Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis (Post, 1992) states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress. The present study involved a comprehensive and precise examination of the kindling hypothesis in 102 participants with bipolar II disorder that allowed for a direct comparison of sensitization and autonomy models. Polarity-specific tests were conducted across the continuum of event severity with respect to both impact and frequency of life events. Hypotheses were polarity- and event-valence specific and were based on the stress sensitization model. Results were only partially consistent with the sensitization model: individuals with more prior mood episodes had an increased frequency of minor negative events prior to depression, and of minor positive events prior to hypomania. However, the number of past episodes did not moderate relationships between life events and time until prospective onset of mood episodes. These results are more consistent with a sensitization than an autonomy model, but several predictions of the sensitization model were not supported. Methodological strengths, limitations, and implications are discussed regarding putative changes in stress reactivity that may occur with repeated exposure to mood episodes in bipolar II disorder.
Kindling; Stress Sensitization; Bipolar Disorder; Life Events; Course
The concept of stress generation is a powerful tool that is consistent with existing cognitive-behavioral theories of depression. In this brief commentary on the literature on stress generation in depression, we highlight several issues that we believe will help to advance the stress generation field. Specifically, we discuss important methodological considerations, issues related to generality and specificity, and theoretical and clinical implications of stress generation. We then address common misperceptions of the stress generation hypothesis. Finally, we end by posing several questions about the mechanisms driving stress generation that should be addressed in future research. Advancing the field’s knowledge about stress generation will yield a tangible direction for theory-driven, targeted intervention. Our hope is that this commentary will help to stimulate and frame future research in this exciting area.
Research suggests that bipolar disorder individuals may have less social rhythm regularity than normal controls and that this may contribute to their affective symptoms and episodes. This study examined whether regularity prospectively predicted time to onset of major depressive, hypomanic and manic episodes in a sample with bipolar spectrum disorders.
We recruited 414 undergraduate students from Temple University and University of Wisconsin diagnosed with cyclothymia, bipolar II disorder, or with no affective disorder (normal controls). Participants completed the Social Rhythm Metric at Time 1 and structured interviews approximately every four months for an average follow-up period of 33 months.
Participants diagnosed with cyclothymia and bipolar II disorder reported significantly fewer regular activities than normal controls, and approximately half of these participants experienced a worsening course of their illness over the study duration. Survival analyses indicated that both diagnosis and social rhythm regularity significantly predicted the time to participants’ first prospective onset of major depressive, hypomanic and manic episodes.
Consistent with the social zeitgeber theory, bipolar spectrum participants reported less social rhythm regularity than normal controls, which prospectively predicted the survival time to affective episodes.
affective episodes; bipolar disorder; social rhythms
A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14–19) at an “age of risk” for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and Moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.
bipolar spectrum disorder; first onset; Behavioral Approach System (BAS); reward responsiveness; goal-striving
We examined the concurrent associations between multiple cognitive vulnerabilities to depression featured in Hopelessness Theory, Beck’s Theory, and Response Styles Theory and depressive symptoms and diagnoses in a sample of early adolescents. We also examined the specificity of these cognitive vulnerabilities to depression versus anxiety and externalizing psychopathology, controlling for co-occurring symptoms and diagnoses.
Male and female, Caucasian and African-American, 12–13 year old adolescents were assessed in a cross-sectional design. Cognitive vulnerabilities of hopelessness, inferential style, rumination, and self-referent information processing were assessed with self-reports and behavioral tasks. Symptoms and diagnoses of depressive, anxiety, and externalizing disorders were assessed with self-report questionnaires and diagnostic interviews.
Hopelessness exhibited the greatest specificity to depressive symptoms and diagnoses, whereas negative inferential styles, rumination, and negative self-referent information processing were associated with both depressive and anxiety symptoms and diagnoses and, in some cases, with externalizing disorders.
