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.

Pilot Study: Web-based CBT Adheres to Professional Practice Standards and Outcomes

Background: The primary objective of this pilot study was to demonstrate reliable adherence to a group cognitive behavioral (CBT) therapy protocol when delivered using on-line video conferencing as compared with face-to-face delivery of group CBT. A secondary aim was to show comparability of changes in subject depression inventory scores between on-line and face-to-face delivery of group CBT.

Methods: We screened 31 individuals, 18 of whom met the criteria for a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis of mood and/or anxiety disorder. All qualifying participants had the necessary equipment (computer, webcam, Internet) for participation in the study, but could exercise their preference for either the on-line or face-to-face format. Eighteen completed the 13 weekly session intervention program (ten face-to-face; eight video conferencing). We coded adherence to protocol in both intervention formats and generated pre–post changes in scores on the Beck Depression Inventory Second Edition (BDI-II) for each participant.

Results: Application of the CBT protocol coding system showed reliable adherence to the group CBT intervention protocol in both delivery formats. Similarly, qualitative analysis of the themes in group discussion indicated that both groups addressed similar issues. Pre–post intervention scores for the BDI-II were comparable across the two delivery formats, with 60% of participants in each group showing a positive change in BDI-II severity classification (e.g., from moderate to low symptoms).

Conclusion: This pilot study demonstrates that group CBT could be delivered in a technology-supported environment (on-line video conferencing) and can meet the same professional practice standards and outcomes as face-to-face delivery of the intervention program.

Khatri, N., Marziali, E., Tchernikov, I., & Sheppard, N. (May 01, 2014). Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: a pilot study. Clinical Interventions in Aging, 765.

Mood Disorders: Effects of Intensive CBT

NewStudy-Graphic-72x72_edited-3A recent study in the Journal of Psychiatric Practice found that Cognitive Behavioral Therapy (CBT) interventions used in an intensive partial-hospital (PH) setting are effective in treating severe mood disorders.

PH settings differ from inpatient treatment in that they are more flexible and less expensive. In this study, with CBT as the primary treatment, the length of stay was only 2 weeks. The researchers’ aims were to find the specific aspects of CBT that were successful in the treatment of mood disorders in a short-term PH setting.

The treatment included group and individual psychotherapy. Patients attended 12-20 group sessions per week. A written treatment contract was used and reviewed weekly to set specific goals and promote collaboration between patients and staff.

Group therapy was primarily CBT-oriented. The goals of therapy included teaching self-assessment (such as challenging maladaptive thoughts), behavioral coping (such as behavioral scheduling and behavioral activation), and developing better and more effective communication strategies.

The two-week treatment was divided into two stages. In the first, patients learned to identify triggers and utilize cognitive restructuring, among other interventions. The second stage included relapse prevention plans for a crisis situation and future plans (such as returning to work or school).

The researchers showed that both behavioral activation and a decrease in negative cognitions are associated with a decrease in depressive symptomatology at discharge. Additionally a decrease in negative thinking is associated with reduced general psychological distress at discharge.

Study Authors: M. S. Christopher, K. L. Jacob, E. C. Neuhaus, T. J. Neary, L. A. Fiola