Jordan A. Tharp

Emotion in bipolar I disorder: Implications for functional and symptom outcomes

Despite the centrality of emotion disturbance in neurobiological models of bipolar disorder, the behavioral literature has not yet clearly identified the most central aspects of emotion disturbance in bipolar disorder. Toward this aim, we gathered a battery of emotion-related measures in 67 persons diagnosed with bipolar I disorder as assessed with the SCID and a well-matched control group of 58 persons without a history of mood disorders. Those with bipolar disorder were interviewed monthly until they achieved remission, and then tested on emotion measures. A subset of 36 participants with bipolar disorder completed symptom severity interviews at 12-month follow-up. Factor analyses indicated 4 emotion factor scores: Negative Emotion, Positive Emotion, Reappraisal, and Suppression. Bivariate analyses suggested that bipolar disorder was tied to a host of emotion disturbances, but multivariate analyses suggested that bipolar disorder was particularly tied to elevations of Negative Emotion. High Negative Emotion, low Positive Emotion, and high Suppression were conjointly related to lower functioning. Reappraisal predicted declines in depression over time for those with bipolar disorder. Findings highlight the importance of considering the overall profile of emotion disturbance in bipolar disorder. Emotion and emotion regulation appear central to a broad range of outcomes in bipolar disorder.

Positive urgency is related to difficulty inhibiting prepotent responses.

Positive urgency, the tendency to respond impulsively to positive affective states, has been linked to many psychopathologies, but little is known about mechanisms underpinning this form of impulsivity. We examined whether the Positive Urgency Measure (PUM) related to higher scores on performance-based measures of impulsivity and cognitive control that were administered after a positive mood induction. Undergraduates (n = 112) completed the self-report PUM, several positive mood inductions, and behavioral measures of impulsivity and cognitive control. PUM scores were significantly related to poor performance on the antisaccade task, a measure of prepotent response inhibition, but not to other performance measures. Together with existing literature, findings implicate deficits in response inhibition as one mechanism involved in emotion-related impulsivity. (PsycINFO Database Record

Tourette Syndrome: Complementary Insights from Measures of Cognitive Control, Eyeblink Rate, and Pupil Diameter

Some individuals with Tourette syndrome (TS) have severe motoric and vocal tics that interfere with all aspects of their lives, while others have mild tics that pose few problems. We hypothesize that observed tic severity reflects a combination of factors, including the degree to which dopaminergic (DA) and/or noradrenergic (NE) neurotransmitter systems have been affected by the disorder, and the degree to which the child can exert cognitive control to suppress unwanted tics. To explore these hypotheses, we collected behavioral and eyetracking data from 26 patients with TS and 26 controls between ages 7 and 14, both at rest and while they performed a test of cognitive control. To our knowledge, this is the first study to use eyetracking measures in patients with TS. We measured spontaneous eyeblink rate as well as pupil diameter, which have been linked, respectively, to DA and NE levels in the central nervous system. Here, we report a number of key findings that held when we restricted analyses to unmedicated patients. First, patients’ accuracy on our test of cognitive control accounted for fully 50% of the variance in parentally reported tic severity. Second, patients exhibited elevated spontaneous eyeblink rates compared to controls, both during task performance and at rest, consistent with heightened DA transmission. Third, although neither task-evoked pupil dilation nor resting pupil diameter differed between TS patients and controls, pupil diameter was positively related to parentally reported anxiety levels in patients, suggesting heightened NE transmission in patients with comorbid anxiety. Thus, with the behavioral and eyetracking data gathered from a single task, we can gather objective data that are related both to tic severity and anxiety levels in pediatric patients with TS, and that likely reflect patients’ underlying neurochemical disturbances.

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

&NA; 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.

Positive Urgency and Emotional Reactivity: Evidence for Altered Responding to Positive Stimuli.

