Objectives: Interest in the psychology of bipolar disorder has led to a shift away from solely biological accounts, towards integrative biopsychosocial models. Three such models formed the basis for the current study. These were: the behavioural activation model (Depue & Iacono, 1989), the circadian rhythm instability and appraisal model (Jones, 2001), and the integrative cognitive model (lCM), (Mansell et ai, 2007). The behavioural activation model proposes that behavioural activation system (BAS) hypersensitivity increases vulnerability towards developing bipolar disorder. Likewise, cognitive style, which is central to the circadian rhythm instability and appraisal model and the ICM, can also increase vulnerability. To date, few studies have explored these factors amongst bipolar individuals who are in episode. Furthermore, no comparisons have been made on these dimensions between bipolar individuals and individuals experiencing other psychiatric disorders. This was addressed in the current study. Methodology: Twenty inpatients with a diagnosis of bipolar disorder were compared to 20 inpatients with a diagnosis of schizophrenia on dimensions of behavioural activation and cognitive style. All individuals were recruited from psychiatric wards in Greater Manchester. Diagnostic status was confirmed using the SCID (all participants were experiencing an acute episode). BAS sensitivity was assessed using the BIS-BAS (Carver & White, 1994) whilst cognitive style was assessed using bipolar specific measures, namely the HIQ (Jones et ai, 2006) and the Brief-HAPPI (Mansell & Jones, 2006). Symptoms of mania and depression were also assessed using observer rated and self-report measures Results: As hypothesised, the bipolar group displayed significantly elevated levels of BAS sensitivity than the schizophrenia group. This was reflected across all three BAS subscales (fun seeking, drive and reward responsiveness). The bipolar group also displayed significantly elevated positive self-dispositional appraisals of hypomanic experiences than the schizophrenia group, as measured by the HIQ-H subscale. However, the groups only differed significantly on some of the dysfunctional beliefs outlined in the Brief-HAPP!. This was reflected in the significant group difference on Brief-HAPPI (forward items) but not on the Brief- HAPPI (reverse items). Despite the significant differences between the groups, a logistic regression revealed that there were no significant single predictors of diagnostic group membership, although HIQ-H was approaching significance. Conclusions: The current findings propose that BAS hypersensitivity and positive self-dispositional appraisals of hypomanic experiences are elevated amongst bipolar individuals who are in episode, as are certain dysfunctional beliefs. There is also evidence to suggest that these factors may be specific to bipolar individuals in the context of severe and enduring psychiatric disorders. Whilst BAS hypersensitivity and cognitive style may increase an individual's vulnerability towards experiencing extreme shifts in affect, prospective longitudinal studies are required that further explore this notion. The current findings, as well as providing support for the three biopsychosocial models mentioned above, also contribute towards the further advancement of psychological therapies for bipolar disorder, and in particular cognitive behavioural therapy (CBT).

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Background: Theoretical models of mania suggest that people with bipolar disorder might be more susceptible to developing positive or activated mood states and associated cognitive biases. Naturalistic studies offer some support for these models, however replicable experimental induction techniques are also needed. The present study used an imagery-based mood and cognitive bias induction technique, called positive interpretation training (PIT; Holmes, Mathews, Dalgliesh & Mackintosh, 2006) to investigate these considerations. PIT had been used previously in those without a history of affective disorder but the present study was the first to apply it to a clinical population. Method: Individuals with a diagnosis of bipolar disorder (n=14) were compared with control participants with no history of depression, dysthymia, mania or hypomania (n=14). All participants were screened for current and past DSM-IV (1994) diagnoses using the SCID-I/P (First, Spitzer, Gibbon & Williams, 2002). Measures of current symptoms, trait anxiety and the tendency to use imagery in everyday life were administered on the day of testing. Measures of positive affect, behavioural engagement, state anxiety and positive and negative cognitive bias were given immediately before and after PIT. Results: Positive affect and behavioural engagement increased in both the bipolar and control groups following PIT, demonstrating that the induction technique was effective. However, there was no difference between groups in the degree to which these variables increased. There were differences between the groups on other measures. State anxiety decreased more following PIT in the bipolar group. On a measure of positive cognitive bias, there was a trend for both groups to show greater positive bias following PIT. Although no significant difference between the groups was found on this measure, effect sizes indicated that the increase in positive bias may have been particularly strong for the bipolar group. Negative cognitive bias decreased in those with bipolar disorder but not in the control group. Conclusions: The results provide preliminary indications that individuals with bipolar disorder show some differences relative to a control group in terms of their response to an imagery-based mood and bias induction technique. The greater reductions in anxiety and negative cognitive bias in those with bipolar disorder may have been a reflection of higher levels of anxiety and negative biases in this group initially, but are nevertheless of clinical relevance. The possibility that improvements in positive cognitive bias may have been stronger for the bipolar group, suggests that elevated positive responses in bipolar groups warrant further investigation. Overall, PIT offers a promising new method for investigating mood state dependent changes in activation and cognitive bias in bipolar disorder.

The present research addressed several diathesis models of bipolar disorder including Behavioural Activation, stress sensitivity and circadian rhythm disruption and considered cognitive vulnerability factors such as self-esteem and affective instability, response styles to depression and depressogenic cognitive styles. These relationships were examined prospectively in healthy controls, remitted unipolar patients and bipolar disorder participants who were remitted, depressed or hypomanic.

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Background: The current understanding of bipolar disorder attributes a causal role to abnorma1 psychological processes in its development. However, little research has so far adequately tested this assumption. Two approaches might be employed to do so: (i) longitudinal investigations of psychological processes in patients (with some limitations); (ii) examinations of such processes in high-risk individuals. Methods: Three cohorts of participants were examined: two different cohorts of adults with bipolar disorder (using secondary data, Chapter 2 and 3), and adolescent offspring of parents with bipolar disorder, in comparison to offspring of control parents (Chapters 4, 5, 6). In adults with bipolar disorder, the associations between self-referential processes and symptoms of depression and mania (Chapter 2), and the inter-relationship between self-esteem, mood and response styles (Chapter 3) were examined longitudinally. In adolescent children, longitudinal relationship between mood, self-esteem and coping style (Chapter 4), abnormal psychological processes (Chapter 5), and explicit and implicit self-esteem and their discrepancies (Chapter 6), were investigated. Results: In adults with bipolar disorder, symptoms of depression and mania were associated with distinct psychological processes, with self-esteem being the most robust predictor (Chapter 2). However, mood, rather than self-esteem, instigated, and was affected by, an engagement in coping strategies (Chapter 3). In adolescents, index adolescents showed compromised capacity to employ adaptive coping, and employed risktaking in response to low self-esteem (Chapter 4). Further, no differences in abnormal psychological processes were found, unless children have already met diagnostic criteria for psychiatric disorders (Chapter 5). Despite no differences in explicit and implicit self-esteem, index offspring reported marginally higher level of self-esteem discrepancies. In addition, damaged self-esteem (i.e. low explicit self-esteem and high implicit self-esteem) was related to symptoms of depression, whilst low implicit self-esteem to symptoms of mania. Conclusions: Early coping abnormalities are important markers of individuals at ultra high lisk of bipolar disorder. Further, the relevance of self-esteem in bipolar disorder has been suggested. Implications for future research and psychotherapy are discussed.