1
|
So SHW, Chau AKC, Chung LKH, Leung CM, Chong GH, Chang WC, Mak AD, Chan SS, Lee S, Sommer IE. Moment-to-moment affective dynamics in schizophrenia and bipolar disorder. Eur Psychiatry 2023; 66:e67. [PMID: 37544924 PMCID: PMC10594258 DOI: 10.1192/j.eurpsy.2023.2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested. METHODS Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46). RESULTS Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect. CONCLUSIONS Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.
Collapse
Affiliation(s)
- Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Chung-ming Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - George H.C. Chong
- Department of Clinical Psychology, Kwai Chung Hospital, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Arthur D.P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sandra S.M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Iris E. Sommer
- Department of Psychiatry, University Medical Centre Groningen, The Netherlands
| |
Collapse
|
2
|
Boemo T, Nieto I, Vazquez C, Sanchez-Lopez A. Relations between emotion regulation strategies and affect in daily life: A systematic review and meta-analysis of studies using ecological momentary assessments. Neurosci Biobehav Rev 2022; 139:104747. [PMID: 35716875 DOI: 10.1016/j.neubiorev.2022.104747] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 01/17/2023]
Abstract
Emotion regulation (ER) is a central target in the study of psychological and neurobiological processes of emotions for numerous psychological disorders. Ecological momentary assessments, overcoming retrospective self-reports, allow a better understanding of the relation between the use of ER strategies and daily life affective experiences. A systematic review and meta-analyses of studies testing these relations through experience sampling methods (ESM) and daily diaries were conducted. ESM studies showed significant large effect sizes in contemporaneous relations between negative affect (NA) and rumination, suppression, and worry, and in both contemporaneous and prospective relations between positive affect (PA) and reappraisal; medium effect sizes in prospective relations between NA and rumination, and PA and distraction; and a small effect size in the prospective relation between NA and suppression. Daily diary studies showed significant large effect sizes in contemporaneous relations between NA and rumination and suppression, and in both contemporaneous and prospective relations between PA and reappraisal; medium effect sizes in contemporaneous relations between PA and acceptance, and problem-solving; and a small effect size in the prospective relation between NA and reappraisal. These findings shed light on the temporal relations between the use of ER strategies and affective experiences and highlight conceptual and methodological limitations in the field.
Collapse
Affiliation(s)
- Teresa Boemo
- School of Psychology, Complutense University of Madrid, Spain.
| | - Ines Nieto
- School of Psychology, Complutense University of Madrid, Spain.
| | - Carmelo Vazquez
- School of Psychology, Complutense University of Madrid, Spain.
| | | |
Collapse
|
3
|
Batmaz S, Altinoz AE, Sonkurt HO. Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder. World J Psychiatry 2021; 11:589-604. [PMID: 34631463 PMCID: PMC8474997 DOI: 10.5498/wjp.v11.i9.589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/16/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder (BD). However, relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD. Given its unique view in the explanation of psychopathological states, metacognitive therapy (MCT) might be helpful for BD. Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome (CAS) and that it is influenced and maintained by dysfunctional metacognitive beliefs, perseverative thinking, attentional biases, and dysfunctional coping strategies. In this review, literature data regarding these areas in BD are examined. Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD. Regarding attentional biases, literature data show that state-dependent, mood-changing attentional biases and a ruminative self-focused attention are present. Studies also suggest that cognitive self-consciousness is higher in BD compared to controls. It is seen that maladaptive coping strategies are frequently reported in BD, and that these strategies are associated with depression severity, negative affect and relapse risk. Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs, self-consciousness, need to control thoughts, and a lack of cognitive confidence. Also, dysfunctional metacognitive beliefs were associated with depressive symptomatology. These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD. For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions, MCT might be an alternative way to consider as a treatment option. In conclusion, taken the available data together, we propose a sequential treatment protocol for BD, mainly based on the MCT treatment plan of depressive disorders.
