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Maladaptive Cognitions and Attributional Styles Among Youth with Pediatric Bipolar Disorder

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Abstract

Although studies have examined cognitive styles among adults with bipolar disorder (BD), less is known about this issue in pediatric samples. Therefore, we investigated negative cognitions and attributional styles in pediatric patients with BD and healthy controls (HC). Participants completed measures about their views of themselves, the world, and the future and causal attributions for positive and negative events. Compared to HCs, youth with BD displayed greater negative thoughts about others and the future, but not about themselves. They were also more likely to report dysfunctional attributional styles for negative events. When including depressive and manic symptoms in the analyses, both were significant covariates and accounted for the group differences in negative cognitions. Findings point to the importance of manic and depressive symptoms in the occurrence of maladaptive thinking patterns among pediatric patients with BD and highlight the unique cognitive styles specific to this group.

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References

  • Abela, J. R. Z. (2001). The hopelessness theory of depression: A test of the diathesis–stress and causal mediation components in third and seventh grade children. Journal of Abnormal Child Psychology, 29(3), 241–254. https://doi.org/10.1023/A:1010333815728.

    Article  PubMed  Google Scholar 

  • Abela, J. R. Z., & Sarin, S. (2002). Cognitive vulnerability to hopeless depression: A chain is only as strong as its weakest link. Cognitive Therapy and Research, 26(6), 811–829. https://doi.org/10.1023/A:1021245618183.

    Article  Google Scholar 

  • Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96, 358–372. https://doi.org/10.1037/0033-295X.96.2.358.

    Article  Google Scholar 

  • Abramson, L. Y., Seligman, M. E. P., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformation. Journal of Abnormal Psychology, 87(1), 49–74. https://doi.org/10.1037/0021-843X.87.1.49.

    Article  PubMed  Google Scholar 

  • Alloy, L. B., Abramson, L. Y., Urosevic, S., Walshaw, P. D., Nusslock, R., & Neeren, A. M. (2005). The psychosocial context of bipolar disorder: Environmental, cognitive, and developmental risk factors. Clinical Psychology Review, 25, 1043–1075. https://doi.org/10.1016/j.cpr.2005.06.006.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.).

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. Hoeber Medical Division, Harper & Row.

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

  • Bentall, R. P., Kinderman, P., & Manson, K. (2005). Self-discrepancies in bipolar disorder: Comparison of manic, depressed, remitted and normal participants. The British Journal of Clinical Psychology, 44, 457–473. https://doi.org/10.1348/014466505X29189.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Gill, M. K., Axelson, D. A., Goldstein, B. I., Goldstein, T. R., Yu, H., Liao, F., Iyengar, S., Diler, R. S., Strober, M., Hower, H., Yen, S., Hunt, J., Merranko, J. A., Ryan, N. D., & Keller, M. B. (2014). Longitudinal trajectories and associated baseline predictors in youths with bipolar spectrum disorders. American Journal of Psychiatry, 171(9), 990–999. https://doi.org/10.1176/appi.ajp.2014.13121577.

    Article  PubMed  Google Scholar 

  • Bonnín, C., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., Montejo, L., & Vieta, E. (2019). Improving functioning, quality of life, and well-being in patients with bipolar disorder. The International Journal of Neuropsychopharmacology, 22(8), 467–477. https://doi.org/10.1093/ijnp/pyz018.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chandler, S., Charman, T., Baird, G., Simonoff, E., Loucas, T., Meldrum, D., Scott, M., & Pickles, A. (2007). Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(10), 1324–1332. https://doi.org/10.1097/chi.0b013e31812f7d8d.

    Article  PubMed  Google Scholar 

  • Cohen, J. R., So, F. K., Hankin, B. L., & Young, J. F. (2019). Translating cognitive vulnerability theory into improved adolescent depression screening: A receiver operating characteristic approach. Journal of Clinical Child and Adolescent Psychology, 48, 582–595. https://doi.org/10.1080/15374416.2017.1416617.

    Article  PubMed  Google Scholar 

  • Cole, D. A., Jacquez, F. M., Truss, A. E., Pineda, A. Q., Weitlauf, A. S., Tilghman-Osborne, C. E., Felton, J. W., & Maxwell, M. A. (2009). Gender differences in the longitudinal structure of cognitive diatheses for depression in children and adolescents. Journal of Clinical Psychology, 65(12), 1312–1326. https://doi.org/10.1002/jclp.20631.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Everaert, J., Bronstein, M. V., Castro, A. A., Cannon, T. D., & Joormann, J. (2020). When negative interpretations persist, positive emotions don't! Inflexible negative interpretations encourage depression and social anxiety by dampening positive emotions. Behavior Research and Therapy, 124(103510), 1–12. https://doi.org/10.1016/j.brat.2019.103510.

