Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T04:04:55.610Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding familial liability for emotion regulation difficulties in bipolar disorder

Published online by Cambridge University Press:  17 December 2020

Tamsyn E. Van Rheenen Open the ORCID record for Tamsyn E. Van Rheenen [Opens in a new window] ,
Kamilla Miskowiak ,
James Karantonis ,
Lisa S. Furlong ,
Greg Murray  and
Susan L. Rossell
Tamsyn E. Van Rheenen*
Affiliation:
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
Kamilla Miskowiak
Affiliation:
Neurocognition and Emotion in Affective Disorders Group, Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark Department of Psychology, University of Copenhagen, Copenhagen, Denmark
James Karantonis
Affiliation:
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
Lisa S. Furlong
Affiliation:
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
Greg Murray
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
Susan L. Rossell
Affiliation:
Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia Department of Psychiatry, St Vincent's Hospital, VIC, Australia
*
Author for correspondence: Tamsyn E. Van Rheenen, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There has been relatively limited work focused on understanding whether relatives of individuals with bipolar disorder (BD) have difficulties in the regulation of emotion, particularly in relation to perceptions about whether emotions can be effectively regulated, or trait behaviours that acknowledge emotions as self-regulators themselves. In this study, we assessed the presence and extent of difficulties in these dimensions of emotion regulation in individuals with BD compared to unaffected first-degree biological relatives (FDR) for the first time.

Methods

In total, 161 participants, including euthymic individuals with BD, unaffected FDRs, and healthy controls, were compared on the Difficulties in Emotion Regulation Scale (DERS) – a multi-dimensional measure of habitual emotion regulation. Clinical data were also collected and examined in relation to DERS scores in a secondary analysis.

Results

In the BD group, difficulties were evident for most dimensions of emotion regulation as measured by the DERS; and correlated with an earlier onset of illness and more mood episodes. FDRs displayed generally normal emotion regulation, except in terms of their beliefs that emotions can be effectively regulated; on this dimension, their reported difficulty was intermediate to the BD group and controls.

Conclusion

Habitual emotion regulation difficulties in BD persist irrespective of mood state, are related to the course of illness, and should be targeted in psychological interventions. Further, the perception that emotions cannot be effectively regulated during times of distress seems to represent an endophenotype for BD.

