Toward New Therapeutic Mechanisms in Bipolar Disorder: Analog Investigation of Self-Compassion and Nonattachment to Self

The mediating role of self-compassion in the relationship between internalized stigma and psychological resilience in bipolar disorder

INTRODUCTION

Internalized stigma is known to be high in bipolar disorder (BD). Concepts such as self-compassion and psychological resilience have recently begun to be studied as protective factors for BD. The aim of the current study was to examine the relationships between internalized stigma, self-compassion and resilience among individuals with BD.

METHOD

One hundred and thirty-two male and female (18-65 years of age) participants with a DSM 5 diagnosis of BD (BD- I & BD- II) were included. The remission criteria (YMRS< 5 and HDRS< 7) was evaluated using clinician-administered measures and all participants were found to be remitted. Correlation and mediation analyses were performed. Participants completed the Internalized Stigma in Mental Illness Scale (ISMI), the Self-Compassion Scale (SCS) and the Resilience Scale for Adults (RSA).

RESULTS

Significant correlations were found between internalized stigma, sub-dimensions of self-compassion (self-kindness, self-judgement, common humanity, isolation, mindfulness, and over-identification), and resilience in the expected directions like negative correlations between internalized stigma and positive dimensions of self-compassion (self-kindness, common humanity and mindfulness). Self-judgement and self-kindness mediated the relationship between internalized stigma and psychological resilience.

CONCLUSIONS

The findings of the study shed light on which dimensions of self-compassion might be more beneficial to work with in order to increase resilience when working with internalized stigma in BD. This strengths-based investigation would be valuable to enrich psycho-social interventions for the prevention of relapse in BD.

Performance of a measure to assess distress in bipolar disorder

INTRODUCTION

Bipolar disorder is a condition that causes distress even for euthymic patients, having an impact on functional capabilities and quality of life. Personal and social variables are potential sources of distress. Yet, there is a lack of measures to identify specific distress in bipolar disorder. This study describes the development and evaluation of a brief measure for assessing distress in patients with bipolar disorder. We also identify associations with related constructs such as functioning, stigma, and personal beliefs regarding mental illness.

MATERIAL AND METHODS

We used a sample of 101 euthymic bipolar outpatients. Psychological assessment consisted of the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D) to establish euthymia. Distress was assessed with Distress on Bipolar Patients-Short (DISBIP-S); associated variables were assessed with the Functioning Assessment Short Scale (FAST), the Internalized Stigma of Mental Illness (ISMI), and the Personal Beliefs about Illness Questionnaire (PBIQ).

RESULTS

The DISBIP-S has strong internal consistency (Cronbach's alpha=0.90), and medium-high correlation coefficients with the time since last relapse (r=-0.401), predominant polarity (r=0.309), HDRS (r=-0.644), FAST (r=0.453), ISMI (r=0.789), and PBIQ (r=-0.796). Taken together, the scores on the ISMI, and PBIQ and the time since last relapse together explain 69.2% of the variability in distress.

CONCLUSIONS

The DISBIP-S can be used as a first step to develop interventions aimed at dealing with problematic personal beliefs and interpersonal sources of distress. Reducing distress experienced by bipolar disorder patients could help improve their quality of life and daily functioning.

Variation in self and familiar facial recognition in bipolar disorder patients at different clinical stages

Previous studies suggest a close relationship between self-disorders and schizophrenia or unipolar depression. However, few studies have explored the characteristics of self-processing in bipolar disorder (BD) during different clinical states. This study compared the differences in self-face recognition (SFR) among patients with bipolar mania (BPM), bipolar depression (BPD), bipolar remission (RM), and healthy controls (HC). Images of subject's own face, a familiar face, and an unfamiliar face were combined in pairs at a certain proportion to obtain three types of blended images. We then compared the tendency between BD and HC while judging two kinds of blended faces emerging from presentation software. The results showed that the BPM and BPD groups seemed to lack an advantage in self-recognition. Self-processing and familiarity processing were significantly enhanced in BPM patients, while only familiarity processing was enhanced in BPD. The severity of clinical symptoms was not significantly correlated with self-bias or familiarity bias in BD.

