person visit. Discussion Consistent with calls from the NIH director, this study seeks to diversify the tools used in stress research by validating a novel reward-salient stressor (in contrast to the field's reliance on social stressors) with respect to affective and immunological stress reactivity. In addition to this methodological goal, Project MIME is the first study specifically designed to test the immunocognitive model of mood psychopathology. Given the integration of several malleable treatment targets (approach behavior, emotion regulation, inflammation) into this model, results from this study could inform comprehensive, flexible intervention strategies for mood disorder prevention and treatment.
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Social and environmental variables as predictors of mania: a review of longitudinal research findings. DISCOVER MENTAL HEALTH 2022; 2:7. [PMID: 35310132 PMCID: PMC8918447 DOI: 10.1007/s44192-022-00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 10/31/2022]
Abstract
AbstractConsiderable evidence suggests that psychosocial variables can shape the course of bipolar disorder. Here, though, we focus on the more specific idea that the social environment can predict the course of mania. We systematically review evidence from longitudinal studies concerning how social support, family interactions, traumatic life events, and recent life events relate to the age of onset, the frequency of episode recurrence, and the severity of manic symptoms. Although we find some evidence that the course of mania can be worsened by social environmental factors, the links are specific. Among social variables, some studies indicate that conflict and hostility are predictive, but more general social relationship qualities have not been found to predict mania. Some research indicates that childhood trauma, and recent life events involving goal attainment or sleep disruption can predict mania. Taken together, the profile of variables involving recent exposure that are most predictive include those that are activating, reward-related, or sleep-disrupting, which fits with general psychological hypotheses of behavioral activation and sleep disruption as important for mania. We discuss gaps in the literature, and we note future directions for research, including the need for more integrative, longitudinal research on a fuller range of social and biological risk variables.
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Chat IKY, Dunning EE, Bart CP, Carroll AL, Grehl MM, Damme KS, Abramson LY, Nusslock R, Alloy LB. The Interplay between Reward-Relevant Life Events and Trait Reward Sensitivity in Neural Responses to Reward Cues. Clin Psychol Sci 2022; 10:869-884. [PMID: 36381350 PMCID: PMC9662616 DOI: 10.1177/21677026211056627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
The reward hypersensitivity model posits that trait reward hypersensitivity should elicit hyper/hypo approach motivation following exposure to recent life events that activate (goal-striving and goal-attainment) or deactivate (goal-failure) the reward system, respectively. To test these hypotheses, eighty-seven young adults with high (HRew) versus moderate (MRew) trait reward sensitivity reported frequency of life events via the Life Event Interview. Brain activation was assessed during the fMRI Monetary Incentive Delay task. Greater exposure to goal-striving events was associated with higher nucleus accumbens (NAc) reward anticipation among HRew participants and lower orbitofrontal cortex (OFC) reward anticipation among MRew participants. Greater exposure to goal-failure events was associated with higher NAc and OFC reward anticipation only among HRew participants. This study demonstrated different neural reward anticipation (but not outcome) following reward-relevant events for HRew versus MRew individuals. Trait reward sensitivity and reward-relevant life events may jointly modulate reward-related brain function, with implications for understanding psychopathology.
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Affiliation(s)
- Iris Ka-Yi Chat
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Erin E. Dunning
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Corinne P. Bart
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Ann L. Carroll
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Mora M. Grehl
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | | | | | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Lauren B. Alloy
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
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Kaźmierczak I, Sarzyńska-Wawer J, Wawer A, Chądzyńska M. Describing a critical life event and its psychological consequences: The type of language used by patients suffering from depression and its relationship with personality development. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractInformation on personality development (and its linguistic predictors) in the aftermath of a critical life event among depressive patients is relatively limited. The study’s aim was to verify two hypotheses: (1) Participants with depression will use concrete rather than abstract language to describe their most recent critical life event and its psychological consequences and (2) The more abstract the language used, the higher the level of personality development. 16 Cognitive Behavioral Therapy patients suffering from depression participated in the study (M = 34 years old; SD = 4.02). Their level of personality development was assessed qualitatively by two independent coders. The coding system was based on the Positive Disintegration Theory (Dąbrowski 1964). We used typology from the Linguistic Category Model (Semin and Fiedler 1991) to analyse the level of abstractness vs. concreteness. Depressed patients were classified as either abstract language speakers or concrete language speakers. There were equal numbers of both types of speakers. Moreover participants consistently used one type of language, regardless of whether they were describing the critical life event itself or its psychological consequences. As expected, using higher levels of language abstractness when speaking correlated with possessing higher levels of personality development. Our findings provide practitioners with useful knowledge on the benefits of using abstract language to improve supportive strategies when dealing with people in crisis and modify the psychotherapeutic protocols used to treat depression.
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Dempsey RC, Eardley K, Dodd AL. The role of tenacious versus flexible goal pursuit in the vulnerability to bipolar disorder. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractThe vulnerability to bipolar disorder is characterized by dysregulated goal-related behavior, the setting of ambitious and extreme goals, and increases in goal approach behaviors. To date, no studies have investigated the nature of goal pursuit behaviors amongst individuals at a behavioral risk for bipolar disorder in terms of whether goal pursuit is characterized by a tenacious active striving for goals or a more flexible changeable focus on goals. A non-clinical sample of 168 participants completed online measures of mood, bipolar-vulnerability, reward sensitivity, goal-related perfectionist tendencies, tenacious goal pursuit and flexible goal adjustment behaviors. Our findings demonstrate that bipolar-vulnerability is characterized by the tenacious, not flexible, pursuit of goals, in combination with low regulation of goal behavior, and tendencies towards narcissistic and self-critical perfectionism indicative of setting high ambitious standards and making overly harsh self-judgments when such standards are not met. These findings are similar to those from clinical bipolar samples where there is evidence of prolonged symptom recoveries after the experience of goal frustrations and failures. Reducing the tenacious, active striving for goals amongst at-risk individuals may be a potential avenue for early intervention.
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Chan SHW, Yu CH, Liu KHK, Lau C, Fung AOY, Tse S. Evaluating the emotion regulation of positive mood states among people with bipolar disorder using hierarchical clustering. World J Psychiatry 2021; 11:619-634. [PMID: 34631465 PMCID: PMC8474994 DOI: 10.5498/wjp.v11.i9.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/25/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with bipolar disorder (BD) frequently struggle with the recurrence of affective symptoms. However, the interplay between coping mechanism and positive mood state remains under-researched.
AIM To explore the associations among behavioral approach system (BAS) sensitivity level, coping, and positive mood states among people with BD.
METHODS Using a cross-sectional study design, 90 participants with BD were presented with four BAS-activating life event scenarios and assessed with regard to their BAS trait sensitivity, coping flexibility, and mood states. A hierarchical clustering method was used to identify different groups with different styles of coping. Multiple hierarchical regression analyses were conducted to examine the mediating and moderating roles of different components of coping on mood states.
RESULTS A three-cluster solution was found to best fit the present data set. The findings showed that a low mass of coping combined with low BAS sensitivity level protects people with BD from detrimentally accentuating mood states when they encounter BAS-activating life events. Moreover, coping flexibility is demonstrated to mediate and moderate the relationships between BAS sensitivity level and mood states. Specifically, subduing the perceived controllability and reducing the use of behavioral-activation/emotion-amplifying coping strategies could help buffer the effect of positive affect.