Collapse
Affiliation(s)
- Sedat Batmaz
- Department of Psychiatry, School of Medicine, Tokat Gaziosmanpasa University, Tokat 60100, Turkey
| | - Ali Ercan Altinoz
- Department of Psychiatry, School of Medicine, Eskisehir Osmangazi University, Eskisehir 26000, Turkey
| | | |
Collapse
|
4
|
So SHW, Chung LKH, Tse CY, Chan SSM, Chong GHC, Hung KSY, Sommer IEC. Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices. Psychol Med 2021; 51:661-667. [PMID: 31907105 DOI: 10.1017/s0033291719003611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative affect (NA) has been suggested to be both an antecedent and a consequence of auditory verbal hallucinations (AVH). Furthermore, negative appraisals of voices have been theorized to contribute to the maintenance of AVH. Using the experience sampling method (ESM), this study examined the bi-directional relationship between NA and AVH, and the moderating effect of negative beliefs about voices. METHODS Forty-seven patients diagnosed with schizophrenia spectrum disorders with frequent AVH completed a clinical interview, followed by ESM for 10 times a day over 6 days on an electronic device. Time-lagged analyses were conducted using multilevel regression modeling. Beliefs about voices were assessed at baseline. RESULTS A total of 1654 data points were obtained. NA predicted an increase in AVH in the subsequent moment, and AVH predicted an increase in NA in the subsequent moment. Baseline beliefs about voices as malevolent and omnipotent significantly strengthened the association between NA and AVH within the same moment. In addition, the belief of omnipotence was associated with more hallucinatory experiences in the moment following NA. However, beliefs about voices were not associated directly with momentary levels of NA or AVH. CONCLUSIONS Experiences of NA and AVH drove each other, forming a feedback loop that maintained the voices. The associations between NA and AVH, either within the same moment or across moments, were exacerbated by negative beliefs about voices. Our results suggest that affect-improving interventions may stop the feedback loop and reduce AVH frequency.
Collapse
Affiliation(s)
- Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Lawrence Kin-Hei Chung
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Chun-Yu Tse
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Sandra Sau-Man Chan
- Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | | | - Karen Shee-Yueng Hung
- Department of Psychiatry, Castle Peak Hospital, New Territories, Hong Kong SAR, China and
| | - Iris E C Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
| |
Collapse
|
5
|
So SH, Mak ADP, Chan PS, Lo CCW, Na S, Leung MHT, Ng IHC, Chau AKC, Lee S. Efficacy of Phase 1 of Life Goals Programme on symptom reduction and mood stability for bipolar disorder. J Affect Disord 2021; 281:949-957. [PMID: 33229019 DOI: 10.1016/j.jad.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Life Goals Programme (LGP) was developed as a psychological intervention for bipolar disorder, with its structured 6-session psychoeducation phase (Phase 1) targeting understanding of the disorder, medication adherence, early warning signs, and coping with symptoms and triggers. The present study tested the efficacy of Phase 1 of the LGP on symptom recovery and moment-by-moment mood stability, as well as medication adherence and quality of life. METHODS Adults with bipolar disorder were randomly allocated to the LGP condition (six weekly group sessions) or the waitlist condition (six weeks of standard care, followed by the same LGP intervention). Participants were assessed before and after treatment, and at 6-month follow up. Waitlist participants were additionally assessed at baseline. Assessment included a clinical interview (SCID, MADRS, YMRS, and HAM-A), self-reported questionnaires, and 6-day experience sampling assessment on a mobile device. RESULTS 64 out-patients with bipolar disorder (44 Bipolar I and 20 Bipolar II subtypes) participated in this study. LGP was well received and attended. Following LGP, there were significant improvements in knowledge about illness and level of anxiety, which were of large effect sizes and sustained at 6-month follow-up. Experience sampling assessment revealed small but significant improvements in moment-by-moment mood stability. Improvement in medication adherence was significant at 6 months and was of a moderate-to-large effect size. Changes in anxiety and mood stability were significantly greater following LGP than standard care. LIMITATIONS Our results warrant further testing against active control. CONCLUSIONS There was a robust improvement in emotional regulation following the 6-week LGP.
Collapse
Affiliation(s)
- Suzanne H So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR.
| | - Arthur Dun-Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Pui-Shuen Chan
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chloe Chor-Wing Lo
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Shirley Na
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Iris Hoi-Ching Ng
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| |
Collapse
|
6
|
Koenders M, Dodd A, Karl A, Green M, Elzinga B, Wright K. Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|