Consistent with cognitive theories of depression, hopelessness, negative inferential styles, rumination, and negative self-referent information processing were associated with depressive symptoms and diagnoses. However, with the exception of hopelessness, most of the remaining cognitive vulnerabilities were not specific to depression. With further maturation of our sample, these cognitive vulnerabilities may become more specific to depression as cognitive styles further develop and consolidate, the rates of depression increase, and individuals’ presentations of psychopathology become more differentiated.
cognitive vulnerability; depression; psychopathology; adolescence
The hopelessness theory of depression proposes that individuals with a depressogenic cognitive style are more likely to become hopeless and experience depression following negative life events. Although the neurophysiological underpinnings of cognitive style remain speculative, research indicates that decreased relative left-frontal brain electrical activity holds promise as a trait-like marker of depression. This begs the question: do measures of depressogenic cognitive style and resting frontal brain asymmetry index a common vulnerability? The present study provides preliminary support for this hypothesis. At baseline assessment, increased cognitive vulnerability to depression was associated with decreased relative left-frontal brain activity at rest in individuals with no prior history of, or current, depression. Following baseline assessment, participants were followed prospectively an average of 3.0 years with structured diagnostic interviews at 4-month intervals. Both cognitive vulnerability and asymmetric frontal cortical activity prospectively predicted onset of first depressive episode in separate univariate analyses. Furthermore, multivariate analyses indicated that cognitive vulnerability and frontal asymmetry represented shared, rather than independent, predictors of first depression onset.
Cognitive Vulnerability; Frontal EEG; Depression
Little longitudinal research has examined progression to more severe bipolar disorders in individuals with “soft” bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a non-patient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of “soft” bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.
bipolar disorder; Behavioral Approach System sensitivity; impulsivity
Bipolar spectrum disorders are characterized by highs and lows of mood, energy, motivation, cognition, and activity. The behavioral approach system (BAS) dysregulation theory provides an integrated model for understanding psychosocial and biological features of bipolar disorders. The theory emphasizes the role that sensitivity to rewards and goals plays in bipolar disorder. We review theory and evidence for the BAS-dysregulation model of bipolar disorders. We consider whether high BAS sensitivity is a correlate of, vulnerability factor for, and predictor of the course of bipolar spectrum disorders. We also discuss BAS-relevant life events as triggers of bipolar mood episodes. Finally, we address the implications of the BAS model for treatment and prevention of bipolar disorders and suggest directions for further research.
bipolar disorder; behavioral approach system; hypomania; mania; depression
We examined concurrent and prospective associations of self-focused cognitive styles with bipolar spectrum disorders. Controlling for depressive and hypomanic/manic symptoms, 125 individuals with bipolar spectrum disorders scored higher than 149 demographically similar normal controls on the rumination scale of the Response Styles Questionnaire (RSQ) and the private self-consciousness subscale of the Self-Consciousness Scale (SCS). The two groups did not differ on the distraction scale of the RSQ or the public self-consciousness and social anxiety subscales of the SCS. In addition, among the bipolar individuals, controlling for initial depressive and hypomanic/manic symptoms, rumination predicted the number, but not the likelihood of onset, of depressive episodes, whereas private self-consciousness predicted the likelihood of onset, but not the number, of hypomanic/manic episodes over a 3.5-year follow-up.
Bipolar Spectrum Disorder; Self-focused cognitive styles; Rumination; Self-consciousness; Depression; Hypomania/Mania
Bipolar disorders and substance use disorders (SUDs) show high co-occurrence. One explanation for this co-occurrence may be common personality vulnerabilities involved in both. We tested whether high Behavioral Approach System (BAS) sensitivity and impulsiveness are shared personality vulnerabilities in bipolar spectrum disorders and substance use problems and their co-occurrence in a longitudinal study of 132 bipolar spectrum and 153 normal individuals. At Time 1, participants completed the BIS/BAS Scales and the Impulsive Nonconformity Scale. Substance use problems were assessed via the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test at 4 month intervals for one year. Bipolar participants had higher rates of lifetime SUDs and substance use problems during the follow-up, relative to normal controls. In line with hypotheses, higher BAS sensitivity and impulsiveness predicted bipolar status and increased substance use problems prospectively. BAS Total, BAS Fun-seeking, and impulsiveness mediated the association between bipolar spectrum status and prospective substance use problems, with impulsiveness as the most important mediator. High BAS sensitivity and impulsiveness may represent shared personality vulnerabilities for both disorders, and may partially account for their co-occurrence.
