Process and Content in a Therapy Group for Bipolar Outpatients

Although the literature suggests that homogeneous therapy groups are useful for bipolar outpatients, little is known about the process in such groups. Using the GCQ-S and a content analysis of discussion topics, we evaluated group process during the first 31 sessions of an outpatient bipolar group. Compared with normative samples, our group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions and in the anxiety/tension scale. Furthermore, 81% of the discussion topics were related to the three group goals, and an additional 18% dealt with general group issues such as orienting new members and attendance. The results from this pilot study suggest that bipolar patients can discuss relevant issues in a homogeneous group environment that is cohesive, open, and safe.     

Suicidality in Bipolar Disorder: The Role of Emotion‐Triggered Impulsivity

A growing body of research suggests that impulsive responses to emotion more robustly predict suicidality than do other forms of impulsivity. This issue has not yet been examined within bipolar disorder, however. Participants diagnosed with bipolar I disorder (n = 133) and control participants (n = 110) diagnosed with no mood or psychotic disorder completed self‐report measures of emotion‐triggered impulsivity (Negative and Positive Urgency Scales) and interviews concerning lifetime suicidality. Analyses examined the effects of emotion‐triggered impulsivity alone and in combination with gender, age of onset, depression severity, comorbid anxiety, comorbid substance use, and medication. A history of suicide ideation and attempts, as well as self‐harm, were significantly more common in the bipolar disorder group compared with the control group. Impulsive responses to positive emotions related to suicide ideation, attempts, and self‐harm within the bipolar group. Findings extend research on the importance of emotion‐triggered impulsivity to a broad range of key outcomes within bipolar disorder. The discussion focuses on limitations and potential clinical implications.     

Social adjustment in the offspring of parents with bipolar affective disorder

The social adjustment of the adolescent offspring of parents with bipolar affective disorder (n=41) was compared to that of the offspring of parents with nonaffective psychiatric disorders (n=22) and the offspring of normal controls (n=26). In addition, the relationship between social adjustment and cyclothymia in offspring was determined. Social adjustment was assessed using the Life Activities Inventory, a new measure developed to assess social functioning in adolescents and young adults. Cyclothymia was assessed with the General Behavior Inventory. As a group, the offspring of bipolar parents did not differ significantly from either control group on social adjustment. However, the cyclothymic offspring of bipolar parents exhibited significantly poorer social adjustment than the noncyclothymic offspring of bipolars and the offspring of psychiatric and normal controls. These findings suggest that poor social functioning in the adolescent offspring of parents with bipolar illness may be associated with the early manifestations of affective disorder. In addition, these data indicate that despite its subsyndromal intensity, cyclothymia can result in significant social impairment.This study was supported in part by National Institute of Mental Health (NIMH) Research Grant MH-39782 to Daniel N. Klein and NIMH Grants MH-33083 and MH-37195 to Richard A. Depue.     

Occupational Therapy with Emotionally Disturbed Children in a Public Elementary School

This article describes a model of delivering occupational therapy services to a class of emotionally disturbed children in a public elementary school. It was determined that many of the children were placed in a special class because of inappropriate social skills. A weekly occupational therapy program was developed to address the chi Y dren's lack of age-appropriate social skills. A task-oriented group was chosen as the format, with activities selected based upon the level of the children's group interaction skills. The children exhibited an improvement in their social skills over the course of the school year.     

Psychosocial factors in the course and treatment of bipolar disorder: introduction to the special section

Bipolar disorder is associated with high rates of relapse and high social and economic costs, even when patients are maintained on proper pharmacotherapy. The background and rationale are offered here for a series of articles that address the role of psychosocial agents in the course of bipolar disorder and psychosocial treatments as adjuncts to pharmacotherapy in the disorder's outpatient maintenance. It is argued that stressful life events and disturbances in social-familial support systems affect the cycling of the disorder against the backdrop of genetic, biological and cognitive vulnerabilities. Current models of psychosocial treatment focus on modifying the effects of social or familial risk factors as an avenue for improving the course of the disorder.     

Rapid Cycling

Rapid cycling is not a distinct disorder, but is a particularly severe form of bipolar disease. One in six patients with bipolar disease seen by psychiatrists either as an outpatient or as an inpatient suffers from four or more episodes per year. If at least four episodes occur within one year, this high-frequency phase is called ?rapid cycling“ (RC). Treatment for bipolar disorder with RC usually includes trialling mood stabilizers, such as lithium, anticonvulsants, and modern antipsychotics.In four out of five RC patients, treatment improves disease progression; however, some patients exhibit RC for many years.Specific studies have raised the suspicion that administering antidepressive therapy could facilitate an unfavorable course of bipolar affective disorder. The present case demonstrates disease progression and treatment attempts in a patient with distinct RC progression.     

