Appraisal of hypomania-relevant experiences: Development of a questionnaire to assess positive self-dispositional appraisals in bipolar and behavioural high risk samples

doi:10.1016/j.jad.2006.01.017

Journal of Affective Disorders

Volume 93, Issues 1–3, July 2006, Pages 19-28

https://doi.org/10.1016/j.jad.2006.01.017 Get rights and content

Abstract

Background

This paper reports two studies concerned with the development and validation of the Hypomania Interpretations Questionnaire (HIQ) designed to assess positive self-dispositional appraisals for hypomania-relevant experiences.

Methods

Study 1: 203 late adolescent participants completed the HIQ along with additional measures of general symptom interpretation, dysfunctional attitudes and hypomanic personality.

Study 2: 56 adults with a self-reported diagnosis of bipolar disorder and 39 controls completed a revised HIQ and a measure of current mood symptoms.

Results

Study 1: The final 10 item HIQ had two subscales: a) positive self-dispositional appraisals (HIQ-H); and b) normalising appraisals (HIQ-NE). Internal and test–retest reliability were adequate. Hypomanic personality scores were significantly and uniquely predicted by recent hypomania-relevant experiences and HIQ-H score.

Study 2: HIQ remained internally reliable within this sample. Bipolar participants (BD) reported more subsyndromal mood symptoms than controls (C) and scored significantly higher on HIQ-H even after covarying for these. HIQ-H was the primary predictor of diagnostic group. Its ability to discriminate BD from C was confirmed by ROC analysis.

Limitations

The studies are cross-sectional and did not include non-bipolar psychiatric control groups.

Conclusions

HIQ appears to be a reliable and valid measure for the assessment of positive self-dispositional appraisals which seem to be linked to both hypomanic personality and bipolar disorder. The relevance of such appraisals for symptom exacerbation, relapse and psychological treatment would merit future investigation.

Section snippets

General introduction

Bipolar disorder is often described as a cyclical illness with a typical course of repeated relapse and recurrence. This is supported by recent investigations which have confirmed this pattern with large collaborative study samples (Coryell et al., 2003, Dittmann et al., 2002, Leverich et al., 2003, Post et al., 2003). Diagnostic criteria for both mania and depression highlight the importance of sleep and behavioural disturbances as symptoms in both types of episode (First et al., 1997). In

General discussion

Previous work has identified circadian and social rhythm disruption in bipolar disorder (Jones et al., 2005a, Malkoff-Schwartz et al., 2000). Furthermore it has been proposed that the interpretation of experiences associated with such disruption may be a key factor in the development of bipolar symptoms (Healy and Williams, 1989, Jones, 2001). More generally, negative attributional styles (a tendency to attribute more negative events to the self) have been reported in individuals with bipolar

References (42)

F. Benedetti et al.
Sleep phase advance and lithium to sustain the antidepressant effect of total sleep deprivation in bipolar depression: new findings supporting the internal coincidence model?
J. Psychiatr. Res.
(2001)
E. Frank et al.
Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder
Biol. Psychiatry
(2000)
S.H. Jones
Circadian rhythms, multilevel models of emotion and bipolar disorder — an initial step towards integration?
Clin. Psychol. Rev.
(2001)
A. Millar et al.
The sleep of remitted bipolar outpatients: a controlled naturalistic study using actigraphy
J. Affect. Disord.
(2004)
D.M. Young
Psychiatric morbidity in travelers to Honolulu, Hawaii
Compr. Psychiatry
(1995)
L.B. Alloy et al.
Cognitive styles and life events in subsyndromal unipolar and bipolar disorders: stability and prospective prediction of depressive and hypomanic mood swings
J. Cogn. Psychother.
(1999)
American Psychiatric Association
Diagnostic and Statistical Manual for Mental Disorders
(1994)
J. Aschoff et al.
Human circadian rhythms: a multioscillatory system
Fed. Proc.
(1976)
M.S. Bauer et al.
Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania
Arch. Gen. Psychiatry
(1991)
M.S. Bauer et al.
The internal state scale: replication of its discriminating abilities in a multisite, public sector sample
Bipolar Disord.
(2000)

D.M. Clark et al.

Two psychological treatments for hypochondriasis. A randomised controlled trial

Br. J. Psychiatry

(1998)

W. Coryell et al.

The long-term course of rapid-cycling bipolar disorder

Arch. Gen. Psychiatry

(2003)

R.A. Depue et al.