    Article  Google Scholar 

  • Everaert, J., & Joormann, J. (2019). Emotion regulation difficulties related to depression and anxiety: A network approach to model relations among symptoms, positive reappraisal, and repetitive negative thinking. Clinical Psychological Science: A Journal of the Association for Psychological Science, 7, 1304–1318. https://doi.org/10.1177/2167702619859342.

    Article  Google Scholar 

  • Frazier, T. W., Demeter, C. A., Youngstrom, E. A., Calabrese, J. R., Stansbrey, R. J., McNamara, N. K., & Findling, R. L. (2007). Evaluation and comparison of psychometric instruments for pediatric bipolar spectrum disorders in four age groups. Journal of Child and Adolescent Psychopharmacology, 17(6), 853–866. https://doi.org/10.1089/cap.2007.0057.

    Article  PubMed  Google Scholar 

  • Goldstein, B. I., Birmaher, B., Carlson, G. A., DelBello, M. P., Findling, R. L., Fristad, M., Kowatch, R. A., Miklowitz, D. J., Nery, F. G., Perez-Algorta, G., Van Meter, A., Zeni, C. P., Correll, C. U., Kim, H. W., Wozniak, J., Chang, K. D., Hillegers, M., & Youngstrom, E. A. (2017). The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research. Bipolar Disorders, 19(7), 524–543. https://doi.org/10.1111/bdi.12556.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gross, J. J. (2013). Handbook of emotion regulation (2nd ed). Guilford Press.

  • Gross, J. J. (2008). Emotion regulation. In Lewis, M. Haviland-Jones, J. M. & Feldman Barrett, L. (Eds.), Handbook of emotions (3rd ed., pp. 497–512). Guilford Press.

  • Hamilton, J. L., Stange, J. P., Shapero, B. G., Connolly, S. L., Abramson, L. Y., & Alloy, L. B. (2013). Cognitive vulnerabilities as predictors of stress generation in early adolescence: Pathway to depressive symptoms. Journal of Abnormal Child Psychology, 41(7), 1027–1039. https://doi.org/10.1007/s10802-013-9742-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hankin, B. L., Abramson, L. Y., & Siler, M. (2001). A prospective test of the hopelessness theory of depression in adolescence. Cognitive Therapy and Research, 25, 607–632.

    Article  Google Scholar 

  • Jenkins, M. M., Youngstrom, E. A., Youngstrom, J. K., Feeny, N. C., & Findling, R. (2012). Generalizability of evidence-based assessment recommendations for pediatric bipolar disorder. Psychological Assessment, 24(2), 269–281. https://doi.org/10.1037/a0025775.

    Article  PubMed  Google Scholar 

  • Johnson, S. L., & Fingerhut, R. (2004). Negative cognitions predict the course of bipolar depression, not mania. Journal of Cognitive Psychotherapy, 18(2), 149–162.

    Article  Google Scholar 

  • Kaslow, N. J. & Nolen-Hoeksema, S. (1991). Children’s Attributional Style Questionnaire - Revised. [unpublished manuscript]. Emory University.

  • Kaslow, N. J., Stark, K. D., Printz, B., Livingston, R., & Ling Tsai, S. (1992). Cognitive triad inventory for children: Development and relation to depression and anxiety. Journal of Clinical Child Psychology, 21(4), 339–347. https://doi.org/10.1207/s15374424jccp2104_3.

    Article  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Williamson, D., & Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  Google Scholar 

  • Kircanski, K., Joormann, J., & Gotlib, I. H. (2012). Cognitive aspects of depression. Wiley Interdisciplinary Reviews: Cognitive Science, 3(3), 301–313. https://doi.org/10.1002/wcs.1177.

    Article  PubMed  Google Scholar 

  • LaGrange, B., Cole, D. A., Dallaire, D. H., Ciesla, J. A., Pineda, A. Q., Truss, A. E., & Folmer, A. (2008). Developmental changes in depressive cognitions: A longitudinal evaluation of the cognitive triad inventory for children. Psychological Assessment, 20(3), 217–226. https://doi.org/10.1037/1040-3590.20.3.217.

    Article  PubMed  Google Scholar 

  • Lyon, H. M., Startup, M., & Bentall, R. P. (1999). Social cognition and the manic defense: Attributions, selective attention, and self-schema in bipolar affective disorder. Journal of Abnormal Psychology, 108(2), 273–282.