Psychoanalysis and the Education of the Child by Gerald H. J. Pearson

A conceptualization is presented which encourages a renewed exploration of the way in which psychiatric patients discuss their medications in the group therapy setting. It is suggested that process-oriented group therapiststend to harbor subtle prejudices which may inhibit examination of this material. If we listen to medication-related discourse more carefully, we find that patients disclose important information about hopes and fears about treatment, self-efficacy, attitudes about control and authority, and other sensitive or disowned parts of experience. The process of interactions about medicines often reveals interpersonal difficulties, particularly around intimacy. Suggestions for intervening more effectively with this type of material are presented. The importance of medication attributions in revealing curative fantasies is discussed.     

Mental imagery as an emotional amplifier: application to bipolar disorder

Cognitions in the form of mental images have a more powerful impact on emotion than their verbal counterparts. This review synthesizes the cognitive science of imagery and emotion with transdiagnostic clinical research, yielding novel predictions for the basis of emotional volatility in bipolar disorder. Anxiety is extremely common in patients with bipolar disorder and is associated with increased dysfunction and suicidality, yet it is poorly understood and rarely treated. Mental imagery is a neglected aspect of bipolar anxiety although in anxiety disorders such as posttraumatic stress disorder and social phobia focusing on imagery has been crucial for the development of cognitive behavior therapy (CBT).In this review we present a cognitive model of imagery and emotion applied to bipolar disorder. Within this model mental imagery amplifies emotion, drawing on Clark's cyclical panic model [(1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470]. We (1) emphasise imagery's amplification of anxiety (cycle one); (2) suggest that imagery amplifies the defining (hypo-) mania of bipolar disorder (cycle two), whereby the overly positive misinterpretation of triggers leads to mood elevation (escalated by imagery), increasing associated beliefs, goals, and action likelihood (all strengthened by imagery).Imagery suggests a unifying explanation for key unexplained features of bipolar disorder: ubiquitous anxiety, mood instability and creativity. Introducing imagery has novel implications for bipolar treatment innovation - an area where CBT improvements are much-needed.     

University and student segmentation: Multilevel latent‐class analysis of students’ attitudes towards research methods and statistics

Background. It is often claimed that psychology students’ attitudes towards research methods and statistics affect course enrolment, persistence, achievement, and course climate. However, the inter‐institutional variability has been widely neglected in the research on students’ attitudes towards research methods and statistics, but it is important for didactic purposes (heterogeneity of the student population). Aims. The paper presents a scale based on findings of the social psychology of attitudes (polar and emotion‐based concept) in conjunction with a method for capturing beginning university students’ attitudes towards research methods and statistics and identifying the proportion of students having positive attitudes at the institutional level. Sample. The study based on a re‐analysis of a nationwide survey in Germany in August 2000 of all psychology students that enrolled in fall 1999/2000 (N= 1,490) and N= 44 universities. Methods. Using multilevel latent‐class analysis (MLLCA), the aim was to group students in different student attitude types and at the same time to obtain university segments based on the incidences of the different student attitude types. Results. Four student latent clusters were found that can be ranked on a bipolar attitude dimension. Membership in a cluster was predicted by age, grade point average (GPA) on school‐leaving exam, and personality traits. In addition, two university segments were found: universities with an average proportion of students with positive attitudes and universities with a high proportion of students with positive attitudes (excellent segment). Conclusions. As psychology students make up a very heterogeneous group, the use of multiple learning activities as opposed to the classical lecture course is required.     

Sigmund Freud: Four Centenary Addresses by Ernest Jones

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their “typical” outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication.

Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.     

The Role of the Family in the Course and Treatment of Bipolar Disorder

ABSTRACT— Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.     

Inpatient adolescent group therapy as a social system

This paper describes a method of group therapy that 1) utilizes open systems theory to describe the social structure of group therapy, and 2)presents interventions drawn from Masterson's ideas for treating borderline personality disorders. Illustrations from a group therapy program for chemically dependent adolescents in a short-term, inpatient treatment unit of a general hospital are offered. It is proposed that under constrained conditions of treatment, such as those described, group therapy can be effective if there is precision about the system boundaries of task, role, time and place, and if group interventions are based upon a theoretically and clinically consistent model such as Masterson's.     

The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder

Distress tolerance (DT) and intolerance of uncertainty (IU) have been identified as transdiagnostic processes that predict symptom severity across a range of distinct anxiety disorders. However, the joint effect of these two variables on therapeutic outcome has not yet been examined. It is possible that DT and IU may both impact on treatment response to cognitive-behavioural therapy (CBT) in clients with anxiety, as clients with weak DT and strong IU may be less likely to engage in exposure and cognitive restructuring tasks across treatment due to their associated distress. The purpose of this study was to examine the interaction of DT and IU as predictors of post-treatment symptom severity and treatment response to group CBT in participants with primary DSM-IV-TR diagnosed social anxiety disorder (SAD). Participants (N = 95) with SAD completed 12 weeks of manualized group CBT. Results of multilevel longitudinal analysis demonstrated an interaction effect, such that lower DT and higher IU predicted higher SAD symptom severity across the course of therapy. The findings are discussed in terms of clinical implications for the disorder-specific and transdiagnostic treatment of anxiety disorders.     