CONCLUSION The judicious use of coping in emotion regulation for people with BD when encountering BAS-activating life events was indicated. Practical applications and theoretical implications are highlighted.
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Affiliation(s)
- Sunny Ho-Wan Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chong Ho Yu
- School of Behavioral and Applied Science, Azusa Pacific University, Azusa, CA 91702, United States
| | - Ken Ho Kan Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Charlie Lau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Anna On Yee Fung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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14
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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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15
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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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16
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Kim BN. Behavioral activation system (BAS) dysregulation and bipolar spectrum psychopathology in daily life: An online-diary study. Psychiatry Res 2020; 291:113180. [PMID: 32544707 DOI: 10.1016/j.psychres.2020.113180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 01/15/2023]
Abstract
Dysregulation of the behavioral activation system (BAS) has been theorized to be a core factor underlying mood swings in bipolar disorder (BD). However, few studies have directly addressed BAS dysregulation and more research is needed to understand its dynamic expression in daily life. The aim of this study was to directly assess BAS dysregulation, and to examine its moderating effect on the relationship between life events and bipolar spectrum symptoms via multilevel modeling. Korean young adults (n = 100) were screened using the Hypomanic Personality Scale (HPS) from a large sample (N = 1,591). They completed online diaries for 7 consecutive days including the Daily Events Record as well as bipolar spectrum symptoms. BAS-activating and/or -deactivating scores were allocated to each reported life event by an expert consensus rating. Cross-level interaction analysis showed that the occurrence of BA life events contributed to a steeper increase in bipolar spectrum symptoms, particularly for individuals with high BAS dysregulation. The present study suggests that BAS dysregulation is a unique construct that deserves further exploration in BD.
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Affiliation(s)
- Bin-Na Kim
- Department of Psychology, Seoul National University, Gwanakro 1, Gwanak-Gu, Seoul151-746, South Korea; Department of Psychology, Gachon University, Seongnam-daero 1342, Sujeong-gu, Seongnam, Gyeonggi-do, South Korea.
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17
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Kautz MM, Coe CL, McArthur BA, Mac Giollabhui N, Ellman LM, Abramson LY, Alloy LB. Longitudinal changes of inflammatory biomarkers moderate the relationship between recent stressful life events and prospective symptoms of depression in a diverse sample of urban adolescents. Brain Behav Immun 2020; 86:43-52. [PMID: 30822466 PMCID: PMC6710165 DOI: 10.1016/j.bbi.2019.02.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/23/2018] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
This study investigated whether longitudinal changes in inflammatory physiology moderated the relationship between recent stressful life events and subsequent depressive symptoms in adolescence. A diverse sample of adolescents representative of an urban community (N = 129; Age at baseline = 12.5 years; 48.8% female; 55.0% African American) completed measures of stressful life events, depressive symptoms, and two annual blood draws (BD1 and BD2). Controlling for inflammatory activity at BD1, depression at BD1, demographics and the time between assessments, increases in interleukin-6 (IL-6; b = 0.878, p = .007) and C-reactive protein (CRP; b = 0.252, p = .024) from BD1 to BD2 interacted with recent stressful life events before BD1 to predict severity of depressive symptoms at BD2. Similar associations were evident for IL-6 (b = 2.074, p = .040) and CRP (b = 0.919, p = .050) when considering acute stressful life events that had occurred within the two weeks before the first blood collection. More frequent stressful life events before BD1 predicted significantly more severe depressive symptoms at BD2, but only for adolescents with moderate (50th percentile) and high (84th percentile) levels of IL-6 and CRP at BD2. In conclusion, adolescents who experienced both recent stressful life events and larger increases in inflammatory activity following these stressors were at increased risk for more severe depressive symptoms after approximately one year. The findings indicate that the interaction of stress and larger changes in inflammatory activity following these stressors are prognostic risk factors for depression severity in adolescents.
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Affiliation(s)
- Marin M Kautz
- Department of Psychology, Temple University, United States
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, United States
| | | | | | | | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, United States
| | - Lauren B Alloy
- Department of Psychology, Temple University, United States.
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18
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Leboeuf I, Mahanga J, Rusinek S, Delamillieure P, Gheysen F, Andreotti E, Antoine P. Validation of the French version of the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. Stress Health 2020; 36:31-36. [PMID: 31714019 DOI: 10.1002/smi.2909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/05/2019] [Accepted: 10/28/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Self-criticism and self-reassurance are internal processes of self-to-self relating that have received increasing attention in psychology. The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS), which was first studied by Gilbert, Clarke, Hempel, Miles, and Irons, is a self-report instrument that has been used in various populations and has shown satisfactory reliability. The goal of this work is to explore the psychometric properties of a French version of the scale in a large nonclinical sample. METHOD Data from 285 nonclinical participants were analysed. RESULTS Confirmatory factor analysis indicated an acceptable to good fit of the FSCRS items to a three-factor model. Good internal consistency and convergent validity were found. CONCLUSIONS The French validation results corroborate previous findings in a nonclinical population and confirm that the French version of the FSCRS is a robust and reliable instrument.
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Affiliation(s)
- Isabelle Leboeuf
- CNRS, UMR 9193-SCALab-Sciences Cognitives et Sciences Affectives, Univ. Lille, Lille, France
| | - Julianna Mahanga
- Psychologie: Interactions Temps Emotions Cognitions (PSITEC), Université de Lille Nord De France, Villeneuve d'Ascq, France
| | - Stéphane Rusinek
- Psychologie: Interactions Temps Emotions Cognitions (PSITEC), Université de Lille Nord De France, Villeneuve d'Ascq, France
| | - Pascal Delamillieure
- Service de Psychiatrie Adulte, CHU de Caen Normandie, Caen, France.,UNICAEN, UFR de Médecine (Medical School), Normandie Univ, Caen, France.,Compassionate Mind Foundation France, Caen, France
| | - Francis Gheysen
- Service de Psychiatrie Adulte, CHU de Caen Normandie, Caen, France.,Compassionate Mind Foundation France, Caen, France
| | - Eva Andreotti
- CNRS, UMR 9193-SCALab-Sciences Cognitives et Sciences Affectives, Univ. Lille, Lille, France
| | - Pascal Antoine
- CNRS, UMR 9193-SCALab-Sciences Cognitives et Sciences Affectives, Univ. Lille, Lille, France
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19
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Löw CA, Schauenburg H, Dinger U. Self-criticism and psychotherapy outcome: A systematic review and meta-analysis. Clin Psychol Rev 2019; 75:101808. [PMID: 31864153 DOI: 10.1016/j.cpr.2019.101808] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 11/06/2019] [Accepted: 11/16/2019] [Indexed: 12/14/2022]
Abstract
Self-criticism involves constant and harsh self-scrutiny, overly critical evaluations of one's own behavior, and negative reactions to perceived failures in terms of active self-bashing. Self-criticism is associated with various mental disorders and psychotherapy outcome. This paper provides (1) a meta-analysis of the association between pre-treatment self-criticism and multiple treatment outcomes, and (2) a systematic review of the association between change in self-criticism and therapy outcome. Based on a systematic literature search, 49 longitudinal studies (56 independent effect sizes; 3277 patients) were included in the meta-analysis and 7 studies were identified for the additional systematic review. A random-effects meta-analysis was performed to assess the magnitude of the association between self-criticism and outcome, also considering potential moderators. The overall association between pre-treatment self-criticism and psychotherapy outcome was r = -.20 (95% CI = -.25 - -.16, p < .0001), suggesting that higher levels of self-criticism are related to poorer outcome. Although effect sizes showed little heterogeneity, the association varied by type of mental health problem and indicated stronger associations with certain disorders (e.g., eating disorders). The review based on change scores yielded inconsistent results. Our findings support the relevance of self-criticism for psychotherapy outcome.
