Abstract
Treatment of psychotic illness has, to date, been dominated by biomedical interventions. Work in the field of schizophrenia has demonstrated that psychological factors have a role to play initiating and maintaining psychotic disorders. This work is now beginning to be extended to bipolar affective disorder. Psychotic experiences are thought to lie on a continuum of normal cognitive processing. This study aims to explore cognitive factors involved in bipolar affective disorder, examining the beliefs that people hold about themselves, others and the world. Twenty-two participants with a diagnosis of bipolar affective disorder were recruited and asked to complete a battery of seven standardised questionnaires on six occasions, over a six-month period. Two of the questionnaires were used to assess and classify mood in terms of mania, depression or euthymia (remission). The other five questionnaires focussed on self-esteem; negative evaluative beliefs; assumptions; locus of control and social comparison. A comparison (control) group was also recruited, which was age and gender matched with all participants who were euthymie at time point one (i.e., completion of the first set of questionnaires). Results showed that that only in certain areas are beliefs affected by mood. Self-esteem was lower in depression. There were some significant changes in measures as mood shifted but not where it stayed the same. Negative self-self and self-other evaluative beliefs were higher in depression compared to euthymia, but mania had the highest level of negative self-other and other-self evaluative beliefs. In depression, people compare themselves less favourably to others and in mania more favourably. Depression and mania are associated with the greatest degree of dysfunctional assumptions in the areas of 'Love’. Dysfunctional attitudes towards ‘Approval’ and ‘Omnipotence’ are held in mania and towards ‘Autonomy’ in depression. Overall the ‘Total’ levels of dysfunctional assumptions are greater in depression compared to euthymia. Locus of control over health was more internal in mania. Mania was associated with more anxiety than depression. Beliefs of bipolar patients were less extreme/dysfunctional compared to unipolar depression. There were no differences between the beliefs of bipolar affective disorder patients when euthymic than matched controls other than euthymic patients felt their health to be less influenced by ‘chance’ and more influenced by the actions of others than non-psychiatric controls. Findings suggest that cognitive factors do play a part in bipolar affective disorder and specific cognitive interventions may have a role in treatment of this illness. Improving patient’s efficacy for controlling their illness may be a target for therapy, particularly in relation to specific mood states. Increasing awareness through monitoring and working on cognitive factors that influence, or arise from, mood state may help people gain a greater sense of efficacy over this debilitating illness.