The Relationship between Two Measures of the Tendency to Give Socially Desirable Responses

Two measures of the tendency to endorse socially desirable (SD) responses were obtained for 137 Ss. The first was from Edwards' SD scale and the second from an experimental scale consisting of responses in the P-F Study for which ratings of SD were available. There was no significant correlation between these measures. A second group of 94 Ss then rated a sample of 10 items each from the 2 scales on six bipolar dimensions. It is concluded that there is agreement across Ss as to the connotations of a socially desirable response but that personality type statements differ from responses in social situations in respect to the measure each provides of a person's tendency to endorse SD responses.     

Assessing alternative models of individualism and collectivism: a confirmatory factor analysis

Six alternative structural models of individualism–collectivism are reviewed and empirically compared in a confirmatory factor analysis of questionnaire data from an Australian student sample (N = 340). Central to the debate about the structure of this broad social attitude are the issues of (1) polarity (are individualism and collectivism bipolar opposites, or orthogonal factors?) and (2) dimensionality (are individualism and collectivism themselves higher‐order constructs subsuming several more specific factors and, if so, what are they?). The data from this Australian sample support a model that represents individualism and collectivism as a higher‐order bipolar factor hierarchically subsuming several bipolar reference‐group‐specific individualisms and collectivisms. Copyright © 2001 John Wiley & Sons, Ltd.     

双相障碍及其社会-心理治疗的研究现状

双相障碍是以起伏性躁狂或抑郁为特征的慢性周期性精神疾病。近年来,社会-心理疗法作为药物治疗的辅助手段被引入到该类疾病的治疗过程中。本文基于近期关于双相障碍的病因学的研究,评述了各种不同形式的社会-心理疗法在双相障碍治疗中的应用及其疗效,指出今后的研究需要进行严格的临床设计,以保证不同研究间的可比性和可重复性;应尽可能延长追踪观察的时间,并进行大样本多变量研究,以保证研究结果的普遍性。     

Identity in bipolar disorder: Self-worth and achievement

This article considers self and self-concept in bipolar disorder. Bipolar disorder, defined on the basis of manic symptoms, is a highly debilitating psychopathology. It is heavily grounded in biology but symptom course is still very responsive to psychological and social forces in the lives of persons who have the disorder. This review assumes an overall view of the self that is typical of personality psychology: self as traits, self as goals and aspirations, and ongoing efforts to attain those goals. In this review, we will discuss two different facets of self and identity in bipolar disorder. First, we review a body of goal pursuit literature suggesting that persons with bipolar disorder endorse heightened ambitions for attaining goals and recognition from others. Second, we will review multiple findings which suggest that among persons with bipolar disorder, self-worth depends on measurable success in an extreme way. We will consider how the intersection of these two themes may lead to unique identity challenges for people with bipolar disorder, drawing from self-report, behavioral, and neuroscience findings to critically examine this viewpoint.     

Marital dissolution and distress in a psychiatric population: A longitudinal design

There has been interest in recent years in the relationship between marital distress and psychopathology. It has been rare, however, for investigators to follow patients after their release from the hospital and observe the course of their marital relationships. The present study included patients meeting criteria for three DSM III DISORDERS (MAjor depressive, bipolar, and schizophrenic) and a normal control sample, all of whom are participants in an ongoing longitudinal study of children at risk for psychopathology (Stony Brook High-Risk Project; Weintraub & Neale, 1984). Marital Adjustment Test (MAT; Locke & Wallace, 1959) scores were collected on patients at entry into the project (Phase I) and at a three year follow-up (Phase II). Course of marriage was defined as negative if the couple's marital adjustment was rated as poor at Phase II or resulted in divorce or separation at Phase II. It was found that only the depressed group differed from the normal group in having significantly worse course of marital relationship; 84% of the depressive couples showed a “negative” course of marital change over time. However, all three patient groups had significantly higher rates of divorce by Phase II. MAT scores at Phase I successfully predicted course of marital relationship for all diagnostic groups. Implications for aftercare of psychiatric inpatients are discussed.     

Mood stability versus mood instability in bipolar disorder: a possible role for emotional mental imagery

A cognitive model of bipolar disorder suggests that mental imagery acts as an emotional amplifier of mood and may be heightened in bipolar disorder. First, we tested whether patients with bipolar disorder would score higher on mental imagery measures than a matched healthy control group. Second, we examined differences in imagery between patients divided into groups according to their level of mood stability. Mood ratings over approximately 6-months, made using a mobile phone messaging system, were used to divide patients into stable or unstable groups. Clinician decisions of mood stability were corroborated with statistical analysis. Results showed (I) compared to healthy controls, patients with bipolar disorder had significantly higher scores for general mental imagery use, more vivid imagery of future events, higher levels of intrusive prospective imagery, and more extreme imagery-based interpretation bias; (II) compared to patients with stable mood, patients with unstable mood had higher levels of intrusive prospective imagery, and this correlated highly with their current levels of anxiety and depression. The findings were consistent with predictions. Further investigation of imagery in bipolar disorder appears warranted as it may highlight processes that contribute to mood instability with relevance for cognitive behaviour therapy.