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20
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Bart CP, Abramson LY, Alloy LB. Impulsivity and Behavior-Dependent Life Events Mediate the Relationship of Reward Sensitivity and Depression, but Not Hypomania, Among at-Risk Adolescents. Behav Ther 2019; 50:531-543. [PMID: 31030871 PMCID: PMC6494114 DOI: 10.1016/j.beth.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both reward sensitivity and impulsivity are related to the development and course of bipolar spectrum disorders (BSDs) and have been implicated in other disorders and negative functional outcomes such as substance abuse, obesity, suicidal behaviors, and risk-taking. Furthermore, according to the transactional component of the Behavioral Approach System (BAS)/reward hypersensitivity theory of BSDs, people with reward hypersensitivity should experience more BAS-relevant events, and thus, are more vulnerable to mood symptoms and episodes via stress generation. Impulsivity may exacerbate stress generation in individuals at risk for BSDs based on exhibiting reward hypersensitivity. The current study examined whether impulsivity explained the generation of stress and subsequent mood symptoms beyond what is explained by reward sensitivity alone. Participants were 131 Moderate BAS and 216 High BAS sensitivity adolescents (M = 18.43 years, SD = 1.40), who completed baseline measures of reward sensitivity and impulsivity, as well as follow-up measures of life events and mood symptoms. Results from linear regression analyses indicated that higher baseline impulsivity predicted behavior-dependent, but not behavior-independent, life events. Furthermore, path analyses suggested that the effect of BAS group on depression symptoms at next follow-up was partly explained via the indirect effect of impulsivity and negative behavior-dependent life events. We did not find these effects for behavior-independent or positive-dependent events or for prediction of hypomanic symptoms. The findings suggest that impulsivity may account for stress generation of negative events that precede depression.
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Affiliation(s)
- Corinne P. Bart
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lyn Y. Abramson
- Department of Psychology, University of Wisconsin-Madison, Madison, WI
| | - Lauren B. Alloy
- Department of Psychology, Temple University, Philadelphia, PA
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21
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Fletcher K, Yang Y, Johnson SL, Berk M, Perich T, Cotton S, Jones S, Lapsley S, Michalak E, Murray G. Buffering against maladaptive perfectionism in bipolar disorder: The role of self-compassion. J Affect Disord 2019; 250:132-139. [PMID: 30852365 DOI: 10.1016/j.jad.2019.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Maladaptive perfectionism is a transdiagnostic risk and maintaining factor for a range of mental health conditions, including bipolar disorder (BD). Self-compassion represents a potential protective factor against maladaptive perfectionism, however no studies to date have examined the relationship of these constructs in BD. The aim of the present study was to examine associations between maladaptive perfectionism, self-compassion and symptoms among individuals with BD. METHODS Baseline data were collected from 302 participants with a DSM-IV diagnosis of BD participating in an international randomised controlled trial. Participants completed measures of maladaptive perfectionism, self-compassion, symptom severity and emotion regulation difficulties. Clinician-administered measures of depression and mania severity were additionally collected. Correlation and mediation analyses were conducted. RESULTS Maladaptive perfectionism was positively associated with depression, anxiety and emotion regulation difficulties. Lower levels of self-compassion correlated with greater self-reported depression, anxiety and emotion regulation difficulties. Self-compassion partially mediated relationships between maladaptive perfectionism, depression, anxiety and emotion regulation difficulties. LIMITATIONS The cross-sectional design limits conclusions about causal relationships between study variables. Results may not be generalizable to other BD populations. The role of maladaptive perfectionism and self-compassion in elevated mood states of BD remains unclear. CONCLUSION Self-compassion represents one mechanism through which maladaptive perfectionism influences symptoms of depression, anxiety and emotion regulation difficulties in BD. Self-compassion represents a modifiable treatment target; individuals with BD exhibiting maladaptive perfectionistic tendencies may benefit from interventions fostering self-compassion.
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Affiliation(s)
- Kathryn Fletcher
- Centre for Mental Health, Swinburne University, Melbourne, Australia.
| | - Yan Yang
- Centre for Mental Health, Swinburne University, Melbourne, Australia
| | | | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, Melbourne, Australia
| | - Tania Perich
- Western Sydney University, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sue Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sara Lapsley
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Erin Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Greg Murray
- Centre for Mental Health, Swinburne University, Melbourne, Australia
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22
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Ironside ML, Johnson SL, Carver CS. Identity in bipolar disorder: Self-worth and achievement. J Pers 2019; 88:45-58. [PMID: 30714166 DOI: 10.1111/jopy.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/10/2018] [Accepted: 01/27/2019] [Indexed: 12/17/2022]
Abstract
This article considers self and self-concept in bipolar disorder. Bipolar disorder, defined on the basis of manic symptoms, is a highly debilitating psychopathology. It is heavily grounded in biology but symptom course is still very responsive to psychological and social forces in the lives of persons who have the disorder. This review assumes an overall view of the self that is typical of personality psychology: self as traits, self as goals and aspirations, and ongoing efforts to attain those goals. In this review, we will discuss two different facets of self and identity in bipolar disorder. First, we review a body of goal pursuit literature suggesting that persons with bipolar disorder endorse heightened ambitions for attaining goals and recognition from others. Second, we will review multiple findings which suggest that among persons with bipolar disorder, self-worth depends on measurable success in an extreme way. We will consider how the intersection of these two themes may lead to unique identity challenges for people with bipolar disorder, drawing from self-report, behavioral, and neuroscience findings to critically examine this viewpoint.
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Affiliation(s)
- Manon L Ironside
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Charles S Carver
- Department of Psychology, University of Miami, Coral Gables, Florida
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23
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Chan SHW, Tse S. An explorative study on coping flexibility with behavioral approach system-activating stimuli: A comparison of people with and without bipolar disorder. Psychiatry Res 2018; 269:399-407. [PMID: 30173047 PMCID: PMC7112654 DOI: 10.1016/j.psychres.2018.08.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 06/26/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022]
Abstract
Life events play a significant role in affecting mood symptoms of people with bipolar disorder (BD). However, we lack empirical data about the associations among disorder, mood state, behavioral activation system (BAS) sensitivity, and psychosocial functioning level. Thus, the present study aimed to identify the role of coping flexibility with BAS activating stimuli in relation to mood states among a sample of individuals with BD (n = 90) and a healthy control group (n = 90). Through multiple regressions, the moderating role of coping flexibility was determined. Findings showed that coping flexibility had an additional value in predicting mood states beyond BAS sensitivity and psychosocial functioning level. Specifically, perceived controllability was considerably important for the BD group, whereas fit index was crucial in the controls. In addition, a moderation analysis showed that perceived controllability alleviated the effects of BD diagnosis, BAS sensitivity, and psychosocial functioning level on mood states. Theoretically, this study helps integrate the concept of coping flexibility into the BAS dysregulation theory as it applies to BD. The practical implication for enhancing mindfulness practice is also discussed.