Keywords

Emotionemotional acceptanceemotional clarityendophenotypefamilial liabilityfirst-degree relativesgeneticsself-efficacy
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 13 , October 2022 , pp. 2614 - 2621
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Becerra, R., Cruise, K., Murray, G., Bassett, D., Harms, C., Allan, A., & Hood, S. (2013). Emotion regulation in bipolar disorder: Are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders? Open Journal of Psychiatry, 3(4), 1–7.CrossRefGoogle Scholar
Boden, M. T., & Thompson, R. J. (2017). Meta-analysis of the association between emotional clarity and attention to emotions. Emotion Review, 9(1), 79–85.CrossRefGoogle Scholar
Bridi, K. P. B., Loredo-Souza, A. C. M., Fijtman, A., Moreno, M. V., Kauer-Sant'Anna, M., Ceresér, K. M. M., & Kunz, M. (2018). Differences in coping strategies in adult patients with bipolar disorder and their first-degree relatives in comparison to healthy controls. Trends in Psychiatry and Psychotherapy, 40(4), 318–325.CrossRefGoogle ScholarPubMed
Calafiore, D., Rossell, S. L., & Van Rheenen, T. E. (2018). Cognitive abilities in first-degree relatives of individuals with bipolar disorder. Journal of Affective Disorders, 225, 147–152. doi: https://doi.org/10.1016/j.jad.2017.08.029CrossRefGoogle ScholarPubMed
Campos, J. J., Mumme, D., Kermoian, R., & Campos, R. G. (1994). A functionalist perspective on the nature of emotion. Japanese Journal of Research on Emotions, 2(1), 1–20.CrossRefGoogle Scholar
Canli, T., Ferri, J., & Duman, E. A. (2009). Genetics of emotion regulation. Neuroscience, 164(1), 43–54.CrossRefGoogle ScholarPubMed
Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890.CrossRefGoogle Scholar
Craddock, N., & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381(9878), 1654–1662.CrossRefGoogle ScholarPubMed
Dodd, A., Lockwood, E., Mansell, W., & Palmier-Claus, J. (2019). Emotion regulation strategies in bipolar disorder: A systematic and critical review. Journal of Affective Disorders, 246, 262–284.CrossRefGoogle ScholarPubMed
Fergus, T. A., Bardeen, J. R., & Orcutt, H. K. (2013). Experiential avoidance and negative emotional experiences: The moderating role of expectancies about emotion regulation strategies. Cognitive Therapy and Research, 37(2), 352–362.CrossRefGoogle Scholar
Fernández-Rodríguez, C., Paz-Caballero, D., González-Fernández, S., & Pérez-Álvarez, M. (2018). Activation vs. experiential avoidance as a transdiagnostic condition of emotional distress: An empirical study. Frontiers in Psychology, 9, 1618.CrossRefGoogle ScholarPubMed
Fletcher, K., Parker, G. B., & Manicavasagar, V. (2013). Coping profiles in bipolar disorder. Comprehensive Psychiatry, 54(8), 1177–1184.CrossRefGoogle ScholarPubMed
Ford, B. Q., Lam, P., John, O. P., & Mauss, I. B. (2018). The psychological health benefits of accepting negative emotions and thoughts: Laboratory, diary, and longitudinal evidence. Journal of Personality and Social Psychology, 115(6), 1075.CrossRefGoogle ScholarPubMed
Fortgang, R. G., Hultman, C. M., & Cannon, T. D. (2016). Coping styles in twins discordant for schizophrenia, bipolar disorder, and depression. Clinical Psychological Science, 4(2), 216–228.CrossRefGoogle ScholarPubMed
Gottesman, I. I., & Gould, T. D. (2003). The endophenotype concept in psychiatry: Etymology and strategic intentions. American Journal of Psychiatry, 160, 636–645.CrossRefGoogle ScholarPubMed
Gratz, K., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.CrossRefGoogle Scholar
Green, M. J., Lino, B. J., Hwang, E. J., Sparks, A., James, C., & Mitchell, P. B. (2011). Cognitive regulation of emotion in bipolar I disorder and unaffected biological relatives. Acta Psychiatrica Scandinavica, 124(4), 307–316. doi: 10.1111/j.1600-0447.2011.01718.xCrossRefGoogle ScholarPubMed
Greven, C. U., Harlaar, N., Kovas, Y., Chamorro-Premuzic, T., & Plomin, R. (2009). More than just IQ: School achievement is predicted by self-perceived abilities—But for genetic rather than environmental reasons. Psychological Science, 20(6), 753–762.CrossRefGoogle Scholar
Hallion, L. S., Steinman, S. A., Tolin, D. F., & Diefenbach, G. J. (2018). Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS) and its short forms in adults with emotional disorders. Frontiers in Psychology, 9, 539.CrossRefGoogle ScholarPubMed
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.CrossRefGoogle ScholarPubMed
Heissler, J., Kanske, P., Schönfelder, S., & Wessa, M. (2014). Inefficiency of emotion regulation as vulnerability marker for bipolar disorder: Evidence from healthy individuals with hypomanic personality. Journal of Affective Disorders, 152–154(0), 83–90. doi: http://dx.doi.org/10.1016/j.jad.2013.05.001CrossRefGoogle ScholarPubMed
Jørgensen, M. M., Zachariae, R., Skytthe, A., & Kyvik, K. (2007). Genetic and environmental factors in alexithymia: A population-based study of 8785 Danish twin pairs. Psychotherapy and Psychosomatics, 76(6), 369–375.CrossRefGoogle ScholarPubMed
Kanske, P., Heissler, J., Schönfelder, S., Forneck, J., & Wessa, M. (2013). Neural correlates of emotional distractibility in bipolar disorder patients, unaffected relatives, and individuals with hypomanic personality. American Journal of Psychiatry, 170(12), 1487–1496. doi: 10.1176/appi.ajp.2013.12081044CrossRefGoogle ScholarPubMed
Kanske, P., Schönfelder, S., Forneck, J., & Wessa, M. (2015). Impaired regulation of emotion: Neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives. Translational Psychiatry, 5(1), e497–e497.CrossRefGoogle ScholarPubMed
