Responsiveness to Threat and Incentive in Bipolar Disorder: Relations of the BIS/BAS Scales with Symptoms

Over the past 10 years, theorists have suggested that bipolar disorder symptoms result from increases and decreases in the activity of the Behavioral Activation or Facilitation System (BAS or BFS) and the Behavioral Inhibition System (BIS). These neurobehavioral systems are thought to determine the intensity of affective and behavioral responses to incentives and threats. This study examined cross-sectional and prospective associations of self-reported BIS and BAS with mania and depression in a sample of 59 individuals diagnosed with Bipolar I disorder. Depression was tied to BIS, pointing to the importance of sensitivity to threats in depression. However, links between BIS and depression appeared state-dependent. BAS subscales did not correlate with manic symptoms in a state-dependent manner; however, BAS (total scale and reward responsiveness subscale) predicted relative intensification of manic symptoms over time. Thus, evidence suggests that BAS sensitivity may constitute a vulnerability to mania among persons diagnosed with bipolar disorder. Discussion focuses on the integrative potential of the BIS/BAS constructs for linking psychosocial and biological research on bipolar disorder.     

Exploring Behavioral Activation and Inhibition Sensitivities Among College Students at Risk for Bipolar Spectrum Symptomatology

We explored cross-sectionally the roles in bipolar spectrum symptomatology of two broad motivational systems that are thought to control levels of responsiveness to cues of threat and reward, the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS). Undergraduate students (n = 357) completed questionnaires regarding (a) bipolar spectrum disorders [the General Behavior Inventory (GBI), a well-established clinical screening measure], (b) current depression and mania symptoms (the Internal State Scale; ISS), and (c) BIS/BAS sensitivities (the BIS/BAS scales). Validated cutoff scores on the GBI were used to identify individuals at risk for a mood disorder. It was hypothesized that, among at-risk respondents, high BAS and low BIS levels would be associated with high current mania ratings, whereas low BAS and high BIS would be associated with high current depression ratings. Multiple regression analyses indicated that, among at-risk individuals (n = 63), BAS accounted for 27% of current mania symptoms but BIS did not contribute. For these individuals, BAS and BIS were both significant and together accounted for 44% of current depressive symptoms.     

Behavioral Approach System Sensitivity and Risk Taking Interact to Predict Left-Frontal EEG Asymmetry

The Behavioral Approach System (BAS) hypersensitivity theory of bipolar disorder (BD; Alloy & Abramson, 2010; Depue & Iacono, 1989) suggests that hyperreactivity in the BAS results in the extreme fluctuations of mood characteristic of BD. In addition to risk conferred by BAS hypersensitivity, cognitive and personality variables may play a role in determining risk. We evaluated relationships among BAS sensitivity, risk taking, and an electrophysiological correlate of approach motivation, relative left-frontal electroencephalography (EEG) asymmetry. BAS sensitivity moderated the relationship between risk taking and EEG asymmetry. More specifically, individuals who were high in BAS sensitivity showed left-frontal EEG asymmetry regardless of their level of risk-taking behavior. However, among individuals who were moderate in BAS sensitivity, risk taking was positively associated with asymmetry. These findings suggest that cognitive and personality correlates of bipolar risk may evidence unique contributions to a neural measure of trait-approach motivation. Clinical implications of these findings are discussed.     

Does Exposure and Response Prevention Behaviorally Activate Patients With Obsessive-Compulsive Disorder? A Preliminary Test

Exposure and response prevention (ERP) and behavioral activation (BA) are effective treatments for obsessive-compulsive disorder (OCD) and depression, respectively. Patients with OCD often exhibit depression; furthermore, ERP for OCD is associated with reduced depressive symptoms. To our knowledge, no study has examined whether ERP itself functions to behaviorally activate patients with concurrent OCD and depressive symptoms. This prospective study was designed to test the hypotheses that (a) OCD exposure hierarchy completion, increased BA, and depressive symptom reduction would all be related, and (b) pre- to posttreatment changes in BA would mediate the direct effect of OCD hierarchy completion on posttreatment depressive symptoms, even after controlling for pretreatment depressive symptoms, pretreatment BA, pre- to posttreatment reductions in OCD symptoms, treatment duration, and antidepressant medication use. Patients (N = 90) with a primary diagnosis of OCD who received residential ERP for OCD completed a self-report battery at pre- and posttreatment. Exposure hierarchy completion, increases in BA, and decreases in depression were all significantly correlated (rs ranged .33 to .44). The effect of hierarchy completion on posttreatment depressive symptoms was fully mediated by pre- to posttreatment changes in BA. Findings highlight the potential for ERP to exert antidepressant effects by behaviorally activating patients. Limitations, clinical implications, and future directions are discussed.     