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Affiliation(s)
- Sunny H W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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24
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25
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Chan SHW, Tse S. Coping with amplified emotionality among people with bipolar disorder: A longitudinal study. J Affect Disord 2018; 239:303-312. [PMID: 30031250 DOI: 10.1016/j.jad.2018.07.025] [Citation(s) in RCA: 2] [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: 02/15/2018] [Revised: 05/20/2018] [Accepted: 07/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The amplified emotionality characteristics of bipolar disorder (BD) may interfere with goal pursuit in the recovery process. This is the first study to test the coping flexibility model empirically among people with BD. Finding ways to cope with goal-striving life events should shed light on managing elevated mood states. METHODS Using a 12-month longitudinal follow-up design, this study examined the stability in coping flexibility with experimentally-devised Behavioral Approach System (BAS) activating life events and mood states at 6- and 12-month time points for individuals with BD (n = 83) and healthy controls (n = 89). Hierarchical linear modeling tested the individual growth model by studying the longitudinal data. RESULTS The findings showed fluctuations in different components of coping flexibility and mood states across time. They confirmed the amplified emotionality characteristics of BD. Moreover, coping flexibility took precedence over BAS sensitivity and psychosocial functioning levels in predicting mood states. LIMITATIONS Measurements of BAS sensitivity may focus on trait nature only and prone to subjective bias. The assessment of mood or coping flexibility may not accurately capture actual experience in daily life. Lack of respective data on bipolar subtypes and significant differences in some dimensions between the BD and control groups are further limitations of the study. CONCLUSIONS The study's findings have implications for coping with amplified emotionality within the personal recovery process for people with BD. Judicious application of coping strategies and adjustment of perceived controllability are crucial for individuals to reach goals pertinent to personal recovery and manage potential manic mood symptoms.
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Affiliation(s)
- Sunny H W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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26
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McIntyre R, Smith P, Rimes KA. The role of self-criticism in common mental health difficulties in students: A systematic review of prospective studies. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mhp.2018.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Titone MK, Freed RD, O'Garro-Moore JK, Gepty A, Ng TH, Stange JP, Abramson LY, Alloy LB. The role of lifetime anxiety history in the course of bipolar spectrum disorders. Psychiatry Res 2018; 264:202-209. [PMID: 29653349 PMCID: PMC5972058 DOI: 10.1016/j.psychres.2018.03.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/13/2018] [Accepted: 03/31/2018] [Indexed: 12/20/2022]
Abstract
Individuals with bipolar spectrum disorder (BSD) frequently meet criteria for comorbid anxiety disorders, and anxiety may be an important factor in the etiology and course of BSDs. The current study examined the association of lifetime anxiety disorders with prospective manic/hypomanic versus major depressive episodes. Participants were 244 young adults (aged 17-26) with milder forms of BSDs (i.e., bipolar-II, cyclothymia, BD-NOS). First, bivariate analyses assessed differences in baseline clinical characteristics between participants with and without DSM-IV anxiety diagnoses. Second, negative binomial regression analyses tested whether lifetime anxiety predicted number of manic/hypomanic or major depressive episodes developed during the study. Third, survival analyses evaluated whether lifetime anxiety predicted time to onset of manic/hypomanic and major depressive episodes. Results indicated that anxiety history was associated with greater illness severity at baseline. Over follow-up, anxiety history predicted fewer manic/hypomanic episodes, but did not predict number of major depressive episodes. Anxiety history also was associated with longer time to onset of manic/hypomanic episodes, but shorter time to onset of depressive episodes. Findings corroborate past studies implicating anxiety disorders as salient influences on the course of BSDs. Moreover, results extend prior research by indicating that anxiety disorders may be linked with reduced manic/hypomanic phases of illness.
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Affiliation(s)
- Madison K Titone
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Rachel D Freed
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Jared K O'Garro-Moore
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Andrew Gepty
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Tommy H Ng
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Jonathan P Stange
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, 1202W. Johnson Street, Madison, WI 53706, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, 1701N. 13th Street, Philadelphia, PA 19122, USA.
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28
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Alloy LB, Nusslock R. Reward-related cognitive vulnerability to bipolar spectrum disorders. World Psychiatry 2018; 17:102-103. [PMID: 29352559 PMCID: PMC5775116 DOI: 10.1002/wps.20494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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29
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Corry J, Green M, Roberts G, Fullerton JM, Schofield PR, Mitchell PB. Does perfectionism in bipolar disorder pedigrees mediate associations between anxiety/stress and mood symptoms? Int J Bipolar Disord 2017; 5:34. [PMID: 28983840 PMCID: PMC5629191 DOI: 10.1186/s40345-017-0102-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/11/2017] [Indexed: 01/12/2023] Open
Abstract
Background Bipolar disorder (BD) and the anxiety disorders are highly comorbid. The present study sought to examine perfectionism and goal attainment values as potential mechanisms of known associations between anxiety, stress and BD symptomatology. Measures of perfectionism and goal attainment values were administered to 269 members of BD pedigrees, alongside measures of anxiety and stress, and BD mood symptoms. Regression analyses were used to determine whether perfectionism and goal attainment values were related to depressive and (hypo)manic symptoms; planned mediation models were then used to test the potential for perfectionism to mediate associations between anxiety/stress and BD symptoms. Results Self-oriented perfectionism was associated with chronic depressive symptoms; socially-prescribed perfectionism was associated with chronic (hypo)manic symptoms. Self-oriented perfectionism mediated relationships between anxiety/stress and chronic depressive symptoms even after controlling for chronic hypomanic symptoms. Similarly, socially-prescribed perfectionism mediated associations between anxiety/stress and chronic hypomanic symptoms after controlling for chronic depressive symptoms. Goal attainment beliefs were not uniquely associated with chronic depressive or (hypo)manic symptoms. Conclusions Cognitive styles of perfectionism may explain the co-occurrence of anxiety and stress symptoms and BD symptoms. Psychological interventions for anxiety and stress symptoms in BD might therefore address perfectionism in attempt to reduce depression and (hypo)manic symptoms in addition to appropriate pharmacotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s40345-017-0102-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justine Corry
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Melissa Green
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia. .,Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, 2031, Australia. .,Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
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30
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Abstract
Abnormalities in parasympathetic nervous system activity have been linked to depression, but less is known about processes underlying this relationship. The present study evaluated resting and stress-reactive respiratory sinus arrhythmia (RSA) to a laboratory stressor as predictors of daily interpersonal stress generation and depressive symptoms, whether stress generation mediated the relationship between RSA and depressive symptoms, and potential sex differences. A sample of formerly depressed 102 emerging adults (18-22 years; 78% female) completed a laboratory stressor and daily assessments of stressors and depressive symptoms over two weeks. Multilevel modeling revealed that: 1) lower resting RSA predicted daily depressive symptoms; 2) less RSA reactivity predicted interpersonal stress generation, 3) interpersonal dependent stressors mediated the relationship between RSA reactivity and daily depressive symptoms, and 4) sex differences occurred in the resting RSA-depression relationship. These findings highlight the importance of resting RSA and RSA reactivity in the examination of depression and interpersonal processes.