A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: a conceptual framework and five validation studies

J. Abnorm. Psychology

(1981)

S. Dittmann et al.

The Stanley Foundation Bipolar Network: results of the naturalistic follow-up study after 2.5 years of follow-up in the German centres

Neuropsychobiology

(2002)

M. Eckblad et al.

Development and validation of a scale for hypomanic personality

J. Abnorm. Psychology

(1986)

M.B. First et al.

Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version

(1997)

D. Healy et al.

Moods, misattributions and mania: an interaction of biological and psychological factors in the pathogenesis of mania

Psychiatr. Dev.

(1989)

P. Jauhar et al.

Psychiatric morbidity and time zone changes: a study of patients from Heathrow airport

Br. J. Psychiatry

(1982)

S.H. Jones et al.

Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder

Bipolar Disord.

(2005)

S.H. Jones et al.

Psychological therapies for bipolar disorder: the role of model-driven approaches to therapy integration

Bipolar Disord.

(2005)

D.J. Kupfer et al.

Demographic and clinical characteristics of individuals in a bipolar disorder case registry

J. Clin. Psychiatry

(2002)

Cited by (76)

Exploring aspects of self-reported emotional mental imagery in patients with bipolar disorder
2023, Journal of Behavior Therapy and Experimental Psychiatry
CBT for patients with bipolar disorder has modest effects. Across disorders, mental imagery has been used to update CBT to increase effectiveness. In order to enhance CBT for bipolar disorder with imagery techniques, research is needed into emotional imagery quality and, related appraisals of imagery and their relationships with mood instability and subsequent behaviour in bipolar disorder.
Patients with bipolar disorder (n = 106), unipolar depression (n = 51), creative imagery prone participants (n = 53) and participants without a history of a mood disorder (n = 135) completed the Dutch Imagery Survey (DImS), an online imagery survey, adapted from the Imagery Interview, assessing self-reported emotional imagery aspects. Imagery quality, appraisals and their self-perceived effects on emotion and behaviour were compared between groups. As unexpected differences within the bipolar group appeared, these were additionally explored.
Imagery appraisals but not imagery quality discriminated between the patient groups and non-patient groups Imagery was perceived as an emotional amplifier in all groups, but this was specifically apparent in bipolar manic and bipolar depressed groups. Only in the bipolar group imagery was experienced to amplify behavioural tendencies.
Results need to be replicated using a larger sample of patients with BD who are currently manic or depressed.
Not only quality of imagery, but especially appraisals associated with imagery are differentiating between imagery prone people with and without mood disorder. Imagery amplifies emotion in all groups, but only in those patients with bipolar disorder currently manic or depressed did this influence behaviour.
Mediation analysis of recovery-focused therapy for recent-onset bipolar disorder
2021, Journal of Affective Disorders Reports
Citation Excerpt :
Lam and colleagues found that, the ways in which the individual interprets their mood experiences (especially valuing hypomanic mood) can potentially influence treatment outcome (Lam et al., 2005). Jones and colleagues have shown that tendency to interpret experiences related to mood elevation as reflecting a fundamental part of the self is elevated in bipolar disorder (positive self-appraisal) and linked to sensitivity to disturbance in sleep wake cycle (Jones et al., 2006; Jones, 2001). Further, appraisals of this type are linked to behaviours likely to exacerbate initial mood changes (Palmier-Claus et al., 2016).
Recovery focused therapy has been shown to improve recovery outcomes in individuals with recent onset bipolar disorder. However the process by which this is achieved is unclear. This paper therefore examines potential mediators of this effect using data from a randomised controlled trial comparing recovery focused therapy with treatment as usual (ISRCTN43062149).
A single-blind randomised controlled trial compared treatment as usual (TAU) with recovery-focused therapy (RfT) plus TAU (n = 67) in participants diagnosed with bipolar disorder with onset within 5 years. Impact of treatment at six and twelve months post baseline on potential mediators (mood appraisal, growth and self-concept) for changes in personal recovery, social functioning and quality of life outcomes were first assessed. Mediation effects were evaluated on each outcome for mediators significantly impacted by treatment.
RfT had a significant impact on positive self-appraisal and stigma at 12 months and self-esteem and post-trauma growth at six months. Both self-esteem and post-trauma growth significantly mediated the effect of RfT on personal recovery at six months follow-up.
This is a relatively small study which was not originally powered to test for exploratory mediation effects.
Improvements in personal recovery following RfT are linked to improvements in personal growth and self-esteem. This mediation relationship was not apparent for functioning or quality of life.
Psychological factors in personal and clinical recovery in bipolar disorder
2021, Journal of Affective Disorders
Background: Research into bipolar disorder (BD) has primarily focused upon clinical recovery (CR), i.e. symptom reduction, and overlooked personally meaningful recovery outcomes emphasized by service users. Personal recovery (PR) has been a major focus in the formulation of mental health policies and guidelines, and yet, research into factors influencing PR in BD is in its infancy. Methods: This study compared psychological associates of concurrent PR and CR, and determined psychological factors in PR prospectively at 6 months. Results: 107 participants completed baseline assessments, of whom 84% completed follow-up at 6 months. Controlling for potential confounders, multiple linear and ordinal regression models showed that some psychological factors underpinned both CR and PR at baseline: worse PR and CR outcomes were associated with higher negative self-dispositional appraisals and dysfunctional attitudes. Better PR, but worse CR ([hypo]mania related) were associated with higher adaptive coping. Additionally, better PR (but not CR) was associated with higher concurrent risk taking at baseline and predicted at follow-up by higher levels of baseline rumination. Better CR ([hypo]mania related), but not PR, was associated with lower impulsivity, but higher BAS processes. Limitations: Psychological and clinical factors were not measured at follow up and may have changed over time. Participants were a convenience sample. Conclusions: Understanding psychological factors driving recovery in BD is essential for refining the conceptual framework of PR, and informing psychological models and related interventions for BD. The identified differences in psychological factors highlight the importance of more individualised, PR focused therapeutic approaches.
Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework
2020, Journal of Affective Disorders Reports
Bipolar disorder is characterized by extreme mood fluctuations and ongoing affective instability. Mechanisms involved in emotion regulation (ER) seem to be a contributing factor, however the nature and extent of these are not clear yet. The aim of the current review is to contribute to a comprehensive model that covers the full scope of the emotion regulation processes in BD, in order to understand the psychological mechanisms that could contribute to the onset of both manic and depressive states. To this end we review each stage (attentional, behavioural and cognitive processes) of the Process Model of Emotion Regulation in relation to the extant literature on mood or emotion-linked responses in BD. Additionally, potential vulnerability factors (e.g. biological, genetic, personality) for dysfunctional emotion regulation patterns are described. We conclude that on all levels of the emotion regulation model there are seemingly contradictory findings in BD, with evidence for a profile that is characterized by the tendency to upregulate positive affect, as well as a profile that tends to over-use downregulation strategies for both positive and negative affect. These profiles could be characterized by different emotion regulation mechanisms, personality profiles and biological and psychological vulnerability factors. Based on these findings we tentatively identify two emotion regulation profiles in BD (reflecting ‘approach’ and ‘avoidant’ behaviours respectively) and discuss clinical implications and different treatment approaches. To illustrate the latter, we present two clinical cases of both ER profiles and their different treatment approaches.
Defeatist performance beliefs in college students: Transdiagnostic associations with symptoms and daily goal-directed behavior
2019, Psychiatry Research
Citation Excerpt :
Further, greater defeatist performance beliefs among people with elevated schizotypy are associated with diminished motivation (Campellone et al., 2016a). Similarly, defeatist performance beliefs have been found in people with elevated symptoms of depression (e.g., Brown et al., 1995) and mania (e.g., Jones et al., 2006), and elevated risk for these disorders is associated with motivational impairment (Dickson et al., 2017). Defeatist performance beliefs are especially important given their association with impairments in motivation (e.g., Campellone et al., 2016b; Rector et al., 2005), a common feature of schizophrenia, depression, and bipolar disorder (e.g., Whitton et al., 2015).
Defeatist performance beliefs are prevalent and linked to decreased motivation in people with psychological disorders. In this study, we investigated whether defeatist performance beliefs were associated with transdiagnostic psychopathology risk in people with no history of formal diagnosis and whether defeatist performance beliefs impacted engagement in daily goal-directed behavior. One hundred and two college students completed self-report measures of defeatist performance beliefs and risk for depression, mania, and psychosis. Sixty-one of these participants were randomly selected to identify a goal and complete daily surveys about their actual and expected goal progress, effort expenditure, experienced pleasure, and difficulty of goal pursuit. We found that greater defeatist performance beliefs were associated with higher risk for depression, mania, and psychosis. Using multilevel modeling, we found that greater defeatist performance beliefs predicted less goal progress, effort expenditure, and pleasure from goal pursuit. Together, these findings suggest that defeatist performance beliefs may impact goal-directed behavior in healthy people with no reported psychiatric history. Interventions targeting defeatist performance beliefs may have utility for actual goal-directed behavior in many people, regardless of psychiatric status.
A prospective study of bipolar disorder vulnerability in relation to behavioural activation, behavioural inhibition and dysregulation of the Behavioural Activation System
2017, European Psychiatry
The weak regulation, or “dysregulation”, of the Behavioural Activation System (BAS) is implicated in the development and recurrence of bipolar disorder. However, there has been a lack of prospective studies investigating the predictive role of BAS dysregulation in relation to bipolar-vulnerability. Furthermore, no studies have tested the prospective predictive utility of the DYS self-report measure of BAS dysregulation in an analogue sample. The goal of the current study was to redress this gap.
Participants (n = 127) completed baseline self-report measures of mood symptoms (Internal States Scale [ISS]), the Hypomanic Personality Scale (HPS), behavioural activation, inhibition and dysregulation of BAS (BIS/BAS and DYS), and at six months, the Mood Disorders Questionnaire (MDQ).
Linear regression analysis indicated a significant main effect of BAS Dysregulation, and a significant interaction between BIS and BAS Fun Seeking, on prospective MDQ scores whilst controlling for baseline mood symptoms and HPS scores. The interaction effect indicated that the relationship between high BAS Fun Seeking and follow-up MDQ scores was strongest when BIS scores were high, whilst the lowest MDQ scores were observed for a combination of low BAS Fun Seeking and high BIS. However, DYS scores were the stronger predictor of MDQ scores compared to the BAS Fun Seeking and BIS interaction.
Bipolar-vulnerability is prospectively associated with heightened BAS Dysregulation, as measured by the DYS subscale, similar to prior findings in clinical samples. Further research investigating the longer-term associations between BAS Dysregulation with the development of clinically significant bipolar mood symptoms is required.

