Response styles to depressed mood in bipolar affective disorder

doi:10.1016/j.jad.2006.10.017

Journal of Affective Disorders

Volume 100, Issues 1–3, June 2007, Pages 249-252

https://doi.org/10.1016/j.jad.2006.10.017 Get rights and content

Abstract

Background

It has been hypothesised that dysfunctional strategies for avoiding depression play an important role in the pathway to mania. Support for this hypothesis comes from studies demonstrating that remitted and manic bipolar patients show similar cognitive biases to currently depressed patients.

Method

Manic patients, depressed bipolar patients, remitted bipolar patients and healthy controls were compared on an expanded version of Nolen-Hoeksema's [Nolen-Hoeksema, S., 1991. Responses to depression and their effects on the duration of depressed mood. Journal of Abnormal Psychology, 100, 569–582.] Response Styles Questionnaire, measuring strategies for coping with depression.

Results

Manic patients reported greater use of active-coping and risk-taking compared to the depressed, remitted and healthy controls. Bipolar remitted patients reported greater rumination.

Conclusions

The findings are consistent with the hypothesis that mania is associated with dysfunctional strategies for regulating negative emotion.

Introduction

It has been argued that mania arises from dysfunctional attempts to avoid depression (Abraham, 1911/1927, Neale, 1988). All versions of this ‘depression avoidance hypothesis’ involve two propositions: (i) vulnerability to mania is associated with depressogenic psychological processes; and, (ii) mania arises from attempts to avoid a negative emotional state. Evidence for the first of these propositions is compelling, with studies reporting depressogenic psychological processes associated with manic, hypomanic and euthymic states (Lyon et al., 1999, Scott et al., 2000, Winters and Neale, 1985).

Nolen-Hoeksema's (1991) response styles theory of depression provides a framework for investigating the second proposition. She suggests that the strategies people use in response to negative mood, which include distraction, risk taking (a type of maladaptive distraction with high potential for negative consequences) and problem solving (planning or acting to relive symptoms), influence the duration and intensity of depression. Thomas and Bentall (2002) in a study of a student sample, found that depression was strongly associated with rumination. However, hypomanic traits were associated not only with rumination, but also distraction and risk-taking. These findings suggest a model in which rumination about initial dysphoria sometimes promotes vigorous attempts to avoid negative emotion through focusing on neutral, pleasant or even high-risk activities, ultimately leading to excitement and mania.

This study is the first to measure response styles in symptomatic bipolar patients. We predicted that mania would be associated with high levels of distraction and risk-taking whereas the depressed phase would be associated with excessive rumination.

Section snippets

Participants

We recruited 73 participants receiving inpatient or outpatient care, diagnosed with bipolar affective disorder by their psychiatrists according to ICD-10 criteria. Current symptoms were ascertained using the Hamilton Rating Scale for Depression (Hamilton, 1967) and Bech–Rafaelson Mania Scale (Bech et al., 1979). 11 men and 3 women with a mean age of 38.28 years (SD = 12.23) were experiencing a depressed episode. Their mean IQ assessed by the National Adult Reading Test (NART; Nelson, 1991) was

Results

RSQ scores are shown in Table 1. Negative correlations were observed between age and both rumination (r = − .17, p < .05) and risk taking (r = − .25, p < .005) but not adaptive coping. There were no significant associations between the RSQ variables and IQ. Age was therefore included as a covariate in analyses of RSQ group differences. Sex was also included as an independent variable but there were no significant effects or interactions involving this variable. ANOVAs revealed significant differences for

Discussion

Group differences in response styles were state-related as predicted. The manic group compared to all the other groups reported more risk-taking and active-coping, consistent with several studies reporting risk-taking and active coping response styles as predictive of hypomanic personality traits (Thomas and Bentall, 2002, Knowles et al., 2005). Correlational analyses of the RSQ data similarly indicated robust associations between severity of mania, active coping and risk taking. Interestingly,

Acknowledgements

This work was carried out by Justin Thomas in partial fulfilment of the requirements for a PhD. We wish to thank Dr Susan Nolen-Hoeksema for providing us with the items for her Response Styles Questionnaire.

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Brief reportResponse styles to depressed mood in bipolar affective disorder

Abstract

Background

Method

Results

Conclusions

Introduction

Section snippets

Participants

Results

Discussion

Acknowledgements

Clinical Psychology Review

Notes on the psychoanalytic investigation and treatment of manic depressive insanity

The Bech–Rafaelsen Mania Scale and the Hamilton Depression Scale

Acta Psychiatrica Scandinavica

Neurobehavioural aspects of affective disorders

Annual Review of Psychology

Development of a rating scale for primary depressive illness

British Journal of Social and Clinical Psychology

Rhythm and blues: neurochemical, neuropharmacological and neuropsychological implications of a hypothesis of circadian rhythm dysfunction in the affective disorders

Psychopharmacology

Increases in manic symptoms after life events involving goal attainment

Journal of Abnormal Psychology

Coping with depression and vulnerability to mania: a factor analytic study of Nolen-Hoeksema's (1991) Response Styles Questionnaire

British Journal of Clinical Psychology

Social cognition and the manic defense

Journal of Abnormal Psychology

Brief report
Response styles to depressed mood in bipolar affective disorder