Background Despite increasing evidence for the effectiveness of individual psychological interven... more Background Despite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder. Aims To evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder. Method A parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder. Results Thirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the inter...
BACKGROUND US suicide rates have risen steadily in the past decade, and suicide risk is especiall... more BACKGROUND US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life. OBJECTIVE This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, whic...
Recent research has highlighted that emotion regulation strategy use varies both between and with... more Recent research has highlighted that emotion regulation strategy use varies both between and within people, and specific individual and contextual differences shape strategy use. Further, use of specific emotion regulation strategies relates to a wide array of differential outcomes, including mental health and behavior. Emotion goals (desire for a given emotion state) are thought to play a particularly important role in shaping people’s use of emotion regulation strategies; yet, surprisingly little is known about whether and how momentary emotion goals predict spontaneous strategy use in daily life. In the present investigation, we examined whether ideal desire for high versus low arousal positive affect was associated with subsequent use of specific emotion regulation strategies. Undergraduate participants (final N = 101) completed ecological momentary assessments (final ks = 1,932 for contemporaneous analyses, 1,386 for time-lagged analyses) of their momentary experienced affect, ...
Impulsivity is defined as a trait-like tendency to engage in rash actions that are poorly thought... more Impulsivity is defined as a trait-like tendency to engage in rash actions that are poorly thought out or expressed in an untimely manner. Previous research has found that impulsivity relates to deficits in decision making, in particular when it necessitates executive control or reward outcomes. Reinforcement learning (RL) relies on the ability to integrate valenced outcomes to make good decisions, and has recently be shown to often recruit executive function; as such, it is unsurprising that impulsivity has been studied in the context of RL. However, how impulsivity relates to the mechanisms of RL remains unclear. We aimed to investigate the relationship between impulsivity and learning in a reward-driven learning task with probabilistic feedback and reversal known to recruit executive function. Based on prior literature in clinical populations, we predicted that higher impulsivity would be associated with poorer performance on the task, driven by more frequent switching following u...
There has been extensive discussion about gender gaps in representation and career advancement in... more There has been extensive discussion about gender gaps in representation and career advancement in the sciences. However, psychological science itself has yet to be the focus of discussion or systematic review, despite our field’s investment in questions of equity, status, well-being, gender bias, and gender disparities. In the present article, we consider 10 topics relevant for women’s career advancement in psychological science. We focus on issues that have been the subject of empirical study, discuss relevant evidence within and outside of psychological science, and draw on established psychological theory and social-science research to begin to chart a path forward. We hope that better understanding of these issues within the field will shed light on areas of existing gender gaps in the discipline and areas where positive change has happened, and spark conversation within our field about how to create lasting change to mitigate remaining gender differences in psychological science.
Because of its prevalence, depression has been described as the common cold of mental illness. To... more Because of its prevalence, depression has been described as the common cold of mental illness. To receive a diagnosis of major depression, an individual must experience the following symptoms for a period of 2 weeks or more: sad mood or loss of pleasure, with at least four ...
Drawing on literature linking bipolar disorder to both creativity and heightened motivation, our ... more Drawing on literature linking bipolar disorder to both creativity and heightened motivation, our aim was to examine whether heightened motivation might contribute to creativity in those with and without bipolar disorder. To examine this, we recruited persons diagnosed with bipolar disorder (n = 49), and persons with no diagnosis of bipolar disorder (n = 37), with over-sampling of those from creative occupations. We gathered measures of lifetime creative accomplishment (Creative Accomplishment Questionnaire), willingness to persist as a creativity task became increasingly difficult (the Compound Remote Associates task) divergent thinking (Unusual Uses Test), self-rated high ambitions (The Willingly Approached Set of Statistically Unlikely Pursuits scale)) and a behavioral measure of willingness to exert physical effort for reward (the Effort Discounting Task). In multiple linear regression models controlling for age and examining the unique effects of the motivation variables, two be...
Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies sugge... more Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies suggest that these deficits can be observed among non-affected first-degree relatives of those with bipolar disorder. Although there is variability in the degree of cognitive deficits, these deficits are robustly relevant for functional outcomes. A separate literature documents clear difficulties in emotionality, emotion regulation, and emotion-relevant impulsivity within bipolar disorder, and demonstrates that these emotion-relevant variables are also central to outcome. Although cognitive and emotion domains are typically studied independently, basic research and emergent findings in bipolar disorder suggest that there are important ties between cognitive deficits and the emotion disturbances observed in bipolar disorder. Understanding these relationships has relevance for fostering more integrative research, for clarifying relevant aspects related to functionality and vulnerability within ...
Journal of behavior therapy and experimental psychiatry, Jan 23, 2015
People prone to mania use emotion regulation (ER) strategies well when explicitly coached to do s... more People prone to mania use emotion regulation (ER) strategies well when explicitly coached to do so in laboratory settings, but they find these strategies ineffective in daily life. We hypothesized that, compared with control participants, mania-prone people would show ER deficits when they received implicit, but not explicit, cues to use ER. Undergraduates (N = 66) completed the Hypomanic Personality Scale (HPS) and were randomly assigned to one of three experimental conditions: automatic ER (scrambled sentence primes), deliberate ER (verbal instructions), or control (no priming or instructions to use ER). Then, participants played a videogame designed to evoke anger. Emotion responses were measured with a multi-modal assessment of self-reported affect, psychophysiology, and facial expressions. Respiratory sinus arrhythmia (RSA) was used to index ER. The videogame effectively elicited subjective anger, angry facial expressions, and heart rate increases when keys malfunctioned. As hy...
Prior research suggests that a traitlike tendency to experience impulsivity during states of high... more Prior research suggests that a traitlike tendency to experience impulsivity during states of high emotion is robustly associated with many forms of psychopathology. Several studies tie emotion‐related impulsivity to response inhibition deficits, but these studies have not focused on the role of emotion or arousal within subjects. The present study tested whether arousal, measured by pupil dilation, amplifies deficits in response inhibition for those high in emotion‐related impulsivity. Participants (N = 85) completed a measure of emotion‐related impulsivity, underwent a positive mood induction procedure that reduced heterogeneity in mood states, and completed a response inhibition task. Pupil dilation was used to index arousal during the response inhibition task. Generalized linear mixed effect modeling yielded the hypothesized interaction between arousal (pupil dilation) and emotion‐related impulsivity in predicting response inhibition performance at the trial level. Emotion‐relate...
Background: ORBIT (Online Recovery‐focused Bipolar Individual Tool) is an NHMRC‐funded project de... more Background: ORBIT (Online Recovery‐focused Bipolar Individual Tool) is an NHMRC‐funded project developed by Swinburne University in conjunction with an international team. ORBIT comprises two low‐intensity guided self‐help interventions (adjunctive to usual clinical care) that aim to improve quality of life (QoL) in late‐stage bipolar disorder. An international randomised controlled trial is underway testing their comparative effectiveness. Published pilot data suggested the first iteration of ORBIT was feasible, safe and effective in improving QoL. Methods: The second iteration of ORBIT (ORBIT 2.0) adopted an innovative consumer co‐design process in developing multimedia content. A central focus is peer‐to‐peer learning via videos of consumers with the lived experience of bipolar disorder, driving the core content of the intervention. Expert videos, reflective exercises, audio exercises and supplementary reading support consumer video material to maximise engagement. In addition, the program facilitates connection between different users via commenting functions, a consumer‐moderated forum, and access to a Personal Coach (asynchronous emails) to support skill development. Results: In this symposium, we will discuss the content development phase of ORBIT 2.0 (key design principles, challenges and learnings), which has involved extensive consultation with consumer advisory groups, research and clinical experts in the field of bipolar disorder. In particular, we will focus on the iterative co‐design process of lived experience video content for the intervention. Conclusions: Innovative eHealth interventions such as ORBIT have significant potential to improve quality of life in bipolar disorder.