Bipolar Spectrum; Substance Use; Behavioral Approach System (BAS) Sensitivity; Impulsiveness
We examined concurrent and prospective associations of Behavioral Approach System (BAS)-relevant and non-BAS-relevant cognitive styles with bipolar spectrum disorders. Controlling for depressive and hypomanic/manic symptoms, 195 individuals with bipolar spectrum disorders scored higher than 194 demographically matched normal controls on BAS sensitivity and BAS-relevant cognitive dimensions of performance concerns, autonomy, and self-criticism, but not on BIS sensitivity and non-BAS-relevant dimensions of approval-seeking, sociotropy, and dependency. Moreover, group differences on autonomy fully mediated the association between higher BAS sensitivity and bipolar status. In addition, only BAS-related cognitive dimensions predicted the likelihood of onset of depressive and hypomanic/manic episodes among the bipolar individuals over a 3.2-year follow-up, controlling for initial symptoms and past history of mood episodes. Higher autonomy and self-criticism predicted a greater likelihood of hypomanic/manic episodes and higher autonomy predicted a lower likelihood of major depressive episodes. In addition, autonomy mediated the associations between BAS sensitivity and prospective hypomanic/manic episodes. These findings suggest that individuals with bipolar spectrum disorders may exhibit a unique profile of BAS-relevant cognitive styles that influence the course of their mood episodes.
Bipolar Spectrum Disorder; Behavioral Approach System (BAS); Cognitive Styles
We review longitudinal predictors, primarily psychosocial, of the onset, course, and expression of bipolar spectrum disorders. We organize our review along a proximal – distal continuum, discussing the most proximal (i.e., prodromes) predictors of bipolar episodes first, then recent environmental (i.e., life events) predictors of bipolar symptoms and episodes next, followed by more distal psychological (i.e., cognitive styles) predictors, and ending with the most distal temperament (i.e., Behavioral Approach System sensitivity) predictors. We then present a theoretical model, the Behavioral Approach System (BAS) dysregulation model, for understanding and integrating the role of these predictors of bipolar spectrum disorders. Finally, we consider the implications of the reviewed longitudinal predictors for future research and psychosocial treatments of bipolar disorders.
Although deficits in executive functions have been linked with both depression and rumination in adulthood, the nature of the relationship between these constructs is not well understood and remains understudied in adolescence. The present study examined the relationship of rumination and depression to deficits in executive functions in early adolescence, a critical developmental period for the emergence of depression and rumination and the development of executive functions. Participants were 486 early adolescents (52.7% female; 47.1% African American, 48.8% Caucasian; 4.2% Biracial/Multiracial/Other; M age = 12.88 years; SD = .62) and their mothers, recruited through local schools. Measures included (a) a semi-structured diagnostic interview of the mother and adolescent, (b) youth self-report forms assessing depressive symptoms and trait rumination, (c) mother-report forms assessing demographic information, and (d) behavioral tests of executive function (sustained, selective and divided attention, attentional set shifting, and working memory). Gender moderated rumination-set shifting associations, such that rumination predicted better set shifting in boys only. The current level of depressive symptoms moderated rumination-sustained attention associations, such that rumination predicted better sustained attention in those with low levels of depressive symptoms and worse sustained attention in those with high levels of depressive symptoms. Rumination did not predict performance on other measures of executive functions. Likewise, depressive symptoms and diagnosis were not associated with executive functions. Implications for future research are discussed.
Executive functions; rumination; depression; adolescence; gender
Adolescence is marked by increases in stressful life events. Although research has demonstrated that depressed individuals generate stress, few studies investigate the generation of emotional victimization. The current study examined the effects of rumination and internalizing symptoms on experiences of peer victimization and familial emotional abuse.
Participants were 216 adolescents (M = 14-years-old; 58% female; 47% African-American) who completed two assessments. Results showed that rumination predicted peer victimization and emotional abuse. The effect of rumination on emotional victimization is heightened for those who have higher levels of depression symptoms. That is, individuals who ruminate and who have depression symptoms experience increases in both peer emotional victimization and parental emotional abuse.
This study builds upon prior research and indicates that rumination may be a stronger predictor of emotional victimization than symptoms of depression or anxiety. Identifying underlying mechanisms may yield targets for interventions aimed at addressing the chronic nature of depression.
