Psychological behaviorism theory of bipolar disorder 2/19/02
Related Topics
Lynd ...@nc.rr.com (LyndaNP)
http://mentalhelp.net/poc/view_doc.php/type/news/id/1664/cn/Bipolar%20Di sorder?PHPSESSID=beee81d4215a880318f0a3e19e502179 Psychological behaviorism theory of bipolar disorder (Psychological Record) This review addresses the etiology of bipolar disorder and presents the literature within a psychological behaviorism framework (Staats, 1996; Staats & Heiby, 1985). The proposed theory attempts to provide an integrative developmental approach that is grounded in established behavioral principles. The bipolar theory posits 15 hypotheses based on past and concurrent biological and situational factors as well as their interactions with an individual's basic behavioral repertoires.
Implications for subcl***ification and treatment research are noted.
During the past several decades, there has been a proliferation of psychological theories of adult unipolar depression that have been extended to children (e.g., Abramson, Seligman, & Teasdale, 1978; Beck, 1967; Ferster, 1973; Lewinsohn, 1974; Rehm, 1977; Staats & Heiby, 1985).
Meanwhile, there has been a paucity of psychological theories of bipolar disorder since Kraepelin (1921) observed mania not only among adults but also among 3% of his child and adolescent patients.
The apparent ***umption of most of the research evaluating the etiology and treatment of bipolar disorder has been that this is primarily a biological condition for which primarily biological interventions are indicated. Biological bias has left the psychological aspects of bipolar disorder largely unexplored and the biological research poorly integrated with advances in other areas of investigation (Depue & Iacono, 1989). Fortunately, a number of investigators have expressed concern about this state of affairs (e.g., Akiskal, 1986; Bebbington, 1986; Depue & Iacono, 1989; O'Connell, 1986; Perris, 1986; Rehm & Tyndall, 1993).
The recent developments of psychosocial (Craighead, Miklowitz, Vajk, & Frank, 1998), cognitive behavioral (fiasco & Rush, 1996), and family (Miklowitz & Goldstein, 1997) treatments for bipolar disorder are promising but have focused primarily on enhancement of medication compliance. They are extensions of treatments developed for unipolar depression and chronic and severe disorders. These treatments are not based upon a psychological theory of the development of bipolar disorder and are not designed as behavioral prevention and change alternatives to psychoactive substances.
It is the purpose of this paper to suggest an integration of the bipolar literature on vulnerability factors in childhood and maintenance factors in adulthood. The guiding theoretical framework for this integration is Staats' (1975) social behaviorism, later referred to as paradigmatic (e.g., Staats, 1986) and more recently psychological behaviorism (Staats, 1996). The theory is an extension of cl***ical and operant conditioning as well as developmental and cumulative human learning principles. Each revision of the theory was accompanied with a broader integration of levels of analysis (e.g., inclusion of organic factors) and additional behavioral principles (e.g., self-administered verbal-emotional stimuli that have directive, affective, and reinforcing effects). Psychological behaviorism (PB) was selected because it has been shown to have heuristic value for organizing the disparate research on intelligence (Leduc, Dumais, & Evans, 1990), unipolar depression (Heiby & Staats, 1990; Staats & Heiby, 1985), anxiety disorders (Hekmat, 1990), and other forms of psychopathology for which there is no generally accepted theory (Eifert & Evans, 1990; Staats, 1996). Although the application of PB theory to unipolar depression includes some mention of bipolar disorder, the utility of the theory for integration of the bipolar literature has not been evaluated previously.
First, bipolar disorder will be described. Second, a summary of general PB theory will be presented. Third, the research investigating the childhood and adult etiology of bipolar disorder will be organized according to the situational, behavioral, and organic factors proposed in PB theory. Finally, 15 hypotheses regarding the etiology of bipolar disorder will be offered and directions for the development of psychological treatments and subtyping are noted.
Definitions and Phenomenology of Bipolar Disorder The reliability and utility of the distinction of bipolar from unipolar depression has been long established (Leonhard, Korff, & Shulz, 1962).
The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994) identifies four types of bipolar disorders, all of which include a history of mania, hypomania, or some admixture of mania and depression. However, a review (Rehm & Tyndall, 1993) of the unipolar--
bipolar distinction argues that bipolar disorder may involve numerous subtypes so that a history of mania, as defined in DSM-IV, is insufficient to specify a taxonomy.
The disparity of the literature on factors related to bipolar disorder is understandable given the episodic and highly variable characteristics inherent in the definition of a manic episode itself. The definition of a manic episode in DSM-IV (APA, 1994) is heterogeneous in terms of the emotion involved as well as accompanying behaviors. An "elevated, expansive, or irritable mood" (p. 332) is one necessary criterion. This criterion permits excessive positive emotions (happiness; euphoria) or excessive negative emotions (anger; irritability). This inclusion of two dysfunctional moods under one category is in contrast to the DSM-IV criteria for a major depressive episode in which one negative emotional state, dysphoria or loss of pleasure, is the defining dysfunctional mood characteristic.
