Valence specific response reversal deficits and risk for mania

How to study psychological mechanisms of mania? A systematic review on the methodology of experimental studies on manic mood dysregulation of leading theories on bipolar disorder

INTRODUCTION

Although there are several psychological theories on bipolar disorders (BD), the empirical evidence on these theories through experimental studies is still limited. The current study systematically reviews experimental methods used in studies on the main theories of BD: Reward Hypersensitivity Theory (RST) or Behavioral Activation System (BAS), Integrative Cognitive Model (ICM), Positive Emotion Persistence (PEP), Manic Defense theory (MD), and Mental Imagery (MI). The primary aim is to provide an overview of the used methods and to identify limitations and suggest areas of improvement.

METHODS

A systematic search of six databases until October 2023 was conducted. Study selection involved two independent reviewers extracting data on experimental study design and methodology.

RESULTS

A total of 84 experimental studies were reviewed. BAS and RST were the most frequently studied theories. The majority of these experimental studies focus on mechanisms of reward sensitivity. Other important elements of the reviewed theories, such as goal setting and-attainment, situation selection (avoidance or approach), activation, affective/emotional reactivity, and regulatory strategies, are understudied. Self-report and neuropsychological tasks are most often used, while mood induction and physiological measures are rarely used.

CONCLUSION

There is a need for more consensus on the operationalization of psychological theories of mania. Standardization of test batteries could improve comparability among studies and foster a more systematic approach to experimental research. Research on affective (activated) states is still underrepresented in comparison with studies on trait vulnerabilities.

To Be or Not to Be Flexible: Selective impairments as a means to differentiate between depression and PTSD symptoms

During the course of their lives, most individuals experience at least one potentially traumatic event. For some individuals this experience may result in them developing depression and/or post-traumatic stress disorder (PTSD) symptoms. The aim of the present study was to test the interactive effect of traumatic exposure and impaired cognitive flexibility on the tendency to develop either depression or PTSD symptoms. Eighty-two college students (M age = 25.32, SD age = 4.09) were assessed for exposure to traumatic events, depressive and PTSD symptoms. In addition, they completed a performance-based learning paradigm to evaluate the unique patterns of cognitive flexibility, defined as reduced and enhanced updating of prior knowledge in the face of new information. We predicted and found that for individuals with reduced updating, greater exposure to trauma was associated with elevated depressive symptoms. Contrary to our prediction, for individuals with enhanced updating, greater exposure was associated with elevated PTSD symptoms. While cognitive flexibility is traditionally associated with adaptive outcomes, our results illuminate the important role of a delicate updating balance to adaptively cope with aversive life events. The findings highlight the possible different roles of cognitive flexibility in the development of psychopathology and may serve as a first step toward developing tailored prevention and treatment methods.