Nonattachment mediates the associations between mindfulness, well-being, and psychological distress: A meta-analytic structural equation modeling approach

Research on nonattachment, a Buddhist psychological construct closely related to mindfulness, has burgeoned since the development of the Nonattachment Scale. The aim of the current meta-analysis was to investigate the mediating role of nonattachment in the relationship between mindfulness and well-being and psychological distress using a meta-analytic structural equation modeling approach. The respective associations of nonattachment and mindfulness with well-being and psychological distress, after controlling for each other, were also examined. Forty-one independent cross-sectional data sets with 24,704 individuals were coded. Results showed that nonattachment partially mediated the associations between mindfulness and well-being and psychological distress. Nonattachment and mindfulness were both significantly positively associated with well-being and negatively associated with psychological distress after controlling for each other. Given the present findings were based on cross-sectional data, more studies with rigorous research design, such as longitudinal, experimental, and intervention studies, should be conducted to further investigate the mediating effect of nonattachment between mindfulness with well-being and distress outcomes and establish causal relations between them. Future research directions regarding nonattachment and its application in mindfulness-based interventions were discussed.

The relative benefits of nonattachment to self and self-compassion for psychological distress and psychological well-being for those with and without symptoms of depression

OBJECTIVES

Self-compassion represents a way of interacting with the self involving kindness and a balanced approach to negative self-related stimuli that has shown to contribute to reduced depression, anxiety and stress, and increased psychological well-being. Due to the potential barriers towards self-compassion for people with depressive symptoms, the objective of the present study what to investigate whether the emerging construct of 'nonattachment to self', which reflects a flexible and balanced approach to all self-related stimuli, may be more beneficial for positive psychological outcomes than self-compassion, for individuals with depressive symptoms.

METHOD

A sample 388 participants (consisting of 71 men, 317 women) aged from 18 to 77 (M = 35.33, SD = 10.81) completed an online questionnaire measuring levels of self-compassion, nonattachment to self, depressive symptoms, and well-being.

RESULTS

Higher levels of both nonattachment to self and self-compassion were related to reduced psychological distress and increased psychological well-being. However, for people with at least mild depressive symptoms, nonattachment to self was found to be a stronger predictor of reduced psychological distress and increased psychological well-being than self-compassion.

CONCLUSION

In conclusion, the present study suggests both nonattachment to self and self-compassion are associated with better mental health in non-clinical populations. Further, for individuals experiencing at least mild symptoms of depression, self-compassion may be less beneficial than taking a more nonattached stance towards the self. The findings have implications for the way we conceptualize self-focused attention and suggest assisting individuals to let go of their fixated, self-focused attention may be especially beneficial for individuals with depressive symptoms.

PRACTITIONER POINTS

The notion of letting of attachment to the separate static self lies at the core of Buddhist psychological teachings and recent research suggests it can have a positive impact on individuals psychological well-being and ill-being Given the barriers to self-compassion experienced by individuals with depressive symptoms, nonattachment to self may represent a healthy interaction with the self than is met with less resistance than self-compassion. Due to the balanced stance of nonattachment to self towards positive and negative self-related stimuli, it may be prove to be a valuable approach to treating individuals who feel conflict with taking any form of positive or kind stance towards the self.

Genetic risk for bipolar disorder and schizophrenia predicts structure and function of the ventromedial prefrontal cortex

BACKGROUND

Bipolar disorder is highly heritable and polygenic. The polygenic risk for bipolar disorder overlaps with that of schizophrenia, and polygenic scores are normally distributed in the population. Bipolar disorder has been associated with structural brain abnormalities, but it is unknown how these are linked to genetic risk factors for psychotic disorders.

METHODS

We tested whether polygenic risk scores for bipolar disorder and schizophrenia predict structural brain alterations in 98 patients with bipolar disorder and 81 healthy controls. We derived brain cortical thickness, surface area and volume from structural MRI scans. In post-hoc analyses, we correlated polygenic risk with functional hub strength, derived from resting-state functional MRI and brain connectomics.

RESULTS

Higher polygenic risk scores for both bipolar disorder and schizophrenia were associated with a thinner ventromedial prefrontal cortex (vmPFC). We found these associations in the combined group, and separately in patients and drug-naive controls. Polygenic risk for bipolar disorder was correlated with the functional hub strength of the vmPFC within the default mode network.

LIMITATIONS

Polygenic risk is a cumulative measure of genomic burden. Detailed genetic mechanisms underlying brain alterations and their cognitive consequences still need to be determined.