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31
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Hamilton JL, Burke TA, Stange JP, Kleiman EM, Rubenstein LM, Scopelliti KA, Abramson LY, Alloy LB. Trait Affect, Emotion Regulation, and the Generation of Negative and Positive Interpersonal Events. Behav Ther 2017; 48:435-447. [PMID: 28577581 PMCID: PMC5600285 DOI: 10.1016/j.beth.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 01/27/2023]
Abstract
Positive and negative trait affect and emotion regulatory strategies have received considerable attention in the literature as predictors of psychopathology. However, it remains unclear whether individuals' trait affect is associated with responses to state positive affect (positive rumination and dampening) or negative affect (ruminative brooding), or whether these affective experiences contribute to negative or positive interpersonal event generation. Among 304 late adolescents, path analyses indicated that individuals with higher trait negative affect utilized dampening and brooding rumination responses, whereas those with higher trait positive affect engaged in rumination on positive affect. Further, there were indirect relationships between trait negative affect and fewer positive and negative interpersonal events via dampening, and between trait positive affect and greater positive and negative interpersonal events via positive rumination. These findings suggest that individuals' trait negative and positive affect may be associated with increased utilization of emotion regulation strategies for managing these affects, which may contribute to the occurrence of positive and negative events in interpersonal relationships.
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Affiliation(s)
- Jessica L. Hamilton
- Department of Psychology, Temple University, 1701 N. 17th St., Philadelphia PA 19122
| | - Taylor A. Burke
- Department of Psychology, Temple University, 1701 N. 17th St., Philadelphia PA 19122
| | - Jonathan P. Stange
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612
| | - Evan M. Kleiman
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138
| | - Liza M. Rubenstein
- Department of Psychology, Temple University, 1701 N. 17th St., Philadelphia PA 19122
| | - Kate A. Scopelliti
- Department of Psychology, Temple University, 1701 N. 17th St., Philadelphia PA 19122
| | - Lyn Y. Abramson
- Department of Psychology, University of Wisconsin-Madison, 1202 West Johnson St., Madison, WI 53706
| | - Lauren B. Alloy
- Department of Psychology, Temple University, 1701 N. 17th St., Philadelphia PA 19122
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Stange JP, Hamilton JL, Olino TM, Fresco DM, Alloy LB. Autonomic reactivity and vulnerability to depression: A multi-wave study. Emotion 2017; 17:602-615. [PMID: 27991819 PMCID: PMC5444964 DOI: 10.1037/emo0000254] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The ability of the autonomic nervous system to flexibly adapt to environmental changes is thought to indicate efficient use of self-regulatory resources. Deficits in autonomic reactivity appear to characterize current depression; however, whether autonomic reactivity confers vulnerability to future depression when individuals encounter environmental stressors is unknown. Fluctuations in respiratory sinus arrhythmia (RSA) and heart rate (HR) were evaluated in response to emotion-eliciting films among 134 undergraduates. Negative events and depressive symptoms were assessed 5 times across 12 weeks. Multilevel modeling demonstrated that smaller decreases in RSA in response to sadness, greater increases in HR following sadness, and smaller increases in HR to amusement were prospectively associated with greater depressive symptoms when individuals encountered high levels of idiographically assessed negative events. These results demonstrate that the lack of contextually appropriate autonomic reactivity may confer vulnerability to depression under conditions of environmental stress, perhaps due to attenuated capacity for effective self-regulation. (PsycINFO Database Record
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33
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Ng TH, Freed RD, Titone MK, Stange JP, Weiss RB, Abramson LY, Alloy LB. Aggression Protects Against the Onset of Major Depressive Episodes in Individuals With Bipolar Spectrum Disorder. Behav Ther 2017; 48:311-321. [PMID: 28390495 PMCID: PMC5385844 DOI: 10.1016/j.beth.2016.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 08/05/2016] [Accepted: 08/20/2016] [Indexed: 12/11/2022]
Abstract
A growing body of research suggests that bipolar spectrum disorders (BSDs) are associated with high aggression. However, little research has prospectively examined how aggression may affect time to onset of hypomanic/manic versus major depressive episodes. In a longitudinal study, we tested the hypothesis that aggression would prospectively predict a shorter time to the onset of hypomanic/manic episodes and a longer time to the onset of major depressive episodes, based on the behavioral approach system theory of BSDs. Young adults (N = 120) diagnosed with cyclothymia, bipolar II disorder, or bipolar disorder not otherwise specified were followed every 4 months for an average of 3.55 years. Participants completed measures of depressive and manic symptoms, family history of mood disorder, impulsivity, and aggression at baseline and were followed prospectively with semistructured diagnostic interview assessments of hypomanic/manic and major depressive episodes and treatment seeking for mood problems. Cox proportional hazard regression analyses indicated that overall, physical, and verbal aggression predicted a longer time to major depressive episode onset, even after controlling for baseline depressive and manic symptoms, family history of mood disorder, treatment seeking for mood problems, and impulsivity. Aggression, however, did not significantly predict time to onset of hypomanic/manic episodes, controlling for the same covariates. The findings suggest that approach-related behaviors may be utilized to delay the onset of major depressive episodes among people with BSDs.
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34
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Shapero BG, Weiss RB, Burke TA, Boland EM, Abramson LY, Alloy LB. Kindling of Life Stress in Bipolar Disorder: Effects of Early Adversity. Behav Ther 2017; 48:322-334. [PMID: 28390496 PMCID: PMC5385846 DOI: 10.1016/j.beth.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 12/11/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
Most theoretical frameworks regarding the role of life stress in bipolar disorders (BD) do not incorporate the possibility of a changing relationship between psychosocial context and episode initiation across the course of the disorder. The kindling hypothesis theorizes that over the longitudinal course of recurrent affective disorders, the relationship between major life stressors and episode initiation declines (Post, 1992). The present study aimed to test an extension of the kindling hypothesis in BD by examining the effect of early life adversity on the relationship between proximal life events and prospectively assessed mood episodes. Data from 145 bipolar participants (59.3% female, 75.2% Caucasian, and mean age of 20.19 years; SD = 1.75 years) were collected as part of the Temple-Wisconsin Longitudinal Investigation of Bipolar Spectrum Project (112 Bipolar II; 33 Cyclothymic disorder). Participants completed a self-report measure of early adversity at baseline and interview-assessed mood episodes and life events at regular 4-month follow-ups. Results indicate that early childhood adversity sensitized bipolar participants to the effects of recent stressors only for depressive episodes and not hypomanic episodes within BD. This was particularly the case with minor negative events. The current study extends prior research examining the kindling model in BD using a methodologically rigorous assessment of life stressors and mood episode occurrence. Clinicians should assess experiences of early adversity in individuals with BD as it may impact reactivity to developing depressive episodes in response to future stressors.
