Advertisement

Cognitive Therapy and Research

, Volume 42, Issue 6, pp 794–802 | Cite as

Reward and Punishment Sensitivity and Emotion Regulation Processes Differentiate Bipolar and Unipolar Depression

  • Lauren M. Weinstock
  • Tina Chou
  • Cintly Celis-deHoyos
  • Ivan W. Miller
  • June Gruber
Original Article

Abstract

Bipolar disorder (BD) and major depressive disorder (MDD) cannot be reliably differentiated by depression symptom expression alone, suggesting a need to identify processes that may more effectively differentiate the two disorders. To explore this question, currently depressed adults with BD (n = 30) and MDD (n = 30), and healthy control participants with no history of psychiatric illness (CTL; n = 30), completed self-report measures of reward and punishment sensitivity (i.e., behavioral activation and inhibition) and emotion regulation processes (i.e., rumination and avoidance). Results revealed that constructs putatively linked to depression across the mood disorders (i.e., behavioral inhibition, negative rumination, dampening of positive affect, behavioral and experiential avoidance) were significantly higher in both mood disorder groups compared to CTLs. Yet there was also some specificity between mood disorder groups, such that the BD group reported significantly greater reward responsiveness and positive rumination, in addition to greater behavioral inhibition and avoidance, compared to the MDD group. These data suggest that patterns of affective responding previously linked to underlying risk for mania in BD may remain evident during a major depressive episode. Further, current models of reward sensitivity in BD may benefit from the inclusion of punishment sensitivity and behavioral avoidance, particularly with respect to bipolar depression.

Keywords

Bipolar disorder Major depressive disorder Reward sensitivity Punishment sensitivity Emotion regulation 

Notes

Funding

This research was supported in part by Grant K23MH079907 from the National Institute of Mental Health (LW) and Grant UL1RR024139 from the National Center for Research Resources and the National Center for Advancing Translational Science (JG).

Compliance with Ethical Standards

Conflict of Interest

Lauren M. Weinstock, Tina Chou, Cintly Celis-deHoyos, Ivan W. Miller, and June Gruber declare that they have no conflicts of interest.

Informed Consent

All procedures were conducted in accordance with the ethical standards of the institutional review committees of Butler Hospital and Brown University, Providence, RI, USA, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