    Article  Google Scholar 

  • Mac Giollabhui, N., Hamilton, J. L., Nielsen, J., Connolly, S. L., Stange, J. P., Varga, S., Burdette, E., Olino, T. M., Abramson, L. Y., & Alloy, L. B. (2018). Negative cognitive style interacts with negative life events to predict first onset of a major depressive episode in adolescence via hopelessness. Journal of Abnormal Psychology, 127(1), 1–11. https://doi.org/10.1037/abn0000301.

    Article  PubMed  Google Scholar 

  • MacPherson, H. A., Weinstein, S. M., Henry, D. B., & West, A. E. (2016). Mediators in the randomized trial of child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder. Behaviour Research and Therapy, 85, 60–71.

    Article  Google Scholar 

  • McCarty, C. A., Vaander, S. A., & McCauley, E. (2007). Cognitive features associated with depressive symptoms in adolescence: Directionality and specificity. Journal of Clinical Child and Adolescent Psychology, 36, 147–158. https://doi.org/10.1080/15374410701274926.

    Article  PubMed  PubMed Central  Google Scholar 

  • Michalak, E. E., Yatham, L. N., & Lam, R. W. (2005). Quality of life in bipolar disorder: A review of the literature. Health and Quality of Life Outcomes, 3, 72. https://doi.org/10.1186/1477-7525-3-72.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mayes, T. L., Bernstein, I. H., Haley, C. L., Kennard, B. D., & Emslie, G. J. (2010). Psychometric properties of the children’s depression rating scale-revised in adolescents. Journal of Child and Adolescent Psychopharmacology, 20(6), 513–516. https://doi.org/10.1089/cap.2010.0063.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meins, E., McCarthy-Jones, S., Fernyhough, C., Lewis, G., Bentall, R. P., & Alloy, L. B. (2012). Assessing negative cognitive style: Development and validation of a short-form version of the cognitive style questionnaire. Personality and Individual Differences, 52, 581–585. https://doi.org/10.1016/j.paid.2011.11.026.

    Article  PubMed  PubMed Central  Google Scholar 

  • Neale, J. M. (1988). Defensive functions of manic episodes. In Oltmanns, T. F. & Maher, B. A. (Eds.), Delusional beliefs (pp. 131–148). Wiley.

  • Poznanski, E., & Mokros, H. (1996). Children’s depression rating scale-revised (CDRS-R). Western Psychological Services.

  • Propper, L., Ortiz, A., Slaney, C., Garnham, J., Ruzickova, M., Calkin, C. V., O’Donovan, C., Hajek, T., & Alda, M. (2015). Early-onset and very-early-onset bipolar disorder: Distinct or similar clinical conditions? Bipolar Disorders, 17(8), 814–820. https://doi.org/10.1111/bdi.12346.

    Article  PubMed  Google Scholar 

  • Quinn, M. E., Grant, K. E., & Adam, E. K. (2018). Negative cognitive style and cortisol recovery accentuate the relationship between life stress and depressive symptoms. Stress (Amsterdam, Netherlands), 21, 119–127. https://doi.org/10.1080/10253890.2017.1414800.

    Article  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Western Psychological Services.

  • Santosh, P. J. (2005). Paediatric bipolar disorder – An update. Psychiatry, 4(8), 101–105. https://doi.org/10.1383/psyt.2005.4.8.101.

    Article  Google Scholar 

  • Shapero, B. G., Stange, J. P., Goldstein, K. E., Black, C. L., Molz, A. R., Hamlat, E. J., Black, S. K., Boccia, A. S., Abramson, L. Y., & Alloy, L. B. (2015). Cognitive styles in mood disorders: Discriminative ability of unipolar and bipolar cognitive profiles. International Journal of Cognitive Therapy, 8(1), 35–60. https://doi.org/10.1521/ijct.2015.8.1.35.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stange, J. P., Adams, A. M., O’Garro-Moore, J. K., Weiss, R. B., Ong, M., Walshaw, P. D., Abramson, L. Y., & Alloy, L. B. (2015). Extreme cognitions in bipolar spectrum disorders: Associations with personality disorder characteristics and risk for episode recurrence. Behavior Therapy, 46(2), 242–256. https://doi.org/10.1016/j.beth.2014.09.003.

    Article  PubMed  Google Scholar 

  • Stange, J. P., Boccia, A. S., Shapero, B. G., Molz, A. R., Flynn, M., Matt, L. M., Abramson, L. Y., & Alloy, L. B. (2013a). Emotion regulation characteristics and cognitive vulnerabilities interact to predict depressive symptoms in individuals at risk for bipolar disorder: A prospective behavioural high-risk study. Cognition & Emotion, 27, 63–84. https://doi.org/10.1080/02699931.2012.689758.