Karantonis, J. A., Rossell, S. L., Carruthers, S. P., Sumner, P., Hughes, M., Green, M. J., … Van Rheenen, T. E. (2020). Cognitive validation of cross-diagnostic cognitive subgroups on the schizophrenia-bipolar spectrum. Journal of Affective Disorders, 266, 710–721.CrossRefGoogle ScholarPubMed
Keltner, D., & Gross, J. J. (1999). Functional accounts of emotions. Cognition & Emotion, 13(5), 467–480.CrossRefGoogle Scholar
Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056.CrossRefGoogle ScholarPubMed
Kjærstad, H. L., Mistarz, N., Coello, K., Stanislaus, S., Melbye, S. A., Harmer, C. J., … Kessing, L. V. (2020). Aberrant cognition in newly diagnosed patients with bipolar disorder and their unaffected relatives. Psychological Medicine, 50(11), 1808–1819.CrossRefGoogle ScholarPubMed
Kjærstad, H. L., Vinberg, M., Goldin, P. R., Køster, N., Støttrup, M. M. D., Knorr, U., … Miskowiak, K. W. (2016). Impaired down-regulation of negative emotion in self-referent social situations in bipolar disorder: A pilot study of a novel experimental paradigm. Psychiatry Research, 238, 318–325.CrossRefGoogle ScholarPubMed
Lindsay, E. K., Young, S., Smyth, J. M., Brown, K. W., & Creswell, J. D. (2018). Acceptance lowers stress reactivity: Dismantling mindfulness training in a randomized controlled trial. Psychoneuroendocrinology, 87, 63–73.CrossRefGoogle ScholarPubMed
Medrano, L. A., & Trógolo, M. (2016). Construct validity of the difficulties in emotion regulation scale: Further evidence using confirmatory factor analytic approach.CrossRefGoogle Scholar
Meluken, I., Ottesen, N. M., Harmer, C., Scheike, T., Kessing, L. V., Vinberg, M., & Miskowiak, K. W. (2019). Is aberrant affective cognition an endophenotype for affective disorders? –A Monozygotic Twin Study. Psychological Medicine, 49(6), 987–996.Google ScholarPubMed
Miskowiak, K. W., Kjærstad, H. L., Meluken, I., Petersen, J. Z., Maciel, B. R., Köhler, C. A., … Carvalho, A. F. (2017). The search for neuroimaging and cognitive endophenotypes: A critical systematic review of studies involving unaffected first-degree relatives of individuals with bipolar disorder. Neuroscience and Biobehavioral Reviews, 73, 1–22.CrossRefGoogle ScholarPubMed
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Mortensen, P. B., Pedersen, C., Melbye, M., Mors, O., & Ewald, H. (2003). Individual and familial risk factors for bipolar affective disorders in Denmark. Archives of General Psychiatry, 60(12), 1209–1215.CrossRefGoogle ScholarPubMed
Reynolds, M. T., Van Rheenen, T. E., & Rossell, S. L. (2014). Theory of mind in first degree relatives of individuals with bipolar disorder. Psychiatry Research, 219, 400–402.CrossRefGoogle ScholarPubMed
Sheehan, D. V., Lecrubier, Y., Harnett Sheehan, K., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of clinical psychiatry, 59, 22–33.Google ScholarPubMed
Smoller, J. W., & Finn, C. T. (2003). Family, twin, and adoption studies of bipolar disorder. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 123C(1), 48–58. doi: 10.1002/ajmg.c.20013CrossRefGoogle ScholarPubMed
Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy, 45(6), 840–850.CrossRefGoogle ScholarPubMed
Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2016). Is experiential avoidance a mediating, moderating, independent, overlapping, or proxy risk factor in the onset, relapse and maintenance of depressive disorders? Cognitive Therapy and Research, 40(2), 150–163.CrossRefGoogle ScholarPubMed
Spinhoven, P., van Hemert, A. M., & Penninx, B. W. (2017). Experiential avoidance and bordering psychological constructs as predictors of the onset, relapse and maintenance of anxiety disorders: One or many? Cognitive Therapy and Research, 41(6), 867–880.CrossRefGoogle ScholarPubMed
Teper, R., & Inzlicht, M. (2012). Meditation, mindfulness and executive control: The importance of emotional acceptance and brain-based performance monitoring. Social Cognitive and Affective Neuroscience, 8(1), 85–92. doi: 10.1093/scan/nss045.CrossRefGoogle ScholarPubMed
Van Rheenen, T. E., Murray, G., & Rossell, S. L. (2015). Emotion regulation in bipolar disorder: Profile and utility in predicting trait mania and depression propensity. Psychiatry Research, 225(3), 425–432..CrossRefGoogle ScholarPubMed
Van Rheenen, T. E., & Rossell, S. L. (2014). Objective and subjective psychosocial functioning in bipolar disorder: An investigation of the relative importance of neurocognition, social cognition and emotion regulation. Journal of Affective Disorders, 162, 134–141. doi: http://dx.doi.org/10.1016/j.jad.2014.03.043CrossRefGoogle ScholarPubMed
Waaktaar, T., & Torgersen, S. (2013). Self-efficacy is mainly genetic, not learned: A multiple-rater twin study on the causal structure of general self-efficacy in young people. Twin Research and Human Genetics, 16(3), 651–660.CrossRefGoogle Scholar
Wechsler, D. (2001). Wechsler test of adult reading (WTAR). San Antonio,TX: Psychological Corporation.Google Scholar
Young, R., Biggs, J., Ziegler, V., & Meyer, D. (1978). A rating scale for mania: Reliability, validity and sensitivity. The British Journal of Psychiatry, 133(5), 429–435. doi: 10.1192/bjp.133.5.429CrossRefGoogle ScholarPubMed
Supplementary material: File

Van Rheenen et al. supplementary material

Van Rheenen et al. supplementary material

Download Van Rheenen et al. supplementary material(File)
File 4.2 MB