References

  1. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.  https://doi.org/10.1016/j.cpr.2009.11.004.CrossRefPubMedGoogle Scholar
  2. Alloy, L. B., Abramson, L. Y., Walshaw, P. D., Cogswell, A., Grandin, L. D., Hughes, M. E., et al. (2008). Behavioral approach system and behavioral inhibition system sensitivities and bipolar spectrum disorders: Prospective prediction of bipolar mood episodes. Bipolar Disorders, 10, 310–322.  https://doi.org/10.1111/j.1399-5618.2007.00547.x.CrossRefPubMedGoogle Scholar
  3. Alloy, L. B., Bender, R. E., Whitehouse, W. G., Wagner, C. A., Liu, R. T., Grant, D. A., et al. (2012). High behavioral approach system (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: A prospective behavioral high-risk design. Journal of Abnormal Psychology, 121, 339–351.  https://doi.org/10.1037/a0025877.CrossRefPubMedGoogle Scholar
  4. Alloy, L. B., Nusslock, R., & Boland, E. M. (2015). The development and course of bipolar spectrum disorders: An integrated reward and circadian rhythm dysregulation model. Annual Review of Clinical Psychology, 11, 213–250.  https://doi.org/10.1146/annurev-clinpsy-032814-112902.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Altman, E. G., Hedeker, D., Peterson, J. L., & Davis, J. M. (1997). The Altman self-rating mania scale. Biological Psychiatry, 42, 948–955.  https://doi.org/10.1016/S0006-3223(96)00548-3.CrossRefPubMedGoogle Scholar
  6. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.  https://doi.org/10.1176/appi.books.9780890423349.CrossRefGoogle Scholar
  7. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The Alcohol Use Disorders Identification Test: Guidelines for use in primary care. Geneva: World Health Organization.Google Scholar
  8. Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57, 289–300.Google Scholar
  9. Berman, A. H., Bergman, H., Palmstierna, T., & Schlyter, F. (2003). The drug use disorders identification test manual. Stockholm: Karolinska Institute.Google Scholar
  10. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therarpy, 42, 676–688.  https://doi.org/10.1016/j.beth.2011.03.007.CrossRefGoogle Scholar
  11. Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS scales. Journal of Personality and Social Psychology, 67, 319–333.  https://doi.org/10.1037/0022-3514.67.2.319.CrossRefGoogle Scholar
  12. Chase, H. W., Nusslock, R., Almeida, J. R., Forbes, E. E., Labarbara, E. J., & Phillips, M. L. (2013). Dissociable patterns of abnormal frontal cortical activation during anticipation of an uncertain reward or loss in bipolar versus major depression. Bipolar Disorders, 15, 839–854.  https://doi.org/10.1111/bdi.12132.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Lawrence Erlbaum Associates, Inc.Google Scholar
  14. Cribb, G., Moulds, M. L., & Carter, S. (2006). Rumination and experiential avoidance in depression. Behaviour Change, 23, 165–176.  https://doi.org/10.1375/bech.23.3.165.CrossRefGoogle Scholar
  15. Cuellar, A. K., Johnson, S. L., & Winters, R. (2005). Distinctions between bipolar and unipolar depression. Clinical Psychology Review, 25, 307–339.  https://doi.org/10.1016/j.cpr.2004.12.002.CrossRefPubMedPubMedCentralGoogle Scholar
  16. De Almeida, J. R. C., & Phillips, M. L. (2013). Distinguishing between unipolar depression and bipolar depression: Current and future clinical and neuroimaging perspectives. Biological Psychiatry, 73, 111–118.  https://doi.org/10.1016/j.biopsych.2012.06.010.CrossRefGoogle Scholar
  17. Depue, R. A., & Iacono, W. G. (1989). Neurobehavioral aspects of affective disorders. Annual Review of Psychology, 40, 457–492.  https://doi.org/10.1146/annurev.ps.40.020189.002325.CrossRefPubMedGoogle Scholar
  18. Dickson, K. S., Ciesla, J. a., & Reilly, L. C. (2012). Rumination, worry, cognitive avoidance, and behavioral avoidance: Examination of temporal effects. Behavior Therapy, 43, 629–640.  https://doi.org/10.1016/j.beth.2011.11.002.CrossRefPubMedGoogle Scholar
  19. Feldman, G. C., Joormann, J., & Johnson, S. L. (2008). Responses to positive affect: A self-report measure of rumination and dampening. Cognitive Therapy and Research, 32, 507–525.  https://doi.org/10.1007/s10608-006-9083-0.CrossRefPubMedPubMedCentralGoogle Scholar
  20. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  21. Ghaemi, N., Sachs, G. S., & Goodwin, F. K. (2000). What is to be done? Controversies in the diagnosis and treatment of manic-depressive illness. World Journal of Biological Psychiatry, 1, 65–74.  https://doi.org/10.3109/15622970009150569.CrossRefPubMedGoogle Scholar
  22. Gilbert, K. E., Nolen-Hoeksema, S., & Gruber, J. (2013). Positive emotion dysregulation across mood disorders: How amplifying versus dampening predicts emotional reactivity and illness course. Behaviour Research and Therapy, 51, 736–741.  https://doi.org/10.1016/j.brat.2013.08.004.CrossRefPubMedGoogle Scholar