Internalizing symptoms; rumination; emotional abuse; peer victimization
This research examined an integration of cognitive and interpersonal theories of depression by investigating the prospective contribution of depressive rumination to perceptions of social support, the generation of interpersonal stress, and depressive symptoms. It was hypothesized that depressive ruminators would generate stress in their relationships, and that social support discontent would account for this association. Further, depressive rumination and dependent interpersonal stress were examined as joint and unique predictors of depressive symptoms over time. Participants included 122 undergraduate students (M age = 19.78 years, SD = 3.54) who completed assessments of depressive rumination, perceptions of social support, life stress, and depressive symptoms across three waves, each spaced 9 months apart. Results revealed that social support discontent accounted for the prospective association between depressive rumination and dependent interpersonal stress, and that both depressive rumination and dependent interpersonal stress contributed to elevations in depressive symptoms over time. These findings highlight the complex interplay between cognitive and interpersonal processes that confer vulnerability to depression, and have implications for the development of integrated depression-focused intervention endeavors.
Rumination; Social support; Interpersonal stress; Depression
Although there is substantial evidence documenting the stress generation effect in depression (i.e., the tendency for depression-prone individuals to experience higher rates of life stress to which they contribute), additional research is required to advance current understanding of the specific types of dependent stress (i.e., events influenced by characteristics and attendant behaviors of the individual) relevant to this effect. The present study tested an extension of the stress generation hypothesis, in which the content of dependent stress that is produced by depression-prone individuals is contingent upon, and matches, the nature of their particular vulnerabilities. This extension was tested within the context of two cognitive models (i.e., hopelessness theory [Abramson, Metalsky, & Alloy, 1989] and Cole’s [1990, 1991] competency-based model) and two interpersonal models (i.e., Swann’s  self-verification theory and Coyne’s  interpersonal theory) of depression. Overall, support was obtained for vulnerability-specific stress generation. Specifically, in analyses across vulnerability domains, evidence of stress-generation specificity was found for all domain-specific cognitive vulnerabilities except self-perceived social competence. The within-domain analyses for cognitive vulnerabilities produced more mixed results, but were largely supportive. Additionally, excessive reassurance-seeking was specifically predictive of dependent stress in the social domain, and moderated, but did not mediate, the relation between negative inferential styles overall and in the interpersonal domain and their corresponding generated stress. Finally, no evidence was found for a stress generation effect with negative feedback-seeking.
stress generation; cognitive styles; interpersonal styles; depression
Although individuals with depression have been found to experience a higher rate of stress in their lives, it remains unclear to what extent other personal characteristics may contribute to stress generation. The current study extended past research by examining the effects of two theoretically and empirically supported cognitive vulnerabilities to depression (negative cognitive style and rumination) as predictors of dependent interpersonal and achievement events, independent events, and relational peer victimization. In a diverse sample of 301 early adolescents (56% female; Mage = 12.82 years), we found that negative cognitive style prospectively predicted the experience of dependent interpersonal stress and relational victimization, and that rumination did not predict stress in any of the domains. Furthermore, the occurrence of intervening stress mediated the associations between negative cognitive style and subsequent depressive symptoms. Additionally, whereas negative cognitive style predicted relational victimization among both boys and girls, girls were particularly vulnerable to developing depressive symptoms following the occurrence of relational victimization. Thus, a negative cognitive may contribute to the occurrence of stressful events, which in turn increases depressive symptoms. Girls may be particularly reactive to the effects of relational victimization, representing one pathway through which sex differences in depression may emerge.
stress generation; peer victimization; adolescence; cognitive vulnerability; depression
The Behavioral Approach System (BAS) hypersensitivity theory of bipolar disorder (BD; Alloy & Abramson, 2010; Depue & Iacono, 1989) suggests that hyperreactivity in the BAS results in the extreme fluctuations of mood characteristic of BD. In addition to risk conferred by BAS hypersensitivity, cognitive and personality variables may play a role in determining risk. We evaluated relationships among BAS sensitivity, risk taking, and an electrophysiological correlate of approach motivation, relative left-frontal electroencephalography (EEG) asymmetry. BAS sensitivity moderated the relationship between risk taking and EEG asymmetry. More specifically, individuals who were high in BAS sensitivity showed left-frontal EEG asymmetry regardless of their level of risk-taking behavior. However, among individuals who were moderate in BAS sensitivity, risk taking was positively associated with asymmetry. These findings suggest that cognitive and personality correlates of bipolar risk may evidence unique contributions to a neural measure of trait-approach motivation. Clinical implications of these findings are discussed.