自恋与行为抑制/激活系统的关系：元分析

运用元分析方法探讨自恋与行为抑制/激活系统的关系。经过文献检索和筛选, 纳入原始文献19篇, 包含25个独立样本, 共7702名被试。根据同质性检验结果, 选用随机效应模型。结果发现, 自恋与行为抑制系统存在中度负相关(r = -0.27, 95% CI为[-0.34, -0.21]), 自恋测量工具在两者间起显著的调节作用; 自恋与行为激活系统存在高度正相关(r = 0.46, 95% CI为[0.40, 0.52]), 被试类型在两者间起显著的调节作用。自恋与行为抑制/激活系统的密切关系支持了自恋的主体性理论和人格强化敏感性理论。     

“Me”, “We”, and Materialism: Associations between Contingent Self-Worth and Materialistic Values across Cultures

Abstract

Individuals with high levels of externally contingent self-worth tend to base their self-esteem on factors such as appearance, competitive success, and others’ approval. Such tendencies might also elevate people’s focus on material possessions. However, cultural moderation of these associations has yet to be explored. A cross-cultural survey among Chinese and Dutch college students examined the link between externally-based contingent self-worth and materialistic values, as well as the mediating roles of need to belong and need for self-enhancement. An initial multi-group path analysis indicated a stronger link between externally contingent self-worth and materialism for Chinese students than for Dutch students. For both Chinese and Dutch students, externally contingent self-worth was positively related to materialistic values, need to belong, and need for self-enhancement. Need to belong and need for self-enhancement were positively linked with materialism, and need to belong and need for self-enhancement mediated the link between externally contingent self-worth and materialism. Though the indirect effect via self-enhancement was somewhat stronger among Chinese participants, this research demonstrates that people’s externally contingent self-worth might be a factor predicting materialism across cultures, with need to belong and need for self-enhancement playing similar roles as underlying processes in different societies.     

Impulsivity and Behavior-Dependent Life Events Mediate the Relationship of Reward Sensitivity and Depression,but Not Hypomania,Among at-Risk Adolescents

Both reward sensitivity and impulsivity are related to the development and course of bipolar spectrum disorders (BSDs) and have been implicated in other disorders and negative functional outcomes such as substance abuse, obesity, suicidal behaviors, and risk-taking. Furthermore, according to the transactional component of the Behavioral Approach System (BAS)/reward hypersensitivity theory of BSDs, people with reward hypersensitivity should experience more BAS-relevant events, and thus, are more vulnerable to mood symptoms and episodes via stress generation. Impulsivity may exacerbate stress generation in individuals at risk for BSDs based on exhibiting reward hypersensitivity. The current study examined whether impulsivity explained the generation of stress and subsequent mood symptoms beyond what is explained by reward sensitivity alone. Participants were 131 Moderate BAS and 216 High BAS sensitivity adolescents (M = 18.43 years, SD = 1.40), who completed baseline measures of reward sensitivity and impulsivity, as well as follow-up measures of life events and mood symptoms. Results from linear regression analyses indicated that higher baseline impulsivity predicted behavior-dependent, but not behavior-independent, life events. Furthermore, path analyses suggested that the effect of BAS group on depression symptoms at next follow-up was partly explained via the indirect effect of impulsivity and negative behavior-dependent life events. We did not find these effects for behavior-independent or positive-dependent events or for prediction of hypomanic symptoms. The findings suggest that impulsivity may account for stress generation of negative events that precede depression.     

高低行为激活系统个体在赌博任务下的决策模式

为考察不同行为激活系统/行为抑制系统下的个体在Iowa赌博任务反应模式下的决策行为,本研究采用人格问卷与行为实验相结合的方式,探讨了人格、冲动和行为决策间的关系。结果发现:(1)行为激活系统三个维度与行为决策存在显著负相关,行为激活系统低分组的IGT得分较高,行为激活系统高分组的IGT得分较低,而冲动特征与IGT得分相关不显著;(2)行为激活系统高、低分者在IGT任务上差异显著,且行为激活系统高分组者在收益-风险并存情境中表现出"即时收益优先"的决策模式。结果提示,在收益-风险并存情境中,高行为激活的人格特征者倾向风险决策模式。     

Development and Preliminary Feasibility Study of a Brief Behavioral Activation Mobile Application (Behavioral Apptivation) to Be Used in Conjunction With Ongoing Therapy

Depressive symptoms are the most frequently treated psychiatric condition in the United States. Brief behavioral activation treatment for depression (BATD) is a popular, evidence-based psychotherapy with strong research support for the treatment of depression. In this paper, we describe the development and initial pilot feasibility testing of a BATD mobile application (Behavioral Apptivation) to be used by patients and therapists in conjunction with BATD therapy. We present information regarding the app development process as well as results from a small open-label feasibility trial of the app utilized in conjunction with individual BATD. We include a case series from the open-label trial highlighting how Behavioral Apptivation can be utilized in clinical practice.     