Objectives People in the late stage of bipolar disorder (BD) experience elevated relapse rates an... more Objectives People in the late stage of bipolar disorder (BD) experience elevated relapse rates and poorer quality of life (QoL) compared with those in the early stages. Existing psychological interventions also appear less effective in this group. To address this need, we developed a new online mindfulness-based intervention targeting quality of life (QoL) in late stage BD. Here, we report on an open pilot trial of ORBIT (online, recovery-focused, bipolar individual therapy). Methods Inclusion criteria were: self-reported primary diagnosis of BD, six or more episodes of BD, under the care of a medical practitioner, access to the internet, proficient in English, 18–65 years of age. Primary outcome was change (baseline – post-treatment) on the Brief QoL.BD (Michalak and Murray, 2010). Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lovibond and Lovibond, 1993). Results Twenty-six people consented to participate (Age M=46.6 years, SD=12.9, and 75% female). Ten participants were lost to follow-up (38.5% attrition). Statistically significant improvement in QoL was found for the completers, t(15)=2.88, 95% CI:.89–5.98, p=.011, (Cohen׳s dz=.72, partial η2=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:.47–3.76, (Cohen׳s dz=.52; partial η2=.22). A non-significant trend towards improvement was found on the DASS anxiety scale (p=.06) in both completer and intent-to-treat samples, but change on depression and stress did not approach significance. Limitations This was an open trial with no comparison group, so measured improvements may not be due to specific elements of the intervention. Structured diagnostic assessments were not conducted, and interpretation of effectiveness was limited by substantial attrition. Conclusion Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective, and ORBIT warrants full development. Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention, adding cautions about the impact of extended meditations, and addition of coaching support/monitoring to optimise engagement.
Background The primary objective is to test the effectiveness of a novel online quality of life (... more Background The primary objective is to test the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. Methods An NH&MRC funded international RCT to compare the effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants were recruited primarily via social media channels. Evaluations occurred at pre- and post- treatment, and at 3- and 6- months follow-up. A secondary outcome measure was BD-related symptoms (depression). A longitudinal analysis was conducted using random effects mixed models. Results Preliminary results suggest no change in mean QIDS_total over time (p = 0.891). Nor does there appear to be a difference in gro...
Background Despite increasing evidence for the effectiveness of individual psychological interven... more Background Despite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder. Aims To evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder. Method A parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder. Results Thirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the inter...
BACKGROUND US suicide rates have risen steadily in the past decade, and suicide risk is especiall... more BACKGROUND US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life. OBJECTIVE This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, whic...
Recent research has highlighted that emotion regulation strategy use varies both between and with... more Recent research has highlighted that emotion regulation strategy use varies both between and within people, and specific individual and contextual differences shape strategy use. Further, use of specific emotion regulation strategies relates to a wide array of differential outcomes, including mental health and behavior. Emotion goals (desire for a given emotion state) are thought to play a particularly important role in shaping people’s use of emotion regulation strategies; yet, surprisingly little is known about whether and how momentary emotion goals predict spontaneous strategy use in daily life. In the present investigation, we examined whether ideal desire for high versus low arousal positive affect was associated with subsequent use of specific emotion regulation strategies. Undergraduate participants (final N = 101) completed ecological momentary assessments (final ks = 1,932 for contemporaneous analyses, 1,386 for time-lagged analyses) of their momentary experienced affect, ...
Impulsivity is defined as a trait-like tendency to engage in rash actions that are poorly thought... more Impulsivity is defined as a trait-like tendency to engage in rash actions that are poorly thought out or expressed in an untimely manner. Previous research has found that impulsivity relates to deficits in decision making, in particular when it necessitates executive control or reward outcomes. Reinforcement learning (RL) relies on the ability to integrate valenced outcomes to make good decisions, and has recently be shown to often recruit executive function; as such, it is unsurprising that impulsivity has been studied in the context of RL. However, how impulsivity relates to the mechanisms of RL remains unclear. We aimed to investigate the relationship between impulsivity and learning in a reward-driven learning task with probabilistic feedback and reversal known to recruit executive function. Based on prior literature in clinical populations, we predicted that higher impulsivity would be associated with poorer performance on the task, driven by more frequent switching following u...