Heterogeneity is also illustrated in the DSM-IV criteria indicating that any three or four of a possible seven remaining symptoms can constitute the definition of a manic episode. These include inflated self-esteem or grandiosity, decreased necessary sleep, talkativeness, racing ideas, distractibility, increased activity, and excessive involvement in pleasurable activities such that there is a risk for eventual adverse consequences. For children and adolescents, these behaviors overlap with normal development at some ages as well as with irritable depression, conduct disorder, attention-deficit/hyperactivity disorder (APA, 1994), and schizophrenia (Goodyer, 1992), further obfuscating a clear identification of bipolar disorder among youth.
The characteristics of manic episodes are a challenge to establish because they are relatively rare and the onset is difficult to predict.
Prevalence during childhood and adolescence is unknown. Childhood onset of mania among adults exhibiting bipolar disorder has been estimated to occur in 20% of cases (Goodwin & Jamison, 1990). Among adults, a 1 month U. S. adult population prevalence of 0.4% for manic vs. 2.2% for major depressive episodes has been estimated (Regier et al., 1988). Lifetime prevalence of a manic episode has been estimated to be 1.6% and of a depressive episode to be 17.1% (Kessler et al., 1994). Some epidemiological research has addressed the degree of variability in expression of the behaviors included in the DSM-IV (APA, 1994) definition of a manic episode. In their review, Rehm and Tyndall (1993) indicate that racing ideas may be present in 41% to 100% of manic episodes, pressured speech in 75% to 100%, delusions in 44% to 75%, hallucinations in 4% to 40%, heightened activity in 87%, and decreased sleep in 81%.
It is unknown what percentage of individuals exhibiting manic episodes express irritability. However, one review suggests anger may be as common as euphoria (Goodwin & Jamison, 1990) while one study found 8% exhibit irritability only, 30% euphoria only, and 62% both irritability and euphoria (Winokur & Tsuang, 1975). The presence of irritability seems like an important distinction as the affective states of euphoria and anger are not only subjectively different, but may also emit and reinforce quite different operant behaviors (e.g., prosocial yet unproductive gambling versus antisocial dangerousness to others).
Given the stark contrast between the behaviors defining depression and mania, it is not surprising that research comparing characteristics of depression between individuals exhibiting unipolar and bipolar depression has identified a variety of distinctions. This research most likely involves a subcl*** of bipolar subjects, as the reported percentage of bipolar individuals exhibiting a history of depressive episodes has ranged from 5% to 100% (Goodwin & Jamison, 1990). The temporal nature of the mood change between depression and mania has been reported to range from less than 2 days to years (Rehm& Tyndall, 1993).
Compared to unipolar depression, depression in a bipolar disorder has been shown to differ on the following characteristics: (a) an earlier average age of onset (Rehm & Tyndall, 1993; Shulman, Tohen, Satlin, & Mallya, 1992); (b) more sporadic, frequent, and rapid severe mood changes but with less chronicity (Winokur, Coryell, Keller, Endicott, & Akiskal, 1993); (c) psychomotor retardation (vs. agitation); and (d) hypersomnia (vs. hyposomnia) (Rehm & Tyndall, 1993).
The importance of the distinctions between bipolar and unipolar depression is unclear. Rehm and Tyndall (1993) conclude in their review of major theories of mood disorders that current approaches are too narrow and very little is known or theorized about bipolar dis\order among children and adults. They agreed with a suggestion by Craighead (1980) two decades ago that future subtyping of mood disorders integrate biological, environmental, and psychological factors. The following sections describe a psychological behaviorism theory of bipolar disorder as one step toward addressing the need to provide a framework to study the development of and heterogeneity in the expression of mania. The proposed framework is an extension of the then ...
sue_bilst ...@yahoo.com (Sue Bilstein)
(Crossposted to sci.med.psychobiology. I have heavily snipped this article, but the full text is available at the URL Lynda supplied)) The theories presented in this article, about possible psychosocial origins of bipolar disorder, ring totally false for me. I'd just like to lay out my own experience against some points below. I wonder what other BPers think about the fit of these theories to their own history.
I suspect that any "psychosocial" correlations are the result of BP rather than the cause of it.
Briefly, I had my first manic episode (acute, with psychosis) 18 years ago, at the age of 29. I had 3 further episodes up to 1990 (each one after stopping lithium). Since then I have been stable on lithium.