  23. Gray, J. A. (1981). A critique of Eysenck’s theory of pesronality. In H. J. Eysenck (Ed.), A Model for Personality (pp. 246–276). Berlin: Springer.  https://doi.org/10.1007/978-3-642-67783-0_8.CrossRefGoogle Scholar
  24. Gruber, J., Eidelman, P., Johnson, S. L., Smith, B., & Harvey, A. G. (2011). Hooked on a feeling: Rumination about positive and negative emotion in inter-episode bipolar disorder. Journal of Abnormal Psychology, 120, 956–961.  https://doi.org/10.1037/a0023667.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Hasler, G., Drevets, W. C., Gould, T. D., Gottesman, I. I., & Manji, H. K. (2006). Toward constructing an endophenotype strategy for bipolar disorders. Biological Psychiatry, 60, 93–105.  https://doi.org/10.1016/j.biopsych.2005.11.006.CrossRefPubMedGoogle Scholar
  26. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578.CrossRefGoogle Scholar
  27. 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.  https://doi.org/10.1037/0022-006X.64.6.1152.CrossRefPubMedGoogle Scholar
  28. Joffe, R. T., Young, L. T., & MacQueen, G. M. (1999). A two-illness model of bipolar disorder. Bipolar Disorders, 1, 25–30.  https://doi.org/10.1034/j.1399-5618.1999.10107.x.CrossRefPubMedGoogle Scholar
  29. Johnson, S. L., & Carver, C. S. (2006). Extreme goal setting and vulnerability to mania among undiagnosed young adults. Cognitive Therapy and Research, 30, 377–395.  https://doi.org/10.1007/s10608-006-9044-7.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Johnson, S. L., McKenzie, G., & McMurrich, S. (2008). Ruminative responses to negative and positive affect among students diagnosed with bipolar disorder and major depressive disorder. Cognitive Therapy and Research, 32, 702–713.  https://doi.org/10.1007/s10608-007-9158-6.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Judd, C. M., McClelland, G. H., & Ryan, C. S. (2009). Data analysis: A model comparison approach (2nd ed.). New York: Routledge.  https://doi.org/10.4324/9780203892053.CrossRefGoogle Scholar
  32. Judd, L. L., Akiskal, H. S., Schettler, P. J., Endicott, J., Leon, A. C., Solomon, D. A., et al. (2005). Psychosocial disability in the course of bipolar I and II disorders: A prospective, comparative, longitudinal study. Archives of General Psychiatry, 62, 1322–1330.  https://doi.org/10.1001/archpsyc.62.12.1322.CrossRefPubMedGoogle Scholar
  33. Judd, L. L., Akiskal, H. S., Schettler, P. J., Endicott, J., Maser, J., Solomon, D. A., et al. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59, 530–537.  https://doi.org/10.1001/archpsyc.59.6.530.CrossRefPubMedGoogle Scholar
  34. Kasch, K. L., Rottenberg, J., Arnow, B. A., & Gotlib, I. H. (2002). Behavioral activation and inhibition systems and the severity and course of depression. Journal of Abnormal Psychology, 111, 589–597.  https://doi.org/10.1037/0021-843X.111.4.589.CrossRefPubMedGoogle Scholar
  35. Kashdan, T. B., Breen, W. E., Afram, A., & Terhar, D. (2010). Experiential avoidance in idiographic, autobiographical memories: Construct validity and links to social anxiety, depressive, and anger symptoms. Journal of Anxiety Disorders, 24, 528–534.  https://doi.org/10.1016/j.janxdis.2010.03.010.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Lewinsohn, P. M. (1974). A behavioral approach to depression. In R. J. Friendman & M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research (pp. 157–178). Oxford: John Wiley & Sons.Google Scholar
  37. Manos, R. C., Kanter, J. W., & Luo, W. (2011). The Behavioral Activation for Depression Scale Short Form: Development and validation. Behavior Therapy, 42, 726–739.  https://doi.org/10.1016/j.beth.2011.04.004.CrossRefPubMedGoogle Scholar
  38. Meyer, B., Johnson, S. L., & Carver, C. S. (1999). Exploring behavioral activation and inhibition sensitivities among college students at risk for bipolar spectrum symptomatology. Journal of Psychopathology and Behavioral Assessment, 21, 275–292.  https://doi.org/10.1023/A:1022119414440.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Meyer, B., Johnson, S. L., & Winters, R. (2001). Responsiveness to threat and incentive in bipolar disorder: Relations of the BIS/BAS scales with symptoms. Journal of Psychopathology and Behavioral Assessment, 23, 133–143.  https://doi.org/10.1023/A:1010929402770.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Millgram, Y., Joorman, J., Huppert, J. D., & Tamir, M. (2015). Sad as a matter of choice? Emotion-regulation goals in depression. Psychological Science, 26, 1216–1228.  https://doi.org/10.1177/0956797615583295.CrossRefPubMedGoogle Scholar
  41. Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.  https://doi.org/10.1037/0021-843X.100.4.569.CrossRefPubMedGoogle Scholar