There has been extensive discussion about gender gaps in representation and career advancement in... more There has been extensive discussion about gender gaps in representation and career advancement in the sciences. However, psychological science itself has yet to be the focus of discussion or systematic review, despite our field’s investment in questions of equity, status, well-being, gender bias, and gender disparities. In the present article, we consider 10 topics relevant for women’s career advancement in psychological science. We focus on issues that have been the subject of empirical study, discuss relevant evidence within and outside of psychological science, and draw on established psychological theory and social-science research to begin to chart a path forward. We hope that better understanding of these issues within the field will shed light on areas of existing gender gaps in the discipline and areas where positive change has happened, and spark conversation within our field about how to create lasting change to mitigate remaining gender differences in psychological science.
Because of its prevalence, depression has been described as the common cold of mental illness. To... more Because of its prevalence, depression has been described as the common cold of mental illness. To receive a diagnosis of major depression, an individual must experience the following symptoms for a period of 2 weeks or more: sad mood or loss of pleasure, with at least four ...
Drawing on literature linking bipolar disorder to both creativity and heightened motivation, our ... more Drawing on literature linking bipolar disorder to both creativity and heightened motivation, our aim was to examine whether heightened motivation might contribute to creativity in those with and without bipolar disorder. To examine this, we recruited persons diagnosed with bipolar disorder (n = 49), and persons with no diagnosis of bipolar disorder (n = 37), with over-sampling of those from creative occupations. We gathered measures of lifetime creative accomplishment (Creative Accomplishment Questionnaire), willingness to persist as a creativity task became increasingly difficult (the Compound Remote Associates task) divergent thinking (Unusual Uses Test), self-rated high ambitions (The Willingly Approached Set of Statistically Unlikely Pursuits scale)) and a behavioral measure of willingness to exert physical effort for reward (the Effort Discounting Task). In multiple linear regression models controlling for age and examining the unique effects of the motivation variables, two be...
Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies sugge... more Prominent cognitive deficits have been documented in bipolar disorder, and multiple studies suggest that these deficits can be observed among non-affected first-degree relatives of those with bipolar disorder. Although there is variability in the degree of cognitive deficits, these deficits are robustly relevant for functional outcomes. A separate literature documents clear difficulties in emotionality, emotion regulation, and emotion-relevant impulsivity within bipolar disorder, and demonstrates that these emotion-relevant variables are also central to outcome. Although cognitive and emotion domains are typically studied independently, basic research and emergent findings in bipolar disorder suggest that there are important ties between cognitive deficits and the emotion disturbances observed in bipolar disorder. Understanding these relationships has relevance for fostering more integrative research, for clarifying relevant aspects related to functionality and vulnerability within ...
Journal of behavior therapy and experimental psychiatry, Jan 23, 2015
People prone to mania use emotion regulation (ER) strategies well when explicitly coached to do s... more People prone to mania use emotion regulation (ER) strategies well when explicitly coached to do so in laboratory settings, but they find these strategies ineffective in daily life. We hypothesized that, compared with control participants, mania-prone people would show ER deficits when they received implicit, but not explicit, cues to use ER. Undergraduates (N = 66) completed the Hypomanic Personality Scale (HPS) and were randomly assigned to one of three experimental conditions: automatic ER (scrambled sentence primes), deliberate ER (verbal instructions), or control (no priming or instructions to use ER). Then, participants played a videogame designed to evoke anger. Emotion responses were measured with a multi-modal assessment of self-reported affect, psychophysiology, and facial expressions. Respiratory sinus arrhythmia (RSA) was used to index ER. The videogame effectively elicited subjective anger, angry facial expressions, and heart rate increases when keys malfunctioned. As hy...
Prior research suggests that a traitlike tendency to experience impulsivity during states of high... more Prior research suggests that a traitlike tendency to experience impulsivity during states of high emotion is robustly associated with many forms of psychopathology. Several studies tie emotion‐related impulsivity to response inhibition deficits, but these studies have not focused on the role of emotion or arousal within subjects. The present study tested whether arousal, measured by pupil dilation, amplifies deficits in response inhibition for those high in emotion‐related impulsivity. Participants (N = 85) completed a measure of emotion‐related impulsivity, underwent a positive mood induction procedure that reduced heterogeneity in mood states, and completed a response inhibition task. Pupil dilation was used to index arousal during the response inhibition task. Generalized linear mixed effect modeling yielded the hypothesized interaction between arousal (pupil dilation) and emotion‐related impulsivity in predicting response inhibition performance at the trial level. Emotion‐relate...