Dx BP I; sister, aunt and grandmother have same Dx.
My family was American middle cl***, religious, and extremely risk averse.
Quite the opposite - over-cautious parents, if anything.
Realism and modesty were modelled.
First episode, husband A - safe, stable, sensible. Second to fourth, husband B - likewise.
Nope.
I am rather unemotional in character.
Nope.
As a child, through to early twenties, I was shy and introverted.
Would describe myself as socially inept.
This might be the only point on which I have a match. I tend to have one person I rely on, and a network of acquaintances.
Nope.
Nope.
It's what I do for a living ...
sno s...@mindspring.com
It seems like for most people bi polar is started by stress...and stress makes the symptoms worse.....so psychosocial stress can trigger it....
I have often wondered if almost anyone can become bi polar, given enough stess over a long enough period of time...
thank you for listening to my thoughts....
sno
sue_bilst ...@yahoo.com (Sue Bilstein)
Sure, stress triggers it. But these guys think you learn to be manic!
Mania is a bad habit according to them. Depression is what you naturally feel after you make an *** of yourself when manic ... sheesh ...
"Wayne Alan Simon" ari...@bellsouth.net
Current psychiatric thinking clearly looks at bipolar disorder as a disease with an organic cause relating to some type of neurohormonal inbalance, whether it be at the receptor site, or at the neuron production site. The cause and the treatments are viewed as organic.
iriXx ir...@devnull.remove.fsworld.co.uk
for me, i wonder if my work as an artist, and the constant highs and lows that it causes have conditioned me towards bp...?
m
--
~~~~~>><:>~~~~~ iriXx "sometimes i get overcharged...
that's when you see sparks you ask me where the hell i'm going at a thousand feet per second..." radiohead: the tourist
iriXx ir...@devnull.remove.fsworld.co.uk
i think both the psychological behaviorism and the neurohormonal imbalance are too simplistic. the brain is a complex mechanism... for me i can see shades of both the psychological origins (in my case mania feels like a means to run away from the huge emptiness of depression inside of me) and the biological disposition which there may or may not be evidence for in my family... we have a disposition towards depression but not BP...
its all too easy to give it one label... to me thats just bad research...
m
--
~~~~~>><:>~~~~~ iriXx "sometimes i get overcharged...
that's when you see sparks you ask me where the hell i'm going at a thousand feet per second..." radiohead: the tourist
"Wayne Alan Simon" ari...@bellsouth.net
there is a ton of proof, read the journal pharmacological trends, ...
right???
"Wayne Alan Simon" ari...@bellsouth.net
you act as if there aren't thousands of articles documenting the mechanisms of these disorders, When it comes to bipolar disorder, the neurochemical imbalance has come first, if you feel differently your feelings are wrong in the face of overwhelming scientific evidence.
"Wayne Alan Simon" ari...@bellsouth.net
its more likely that you have cause and effect backwards.
"Sue Bilstein" sue_bilst...@yahoo.com
"John 'the Man'" <DeMan[02]@hotmail.com> wrote in message ...
Well, in my case, mania came first - as you see from my history in the post above. In no way does my experience fit the 'psychosocial model'. And lithium treatment is entirely effective in preserving me from mania.
I have tried talking therapy on two occasions for post-mania depression, but found it totally beside the point and useless. I experience depression as a crash-and-burn after mania, it doesn't arise on its own. Two things help in alleviating it: 1) anti-depressants 2) time - I believe the latter is the more important factor.
My experience of bipolar disorder is radically incompatible with your ideas.
Call me the typical case that tests the psychosocial theory.
"Sue Bilstein" sue_bilst...@yahoo.com
"John 'the Man'" <DeMan[02]@hotmail.com> wrote in message ...
No, iriXx's, but welcome in.
Neither one way nor the other, but both. Brain & mind are two sides of the same coin. Of course emotional events can alter your brain function. And brain events can alter your mental balance. Clinical depression developing from grief is an example of the former. Bipolar disorder, as I experience it, is an example of the latter. And I'm a pretty typical case of BP I.
iriXx ir...@devnull.remove.fsworld.co.uk
nope.
couldnt be....
a) there's no biological evidence of BP in my family...
b) i became an artist when i was 6 years old... well, im an artist of various types.... musician, graphic artist, writer...
i know that i became a musician and retreated into that safe world when the rest of the world was frightening and bullied me...
the highs and lows of creativity are like a drug... i crave that high...
and then when its gone, when a piece is finished, i sink so low... i fear i'll never create again...
surely practising that for 24 years has conditioned me somewhat to BP?... ;o))
-read Anthony Kemp 'The Musicians Temperament: Psychology and Personality of Musicians'... he suggests that it is very difficult to tell chicken from egg, whether musicians are born with an 'artists temperament' or if they condition themselves into it...