CONCLUSION

Our multimodal neuroimaging study linked genomic burden and brain endophenotype by demonstrating an association between polygenic risk scores for bipolar disorder and schizophrenia and the structure and function of the vmPFC. Our findings suggest that genetic factors might confer risk for psychotic disorders by influencing the integrity of the vmPFC, a brain region involved in self-referential processes and emotional regulation. Our study may also provide an imaging-genetics vulnerability marker that can be used to help identify individuals at risk for developing bipolar disorder.

An investigation of self-compassion and nonattachment to self in people with bipolar disorder

BACKGROUND

There have been longstanding theories and research evidence into the important role of the person's vulnerability at the level of self-concept in bipolar disorder (BD). The current study investigated two emerging self-related constructs, self-compassion and nonattachment to self in BD. Specifically, we examined the levels of the two constructs in people with BD compared with those from the general population, and the associations between the constructs and bipolar symptomologies within the BD group.

METHODS

The BD group consisted of 302 individuals with a diagnosis of BD participating in an international randomised controlled trial. A general population sample (n = 372) was recruited from an Australian university as a comparison group. All participants completed measures of self-compassion and nonattachment to self. The BD group completed additional measures of depression and symptoms of hypo/mania.

RESULTS

Participants with BD showed significantly lower self-compassion and nonattachment to self than those from the comparison group after controlling for demographic variables (e.g., gender, age, education, occupation). In the BD group, lower self-compassion and nonattachment to self were associated with greater severity of depression on both self- and clinician-rated scales. Nonattachment to self but not self-compassion was negatively associated with hypo/mania symptomology.

LIMITATIONS

The cross-sectional design cannot determine the direction of the relationships between study variables. Nonattachment to self is a novel psychological construct and further research is needed to replicate study findings.

CONCLUSIONS

The study findings suggest that self-compassion and nonattachment to self may be meaningful targets in psychological interventions for people with BD.

Buffering against maladaptive perfectionism in bipolar disorder: The role of self-compassion

BACKGROUND

Maladaptive perfectionism is a transdiagnostic risk and maintaining factor for a range of mental health conditions, including bipolar disorder (BD). Self-compassion represents a potential protective factor against maladaptive perfectionism, however no studies to date have examined the relationship of these constructs in BD. The aim of the present study was to examine associations between maladaptive perfectionism, self-compassion and symptoms among individuals with BD.

METHODS

Baseline data were collected from 302 participants with a DSM-IV diagnosis of BD participating in an international randomised controlled trial. Participants completed measures of maladaptive perfectionism, self-compassion, symptom severity and emotion regulation difficulties. Clinician-administered measures of depression and mania severity were additionally collected. Correlation and mediation analyses were conducted.

RESULTS

Maladaptive perfectionism was positively associated with depression, anxiety and emotion regulation difficulties. Lower levels of self-compassion correlated with greater self-reported depression, anxiety and emotion regulation difficulties. Self-compassion partially mediated relationships between maladaptive perfectionism, depression, anxiety and emotion regulation difficulties.

LIMITATIONS

The cross-sectional design limits conclusions about causal relationships between study variables. Results may not be generalizable to other BD populations. The role of maladaptive perfectionism and self-compassion in elevated mood states of BD remains unclear.

CONCLUSION

Self-compassion represents one mechanism through which maladaptive perfectionism influences symptoms of depression, anxiety and emotion regulation difficulties in BD. Self-compassion represents a modifiable treatment target; individuals with BD exhibiting maladaptive perfectionistic tendencies may benefit from interventions fostering self-compassion.

What Would Digital Early Intervention for Bipolar Disorder Look Like? Theoretical and Translational Considerations for Future Therapies

There are growing calls for the development of early intervention/preventive interventions for young people identified to be at risk of bipolar disorder (BD), and digital delivery appears to be a strong candidate delivery method. To date, no such interventions exist, and the aim of this perspective paper is to advance the literature by reviewing theoretical issues related to early intervention in BD and introducing a framework for design of feasible, acceptable, and effective online psychosocial interventions for this population. It is concluded that, by adopting an appropriate transdiagnostic and humanistic framework, and recognizing emerging tenets of digital psychotherapy development, testable online interventions for young people at risk of BD are within reach.