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Bipolar disorder, formerly known as manic depressive illness, is a chronic mood disorder categorised by alternating or linking episodes of depression, hypomania and episodes of mania (Grande, Berk, Birmaher & Vieta, 2016). In 2013, bipolar disorder was ranked fourth after depression, anxiety and schizophrenia as the most common health problem worldwide (Vos et al., 2015). In 2014, research discovered older people were less likely to have bipolar disorder compared to younger people, with only 0.4% of 65 to 74-year olds screened positive while 3.4% of 16 to 24-year olds screened positive (Marwaha & Bebbington, 2016).
Affective disorders can be classed on a spectrum defined by the severity and extent of elevation in mood, from unipolar to bipolar II to bipolar I (Phillips & Kupfer, 2013). Individuals who have depressive episodes only are classed as unipolar and individuals who have increasingly pronounced episodes of mood elevation are classed as bipolar I or bipolar II (Grande et al., 2016). Bipolar disorder is an enduring episodic illness that can often result in a reduction in quality of life, and cognitive and functional impairment (Grande et al., 2013).
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Over the last few years, research has turned to look at the perception of emotions in individuals with bipolar disorder as it has a significant role in an individual’s quality of life (Fulford, Peckham, Johnson & Johnson, 2014). Therefore, understanding the specific process deficits in emotional perception is important when studying bipolar disorder due to its association with chronic functional impairment (American Psychiatric Association, 2000) and profound emotion dysfunction (Phillips & Vieta, 2000).
One theory that has been reported in patients with bipolar disorder is Theory of Mind.
Theory of mind is a key component of social cognition and it relates to the capability to deduce individuals’ intentions, beliefs, aims and emotional states (Schaafsma, Pfaff, Spunt & Adolphs, 2015). Theory of mind impairment has been shown in individuals with disorders such as major depressive disorder, schizophrenia and bipolar disorder (Wang et al., 2018). However, findings relevant to the persistence of theory of mind deficits during euthymia are inconsistent due to reported findings being positive and negative. This indicates that although studies have shown effects, there are still inconsistencies in the research. In Samamé, Martino and Strejilevich (2012, 2015) conducted a meta-analysis of social cognition in bipolar disorder. A preliminary examination of 9 and 11 theory of mind studies was conducted, respectively, in ‘remitted’ bipolar disorder patients and they found modest but significant impairments. However, the meta-analyses did not use a strict euthymic criterion and multiple studies included a varied patient sample which contained patients with subsyndromal manic/depressive or mild depression (Thaler, Allen, Sutton, Vertinski & Ringdahl, 2013; Lee, Altshuler, Glahn, Miklowitz, Ochsner & Green, 2013). This suggests theory of mind was not just looked at in bipolar disorder patients, therefore the sample sizes in these studies would be smaller, this would make it difficult to generalise the findings to all patients with bipolar disorders. In the theory of mind model for bipolar disorder, the deficits are shown less consistently (Mitchell & Young, 2016) and variation depends on the state of bipolar illness (Hawken et al., 2016). In these studies, three phases of bipolar disorder were looked at by examining participants theory of mind decoding abilities and they found that only in the manic phase they were significantly less accurate. However, a study by Espinós, Fernández-Abascal and Ovejero (2018) indicated patients with bipolar I and II had certain deficiencies in emotional theory of mind, this therefore indicates there may be an association between these deficits and a characteristic of suffering from bipolar disorder. Theory of mind dysfunction has also been found to be more significantly pronounced in participants having acute episodes and it was also distinct in remitted patients (Bora, Bartholomeusz & Pantelis, 2016). Olley, Malhi, Bachelor, Cahill, Mitchell and Berk (2005) found remitted bipolar disorder patients had increased theory of mind response latency. For example, they took longer to pick a response option and they had lower accuracy when they completed a story comprehension task. These studies indicate theory of mind dysfunction occurs in a variety of phases and disorders in bipolar, however, the studies’ findings varied in significance for different aspects of the studies. This could suggest that the differences in testing could have caused the differences in findings or that the dysfunction varies depending on the participant. Although theory of mind has been linked to bipolar disorder, a reason why there might be inconsistent