Brief reportResponse styles to depressed mood in bipolar affective disorder
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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