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      Mood stability versus mood instability in bipolar disorder: A possible role for emotional mental imagery

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          Abstract

          A cognitive model of bipolar disorder suggests that mental imagery acts as an emotional amplifier of mood and may be heightened in bipolar disorder. First, we tested whether patients with bipolar disorder would score higher on mental imagery measures than a matched healthy control group. Second, we examined differences in imagery between patients divided into groups according to their level of mood stability. Mood ratings over approximately 6-months, made using a mobile phone messaging system, were used to divide patients into stable or unstable groups. Clinician decisions of mood stability were corroborated with statistical analysis. Results showed (I) compared to healthy controls, patients with bipolar disorder had significantly higher scores for general mental imagery use, more vivid imagery of future events, higher levels of intrusive prospective imagery, and more extreme imagery-based interpretation bias; (II) compared to patients with stable mood, patients with unstable mood had higher levels of intrusive prospective imagery, and this correlated highly with their current levels of anxiety and depression. The findings were consistent with predictions. Further investigation of imagery in bipolar disorder appears warranted as it may highlight processes that contribute to mood instability with relevance for cognitive behaviour therapy.

          Highlights

          ► Patients with bipolar disorder were compared to controls on mental imagery measures. ► Patients had higher scores on several imagery measures, e.g. more vivid imagery of future events. ► Patients were divided into groups according to their level of mood stability. ► Patients with unstable (versus stable) mood had higher levels of intrusive prospective imagery. ► Prospective imagery correlated highly with current levels of anxiety and depression.

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          Most cited references 44

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          Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.

          Bipolar spectrum disorders, which include bipolar I, bipolar II, and bipolar disorder not otherwise specified, frequently go unrecognized, undiagnosed, and untreated. This report describes the validation of a new brief self-report screening instrument for bipolar spectrum disorders called the Mood Disorder Questionnaire. A total of 198 patients attending five outpatient clinics that primarily treat patients with mood disorders completed the Mood Disorder Questionnaire. A research professional, blind to the Mood Disorder Questionnaire results, conducted a telephone research diagnostic interview by means of the bipolar module of the Structured Clinical Interview for DSM-IV. A Mood Disorder Questionnaire screening score of 7 or more items yielded good sensitivity (0.73) and very good specificity (0.90). The Mood Disorder Questionnaire is a useful screening instrument for bipolar spectrum disorder in a psychiatric outpatient population.
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            Mental imagery and emotion: a special relationship?

            A special association between imagery and emotion is often assumed, despite little supporting evidence. In Experiment 1, participants imagined unpleasant events or listened to the same descriptions while thinking about their verbal meaning. Those in the imagery condition reported more anxiety and rated new descriptions as more emotional than did those in the verbal condition. In Experiment 2, 4 groups listened to either benign or unpleasant descriptions, again with imagery or verbal processing instructions. Anxiety again increased more after unpleasant (but not benign) imagery; however, emotionality ratings did not differ after a 10-min filler task. Results support the hypothesis of a special link between imagery and anxiety but leave open the question of whether this also applies to other emotions. Copyright (c) 2005 APA, all rights reserved.
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              Developing interpretation bias modification as a "cognitive vaccine" for depressed mood: imagining positive events makes you feel better than thinking about them verbally.

              Two interpretation bias modification experiments found that mental imagery vs. verbal processing of positive material have differential emotional effects. In Experiment 1, participants were instructed to imagine positively resolved auditory descriptions or to listen to the same events while thinking about their verbal meaning. Increases in positive mood and bias were greater in the imagery than in the verbal condition, replicating E. A. Holmes, A. Mathews, T. Dalgleish, and B. Mackintosh (2006). An emotional vulnerability test showed that imagery (relative to the verbal condition) protected against a later negative mood induction. Experiment 2 created 2 new verbal conditions aimed to increase or reduce verbal comparisons. Results suggest making unfavorable comparisons with the highly positive material might be partially responsible for the inferiority of the verbal condition in Experiment 1. The findings demonstrate that imagery can play a key role in cognitive bias modification procedures and thus that task instructions are crucial. Imagining a positive event can make you feel better than thinking about the same event verbally. The authors propose that recruiting imagery will be useful in therapeutic innovations to develop a "cognitive vaccine" for depressed mood.
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                Author and article information

                Journal
                Behav Res Ther
                Behav Res Ther
                Behaviour Research and Therapy
                Elsevier Science
                0005-7967
                1873-622X
                October 2011
                October 2011
                : 49
                : 10
                : 707-713
                Affiliations
                [a ]Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
                [b ]Mathematical Ecology Research Group, Department of Zoology, University of Oxford, OX1 3PS, UK
                [c ]St. Peter’s College, New Inn Hall Street, Oxford OX1 2DL, UK
                Author notes
                []Corresponding author. Tel.: +44 (0) 1865 223 912; fax: +44 (0) 1865 793101. emily.holmes@ 123456psych.ox.ac.uk
                Article
                BRT2398
                10.1016/j.brat.2011.06.008
                3176902
                21798515
                © 2011 Elsevier Ltd.

                This document may be redistributed and reused, subject to certain conditions.

                Categories
                Shorter Communication

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