Bipolar disorder: What can psychotherapists learn from the cognitive research?

Abstract

Randomized controlled trials of psychological treatment, principally cognitive therapy, for bipolar disorder have yielded inconsistent results. Given the status of this evidentiary base, we provide a more fine-grained analysis of the cognitive profiles associated with bipolar disorder to inform clinical practice. In this practice-friendly review, we consider evidence that both negative and positive cognitive styles are related to bipolar disorder. Cross-sectional and prospective evidence suggest that negative cognitive styles are related to depression within bipolar disorder, but there also is evidence that bipolar disorder is related to an elevated focus on goals as well as to increases in confidence during manic states. With such findings as backdrop, we consider the outcomes of psychological treatments for bipolar disorder and advance several suggestions for clinical practice.Keywords cognition therapy; bipolar disorder; mania Bipolar I disorder (BPD) is a highly recurrent disorder with severe consequences for affected persons. Even when the best available medication treatments are provided, many clients with this disorder continue to struggle. Breakthrough episodes of mania have been estimated to occur almost yearly for persons taking lithium (Keller et al., 1992), and depressive symptoms are likely to be present for as many as one third of the weeks of the year (Judd et al., 2002). Rates of completed suicide are 15-fold those of persons in the general population (Harris & Barraclough, 1997).Treatment guidelines place primary focus on mood-stabilizing medications; however, psychotherapy is an important supplement to pharmacotherapy for this disorder. In this practice-friendly review, we review the evidence that BPD is related to cognitive styles, and that those cognitive styles help predict the course of both depression and mania. We then consider ways in which current knowledge about cognitive styles can help guide treatment within BPD. Cognitive Models of BPDAmong nonclinical samples, it is well established that mood state robustly influences whether people pay attention to negative or positive information, whether they remember negative compared to positive personal memories, and how negatively or positively they describe themselves. It also is clear that negative thoughts can trigger and intensify negative moods.

Abnormal resting-state cerebral-limbic functional connectivity in bipolar depression and unipolar depression

“…In addition, BD patients always exhibit poorer neuropsychological performance than UD [42], consistent with our finding that BD patients showed significantly lower score on the WAIS-Digit symbol relative to UD patients. Therefore, abnormal functional connectivity of cerebral cortex in BD but not UD might explain the clinical phenomenon that cognitive impairment are more severe in BD relative to UD [43]. The limbic region is a central part of the ‘‘emotional brain’’ circuitry responsible for the processing and regulation of emotion [14].…”

Incautiously Optimistic: Positively Valenced Cognitive Avoidance in Adult ADHD

“…Hypomania is associated with unrealistically high goals and increasing overconfidence in one's abilities. People at-risk for the disorder may become more overconfident in the face of success than their peers, which suggests that an overly positive cognitive style may be a risk factor for hypomania—although no prospective studies have examined this hypothesis (Johnson & Tran, 2007). Escalating overconfidence may signal the onset of a hypomanic episode and set the occasion for impulsive behavior, which is a good reason for clinicians who treat bipolar disorder to attend to these types of thoughts.…”

A cognitive behavioural group therapy for bipolar disorder using daily mood monitoring

“…We only used the total scores of the DAS-A-NL, as its subscales have not been validated in research. Still, Johnson and Tran (Johnson and Tran, 2007), and Lam and colleagues (Lam et al, 2004) suggested that patients with BD possibly have higher scores on the subscale goal attainment. Consequently, using total scores of the instrument may do no justice to this aspect of BD.…”