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Affiliation(s)
| | | | | | - Elaine M Boland
- Corporal Michael J. Crescenz VA Medical Center; University of Pennsylvania School of Medicine
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35
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Ng TH, Burke TA, Stange JP, Walshaw PD, Weiss RB, Urosevic S, Abramson LY, Alloy LB. Personality disorder symptom severity predicts onset of mood episodes and conversion to bipolar I disorder in individuals with bipolar spectrum disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:271-284. [PMID: 28368159 PMCID: PMC5380154 DOI: 10.1037/abn0000255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Patricia D Walshaw
- Semel Institute for Neuroscience and Human Behavior, University of California
| | | | | | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison
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36
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Kleiman EM, Chiara AM, Liu RT, Jager-Hyman SG, Choi JY, Alloy LB. Optimism and well-being: a prospective multi-method and multi-dimensional examination of optimism as a resilience factor following the occurrence of stressful life events. Cogn Emot 2017; 31:269-283. [PMID: 26558316 PMCID: PMC5215689 DOI: 10.1080/02699931.2015.1108284] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
Optimism has been conceptualised variously as positive expectations (PE) for the future , optimistic attributions , illusion of control , and self-enhancing biases. Relatively little research has examined these multiple dimensions of optimism in relation to psychological and physical health. The current study assessed the multi-dimensional nature of optimism within a prospective vulnerability-stress framework. Initial principal component analyses revealed the following dimensions: PEs, Inferential Style (IS), Sense of Invulnerability (SI), and Overconfidence (O). Prospective follow-up analyses demonstrated that PE was associated with fewer depressive episodes and moderated the effect of stressful life events on depressive symptoms. SI also moderated the effect of life stress on anxiety symptoms. Generally, our findings indicated that optimism is a multifaceted construct and not all forms of optimism have the same effects on well-being. Specifically, our findings indicted that PE may be the most relevant to depression, whereas SI may be the most relevant to anxiety.
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Affiliation(s)
- Evan M. Kleiman
- Harvard University, Department of Psychology, Cambridge, MA 02138
| | | | - Richard T. Liu
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior East Providence, RI 02915
| | - Shari G. Jager-Hyman
- Aaron T. Beck Psychopathology Research Center at the University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA 19104
| | - Jimmy Y. Choi
- Temple University, Department of Psychology, Philadelphia, PA 19122
| | - Lauren B. Alloy
- Temple University, Department of Psychology, Philadelphia, PA 19122
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37
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Weiss RB, Stange JP, Boland EM, Black SK, LaBelle DR, Abramson LY, Alloy LB. Kindling of life stress in bipolar disorder: comparison of sensitization and autonomy models. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 124:4-16. [PMID: 25688428 DOI: 10.1037/abn0000014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis (Post, 1992) states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress. The present study involved a comprehensive and precise examination of the kindling hypothesis in 102 participants with bipolar II disorder that allowed for a direct comparison of sensitization and autonomy models. Polarity-specific tests were conducted across the continuum of event severity with respect to impact and frequency of life events. Hypotheses were polarity- and event-valence specific and were based on the stress sensitization model. Results were only partially consistent with the sensitization model: Individuals with more prior mood episodes had an increased frequency of minor negative events before depression and of minor positive events before hypomania. However, the number of past episodes did not moderate relationships between life events and time until prospective onset of mood episodes. These results are more consistent with a sensitization than an autonomy model, but several predictions of the sensitization model were not supported. Methodological strengths, limitations, and implications are discussed regarding putative changes in stress reactivity that may occur with repeated exposure to mood episodes in bipolar II disorder.
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Affiliation(s)
- Rachel B Weiss
- Department of Psychiatry, McLean Hospital/Harvard Medical School
| | | | | | | | | | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin- Madison
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38
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Assessment and Treatment of Bipolar Spectrum Disorders in Emerging Adulthood: Applying the Behavioral Approach System Hypersensitivity Model. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:289-299. [PMID: 28133431 DOI: 10.1016/j.cbpra.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bipolar disorder is associated with a host of negative physical and interpersonal outcomes including suicide. Emerging adulthood is an age of risk for the onset of bipolar spectrum disorders (BSD) and there has been increased effort to focus on early identification and subsequent intervention for BSDs during this developmental period. Recent research on the behavioral approach system (BAS) hypersensitivity model of bipolar disorder may have implications for the assessment and treatment of BSD in emerging adulthood. We summarize relevant findings on the BAS hypersensitivity model that support the use of reward sensitivity in the early identification of BSDs and suggest evidence-based strategies for clinical work with emerging adults with bipolar spectrum disorders.
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39
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Ng TH, Stange JP, Black CL, Titone MK, Weiss RB, Abramson LY, Alloy LB. Impulsivity predicts the onset of DSM-IV-TR or RDC hypomanic and manic episodes in adolescents and young adults with high or moderate reward sensitivity. J Affect Disord 2016; 198:88-95. [PMID: 27011364 PMCID: PMC4844858 DOI: 10.1016/j.jad.2016.03.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 01/13/2016] [Accepted: 03/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A growing body of research suggests that bipolar disorders (BD) are associated with high impulsivity. Using a multi-method approach, the current study provided the first examination of the hypothesis that impulsivity would prospectively predict shorter time to onset of DSM-IV-TR or RDC hypomanic or manic episodes in a sample selected based on reward sensitivity, a biobehavioral trait shown to predict onset and course of BD. METHODS 163 participants with high reward sensitivity and 114 participants with moderate reward sensitivity were followed every six months for an average of 2.68 years. Participants completed the Barratt Impulsiveness Scale - Version 11 (BIS-11), Balloon Analog Risk Task (BART), Beck Depression Inventory, Altman Self-Rating Mania Scale, and an expanded Schedule for Affective Disorders and Schizophrenia (exp-SADS) - Lifetime Version at baseline and were followed prospectively with the exp-SADS - Change Version to assess onset of hypomanic or manic episodes and treatment seeking for mood problems. RESULTS Cox proportional hazard regression analyses indicated that impulsivity as measured by a behavioral task (BART; OR=1.04, p=.03) and a self-report measure (BIS-11 Attentional Impulsiveness subscale; OR=1.16, p=.01) predicted shorter time to hypomania/mania onset, after controlling for baseline depressive and manic symptoms, family history of mood disorder, treatment seeking for mood problems, and reward sensitivity. LIMITATIONS The study was limited by non-comprehensive assessment of impulsivity and unknown generalizability to clinical samples. CONCLUSIONS Impulsivity confers vulnerability to hypomania or mania. Future studies would benefit from considering how impulsivity can be integrated into existing biopsychosocial models of BD.
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Affiliation(s)
- Tommy H Ng
- Department of Psychology, Temple University, United States
| | | | | | | | - Rachel B Weiss
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Unites States
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, Unites States
| | - Lauren B Alloy
- Department of Psychology, Temple University, United States.
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40
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Boland EM, Stange JP, Labelle DR, Shapero BG, Weiss RB, Abramson LY, Alloy LB. Affective Disruption from Social Rhythm and Behavioral Approach System (BAS) Sensitivities: A Test of the Integration of the Social Zeitgeber and BAS Theories of Bipolar Disorder. Clin Psychol Sci 2015; 4:418-432. [PMID: 27429864 DOI: 10.1177/2167702615603368] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Behavioral Approach System (BAS)/Reward Hypersensitivity Theory and the Social Zeitgeber Theory are two biopsychosocial theories of bipolar spectrum disorders (BSD) that may work together to explain affective dysregulation. The present study examined whether BAS sensitivity is associated with affective symptoms via a) increased social rhythm disruption in response to BAS-relevant life events, or b) greater exposure to BAS events leading to social rhythm disruption and subsequent symptoms. Results indicated that high BAS individuals were more likely to experience social rhythm disruption following BAS-relevant events. Social rhythm disruption mediated the association between BAS-relevant events and symptoms (hypothesis a). High BAS individuals experienced significantly more BAS-relevant events, which predicted greater social rhythm disruption, which predicted greater levels of affective symptoms (hypothesis b). Individuals at risk for BSD may be sensitive to BAS-relevant stimuli, experience more BAS-relevant events, and experience affective dysregulation due to the interplay of the BAS and circadian rhythms.
