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06-06-2011 | Mental health | Article

BD I patients and their relatives show maladaptive emotion regulation strategies


Free abstract

MedWire News: Patients with bipolar I disorder (BD I) and their unaffected relatives exhibit more frequent use of maladaptive emotion regulation strategies compared with mentally healthy individuals without such a family history, research shows.

"Emotion regulation includes flexible cognitive strategies employed to increase, maintain, or decrease the physiological and/or behavioural components of an emotional response," explain Melissa Green (St Vincent's Hospital, Darlinghurst, New South Wales, Australia) and colleagues.

They add that previous studies have found "increased use of the maladaptive strategies (self-blame, rumination, and catastrophizing) alongside decreased use of positive reappraisal in association with clinical and sub-clinical depressive symptomatology."

For the current study, the team investigated whether the increased use of such strategies is evident in bipolar disorder patients and their unaffected relatives.

The researchers used the Cognitive Emotion Regulation Questionnaire (CERQ), the Depression Anxiety Stress Scales (DASS), and the Hypomanic Personality Scale (HPS) to assess 105 patients with BD-I, 124 of their unaffected relatives, and 63 mentally healthy controls without a history of DSM-IV Axis 1 disorders or psychosis in first-degree biological relatives.

They found that BD I patients had significantly higher DASS scores than unaffected relatives and controls for depression (11.95 vs 4.73 and 2.71, respectively), anxiety (8.09 vs 3.63 and 2.40, respectively) and stress (12.55 vs 8.84 and 5.76, respectively). The differences in scores between unaffected relatives and controls were also significant.

BD I patients also had higher scores on the HPS than unaffected relatives and controls, at 15.84 versus 6.94 and 6.67, respectively.

Patients with BD I reported more frequent use of rumination, catastrophizing, and self-blame than unaffected relatives and controls, with corresponding CERQ subscale scores of 12.78 versus 10.48 and 9.43, 9.20 versus 7.44 and 6.81, and 11.20 versus 9.81 and 8.63, respectively. The differences in scores between unaffected relatives and controls were significant for rumination and self-blame.

In addition, BD I patients scored lower than unaffected relatives on the CERQ subscale of "putting into perspective" in response to negative life events, with scores of 12.80 versus 14.34.

In BD I patients, more frequent use of rumination was associated with increased DASS and HPS scores. In unaffected relatives, more frequent use of catastrophizing and self-blame was associated with increased DASS and HPS scores.

In all participants, less frequent use of adaptive cognitive reframing strategies, such as "putting into perspective," was associated with increased DASS scores.

Green and team conclude: "Both BD I and unaffected relatives reported more frequent use of maladaptive regulatory strategies previously associated with depression.

"Emotion regulation strategies of catastrophizing, self-blame, and cognitive reframing techniques may be associated with vulnerability for mood disorders, with the latter active within the general population regardless of biological vulnerability to disorder."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Mark Cowen

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