i said to my pdoc that my dx of cyclothymia sounded like a medical label for the cl***ic 'artists temperament' and he said to me, yup, you're right....
m
--
~~~~~>><:>~~~~~ iriXx "sometimes i get overcharged...
that's when you see sparks you ask me where the hell i'm going at a thousand feet per second..." radiohead: the tourist
iriXx ir...@devnull.remove.fsworld.co.uk
i agree :) that is my experience...
m
--
~~~~~>><:>~~~~~ iriXx "sometimes i get overcharged...
that's when you see sparks you ask me where the hell i'm going at a thousand feet per second..." radiohead: the tourist
"Sue Bilstein" sue_bilst...@yahoo.com
"John 'the Man'" <DeMan[02]@hotmail.com> wrote in message ...
Seems to be a typical reaction from you people - blame someone who doesn't need your prescription for laziness because she's unwilling to waste time on wanking therapy ... just like you blame us for going manic / becoming depressed in the first place.
"Sue Bilstein" sue_bilst...@yahoo.com
"John 'the Man'" <DeMan[02]@hotmail.com> wrote in message ...
Indeed. I offer my experience as one manic-depressive individual. My experience totally contradicts the psychosocial theories about the etiology of manic depression. The question is whether I am totally unique, or whether I am an average manic-depressive of flavour Bipolar I. From what I read, I'm pretty average as we nutters go.
Did I interject myself into a line of thought? I didn't notice one.
"Wayne Alan Simon" ari...@bellsouth.net
the large number of writers, authors artists, are not bipolar. artistic encounters during mania, and sometimes even depression are not uncommon.
But it is clearly backward thinking. If artistic encounters condition people to be bipolar, than there would be a heck of a lot more bipolar folks around. This is an example of left brain thinking without right brain constraints. Psychotherapy in Bipolar disorder is only slightly better than or equal to placebo, or no therapy at all. Current pharmacological treatment, is far superior to placebo, or psychotherapy in the treatment of bipolar disorder. Treating bipolar disorder with psychotherapy alone is tantamount to malpractice. Psychotherapy is a useful adjunct to proper pharmacological therapy in bipolar disorder. I am hoping that some silicone implant, biofeedback, almost avant garde methods may be effective in the future.
"Wayne Alan Simon" ari...@bellsouth.net
clearly there are disorders related to acute and chronic trauma and brainwashing. Post traumatic stress disorder is a good example. Severe early childhood trauma propably causal in multiple personality disorder, and in male anorexia nervosa. But bipolar disorder is a different situation.
Teleiologically there may have been advantages for genetic subtypes, and survival of folks with bipolar disorder. It is almost like a hypernation syndrome alternating with a hyperacute awareness syndrome. However, as opposed to hypomania, and dysthymia, true bipolar disorder is quite severe in both directions.
"Sue Bilstein" sue_bilst...@yahoo.com
Seems likely that people carrying the genes get some kind of survival advantages, otherwise BP would be a 1-in-30,000 probability instead of 1%, eh. Unless it's caused by a virus as wossname thinks.
But the pattern of high achievement in non-BP relations of people with BP, and high achievement by many BP people, backs up the genetic advantage idea.
Maybe consciousness, creativity, religious experience, etc can be considered as mental illness in the first place.
"Sue Bilstein" sue_bilst...@yahoo.com
... this reminds me of Jack Pettigrew's ideas about mania & depression.
sno s...@mindspring.com
Being manic and pissed off probably is a good thing when chasing a saber tooth....<g> (I feel sorry for the saber tooth) sno
Donna Maindrault donn...@SPAMmaindrault.com
Being gay or left-handed is also ***ociated with creativity, and these are also considered "problems" to some degree by some people. In fact, a recent study on sonograms used the increase in the incidence of left-handedness as evidence of "brain damage." (That study had a few weak points!) Perhaps the "purpose for existence" for the "bipolar gene" is to keep the rest of us from being bored to death. Thanks, folks!
-Donna
"Dr. Wayne Simon" ari...@attbroadband.com
I think you are misreading what I am saying. As a useful adjunct, it is more to help the person with other issues in his/her life than to have a direct effect on his/her Bipolarism.
"John Lodder" johnjad...@wanado.nl
Hi Sue, labelling consciousness and creativity as mental ilnesses is a ver bad and poor thing to say.
ciao John
--
*************** CARPE DIEM -----------------
John Lodder ************** "Make a commitment today to something bigger and more important than yourself." (Brian Tracy) "Sue Bilstein" <sue_bilst...@yahoo.com> schreef in bericht ...
"Sue Bilstein" sue_bilst...@yahoo.com
Is it? Why?
| To Top |