The Interpretation of, and Responses to, Changes in Internal States: An Integrative Cognitive Model of Mood Swings and Bipolar Disorders

Abstract

A cognitive approach to understanding mood swings and bipolar disorders is provided, with the interpretation of changes in internal state as a central explanatory factor. The model explains how attempts at affect regulation are disturbed through the multiple and conflicting extreme personal meanings that are given to internal states. They prompt exaggerated efforts to enhance or exert control over internal states, which paradoxically provoke further internal state changes, thereby feeding into a vicious cycle that can maintain or exacerbate symptoms. Counterproductive attempts at control are classified as either ascent behaviours (increasing activation), or descent behaviours (decreasing activation). It is suggested that appraisals of extreme personal meaning are influenced by specific sets of beliefs about affect and its regulation, and about the self and relations with others, leading to an interaction that raises vulnerability to relapse. Pertinent literature is reviewed and found to be compatible with such a model. The clinical implications are discussed and compared to existing interventions.

Attentional biases toward emotional images in the different episodes of bipolar disorder: An eye-tracking study

“…The long fixation times for threatening images would reflect a difficulty to disengage attention from those pictures, and this may contribute to the rumination on threatening information by its through continuous processing-note that MDD has been related with rumination process about sad topics instead (Koster et al, 2011). This pattern supports recent theoretical proposals emphasizing the distinctive traits related to BD and MDD (Mansell et al, 2007).…”

“…The manic patients did not show any clear trend, at least during the extended viewing of competing stimuli in the present experiment. This pattern could reflect conflicting positive and negative appraisals in mania (Mansell et al, 2007). In summary, the avoidance of positive stimuli in the depressive state may disturb emotional self-regulation and may be an important maintenance factor for BD.…”

“…Of particular relevance here is that recent theoretical proposals have emphasized the distinctive features of BD relative to MDD (Mansell et al, 2007). We must keep in mind the following in terms of attentional preferences: (i) bipolar depression usually manifests psychotic and melancholic symptoms; (ii) manic patients show conflicting positive and negative appraisals; and (iii) manic patients are characterized by impulsivity and vigilance deficits that can affect the time course of attentional preferences.…”

A New Approach to Emotional Dysregulation in Bipolar Disorder

“…Taken together [8,9] findings strongly suggest that BD patients when freely attend to emotional stimuli show a bias towards threat-related information, even in early states of information processing. According to [10], threatening information may be emotionally relevant due to BD patients are usually characterized by psychotic and paranoid traits.To sum up, emotion dysregulation in BD are characterized by: i) attentional biases towards happy and sad information depending on their clinical state (i.e., mania and depression, respectively) during voluntarily controlled task; and ii) an attentional biases towards threatening information even in asymptomatic episodes during freeviewing task together with an attentional bias away from happy stimuli in bipolar depression.Traditional cognitive theories on bipolar disorder [6] should be re-formulated in order to a better understanding of the psychological mechanism underlying the mood dysregulation in BD. The cognitive model about unipolar depression cannot be directly extrapolated to BD for three reasons: a) unlike unipolar depression, an anhedonic lack of sensitivity to positive stimuli is more salient than a preference by negative stimuli in BD [8]; b) cognitive theories do not keep in mind the influence of threatening schemata in BD, which are present during free-viewing processing [8,9]; and c) unlike unipolar depression, the mood-congruent bias can also occur in the earliest stages of processing [7,9].…”

“…Taken together [8,9] findings strongly suggest that BD patients when freely attend to emotional stimuli show a bias towards threat-related information, even in early states of information processing. According to [10], threatening information may be emotionally relevant due to BD patients are usually characterized by psychotic and paranoid traits.…”