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Affiliation(s)
- Elaine M Boland
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA
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41
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Non-suicidal self-injury prospectively predicts interpersonal stressful life events and depressive symptoms among adolescent girls. Psychiatry Res 2015; 228:416-24. [PMID: 26165966 PMCID: PMC4540325 DOI: 10.1016/j.psychres.2015.06.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is the deliberate self-harm of one's tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age=18.74, SD=.69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls.
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42
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Stange JP, Hamilton JL, Burke TA, Kleiman EM, O'Garro-Moore JK, Seligman ND, Abramson LY, Alloy LB. Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study. Psychiatry Res 2015; 226:162-8. [PMID: 25660736 PMCID: PMC4361270 DOI: 10.1016/j.psychres.2014.12.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/02/2014] [Accepted: 12/30/2014] [Indexed: 12/11/2022]
Abstract
Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.
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Affiliation(s)
- Jonathan P Stange
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Jessica L Hamilton
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Taylor A Burke
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | | | | | - Nicole D Seligman
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, United States.
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43
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O'Garro-Moore JK, Adams AM, Abramson LY, Alloy LB. Anxiety comorbidity in bipolar spectrum disorders: the mediational role of perfectionism in prospective depressive symptoms. J Affect Disord 2015; 174:180-7. [PMID: 25499686 PMCID: PMC4986825 DOI: 10.1016/j.jad.2014.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bipolar spectrum disorders (BSDs) are highly comorbid with anxiety, which is associated with an extended duration and exacerbation of depressive symptoms. Unfortunately, the underlying mechanisms are not known. This study examined the role of maladaptive cognitive styles in the co-occurrence of BSDs and anxiety disorders and prediction of depressive symptoms. METHODS Participants included 141 young adults (69.6% female, mean age=20.24, SD=2.11), in one of three groups: a BSD group (bipolar II, cyclothymia, n=48), a comorbid BSD/anxiety group (n=50), and a demographically-matched healthy control group (n=43), who were followed prospectively. Participants completed the Cognitive Style Questionnaire (CSQ), Depressive Experiences Questionnaire (DEQ), Dysfunctional Attitudes Scale (DAS), Sociotropy Autonomy Scale (SAS), Halberstadt Mania Inventory (HMI) and Beck Depression Inventory (BDI) at the initial assessment. One year later, participants completed the BDI and HMI again to assess severity of depressive and hypomanic/manic symptoms. RESULTS A multivariate analysis of co-variance (MANCOVA) revealed significant differences between the three groups on their DAS Perfectionism, DEQ Dependency, DEQ Self-Criticism, CSQ Negative, SAS Autonomy, and Time 2 BDI scores, with the BSD/anxiety group scoring higher than the BSD only group on all measures except the CSQ. Preacher and Hayes׳ (2008) bootstrapping method was used to test for mediational effects of the significant cognitive style measures on depressive symptoms at follow-up. The 95% confidence intervals for the indirect effect of group on follow-up depressive symptoms through DAS Perfectionism did not include zero, indicating the presence of a significant mediating relationship for perfectionism. LIMITATIONS This study only used two waves of data; three waves of data would allow one to investigate the full causal effect of one variable on another. Further, a comorbid anxiety diagnosis consisted of any anxiety disorder. Further research should separate groups by their specific anxiety diagnoses; this could afford a more complete understanding of the effect of types of anxiety on prospective depressive symptoms. CONCLUSIONS After taking into account initial levels of depressive and hypomanic/manic symptoms, we found that those with BSD/anxiety comorbidity experienced more severe depressive symptoms, but not more severe hypomanic/manic symptoms. Further, their more severe prospective depressive symptoms are explained by a perfectionistic cognitive style.
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Stange JP, Adams AM, O'Garro-Moore JK, Weiss RB, Ong ML, Walshaw PD, Abramson LY, Alloy LB. Extreme cognitions in bipolar spectrum disorders: associations with personality disorder characteristics and risk for episode recurrence. Behav Ther 2015; 46:242-56. [PMID: 25645172 PMCID: PMC4316749 DOI: 10.1016/j.beth.2014.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 09/05/2014] [Accepted: 09/06/2014] [Indexed: 11/29/2022]
Abstract
Bipolar spectrum disorders (BSDs) are often characterized by cognitive inflexibility and affective extremities, including "extreme" or polarized thoughts and beliefs, which have been shown to predict a more severe course of illness. However, little research has evaluated factors that may be associated with extreme cognitions, such as personality disorders, which are often characterized by extreme, inflexible beliefs and are also associated with poor illness course in BSDs. The present study evaluated associations among BSDs, personality disorder characteristics, and extreme cognitions (polarized responses made on measures of attributional style and dysfunctional attitudes), as well as links between extreme cognitions and the occurrence of mood episodes, among euthymic young adults with BSDs (n=83) and demographically matched healthy controls (n=89) followed prospectively for 3years. The relationship between personality disorder characteristics and negative and positive extreme cognitions was stronger among BSD participants than among healthy controls, even after statistically accounting for general cognitive styles. Furthermore, extreme negative cognitions predicted the prospective onset of major depressive and hypomanic episodes. These results suggest that extreme cognitive styles are most common in individuals with BSDs and personality disorder characteristics, and they provide further evidence that extreme negative cognitions may confer risk for mood dysregulation.
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Alloy LB, Nusslock R, Boland EM. The development and course of bipolar spectrum disorders: an integrated reward and circadian rhythm dysregulation model. Annu Rev Clin Psychol 2015; 11:213-50. [PMID: 25581235 PMCID: PMC4380533 DOI: 10.1146/annurev-clinpsy-032814-112902] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this article, we present and review the evidence for two major biopsychosocial theories of the onset and course of bipolar spectrum disorders (BSDs) that integrate behavioral, environmental, and neurobiological mechanisms: the reward hypersensitivity and the social/circadian rhythm disruption models. We describe the clinical features, spectrum, age of onset, and course of BSDs. We then discuss research designs relevant to demonstrating whether a hypothesized mechanism represents a correlate, vulnerability, or predictor of the course of BSDs, as well as important methodological issues. We next present the reward hypersensitivity model of BSD, followed by the social/circadian rhythm disruption model of BSD. For each model, we review evidence regarding whether the proposed underlying mechanism is associated with BSDs, provides vulnerability to the onset of BSDs, and predicts the course of BSDs. We then present a new integrated reward/circadian rhythm (RCR) dysregulation model of BSD and discuss how the RCR model explains the symptoms, onset, and course of BSDs. We end with recommendations for future research directions.