The behavioral activation for depression scale-short form: development and validation

Following a landmark component analysis of cognitive therapy by Jacobson and colleagues (1996), there has been renewed interest in behavioral activation (BA) treatments for depression. The Behavioral Activation for Depression Scale (BADS) was developed to measure when and how clients become activated over the course of BA treatment. Multiple studies have provided initial support for the BADS but have also identified several potential problems. Four studies were conducted in order to develop and provide initial evaluation of a short form of the BADS that addresses these concerns. In Study 1, an exploratory factor analysis was conducted on existing data using the original BADS in order to identify items to retain for the short form. In Study 2, these items were administered to a new sample of college students with elevated depressive symptoms and were analyzed with exploratory and confirmatory factor analyses. Study 3 examined the predictive validity of the BADS-SF by examining the BADS-SF and depression scores in relation to activity tracking and reward-value ratings over the course of 1 week. Study 4 examined BADS-SF data over the course of BA treatment for two clients using cross-lagged panel correlations. With one client, changes in BADS-SF scores led changes in depression scores by 1 week, whereas with the other client changes in BADS-SF and depression scores occurred concurrently. These studies resulted in a nine-item scale that demonstrated good item characteristics as well as acceptable internal consistency reliability, construct validity, and predictive validity.     

Do mental disorders moderate the association between diabetes status and alcohol consumption?

Although heavy alcohol consumption is associated with diabetes-related complications, little is known about patterns of alcohol use among people with diabetes. Moreover, heavy drinking is more common among individuals with major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD) than in the general population, and these disorders are often comorbid with diabetes. The present study tested the hypothesis that mental disorders moderate the association between diabetes status and alcohol consumption. A total of 14,302 adult participants aged 40-79 were included from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (1,698 with diabetes). Data were analyzed using hierarchical linear regression models. MDD and BD, but not GAD, significantly moderated the association between diabetes status and alcohol quantity, such that the presence of diabetes was strongly and negatively associated with alcohol quantity if individuals had MDD or BD. There was no interaction between diabetes status and any of the mental disorders and alcohol frequency. This study suggests that among individuals with diabetes, those with comorbid MDD or BD drink less than those without MDD or BD. Further investigation of this association is needed and could help inform future alcohol-related interventions among individuals with diabetes.     

Development of a Behavioral Activation–Based Intervention for Cigarette-Smoking Young Adults

Quitting smoking during young adulthood can substantially reduce tobacco-related morbidity and mortality later in life. Depressive symptomatology is prevalent among smokers and increases risk for poor smoking cessation outcomes. However, few integrated behavioral interventions simultaneously target smoking and depressive symptoms and rarely have young smokers been included in the development of these interventions. In this paper we describe an 8-session behavioral activation–based treatment for smoking (BATS; MacPherson et al., 2010) adapted for youth. We conducted a series of focus groups with young adult smokers with depressive symptoms in order to modify treatment manuals to be developmentally appropriate. Subsequently, we completed a small pilot group (n = 5) of the intervention to provide preliminary data on feasibility, acceptability, and outcomes. We provide a case series of the participants in order to provide clinical illustrations of how the modified BATS treatment was implemented among young adults. Most pilot study participants exhibited smoking abstinence and smoking reductions at the end of treatment, as well as improvement in depressive symptoms and maintenance of levels of activation and environmental reward. Participants provided positive qualitative constructive feedback regarding the intervention.     

Memory transfer for emotionally valenced words between identities in dissociative identity disorder

The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including neutral, positive and negative material. List A was shown to one identity, while list B was shown to another identity claiming total amnesia for the words learned by the first identity. The identity claiming amnesia was tested for intrusions from list A words into the recall of words from list B and recognition of the words learned by both identities. Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. It is argued that dissociative amnesia in DID may more adequately be described as a disturbance in meta-memory functioning instead of an actual retrieval inability.     

Comprehensive school-based behavioral assessment of the effects of methylphenidate.

Individualized assessments of the effects of three doses of methylphenidate (MPH) were conducted for 2 students with attention deficit hyperactivity disorder within each child's classroom using behavioral, academic, and social measures. A double-blind, placebo-controlled, multielement design was used to evaluate the results. Results suggested that at least one or more dosages of MPH were associated with some degree of improvement for both children in each area of functioning as compared to placebo. However, the degree of improvement at times varied substantially across dosage and area of functioning. Results suggest that MPH dosage and area of child functioning are critical assessment parameters and that controlled clinical trials are necessary to optimize the effectiveness of treatment with MPH for the individual child.