findings in research is due to the fact that when theory mind is being assessed in individuals, different tasks may be used and therefore produce the varying results (Wang et al., 2018). Studies also operationalise theory of mind differently which makes collective findings difficult to interpret, as factors such as basic neurocognitive functions, indicators of illness burden and subsyndromal symptom severity are not always taken into consideration (Hagg, Haffner, Quinlivan, Brüne & Stamm, 2016). Mitchell and Young (2015) suggested that the link between positive psychotic symptoms and theory of mind deficits may be symptom specific rather than disease specific. Bora, Yücel and Pantelis (2009), who reviewed theory of mind studies in bipolar disorder, affective psychosis and schizophrenia spectrum disorders, suggested that impairment in theory of mind might imitate residual symptom expression and executive dysfunction rather than a precise trait marker. These studies could suggest that theory of mind may not be associated to each disorder but rather the symptoms expressed which could indicate that it can only explain some parts of a disorder and these aspects may be the ones that overlap into other disorders, such as affective psychosis and schizophrenia spectrum disorders. The studies therefore indicate that more research needs to be conducted into theory of mind to define the deficits in bipolar disorder in order to better understand the importance it has n performance on functioning in everyday life (Purcell, Phillips & Gruber, 2013).
One treatment that could be used to treat bipolar disorder is cognitive behavioural therapy. Cognitive behavioural therapy (CBT) is a psychosocial intervention, which is used to try and improve mental health (Field, Beeson & Jones, 2015). The application of CBT is used to change and challenge, behaviour, cognitive distortions (such as attitudes, beliefs and thoughts) which are unhelpful and improve emotional regulation (Benjamin et al., 2011). CBT has been used as an effective treatment for less severe mental disorders and there have been efforts to adapt the treatment for more severe mental disorders (Thase, Kingdon & Turkington, 2014). Many clinically controlled studies have frequently used CBT to treat bipolar disorder (Ball, Mitchell, Corry, Skillecorn, Smith & Malhi, 2006). A meta-analysis found that CBT had a positive effect on clinical symptoms of bipolar disorder (including manic and depressive symptoms), which indicates that it does help with treating patients with bipolar disorder (Szentagotai & David, 2010). However, the analysis also showed there was no evidence of effectiveness in reducing relapse rate of bipolar disorder. Another meta-analysis found although CBT can significantly reduce relapse rates of bipolar disorder after a short period of 6 months, the effectiveness receded at a follow up of 12 months (Ye et al., 2016). Although the effectiveness was only found to be short term, it has been found that CBT has a positive impact as it decreases relapse rates, reduces depression levels and increase psychosocial functioning (Chiang, Tsai, Liu, Lin, Chiu & Chou, 2017). It could also be argued the perceived benefits of CBT seem to come mainly from meta-analysis, which can be a problem as there could be a failure to use control intervention and there could be potential bias caused by a lack of blinding (Lynch, Laws & McKenna, 2010). Also, although CBT seems to be effective, it is usually combined with medication. The Chiang et al. (2017) meta-analysis recommended that CBT should be used as an adjunctive to medication due to the positive effects it had on the post treatment and in the follow up. Though it could be argued that even if CBT is combined with medication, if the treatment is effective it should not be disregarded. This is indicated in Swartz and Swanson (2014) study which claims that when psychotherapy is added to medication to treat bipolar disorder it showed more advantages compared to when medication was used alone.
In conclusion, although the research into both theory of mind and CBT has produced inconsistent data it should not be disregarded. Although there may be other efficient or greater explanations to explain bipolar disorder, the theory and treatment is not ineffective. As shown above CBT has been used frequently to treat bipolar disorder (Ball et al., 2006) and theory of mind seems to effective and inconsistencies may be due to different tasks used (Wang et al., 2018). The theory and treatment have value as it has shown to affect patients with bipolar disorder and should be studied further to have a greater understanding on how and why there are effects on patients and whether there are other more appropriate theories or treatments to use.
Theory of Mind, CBT and Bipolar Disorder. (2024, Jan 25). Retrieved from https://studymoose.com/theory-of-mind-cbt-and-bipolar-disorder-essay
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