Cognitive Styles Associated with Bipolar Spectrum Disorders

Relatively few studies have directly examined the cognitive styles or information processing of individuals with bipolar mood disorders. Based on the grandiosity that is a common symptom of mania and hypomania, one might expect bipolar individuals (who experience manic or hypo-manic episodes) to exhibit cognitive patterns more positive than those of unipolar depressive individuals. On the other hand, based on psycho-dynamic formulations suggesting that the grandiosity of manic or hypo-manic periods is a "defense" or counterreaction to underlying depressive tendencies (Freeman, 1971), bipolar individuals would be expected to exhibit cognitive styles as negative as those of unipolar depressives. In a more modern version of the psychodynamic hypothesis, Neale (1988) suggested that grandiose ideas have the function of keeping distressing cognitions out of awareness and are precipitated by underlying low self-regard. Similarly, based on an extension of the cognitive theories of unipolar depression to bipolar spectrum disorders, it might also be expected that the cognitive patterns of bipolar individuals would be negative. In fact, the studies conducted to date imply that the observed positivity or negativity of bipolar individuals' cognitive patterns depends to some degree both on whether they are in a depressed or manic/hypomanic episode or a euthymic state at the time of the assessment and on whether the assessment of the cognitive patterns is based on explicit or implicit tasks. That is, most studies indicate that persons with bipolar disorders show cognitive styles and self-referent information processing as negative as those of unipolar depressives, but sometimes present themselves in a positive fashion on more explicit cognitive tasks.

Those studies examining the cognitive styles and information processing of currently depressed bipolar individuals have generally found their cognitive patterns to be as negative as those of unipolar depressives. For example, Hollon, Kendall, and Lumry (1986) noted that both depressed unipolar and bipolar patients showed similarly negative automatic thoughts and dysfunctional attitudes characteristic of depression (see also C. V. Hill, Oei, & M. A. Hill, 1989). In a comparison of 57 depressed unipolar women, 9 depressed bipolar women, and 24 nonpsychiatric control women on the self-criticism and dependency scales of the Depressive Experiences Questionnaire (Blatt, D'Afflitti, & Quinlan, 1976), Rosenfarb, Becker, Khan, and Mintz (1998) found that both depressed unipolar and bipolar women were more self-critical than controls. On the other hand, whereas depressed unipolar women were also more dependent than controls, depressed bipolar women did not differ from controls on dependency. In a comparison of the subset of their sample (31 unipolar, 7 bipolar) currently in a depressed episode with 23 normal controls and the currently nondepressed mood disordered participants, Reilly-Harrington et al. (1999) offered that both currently depressed bipolar and unipolar participants exhibited more internal, stable, global attributional styles for negative events, more external, unstable, specific attributional styles for positive events, and more negative self-referent information processing for depression-relevant content than did nondepressed participants.

Three studies have examined the cognitive patterns of currently manic or hypomanic individuals and obtained results consistent with the importance of distinguishing between explicit and implicit assessments of cognitions. Bentall and Thompson (1990) compared students who scored high versus low on a hypomania scale on an emotional Stroop test in which the participants named the ink colors of depression-related and euphoria-related words written in different colored inks. Consistent with prior findings on the emotional Stroop task with unipolar depressed patients (Ingram et al., 1998), Bentall and Thompson found that hypomanic students took longer to color name the depression-related words, but not the euphoria-related words. These findings were replicated by French, Richards, and Scholfield (1996), even after controlling for the effects of anxiety on Stroop task performance. Lyon, Startup, and Bentall (1999) administered Bentall and Thompson's (1990) emotional Stroop test, Winters and Neale's (1985) pragmatic inference task that assesses attributions for hypothetical scenarios in an implicit manner, an explicit attribution questionnaire, and a self-referent incidental recall task designed to assess Beck's concept of self-schema to 15 bipolar manic patients, 15 bipolar depressed patients, and 15 normal controls. Consistent with the hypothesis that bipolar depressed individuals possess negative cognitive styles like those of unipolar depressives, Lyon et al. explained that bipolar depressed patients attributed negative events more than positive events to internal, stable, and global causes on both the attribution questionnaire and the pragmatic inference task, exhibited slowed color-naming for depression-related words on the Stroop task, and endorsed as self-descriptive and recalled more negative trait adjectives on the incidental recall task. Although, like the normal controls, the bipolar manic patients showed a self-serving bias on the explicit attribution questionnaire, taking credit for positive events more than negative events, and endorsed more positive than negative words, on the more implicit tasks, the manic patients exhibited negative cognitive styles or information processing like those of depressed individuals. Specifically, manic patients attributed negative events internally rather than externally on the pragmatic inference task, showed slower color naming for depression-related rather than euphoria-related words on the Stroop task, and recalled more negative than positive words on the self-referent incidental recall task.

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