    Article  Google Scholar 

  • Stange, J. P., Shapero, B. G., Jager-Hyman, S., Grant, D. A., Abramson, L. Y., & Alloy, L. B. (2013b). Behavioral approach system (BAS)-relevant cognitive styles in individuals with high vs. moderate BAS sensitivity: A behavioral high-risk design. Cognitive Therapy and Research, 37(1), 139–149. https://doi.org/10.1007/s10608-012-9443-x.

    Article  PubMed  Google Scholar 

  • Stange, J. P., Sylvia, L. G., da Silva Magalhães, P. V., Miklowitz, D. J., Otto, M. W., Frank, E., Berk, M., Nierenberg, A. A., & Deckersbach, T. (2013c). Extreme attributions predict the course of bipolar depression: Results from the STEP-BD randomized controlled trial of psychosocial treatment. The Journal of Clinical Psychiatry, 74(3), 249–255. https://doi.org/10.4088/JCP.12m08019.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stange, J. P., Sylvia, L. G., Magalhães, P. V., Frank, E., Otto, M. W., Miklowitz, D. J., Berk, M., Nierenberg, A. A., & Deckersbach, T. (2013d). Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder. Journal of Psychiatric Research, 47, 1329–1336. https://doi.org/10.1016/j.jpsychires.2013.05.016.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thompson, M., Kaslow, N. J., Weiss, B., & Nolen-Hoeksema, S. (1998). Children's attributional style questionnaire-revised: Psychometric examination. Psychological Assessment, 10(2), 166–170. https://doi.org/10.1037/1040-3590.10.2.166.

    Article  Google Scholar 

  • Tairi, T. (2020). Associations between cognitive errors and mental health status in New Zealand adolescents. Behavioural and Cognitive Psychotherapy, 48(3), 280–290 https://doi.org/10.1017/S1352465819000626.

  • Van Meter, A., Moreira, A. L. R., & Youngstrom, E. (2019). Updated meta-analysis of epidemiologic studies of pediatric bipolar disorder. The Journal of Clinical Psychiatry, 80(3), e1–e11. https://doi.org/10.4088/JCP.18r12180.

    Article  Google Scholar 

  • Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. The Psychological Corporation: Harcourt Brace & Company.

  • Weinstein, S. M., West, A. E., & Pavuluri, M. (2013). Psychosocial intervention for pediatric bipolar disorder (PBD): Current and future directions. Expert Review of Neurotherapeutics, 13(7), 843–850. https://doi.org/10.1016/j.brat.2016.08.014.

    Article  PubMed  PubMed Central  Google Scholar 

  • West, A. E., Weinstein, S. M., Peters, A. T., Katz, A. C., Henry, D. B., Cruz, R. A., & Pavuluri, M. N. (2014). Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 1168–1178. https://doi.org/10.1016/j.jaac.2014.08.013.

    Article  PubMed  PubMed Central  Google Scholar 

  • Winters, K. C., & Neale, J. M. (1985). Mania and low self-esteem. Journal of Abnormal Psychology, 94(3), 282–290.

    Article  Google Scholar 

  • Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. The British Journal of Psychiatry, 133, 429–435.

    Article  Google Scholar 

  • Youngstrom, E. A., Danielson, C. K., Findling, R. L., Gracious, B. L., & Calabrese, J. R. (2002). Factor structure of the young mania rating scale for use with youths ages 5 to 17 years. Journal of Clinical Child and Adolescent Psychology, 31(4), 567–572. https://doi.org/10.1207/153744202320802232.

    Article  PubMed  Google Scholar 

  • Youngstrom, E. A., Freeman, A. J., & Jenkins, M. M. (2009). The assessment of bipolar disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 18(2), 353–390. https://doi.org/10.1016/j.chc.2008.12.002.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhou, J., Feng, L., Hu, C., Pao, C., Xiao, L., & Wang, G. (2019). Associations among depressive symptoms, childhood abuse, neuroticism, social support, and coping style in the population covering general adults, depressed patients, bipolar disorder patients, and high risk population for depression. Frontiers in Psychology, 10(1321), 1–10. https://doi.org/10.3389/fpsyg.2019.01321.

    Article  Google Scholar 

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  1. Department of Psychology, Rochester Institute of Technology, 18 Lomb Memorial Drive, Rochester, NY, 14623, USA

    Lindsay S. Schenkel & Terra L. Towne

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Schenkel, L.S., Towne, T.L. Maladaptive Cognitions and Attributional Styles Among Youth with Pediatric Bipolar Disorder. J Cogn Ther 13, 218–232 (2020). https://doi.org/10.1007/s41811-020-00080-9

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