Positive urgency, defined as a tendency to become impulsive during positive affective states, has gained support as a form of impulsivity that is particularly important for understanding psychopathology. Despite this, little is known about the emotional mechanisms and correlates of this form of impulsivity. We hypothesized that positive urgency would be related to greater emotional reactivity in response to a positive film clip. Seventy-five undergraduates watched a positive film clip, and a multimodal assessment of emotion was conducted, including subjective emotional experience, physiological activation (i.e., heart rate, respiratory sinus arrhythmia, skin conductance), and facial emotional behavior (i.e., objectively coded using the Facial Action Coding System). Positive urgency was not significantly related to greater positive emotional reactivity but rather a more complex array of emotions expressed in facial behavior, as indexed by similar levels of positive yet greater levels of negative behavior. These findings show that positive urgency may be linked to altered emotionality, but does not appear related to heightened positive emotional reactivity. Potential implications for functional outcomes are discussed.

Cognitive and affective remediation training for mood disorders

Mood disorders are associated with clinically significant impairments and abnormalities in executive functioning, working memory, processing speed and responses to emotionally evocative stimuli. Such features can persist between mood episodes, affect the return to full functional recovery and influence the likelihood of future relapse (Schmid and Hammar, 2013). Cognitive difficulties are often cited as impairing and persistent by patients with mood disorders. However, currently available pharmacological and psychotherapeutic treatments have limited effects on these cognitive impairments and abnormalities, with several studies suggesting that for many patients there are ongoing and significant impairments and abnormalities after recovery of mood symptoms. Considerable research has been conducted into cognitive training programs, using intensive rehabilitative practice of specific cognitive and emotional functions, e.g. in schizophrenia, and to address cognitive decline with aging. This research has received increasing attention in the media and by the lay public, with patients now sometimes using commercial ‘cognitive exercise’ programs before seeking more formal care. The focus of this paper is on therapies targeting cognitive dysfunction in mood disorders; many of these have been adaptations of strategies used in schizophrenia, and others were developed to target specific mechanisms of depression. As a group of therapies, we have here called them cognitive and affective remediation training (CART). Here, we address several issues in the development and application of these therapies.

Eye Tracking of Attention to Emotion in Bipolar I Disorder: Links to Emotion Regulation and Anxiety Comorbidity

Research has yielded mixed findings regarding whether bipolar disorder is related to attentional bias for emotionally-relevant stimuli, yet little research has utilized advances in eye-tracking technology to study attention in this population. The current study used a free-viewing eye-tracking paradigm to test whether people with remitted bipolar disorder show preferential attention to positive faces, and to test if comorbid anxiety or emotion regulation strategies are related to attention bias. Twenty-nine adults with bipolar I disorder and 28 control participants viewed images of emotionally valenced faces while their gaze was tracked, and participants completed self-report measures of emotion regulation. Contrary to hypotheses, people with bipolar disorder did not differ from control participants in attention to positive stimuli, and both anxiety comorbidity and emotion regulation were unrelated to attentional indices. Unlike some findings in unipolar depression, these results suggest that attention to valenced faces may not be characteristic of remitted bipolar disorder.

Willingness to Expend Effort Toward Reward and Extreme Ambitions in Bipolar I Disorder

More than a dozen recent studies have shown that bipolar disorder and key outcomes within bipolar disorder are related to heightened willingness to pursue extremely ambitious life goals, as measured by the Willingly Approached Set of Statistically Unlikely Pursuits (WASSUP). Although it has been argued that this willingness to pursue difficult lifetime ambitions in bipolar disorder could reflect willingness to expend effort toward reward, this has not been tested to date. In this study, 50 individuals with bipolar I disorder were followed until they achieved remission. They then completed the Effort Expenditure for Rewards Task (EEfRT) and the WASSUP. Scores on the WASSUP Financial Success subscale, but not the Popular Fame subscale, were significantly associated with decision making on the EEfRT, even after controlling for significant effects of reward magnitude, gender, and age. These two indices appear to measure related facets of reward sensitivity.