Cognitive Therapy and Research

, Volume 37, Issue 1, pp 51–60 | Cite as

The Role of Beliefs About Mood Swings in Determining Outcome in Bipolar Disorder

  • Fiona Lobban
  • Ivonne Solis-Trapala
  • Elizabeth Tyler
  • Claire Chandler
  • Richard Keith Morriss
  • ERP Group
Original Article


This study explored the impact of beliefs about mood swings on symptomatic outcome in bipolar disorder (BD). Ninety-one people with BD completed a Brief Illness Perception Questionnaire at baseline. Outcome was measured using weekly measures of mood and time to relapse over the following 24 weeks. Beliefs about the consequences of mood swings [Hazard ratio (HR) = 1.38, 95 % CI = (1.07,1.77)], perceived symptoms associated with mood swings [HR = 0.75, 95 % CI = (0.59,0.95)], and emotional concern about mood swings [HR = 1.30, 95 % CI = (1.04,1.61)] had statistically significant effects on hazard of relapse, while beliefs about the consequences of mood swings [Odds ratio (OR) = 1.24, 95 % CI = (1.01,1.52)] and the amount of personal effort individuals believed they were making to get well [OR = 0.82, 95 % CI = (0.67,1.02)] had important effects on weekly LIFE scores of depressive symptoms controlling for baseline depression, mood stabilizer medication and number of previous bipolar episodes. In conclusion, beliefs about mood swings had important effects on weekly fluctuations in depression severity and time to relapse.


Beliefs Outcome Bipolar Mood swings 



This work was funded by the Medical Research Council and Mersey Care NHS Trust, UK. The findings do not necessarily represent the views of the funders. Ivonne Solis-Trapala acknowledges additional support from the Medical Research Council [grant number G0701642].