Background: ORBIT (Online Recovery‐focused Bipolar Individual Tool) is an NHMRC‐funded project de... more Background: ORBIT (Online Recovery‐focused Bipolar Individual Tool) is an NHMRC‐funded project developed by Swinburne University in conjunction with an international team. ORBIT comprises two low‐intensity guided self‐help interventions (adjunctive to usual clinical care) that aim to improve quality of life (QoL) in late‐stage bipolar disorder. An international randomised controlled trial is underway testing their comparative effectiveness. Published pilot data suggested the first iteration of ORBIT was feasible, safe and effective in improving QoL. Methods: The second iteration of ORBIT (ORBIT 2.0) adopted an innovative consumer co‐design process in developing multimedia content. A central focus is peer‐to‐peer learning via videos of consumers with the lived experience of bipolar disorder, driving the core content of the intervention. Expert videos, reflective exercises, audio exercises and supplementary reading support consumer video material to maximise engagement. In addition, the program facilitates connection between different users via commenting functions, a consumer‐moderated forum, and access to a Personal Coach (asynchronous emails) to support skill development. Results: In this symposium, we will discuss the content development phase of ORBIT 2.0 (key design principles, challenges and learnings), which has involved extensive consultation with consumer advisory groups, research and clinical experts in the field of bipolar disorder. In particular, we will focus on the iterative co‐design process of lived experience video content for the intervention. Conclusions: Innovative eHealth interventions such as ORBIT have significant potential to improve quality of life in bipolar disorder.
Objectives People in the late stage of bipolar disorder (BD) experience elevated relapse rates an... more Objectives People in the late stage of bipolar disorder (BD) experience elevated relapse rates and poorer quality of life (QoL) compared with those in the early stages. Existing psychological interventions also appear less effective in this group. To address this need, we developed a new online mindfulness-based intervention targeting quality of life (QoL) in late stage BD. Here, we report on an open pilot trial of ORBIT (online, recovery-focused, bipolar individual therapy). Methods Inclusion criteria were: self-reported primary diagnosis of BD, six or more episodes of BD, under the care of a medical practitioner, access to the internet, proficient in English, 18–65 years of age. Primary outcome was change (baseline – post-treatment) on the Brief QoL.BD (Michalak and Murray, 2010). Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lovibond and Lovibond, 1993). Results Twenty-six people consented to participate (Age M=46.6 years, SD=12.9, and 75% female). Ten participants were lost to follow-up (38.5% attrition). Statistically significant improvement in QoL was found for the completers, t(15)=2.88, 95% CI:.89–5.98, p=.011, (Cohen׳s dz=.72, partial η2=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:.47–3.76, (Cohen׳s dz=.52; partial η2=.22). A non-significant trend towards improvement was found on the DASS anxiety scale (p=.06) in both completer and intent-to-treat samples, but change on depression and stress did not approach significance. Limitations This was an open trial with no comparison group, so measured improvements may not be due to specific elements of the intervention. Structured diagnostic assessments were not conducted, and interpretation of effectiveness was limited by substantial attrition. Conclusion Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective, and ORBIT warrants full development. Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention, adding cautions about the impact of extended meditations, and addition of coaching support/monitoring to optimise engagement.
Background The primary objective is to test the effectiveness of a novel online quality of life (... more Background The primary objective is to test the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. Methods An NH&MRC funded international RCT to compare the effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants were recruited primarily via social media channels. Evaluations occurred at pre- and post- treatment, and at 3- and 6- months follow-up. A secondary outcome measure was BD-related symptoms (depression). A longitudinal analysis was conducted using random effects mixed models. Results Preliminary results suggest no change in mean QIDS_total over time (p = 0.891). Nor does there appear to be a difference in gro...
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