View all citing articles on Scopus

View full text

Research reportAppraisal of hypomania-relevant experiences: Development of a questionnaire to assess positive self-dispositional appraisals in bipolar and behavioural high risk samples

Abstract

Background

Methods

Results

Limitations

Conclusions

Section snippets

General introduction

General discussion

J. Psychiatr. Res.

Biol. Psychiatry

Clin. Psychol. Rev.

J. Affect. Disord.

Compr. Psychiatry

Cognitive styles and life events in subsyndromal unipolar and bipolar disorders: stability and prospective prediction of depressive and hypomanic mood swings

J. Cogn. Psychother.

Diagnostic and Statistical Manual for Mental Disorders

Human circadian rhythms: a multioscillatory system

Fed. Proc.

Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania

Arch. Gen. Psychiatry

The internal state scale: replication of its discriminating abilities in a multisite, public sector sample

Bipolar Disord.

Two psychological treatments for hypochondriasis. A randomised controlled trial

Br. J. Psychiatry

The long-term course of rapid-cycling bipolar disorder

Arch. Gen. Psychiatry

A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: a conceptual framework and five validation studies

J. Abnorm. Psychology

The Stanley Foundation Bipolar Network: results of the naturalistic follow-up study after 2.5 years of follow-up in the German centres

Neuropsychobiology

Development and validation of a scale for hypomanic personality

J. Abnorm. Psychology

Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version

Moods, misattributions and mania: an interaction of biological and psychological factors in the pathogenesis of mania

Psychiatr. Dev.

Psychiatric morbidity and time zone changes: a study of patients from Heathrow airport

Br. J. Psychiatry

Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder

Bipolar Disord.

Psychological therapies for bipolar disorder: the role of model-driven approaches to therapy integration

Bipolar Disord.

Demographic and clinical characteristics of individuals in a bipolar disorder case registry

J. Clin. Psychiatry

Research report
Appraisal of hypomania-relevant experiences: Development of a questionnaire to assess positive self-dispositional appraisals in bipolar and behavioural high risk samples