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Mental Imagery in Bipolar Affective Disorder versus Unipolar Depression during Times of ‘Positive’ Mood

OBJECTIVE: Compared to unipolar depression (UD), depressed mood in bipolar disorder (BD) has been associated with amplified negative mental imagery of the future (‘flashforwards’). However, imagery characteristics during positive mood remain poorly explored. We hypothesise first, that unlike UD patients, the most significant positive images of BD patients will be ‘flashforwards’ (rather than past memories). Second, that BD patients will experience more frequent (and more ‘powerful’) positive imagery as compared to verbal thoughts and third, that behavioural activation scores will be predicted by imagery variables in the BD group.

METHOD: BD (n=26) and UD (n=26) patients completed clinical and trait imagery measures followed by an Imagery Interview and a measure of behavioural activation.

RESULTS: Compared to UD, BD patients reported more ‘flashforwards’ compared to past memories and rated their ‘flashforwards’ as more vivid, exciting and pleasurable. Only the BD group found positive imagery more ‘powerful’, (preoccupying, ‘real’ and compelling) as compared to verbal thoughts. Imagery-associated pleasure predicted levels of drive and reward responsiveness in the BD group.

CONCLUSIONS: This study reveals BD patients experience positive ‘flashforward’ imagery in positive mood, with more intense qualities than UD patients. This could contribute to the amplification of emotional states and goal directed behaviour leading into mania, and differentiate BD from UD.

Ivins, A., Di, S. M., Close, H., Goodwin, G. M., & Holmes, E. (September 01, 2014). Mental imagery in bipolar affective disorder versus unipolar depression: Investigating cognitions at times of ‘positive’ mood. Journal of Affective Disorders, 166, 12, 234-242.

A Monthly Summary of Beck Institute Updates [June 2013]

In its efforts to encourage the growth and dissemination of CBT throughout the world, Beck Institute has expanded its online presence across social media and other platforms. To keep you (our readers) informed of our most recent updates, we’ve decided to implement a monthly summary including: blogs, CBT articles, CBT trainings, and other updates for our readers. We’re very excited about some of the new developments at Beck Institute, including our new Core Curriculum. Please use the following links to go back and read what you may have missed from June 2013:

Click here for a complete schedule of Beck Institute workshops

See what you missed in May 2013

CBT Improves Memory Functioning in Patients with Bipolar I Disorder

According to a recent study published in the Journal of Behavior Therapy and Experimental Psychiatry, cognitive behavior therapy (CBT) improves explicit memory recall and reduces explicit memory bias for negative words in patients with bipolar type I disorder.  Both mania and depression are associated with impaired memory.  In tests in which participants learn words and are then asked to recall them, bipolar patients, both manic and depressive, have been shown to recall less words overall but more words with negative emotional valence than non-bipolar or depressed people.  This suggests that bipolar disorder affects global memory performance and introduces a negative memory bias.  The present study sought to examine if a CBT intervention would improve global memory performance and reduce the negative memory bias in bipolar I patients using a randomized, wait-list controlled design.

Participants (n=73) were bipolar I patients aged 18-65 on a treatment waiting list.  The experimental group (N=53) was given CBT in addition to medication, and the control group (N=20) was treated with just medication.  Participants were assessed for memory at baseline and at a 6-month follow up.  In this procedure, they were given 30 words that had either positive, neutral, or negative affective valence (10 words for each category).  They were first asked to rate the emotional valence of each word on a one to five scale.  Then, they were told to write down as many words as they could recall.  Participants were also assessed for disorder levels with the Hamilton Depression Rating Scale (HDRS), Mania Rating Scale (MRS), and the Hamilton Anxiety Rating Scale (HARS), and completed the Dysfunctional Attitudes Scale (DAS).

Before treatment, there were no significant differences between the two groups in the number of words recalled in any affective valence category or in the severity of bipolar symptoms.   At the follow-up, 11 patients from the experimental group had dropped out.  Of the remaining 42, significant improvements on the HDRS, HARS, and DAS were observed.  No such improvements were observed in the control group.  The primary effect of interest, explicit memory recall, was also improved in the CBT group.  Futher, recall for positive and neutral words was significantly improved, and recall for negative words significantly decreased in this group.  No memory effects were observed in the control group.

These results indicate that CBT is not only effective in improving the general dysfunctional symptoms of bipolar I disorder, but also in improving explicit memory functioning and reducing negative memory bias in patients.  By reducing negative memory bias, CBT may help modify bipolar patients’ cognitive schemas and can contribute to decreased cognitive vulnerabilities such as the negative memory bias. Further, CBT techniques for regulating both positive and negative thoughts and emotions can allow patients to modify unhelpful and intrusive past memories.

Docteur, A., Mirabel-Sarron, C., Guelfi, J.-D., Rouillon, F., & Gorwood, P. (2013). The role of CBT in explicit memory bias in bipolar I patients. Journal of Behavior Therapy and Experimental Psychiatry, 44, 3, 307-311.

Generic Cognitive Model

As a way of simplifying the cognitive model to facilitate a more rapid formulation of a case, Dr. Aaron Beck has proposed a generic cognitive model model. Dr. Beck has applied this model to a host of difficult presentations ranging from bipolar depression to hallucinations to everyday problems like procrastination.

Dr. Beck explains that it is possible to simplify the complete cognitive model by consolidating the various processes into a cognitive-behavioral triad. This procedure can provide a quick snap shot of a selected condition sparing the necessity for spelling out each of the variables.

Bipolar Disorder benefits from Cognitive Behavioral Therapy as part of treatment protocol

A recent review in Annals of General Psychiatry focuses on the current status of treatment protocols for Bipolar Disorder, which the authors describe as “a multi-faceted illness with an inevitably complex treatment.” Psychoactive drugs are, and have been for many years, primary to treatment protocols. After a review of the current data, the authors conclude that in addition to drug therapies, the best approaches to treatment and relapse prevention include psychoeduation, family-focused psychoeducation, and cognitive-behavioral therapy. This multi-level approach also extends to patients’ family members; patients and their families learn to identify possible triggering factors, recognize the early signs of episodes, and initiate early interventions.

Study authors: K. N. Fountoulakis, E. Vieta, M. Siamouli, M. Valenti, S. Magiria, T. Oral, D. Fresno, P. Giannakopoulos, G. S. Kaprinis

CBT and rapid-cycling Bipolar Disorder

People diagnosed with rapid-cycling bipolar disorder experience four or more separate episodes of depression and hypomania within the span of one year. Therapists have recently implemented cognitive behavioral therapy (CBT) to focus on treating depressive symptoms and reducing suicidal risk when caring for patients diagnosed with rapid-cycling bipolar disorder.

In a study reported in the Journal of Psychiatric Practice, researchers trained rapid-cycling bipolar disorder patients to utilize CBT skills to identify and respond to negative core beliefs, such as “Nobody cares about me” or “I am incompetent.” Addressing these beliefs is essential when administering CBT because they are likely to intensify the depressive episodes. Through implementing CBT, patients were also able to develop anxiety-management strategies and reduce symptoms of depression.

Study authors: N. A. Reilly-Harrington, T. Deckersbach, R. Knauz, Y. Wu, T. Tran, P. Eidelman, H. G. Lund, G. Sachs, A. A. Nierenberg