- Title
- Cognitive vulnerability to manic and depressive symptoms in bipolar affective disorder
- Creator
- Babakhani, Anet
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2011
- Description
- Research Doctorate - PhD (Clinical Psychology)
- Description
- The overarching aim of this research was to ascertain why it is that individuals with bipolar affective disorder (BAD) sometimes have depressive episodes and at other times have manic episodes. Most of the existing research has considered the disorder in its entirety without considering the two poles of the disorder separately. Studies of cognitive styles among euthymic people with bipolar affective disorder (BAD) without use of mood induction (MI) techniques to access those cognitive styles give misleading impressions of the normality of those cognitions. The aim of the first study was to assess dysfunctional attitudes of participants with BAD, and control participants with no previous psychiatric histories, after mood inductions (MIs). Sad and happy moods were induced within 49 individuals with BAD and 37 healthy controls. Dysfunctional attitudes were measured following MIs using the Dysfunctional Attitude Scale – short form (DAS-24) which has three subscales of achievement, interpersonal, and goal attainment. It was hypothesized that within individuals with BAD the sad MI would help in accessing dysfunctional attitudes in all three domains relative to the happy MI. This was supported. It was also hypothesized that the MIs would not affect dysfunctional attitudes within controls. This was also supported. When diagnosis was entered as a between group variable, achievement dysfunctional attitudes were significantly higher in individuals with BAD compared to controls after a happy induction. Both sad and happy moods provoked higher levels of dysfunctional attitudes within individuals with BAD. Euphoria may be related to elevated achievement dysfunctional attitudes, raising the risk for mania. The aim of the second study was to investigate the congruency hypothesis, that exacerbations in manic and depressive symptoms are a function of the interaction of interpersonal or achievement dysfunctional attitudes with life events in congruent domains. The same 49 individuals with bipolar I (n = 40) and bipolar II (n = 9) disorders participated in a longitudinal study of life events, using the Life Events and Difficulties Schedule (LEDS; Brown & Harris, 1978). Data were obtained for 44 of the 49 individuals. LEDS was conducted at 6 and 12-months. Mixed models analysis with autoregressive correlation (AR1) was used. Internal State Scale (ISS) activation (ACT) score assessed monthly was the dependent variable; DAS-24 achievement dysfunctional attitudes and number of achievement life events were the independent variables. We hypothesized that after a happy mood induction, achievement dysfunctional attitudes in interaction with achievement life events would predict manic symptom increases (e.g., Lozano & Johnson, 2001; Scott & Pope, 2003). In support of our hypothesis we found, when predicting ACT, achievement DAS after happy induction in interaction with achievement life events lagging three months before the activation month, showed significant effects after inclusion of baseline ACT and medication compliance. At high levels of DAS achievement after happy induction, as the number of achievement life events lagging 3 months from the activation month increased, so did activation. This supported the congruency hypothesis. Further, we hypothesized that interpersonal dysfunctional attitudes, after a sad mood induction, would interact with interpersonal life events to predict manic symptom increases. Interpersonal DAS after sad induction in interaction with interpersonal life events lagging one month before the activation month showed significant effects when predicting ACT, after inclusion of baseline ACT and medication compliance. At high levels of interpersonal DAS after sad induction, as the number of negative interpersonal life events increased, so did ACT scores as predicted by congruency hypothesis. We also hypothesized that interpersonal DAS after sad induction would interact with interpersonal life events which would predict depressive symptoms. This hypothesis was not supported. Unexpectedly though, the interaction of interpersonal DAS after sad induction and number of achievement life events lagging one month from the BDI score was significant after inclusion of baseline BDI and compliance with medications. At high levels of interpersonal DAS after sad induction, as the number of negative achievement events increased, the BDI score decreased. The events however were non-congruent with the DAS. The results are discussed in light of theory, analyses employed and mood induction. We further compared individuals with BAD and a healthy control group on Rosenberg’s (1965) self-esteem scale and a measure of instability of self-esteem. It was found that individuals with BAD had lower self-esteem on Rosenberg’s positive, negative and total self-esteem scales than the healthy control group. In addition, on positive, negative and total SE instability, individuals with BAD had higher self-esteem instability score than the healthy control group. We then tested the buffering hypothesis of self-esteem. That is, self-esteem would buffer the individual against occurrence of life events. We found support for the buffering hypothesis, as individuals with high self-esteem, after experiencing negative life events in the interpersonal domain, had lower levels of BDI and ACT scores. In contrast individuals with low self-esteem had higher levels of BDI and ACT scores, after occurrence of interpersonal life events. More specifically, the number of negative events in the interpersonal domain was predictive of BDI scores in low self-esteem individuals. However, it was found that the long-term threat posed by negative interpersonal events, predicted ACT scores in low self-esteem individuals. Also, individuals with low self-esteem instability tended to respond to life events with increased depressive and manic symptoms as opposed to individuals with high SE instability. The results concerning self-esteem instability were contrary to expectations. We suggested that the interactive effect of trait self-esteem and self-esteem instability might provide reasons for the current results. In the last study, it was hypothesised that high social rhythm disruptive (SRD) life events would increase manic and depressive symptoms of the disorder through disruption of social rhythms as proposed by Ehlers et al. (1988). We did not directly test the above hypothesis. However, we found that maximum SRD interacted with the number of interpersonal events at Lag 3 months to predict BDI such that at higher levels of maximum SRD, once the number of interpersonal events at Lag 3 months increased, BDI score increased. Similarly, maximum SRD interacted with long-term threat for interpersonal events at Lag 4 months to predict ACT, such that at higher levels of maximum SRD, as the long-term threat for interpersonal events at Lag 4 months increased, the ACT score increased. Also, maximum SRD interacted with long-term threat for achievement events at Lag 4 months to predict ACT such that at high levels of maximum SRD, as long-term threat for achievement events at Lag 4 months increased the ACT score increased. The above results were aligned with predictions. However, we also found that at high levels of maximum SRD, as the long-term threat for achievement events at Lag 2 months increased, ACT score decreased, contrary to predictions. In light of the findings of this study, the theory of social rhythms may need to be modified to account for the interaction of SRD with achievement and interpersonal life events to cause symptom exacerbations in mania and depression. This research has contributed to an explanation why individuals with bipolar disorder have manic episodes at some times and depressive episodes at other times. A combination of variables, such as level of self-esteem, instability of self-esteem, dysfunctional attitudes, SRD, achievement and interpersonal life event occurrences, and participants’ mood at the time of event occurrence, decides whether an individual will have depressive or manic episodes.
- Subject
- bipolar affective disorder; life events; cognitive vulnerabilities; social rhythm disruption; self-esteem; self-esteem instability
- Identifier
- http://hdl.handle.net/1959.13/1037322
- Identifier
- uon:13424
- Rights
- Copyright 2011 Anet Babakhani
- Language
- eng
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