Abstract
BackgroundThis study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients.MethodsTo obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state.ResultsIn summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks.ConclusionWe conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.
Highlights
This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder
We aim to provide an overview of what behavioral and neural aberrations are present in individuals at risk for bipolar disorders (BD), patients with current affective episodes, and euthymic patients during explicit ER
Studies we identified in our literature search investigated the ER strategies maintenance, distraction, and reappraisal
Summary
This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The primary characteristics of bipolar disorders (BD) are aberrations of mood and emotion (American Psychiatric Association 2013; Gruber 2011; Phillips 2003; Townsend and Altshuler 2012). These aberrations manifest in episodes of euphoric and excessively elevated mood (i.e., manic and hypomanic episodes), with manic. Explicit ER is trainable and can be volitionally integrated into everyday life and is of particular interest because of its high potential as a treatment target in therapeutic intervention Because of this potential, our aim in the present article is to review and integrate studies that investigate explicit ER in BD. Strategies of ER have been classified, for instance, according to their explicitness (Phillips et al 2008), motivational aspects (Koole, 2009), or the chronological order of regulation (Gross 1998a, 1998b, 2013, 2015)
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