  1. Addington, J. (2003). An integrated treatment approach to substance use in an early psychosis programme. In H. Graham, A. Copello, M. Birchwood, & K. T. Mueser (Eds.), Substance misuse in psychosis: Approaches to treatment and service delivery. Chichester: Wiley.Google Scholar
  2. Alatiq, Y., Crane, C., Williams, J. M. G., & Goodwin, G. M. (2010). Dysfunctional beliefs in bipolar disorder: Hypomanic vs. depressive attitudes. Journal of Affective Disorders, 122(3), 294–300.PubMedCrossRefGoogle Scholar
  3. Bech, P., Rafaelsen, O. J., Kramp, P., & Bolwig, T. G. (1978). The mania rating scale: Scale construction and inter-observer agreement. Neuropharmacology, 17(6), 430–431.PubMedCrossRefGoogle Scholar
  4. Broadbent, E., Ellis, C. J., Thomas, J., Gamble, G., & Petrie, K. J. (2009). Further development of an illness perception intervention for myocardial infarction patients: A randomized controlled trial. Journal of Psychosomatic Research, 67, 17–23.PubMedCrossRefGoogle Scholar
  5. Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, 60(6), 631–637.PubMedCrossRefGoogle Scholar
  6. Colom, F., Vieta, E., Martinez-Aran, A., Reinares, M., Goikolea, J. M., Benabarre, A., et al. (2003). A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General Psychiatry, 60(4), 402–407.PubMedCrossRefGoogle Scholar
  7. Cook, R. J., & Farewell, V. T. (1996). Multiplicity considerations in the design and analysis of clinical trials. Journal of the Royal Statistical Society, 159, 93–110.CrossRefGoogle Scholar
  8. Cox, D. R. (1965). A remark on multiple comparison methods. Technometrics, 7, 223–224.CrossRefGoogle Scholar
  9. First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis I disorders, research version, patient edition. Washington, DC: American Psychiatric Press, Inc.Google Scholar
  10. Goldman, H. H., Skodol, A. E., & Lave, T. R. (1992). Revising axis V for DSM-IV: A review of measures of social functioning. American Journal of Psychiatry, 149(9), 1148–1156.PubMedGoogle Scholar
  11. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology and Psychiatry, 23, 59–62.Google Scholar
  12. Hollyman, J. A., Freeling, P., Paykel, E. S., Bhat, A., & Sedgewick, P. (1988). Double-blind placebo-controlled trial of amitriptyline among depressed patients in general practice. Journal of Royal College of General Practice, 38, 393–397.Google Scholar
  13. Jones, S., Mansell, W., & Waller, L. (2006). Appraisal of hypomania-relevant experiences: Development of a questionnaire to assess positive self-dispositional appraisals in bipolar and behavioural high risk samples. Journal of Affective Disorders, 93(1–3), 19–28.PubMedCrossRefGoogle Scholar
  14. Khazaal, Y., Richard, C., Matthieu-Darekar, S., Quement, B., Kramer, U., & Preisig, M. (2008). Advance directives in bipolar disorder, a cognitive behavioural conceptualization. International Journal of Law and Psychiatry, 31(1), 1–8.PubMedCrossRefGoogle Scholar
  15. Lam, D., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., et al. (2003). A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General Psychiatry, 60(2), 145–152.PubMedCrossRefGoogle Scholar
  16. Lam, D., Wright, K., & Smith, N. (2004). Dysfunctional assumptions in bipolar disorder. Journal of Affective Disorders, 79(1–3), 193–199.PubMedCrossRefGoogle Scholar
  17. Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum & J. Singer (Eds.), A handbook of psychology and health (pp. 219–252). Hillsdale, New Jersey: Erlbaum.Google Scholar
  18. Lobban, F., Barrowclough, C., & Jones, S. (2003). A review of the role of illness models in severe mental illness. Clinical Psychology Review, 23(2), 171–196.PubMedCrossRefGoogle Scholar
  19. Lobban, F., Barrowclough, C., & Jones, S. (2005). Assessing cognitive representations of mental health problems. I. The illness perception questionnaire for schizophrenia. British Journal of Clinical Psychology, 44, 147–162.PubMedCrossRefGoogle Scholar
  20. Lobban, F., Gamble, C., Kinderman, P., Taylor, L., Chandler, C., Tyler, E., et al. (2007). Enhanced relapse prevention for bipolar disorder–ERP trial. A cluster randomised controlled trial to assess the feasibility of training care coordinators to offer enhanced relapse prevention for bipolar disorder. BMC Psychiatry, 7, 6.PubMedCrossRefGoogle Scholar
  21. Lobban, F., Solis-Trapala, I., Symes, W., Morriss, R., & Univ, L. (2011). Early warning signs checklists for relapse in bipolar depression and mania: Utility, reliability and validity. Journal of Affective Disorders, 133(3), 413–422.PubMedCrossRefGoogle Scholar
  22. Lobban, F., Taylor, L., Chandler, C., Sellwood, W., Gamble, C., Tyler, E., et al. (2009). Training staff in enhanced relapse prevention for bipolar disorder: Uptake, skill and confidence. Psychiatric Services, 60, 702–706.PubMedCrossRefGoogle Scholar
  23. Lobban, F., Taylor, L., Chandler, C., Tyler, E., Kinderman, P., Kolamunnage-Dona, R., et al. (2010). Enhanced relapse prevention for bipolar disorder by community mental health teams: Cluster feasibility randomised trial. British Journal of Psychiatry, 196, 59–63.PubMedCrossRefGoogle Scholar
  24. Mansell, W., & Jones, S. H. (2006). The Brief-HAPPI: A questionnaire to assess cognitions that distinguish between individuals with a diagnosis of bipolar disorder and non-clinical controls. Journal of Affective Disorders, 93(1–3), 29–34.PubMedCrossRefGoogle Scholar
  25. McCabe, R., & Priebe, S. (2004). Explanatory models of illness in schizophrenia: Comparison of four ethnic groups. British Journal of Psychiatry, 185, 25–30.PubMedCrossRefGoogle Scholar
  26. McIntyre, R., Kennedy, S., Bagby, M., & Bakish, D. (2002). Assessing full remision. Journal of Psychiatry and Neuroscience, 27(4), 235–239.PubMedGoogle Scholar
  27. Munoz, S. R., & Bangdiwala, S. I. (1997). Interpretation of Kappa and B statistics measures of agreement. Journal of Applied Statistics, 24, 105–111.CrossRefGoogle Scholar
  28. Paykel, E., Abbott, R., Morriss, R., Hayhurst, H., & Scott, J. (2006a). Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. British Journal of Psychiatry, 189(2), 118–123. Royal College of Psychiatrists.PubMedCrossRefGoogle Scholar
  29. Paykel, E., Scott, J., Morriss, R. M., Hayhurst, H., & Abbott, R. (2006b). Subsyndromal and syndromal symptoms in the longitudinal course of bipolar disorder. British Journal of Psychiatry, 189, 118–123.PubMedCrossRefGoogle Scholar
  30. Presson, P. K., & Benassi, V. A. (1996). Locus of control orientation and depressive symptomatology: A meta-analysis. Journal of Social Behavior & Personality, 11(1), 201–212.Google Scholar
  31. R Development Core Team. (2009). A language and environment for statistical computing. R Foundation for Statistical Computing, from
  32. Scott, J. (2002). Using health belief models to understand the efficacy-effectiveness gap for mood stabilizer treatments. Neuropsychobiology, 46(Suppl. 1), 13–15.PubMedCrossRefGoogle Scholar
  33. Scott, J., Paykel, E., Morriss, R., Bentall, R., Kinderman, P., Johnson, T., et al. (2006). Cognitive-behavioural therapy for severe and recurrent bipolar disorders: Randomised controlled trial. British Journal of Psychiatry, 188, 313–320.PubMedCrossRefGoogle Scholar
  34. Scott, J., & Pope, M. (2003). Cognitive styles in individuals with bipolar disorders. Psychological Medicine, 33(6), 1081–1088.PubMedCrossRefGoogle Scholar
  35. Simon, G., & Rutter, C. (2008). Accuracy of recall for mania symptoms using a three month timeline follow-back interview. Journal of Affective Disorders, 107, 271–274.PubMedCrossRefGoogle Scholar
  36. Terry Therneau and original R port by Thomas Lumley. (2009). Survival analysis, including penalised likelihood. R package version 2.35-4, from

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Fiona Lobban
    • 1
  • Ivonne Solis-Trapala
    • 2
  • Elizabeth Tyler
    • 3
  • Claire Chandler
    • 4
  • Richard Keith Morriss
    • 5
  • ERP Group
  1. 1.Spectrum Centre for Mental Health Research, School of Health and MedicineLancaster UniversityLancasterUK
  2. 2.School of Health and MedicineLancaster UniversityLancasterUK
  3. 3.Division of Clinical PsychologyUniversity of ManchesterManchesterUK
  4. 4.Clinical Psychology DepartmentLiverpool UniversityLiverpoolUK
  5. 5.Institute of Mental HealthThe University of NottinghamNottinghamUK

Personalised recommendations