  42. Pinto-Meza, A., Caseras, X., Soler, J., Puigdemont, D., Perez, V., & Torrubia, R. (2006). Behavioural inhibition and behavioural activation systems in current and recovered major depression participants. Personality and Individual Differences, 40, 215–226.  https://doi.org/10.1016/j.paid.2005.06.021.CrossRefGoogle Scholar
  43. Redlich, R., Dohm, K., Grotegerd, D., Opel, N., Zwitserlood, P., Heindel, W., et al. (2015). Reward processing in unipolar and bipolar depression: A functional MRI study. Neuropsychopharmacology, 40, 2623–2631.  https://doi.org/10.1038/npp.2015.110.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Rochefort, C., Baldwin, A. S., & Chmielewski, M. (2017). Experiential avoidance: An examination of the construct validity of the AAQ-II and MEAQ. Behavior Therapy, 49, 435–449.  https://doi.org/10.1016/j.beth.2017.08.008.CrossRefPubMedGoogle Scholar
  45. Ross, S. R., Millis, S. R., Bonebright, T. L., & Bailley, S. E. (2002). Confirmatory factor analysis of the behavioral inhibition and activation scales. Personality and Individual Differences, 33, 861–865.  https://doi.org/10.1016/S0191-8869(01)00196-9.CrossRefGoogle Scholar
  46. Rottenberg, J. (2017). Emotions in depression: What do we really know? Annual Review of Clinical Psychology, 13, 241–263.  https://doi.org/10.1146/annurev-clinpsy-032816-045252.CrossRefPubMedGoogle Scholar
  47. Salavert, J., Caseras, X., Torrubia, R., Furest, S., Arranz, B., Duenas, R., & San, L. (2007). The functioning of the behavioral activation and inhibition systems in bipolar I euthymic patients and its influence in subsequent episodes over an eighteen-month period. Personality and Individual Differences, 42, 1323–1331.  https://doi.org/10.1016/j.paid.2006.10.010.CrossRefGoogle Scholar
  48. Schaffer, A., Isometsä, E. T., Tondo, L., Moreno, H., Turecki, D., Reis, G., et al. (2015). International Society for Bipolar Disorders Task Force on Suicide: Meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disorders, 17, 1–16.  https://doi.org/10.1111/bdi.12271.CrossRefPubMedGoogle Scholar
  49. Shahar, B., & Herr, N. R. (2011). Depressive symptoms predict inflexibly high levels of experiential avoidance in response to daily negative affect: A daily diary study. Behaviour Research and Therapy, 49, 676–681.  https://doi.org/10.1016/j.brat.2011.07.006.CrossRefPubMedGoogle Scholar
  50. Shapero, B. G., Stange, J. P., Goldstein, K. E., Black, C. L., Molz, A. R., Hamlat, E. J., et al. (2015). Cognitive styles in mood disorders: Discriminative ability of unipolar and bipolar cognitive profiles. International Journal of Cognitive Therapy, 8, 35–60.  https://doi.org/10.1521/ijct.2015.8.1.35.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Smith, D. J., & Craddock, N. (2011). Unipolar and bipolar depression: Different of the same? British Journal of Psychiatry, 199, 272–274.  https://doi.org/10.1192/bjp.bp.111.092726.CrossRefPubMedGoogle Scholar
  52. Trew, J. L. (2011). Exploring the roles of approach and avoidance in depression: An integrative model. Clinical Psychology Review, 31, 1156–1168.  https://doi.org/10.1016/j.cpr.2011.07.007.CrossRefPubMedGoogle Scholar
  53. Trivedi, M. H., Rush, A. J., Ibrahim, H. M., Carmody, T. J., Biggs, M. M., Suppes, T., et al. (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: A psychometric evaluation. Psychological Medicine, 34, 73–82.  https://doi.org/10.1017/S0033291703001107.CrossRefPubMedGoogle Scholar
  54. Weinstock, L. M., Strong, D., Uebelacker, L. A., & Miller, I. W. (2009). Differential item functioning of DSM-IV depressive symptoms in individuals with a history of mania versus those without: An item response theory analysis. Bipolar Disorders, 11, 289–297.  https://doi.org/10.1111/j.1399-5618.2009.00681.x.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Weinstock, L. M., Strong, D., Uebelacker, L. A., & Miller, I. W. (2010a). DSM-IV depressive symptom expression among individuals with a history of hypomania: A comparison to those with or without a history of mania. Journal of Psychiatric Research, 44, 979–985.  https://doi.org/10.1016/j.jpsychires.2010.03.010.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Weinstock, L. M., Strong, D., Uebelacker, L. A., & Miller, I. W. (2010b). Use of item response theory methodology to evaluate differences between bipolar and unipolar depression. US Psychiatry, 3, 15–20.Google Scholar
  57. Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., … Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. The Lancet, 382, 1575–1586.  https://doi.org/10.1016/S0140-6736(13)61611-6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Human BehaviorBrown UniversityProvidenceUSA
  2. 2.Psychosocial Research ProgramButler HospitalProvidenceUSA
  3. 3.Department of Psychology and NeuroscienceUniversity of Colorado at BoulderBoulderUSA

Personalised recommendations