Abstract
BackgroundPrevious research has suggested that the way bipolar patients respond to depressive mood impacts on the future course of the illness, with rumination prolonging depression and risk-taking possibly triggering hypomania. However, the relationship over time between variables such as mood, self-esteem, and response style to negative affect is complex and has not been directly examined in any previous study – an important limitation, which the present study seeks to address.MethodsIn order to maximize ecological validity, individuals diagnosed with bipolar disorder (N = 48) reported mood, self-esteem and response styles to depression, together with contextual information, up to 60 times over a period of six days, using experience sampling diaries. Entries were cued by quasi-random bleeps from digital watches. Longitudinal multilevel models were estimated, with mood and self-esteem as predictors of subsequent response styles. Similar models were then estimated with response styles as predictors of subsequent mood and self-esteem. Cross-sectional associations of daily-life correlates with symptoms were also examined.ResultsCross-sectionally, symptoms of depression as well as mania were significantly related to low mood and self-esteem, and their increased fluctuations. Longitudinally, low mood significantly predicted rumination, and engaging in rumination dampened mood at the subsequent time point. Furthermore, high positive mood (marginally) instigated high risk-taking, and in turn engaging in risk-taking resulted in increased positive mood. Adaptive coping (i.e. problem-solving and distraction) was found to be an effective coping style in improving mood and self-esteem.ConclusionsThis study is the first to directly test the relevance of response style theory, originally developed to explain unipolar depression, to understand symptom changes in bipolar disorder patients. The findings show that response styles significantly impact on subsequent mood but some of these effects are modulated by current mood state. Theoretical and clinical implications are discussed.
Highlights
Attempts to understand the psychological mechanisms underlying bipolar disorder are made difficult by the multidimensional, dynamic and fluctuating nature of the symptoms experienced by patients
The term ‘bipolar disorder’ implies that depression and mania lie at opposite ends on a spectrum of affect, cross-sectional comparisons indicate that these two groups of symptoms lie on separate dimensions of psychopathology, so that patients can be simultaneously depressed and manic [1], explaining why patients sometimes present with mixed episodes [2]
Are symptoms of depression and mania associated with daily life correlates?
Summary
Attempts to understand the psychological mechanisms underlying bipolar disorder are made difficult by the multidimensional, dynamic and fluctuating nature of the symptoms experienced by patients. It has been reported that mood in bipolar patients can fluctuate chaotically over short periods of time [3], and longitudinal studies have shown that, within individuals, manic and depressive symptoms vary relatively independently with each other, with a small but statistically significant positive correlation between them [4], again explaining why mixed episodes are sometimes observed. The implication of these observations is that psychological studies of bipolar patients should ideally be conducted with sophisticated designs that take into account the complex cross-sectional and longitudinal structure of symptoms, so that covariations between symptoms and psychological processes can be adequately detected.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