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Affiliation(s)
- Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, Pennsylvania 19122; ,
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Muralidharan A, Kotwicki RJ, Cowperthwait C, Craighead WE. Parental relationships and behavioral approach system dysregulation in young adults with bipolar disorder. J Clin Psychol 2014; 71:387-401. [PMID: 25534712 DOI: 10.1002/jclp.22146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Expressed emotion (EE), or the presence of criticism/hostility/emotional overinvolvement in a family relationship, predicts poorer outcomes in bipolar disorder; however, the mechanism of this is unclear. The present study investigated whether, in a sample of young adults (aged 18-40 years) with bipolar disorder, parental criticism was associated with Behavioral Approach System (BAS) dysregulation, including emotional reactivity to negative feedback and cognitive schemas of self-criticism/perfectionism. METHOD Twenty-two young adults with bipolar I disorder and 22 matched control participants completed an interview, questionnaires, and a computer-based task with false negative feedback; emotional reactivity to this feedback was assessed. RESULTS Compared to control participants, clinical participants exhibited higher levels (p = 0.001) of self-criticism, and a trend towards a greater decrease in positive affect after negative feedback (p = 0.053), even when controlling for mood symptoms. Among clinical participants, perceived criticism from paternal caregivers was associated with self-criticism and perfectionism, and low perceived paternal care was associated with decrease in positive affect. CONCLUSION Strain in parental relationships may be associated with BAS dysregulation for individuals with bipolar disorder.
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Kleiman EM, Riskind JH, Stange JP, Hamilton JL, Alloy LB. Cognitive and interpersonal vulnerability to suicidal ideation: a weakest link approach. Behav Ther 2014; 45:778-90. [PMID: 25311287 PMCID: PMC6659116 DOI: 10.1016/j.beth.2014.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 05/04/2014] [Accepted: 05/19/2014] [Indexed: 11/16/2022]
Abstract
In contrast with traditional models of risk for suicidal ideation that combine multiple vulnerability components into one composite measure, weakest link perspectives posit that individuals are as vulnerable as their most vulnerable component (or "weakest link"). Such a perspective has been applied to depression, but has not been evaluated with respect to suicidal ideation. Thus, the goal of the present study was to apply a weakest link perspective to the study of suicidal ideation. We hypothesized that an individual's "weakest link" among vulnerability components from the hopelessness theory (HT) and interpersonal psychological theory of suicide (IPTS) would interact with high levels of stress to predict increases in suicidal ideation over a 6-week period better than the traditional conceptualizations of HT or IPTS. Participants were 171 college students who completed measures of cognitive vulnerability, stress, and suicidal ideation twice over a period of 6 weeks. Bayesian regression analyses supported our hypotheses. The data fit the weakest link model using HT and IPTS components better than traditional conceptualizations of HT and IPTS. This study implies that weakest link models from depression may be useful in understanding which individuals are most vulnerable to experiencing suicidal ideation in the context of stress.
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Nusslock R, Young CB, Damme KSF. Elevated reward-related neural activation as a unique biological marker of bipolar disorder: assessment and treatment implications. Behav Res Ther 2014. [PMID: 25241675 DOI: 10.1016/j.brat.2014.08.011.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Growing evidence indicates that risk for bipolar disorder is characterized by elevated activation in a fronto-striatal reward neural circuit involving the ventral striatum and orbitofrontal cortex, among other regions. It is proposed that individuals with abnormally elevated reward-related neural activation are at risk for experiencing an excessive increase in approach-related motivation during life events involving rewards or goal striving and attainment. In the extreme, this increase in motivation is reflected in hypomanic/manic symptoms. By contrast, unipolar depression (without a history of hypomania/mania) is characterized by decreased reward responsivity and decreased reward-related neural activation. Collectively, this suggests that risk for bipolar disorder and unipolar depression are characterized by distinct and opposite profiles of reward processing and reward-related neural activation. The objective of the present paper is threefold. First, we review the literature on reward processing and reward-related neural activation in bipolar disorder, and in particular risk for hypomania/mania. Second, we propose that reward-related neural activation reflects a biological marker of differential risk for bipolar disorder versus unipolar depression that may help facilitate psychiatric assessment and differential diagnosis. We also discuss, however, the challenges to using neuroscience techniques and biological markers in a clinical setting for assessment and diagnostic purposes. Lastly, we address the pharmacological and psychosocial treatment implications of research on reward-related neural activation in bipolar disorder.
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Affiliation(s)
- Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL, USA.
| | - Christina B Young
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Nusslock R, Young CB, Damme KSF. Elevated reward-related neural activation as a unique biological marker of bipolar disorder: assessment and treatment implications. Behav Res Ther 2014; 62:74-87. [PMID: 25241675 DOI: 10.1016/j.brat.2014.08.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022]
Abstract
Growing evidence indicates that risk for bipolar disorder is characterized by elevated activation in a fronto-striatal reward neural circuit involving the ventral striatum and orbitofrontal cortex, among other regions. It is proposed that individuals with abnormally elevated reward-related neural activation are at risk for experiencing an excessive increase in approach-related motivation during life events involving rewards or goal striving and attainment. In the extreme, this increase in motivation is reflected in hypomanic/manic symptoms. By contrast, unipolar depression (without a history of hypomania/mania) is characterized by decreased reward responsivity and decreased reward-related neural activation. Collectively, this suggests that risk for bipolar disorder and unipolar depression are characterized by distinct and opposite profiles of reward processing and reward-related neural activation. The objective of the present paper is threefold. First, we review the literature on reward processing and reward-related neural activation in bipolar disorder, and in particular risk for hypomania/mania. Second, we propose that reward-related neural activation reflects a biological marker of differential risk for bipolar disorder versus unipolar depression that may help facilitate psychiatric assessment and differential diagnosis. We also discuss, however, the challenges to using neuroscience techniques and biological markers in a clinical setting for assessment and diagnostic purposes. Lastly, we address the pharmacological and psychosocial treatment implications of research on reward-related neural activation in bipolar disorder.
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Affiliation(s)
- Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL, USA.
| | - Christina B Young
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Krieger T, Zimmermann J, Beutel ME, Wiltink J, Schauenburg H, Holtforth MG. Ein Vergleich verschiedener Kurzversionen des Depressive Experiences Questionnaire (DEQ) zur Erhebung von Selbstkritik und Abhängigkeit. DIAGNOSTICA 2014. [DOI: 10.1026/0012-1924/a000105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Der Depressive Experiences Questionnaire (DEQ) ist ein Fragebogen zur Erfassung der Persönlichkeitsmerkmale Selbstkritik und Abhängigkeit, die als Vulnerabilitätsfaktoren für Depression gelten. Aufgrund seiner Länge und seiner komplexen Auswertungsprozedur wurden im englischsprachigen Raum verschiedene Kurzversionen des DEQ entwickelt. Das Ziel dieser Studie war die psychometrische Überprüfung der verschiedenen DEQ-Versionen in deutscher Sprache sowie die Validierung einer geeigneten Kurzversion. An insgesamt 708 Personen (404 Patienten und 304 nicht-klinische Personen) wurden die psychometrischen Eigenschaften der verschiedenen Versionen verglichen. Es zeigte sich, dass der Theoretische Depressive Experiences Questionnaire–12 Item Version (TDEQ-12) insbesondere aufgrund seiner faktoriellen Validität die besten psychometrischen Eigenschaften aufwies. Zusätzliche Hinweise für die Validität und Reliabilität des TDEQ-12 konnten in vier weiteren Stichproben (436 nicht-klinische Personen, 23 nicht-depressive Personen, 64 depressive Patienten, 74 Studierende) gewonnen werden. Die vorliegende Studie legt nahe, dass der TDEQ-12 eine reliable, valide und ökonomische Alternative zum DEQ für die Erfassung von Selbstkritik und Abhängigkeit darstellt.
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