behavioral approach system; risk taking; left-frontal EEG asymmetry; bipolar disorder
Adolescence and early adulthood are the peak ages for the onset of unipolar and bipolar mood disorders. Moreover, for most individuals with attention deficit hyperactivity disorder (ADHD), symptoms and impairment begin in childhood but persist well into adolescence and adulthood (e.g., Barkley, 2010). Thus, adolescence and early adulthood represent a developmental window wherein individuals can be affected by mood disorders, ADHD, or both. Because treatment protocols for unipolar depression (UPD), bipolar disorder (BD), and ADHD are quite different, it is crucial that assessment instruments used among adolescents and young adults differentiate between these disorders. The primary objectives of this study were to evaluate the predictive and diagnostic validity of General Behavior Inventory (GBI; Depue, Krauss, Spoont, & Arbisi, 1989) scores in discriminating BD from UPD and ADHD. Participants were drawn from adolescent (n=361) and young adult (n=614) samples. Based on findings from logistic regression and receiver operating characteristics analyses, the diagnostic efficiency of the GBI scales range from fair (discriminating UPD from BD) to good (discriminating BD participants from nonclinical controls). Multilevel diagnostic likelihood ratios are also provided to facilitate individual decision making.
Rats were trained on a free-operant avoidance procedure in which shock intensity was controlled by interresponse time. Shocks were random at a density of about 10 shocks per minute. Shock probability was response independent. As long as interresponse times remained less than the limit in effect, any shocks received were at the lower of two intensities (0.75 mA). Whenever interresponse times exceeded the limit, any shocks received were at the higher intensity (1.6 mA). The initial limit of 15 seconds was decreased in 3-second steps to either 6 or 3 seconds. All animals lever pressed to avoid higher intensity shock. As the interresponse time limit was reduced, the response rate during the lower intensity shock and the proportion of brief interresponse times increased. Substantial warmup effects were evident, particularly at the shorter interresponse-time limits. Shock intensity reduction without change in shock probability was effective in the acquisition and maintenance of avoidance responding, as well as in differentiation of interresponse times. This research suggests limitations on the generality of a safety signal interpretation of avoidance conditioning.
avoidance; shock intensity reduction; response-independent shock probability; interresponse time; differentiation; lever press; rats
Background and objectives
The current study tested the resource allocation hypothesis, examining whether baseline rumination or depressive symptom levels prospectively predicted deficits in executive functioning in an adolescent sample. The alternative to this hypothesis was also evaluated by testing whether lower initial levels of executive functioning predicted increases in rumination or depressive symptoms at follow-up.
A community sample of 200 adolescents (ages 12–13) completed measures of depressive symptoms, rumination, and executive functioning at baseline and at a follow-up session approximately 15 months later.
Adolescents with higher levels of baseline rumination displayed decreases in selective attention and attentional switching at follow-up. Rumination did not predict changes in working memory or sustained and divided attention. Depressive symptoms were not found to predict significant changes in executive functioning scores at follow-up. Baseline executive functioning was not associated with change in rumination or depression over time.
Findings partially support the resource allocation hypothesis that engaging in ruminative thoughts consumes cognitive resources that would otherwise be allocated towards difficult tests of executive functioning. Support was not found for the alternative hypothesis that lower levels of initial executive functioning would predict increased rumination or depressive symptoms at follow-up. Our study is the first to find support for the resource allocation hypothesis using a longitudinal design and an adolescent sample. Findings highlight the potentially detrimental effects of rumination on executive functioning during early adolescence.
Rumination; Executive functioning; Adolescence; Depression
The Cognitive Style Questionnaire (CSQ) measures the cognitive vulnerability factor featured in the hopelessness theory of depression. The CSQ has been used in over 30 published studies since its inception, yet detailed information about the psychometric and validity properties of this instrument has yet to be published. In this article, we describe the development of the CSQ and review reliability and validity evidence. Findings to date using college samples, indicate that the CSQ is a reliable measure of cognitive vulnerability with a high degree of construct validity.
