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26-06-2013 | Mental health | Article

Attributional behavior warns of mood transition


Free abstract

medwireNews: A tendency to make extreme attributions may forewarn of a change of mood in patients in a depressive bipolar episode, research suggests.

The association with change to a manic, hypomanic, or mixed episode was irrespective of whether patients' extreme attributions were pessimistic or optimistic, report study co-author Thilo Deckersbach (Massachusetts General Hospital and Harvard Medical School, Boston, USA) and team.

"These results are consistent with the notion that the inflexibility of thoughts or beliefs may be more important than their valence (i.e., positive or negative) in understanding the course of mood disorders," they write in the Journal of Psychiatric Research.

"Individuals who make extreme attributions may have difficulty seeing situations from multiple perspectives, which may lead them to make absolutist types of attributions about the causes of life events."

The researchers assessed 105 depressed patients with bipolar I or II disorder using the Attributional Style Questionnaire (ASQ), which measures how likely patients are to attribute the causes of events to internal or external, stable or unstable, and global sources. During up to 1 year of follow up, five patients shifted to a manic episode, 11 to hypomania, and six to a mixed episode.

Total ASQ score did not correlate with the likelihood or speed of patients changing mood. However, extreme attributional behavior (sum of 1 point on the ASQ for pessimistic attributions and 7 points for optimistic attributions) significantly raised the likelihood for patients shifting to an elevated mood.

The association persisted after controlling for confounders including age, education, age at bipolar disorder onset, and medication, and the same trends, albeit nonsignificant, were seen when pessimistic and optimistic attributions were analyzed separately.

Extreme attributional behavior was also retrospectively linked to a more severe course of bipolar disorder, with extreme pessimistic and optimistic attributions both associated with a higher number of previous depressive episodes, whereas only extreme optimistic attributions were associated with an increased number of elevated mood episodes.

"Identifying which patients tend to make extreme attributions may allow for more intensive treatments to be directed particularly toward patients with higher levels of maladaptive cognitions," say Deckersbach et al.

"In addition, it is possible that traditional [cognitive behavioral therapy] for bipolar disorder is not adequately effective in restructuring extreme maladaptive cognitions. Schema-focused cognitive therapy is a potential intervention that could target this issue."

They also suggest that mindfulness-based bipolar disorder treatments may help patients to make more balanced attributions.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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