According to the stress generation hypothesis (Hammen, 1991), depressed and depression-prone individuals experience higher rates of negative life events influenced by their own behaviors and characteristics (i.e., dependent events), which in part may account for the often recurrent nature of depression. Relatively little is known about the interrelation between stress generation predictors, and distal risk factors for this phenomenon. This study examined whether childhood emotional, sexual, and physical abuse, each uniquely predicted negative dependent events in individuals with a history of depression. The role of negative inferential styles as a potential mediator was also assessed. A sample of 66 adults with a history of depression completed self-report measures of childhood abuse history and negative inferential styles at baseline. The “contextual threat” method was used to assess the occurrence of negative life events over a 4-month prospective follow-up period. Childhood emotional abuse, but not sexual or physical abuse, prospectively predicted greater stress generation. Negative inferential styles mediated this relation. These findings suggest that targeting negative cognitive styles in clinical settings, especially in patients with a history of childhood emotional abuse, may be important for reducing the occurrence of negative life events, thereby possibly decreasing risk for depression recurrence.
Childhood abuse; Life events; Negative cognitive styles; Stress generation
Hopelessness depression (HD) is a subtype of depression postulated by the Hopelessness Theory of Depression to present as a constellation of symptoms occurring when an individual with a specific cognitive vulnerability (negative inferential style) experiences negative life events. In the current study, the course of HD episodes was evaluated prospectively and analyzed to explore patterns of symptom onset and remission.
In 169 HD episodes reported by 65 participants, survival analyses were conducted on the time to onset or remission for 29 individual symptoms. Survival analyses yielded probability density graphs for risk of onset and risk of offset that indicated whether the symptom tended to appear or remit early, late, or unpredictably during the episode.
The symptom of hopelessness often appeared earliest in HD episodes, followed by self-blame, brooding/worry, decreased self-esteem, dependency, and decreased appetite. Hopelessness, decreased self-esteem, self-blame, brooding/worry, dependency, and increased appetite were typically the latest symptoms to remit.
The current study provided evidence for patterns of symptom onset and remission in HD episodes. Hopelessness and other symptoms predicted to appear according to the Hopelessness Theory were generally the earliest to appear, latest to remit, and appeared to form the core syndrome of these HD episodes. Identifying patterns of symptom onset and remission may provide a tool for subtyping depression episodes. Clinically, these results point to the utility of attending to patterns of symptom onset and remission in patients presenting with HD episodes, particularly for treatment planning and monitoring.
depression; hopelessness; symptoms; psychology; psychiatry
Bipolar spectrum disorders (BSDs) are common and impairing, which has led to an examination of risk factors for their development and maintenance. Historically, research has examined cognitive vulnerabilities to BSDs derived largely from the unipolar depression literature. Specifically, theorists propose that dysfunctional information processing guided by negative self-schemata may be a risk factor for depression. However, few studies have examined whether BSD individuals also show self-referent processing biases.
This study examined self-referent information processing differences between 66 individuals with and 58 individuals without a BSD in a young adult sample (age M = 19.65, SD = 1.74; 62% female; 47% Caucasian). Repeated measures multivariate analysis of variance (MANOVA) was conducted to examine multivariate effects of BSD diagnosis on 4 self-referent processing variables (self-referent judgments, response latency, behavioral predictions, and recall) in response to depression-related and nondepression-related stimuli.
Bipolar individuals endorsed and recalled more negative and fewer positive self-referent adjectives, as well as made more negative and fewer positive behavioral predictions. Many of these information-processing biases were partially, but not fully, mediated by depressive symptoms.
Our sample was not a clinical or treatment-seeking sample, so we cannot generalize our results to clinical BSD samples. No participants had a bipolar I disorder at baseline.
This study provides further evidence that individuals with BSDs exhibit a negative self-referent information processing bias. This may mean that those with BSDs have selective attention and recall of negative information about themselves, highlighting the need for attention to cognitive biases in therapy.
Bipolar spectrum disorders; Information processing; Self-schema