Bipolar II Flashcards
Why is there a lack of support for bipolar psychological explanations?
it is a biologically driven disorder, mania usually leads to hospitalization, multiple endpoints of bipolar make it extremely complex to control in experiments
Gray’s Reinforcement Sensitivity Theory
2 motivational systems that work inversely of each other and are responsible for coordinating behavior
What are the two systems in Grays reinforcement sensitivity theory?
Behavioral activation system, behavioral inhibition system
behavioral activation system:
behavior to attain rewards and goals
behavioral inhibition system:
avoidance behavior to avoid threats/punishment
BIS/BAS scale:
24 item self-report questionnaire
What do higher scores in BAS associate with?
higher probability of bipolar diagnosis as well as an indicator of an upcoming episode
Idea of BAS:
in people with bipolar, their BAS system is weakly regulated and highly sensitive as well as prone to extreme fluctuations
Is BAS active or inactive during mania/ depression?
active during mania, deactive during depression
Response styles theory idea:
how people respond to their mood state is indicative of the duration and severity of these mood episodes
Response styles theory-4 response or coping styles
- ruminative style
- distraction style
- risk-taking style
- problem solving style
ruminative style:
thoughts/behaviors that focus persons attention on their symptoms and the causes/consequences of those
distraction style:
thoughts/behaviors that take the individuals mind off their symptoms
risk-taking style
maladaptive distractions (usually dangerous activities)
problem-solving style
plan of action to alleviate symptoms
what does depression score high in?
rumination
what does mania score high in?
rumination, distraction and risk-taking
Manic-defense model:
mania is viewed as an unconscious defense mechanism to evade the depressive state/cognitions
what kind of approach is the manic-defense model?
psychodynamic
What is mania and depression seen as in the depression avoidance theory?
seen as one entity, a counteraction to depressive tendencies
Extensions of the cognitive styles for mdd:
individuals with mania have positive cognitive distortions/schemas about themselves
what is the diathesis of bipolar regarding cognition?
positive cognitive schemas
Barcelona approach:
21 session, group format
What are the 5 things Barcelona approach focus on?
- awareness of disorder
- medication non-adherence (patients dont take medications as described)
- importance of avoiding substance abuse
- early detection of new episodes
- lifestyle regularity (sleeping habits, circadian rhythms, diet)
prodromes:
early symptoms indicating onset of disease/illness
prodrome period:
early signs/mild symptoms that an episode is coming on
Prodromes for mania:
poor quality of sleep/start to decrease need for sleep, elevated mood, increased activity, extreme goal setting
prodromes for depression:
sleep disturbance, anxiety, tension, G.I problems, fatigue, emotional distancing
Goal of targeting prodromes:
identify prodromes and address accordingly to prevent/lessen impact of episode
Family focused therapy number of sessions and duration:
21 sessions over 9 months
Variations of family focused therapy:
multi family (MF~PEP); Individual family (IF~PEP)`
Goal of family focused therapy:
address family dynamics and relationships and how they contribute to factors that help or hurt the illness
The 4 points to address in family focused therapy:
- assessment
- psychoeducation component
- communication enhancement component
- problem solving skills training component
assessment in family focused therapy:
identify communication patterns of family, identify If high expressed emotion is present
psychoeducation component in family focused therapy:
discuss etiology of illness, identify prodromes, improve medication adherence
communication enhancement component in fft:
enhancing quality of family’s communication, active listening and delivering correct feedback
Problem solving skills training component in fft:
brainstorm solutions to problems, weigh pros and cons of proposed solutions, identifying what to do during aftermath of episodes.
CBT basic tenet:
change conceptualization of how individual structures and interprets their moods, experiences, and behavior
Is cbt more difficult while someone has manic symptoms?
yes
what should you target and teach in cbt?
the cognitive thinking patterns and teaching clients to restrain oneself during the prodromal period
4 strategies of cbt in bipolar:
- daily mood monitoring
- activity scheduling
- identify early warning signs/limit impulsivity
- treatment contracting
daily mood monitoring for bipolar:
connections between mood and sleep/stressors
activity scheduling for bipolar:
minimize stimulation during mood elevation
identify early warning signs/limit impulsivity in bipolar:
48 hours before acting rule: wait two full days before acting on any major decision/purchase
treatment contracting in bipolar:
formulate written plan for support team: what are early warning signs, directives in an event of an episode
Dialectal behavior therapy goal:
how thoughts and emotions affect behavior. does not focus on changing cognitive schemas, but rather accept the intense emotions can happen and figure out a way to move on from this. provides you with skills needed to cope
dialectal=
integration of opposites, how acceptance and change can coexist
hierarchy of behavioral targets (4):
- decrease life-threatening behaviors
- decrease therapy-interfering behaviors (alleviating physical/emotional discomfort)
- change quality of life-interfering behaviors (cues to mania, burning bridges)
- increase skills development
DBT 5 components:
- mindfulness
- distress tolerance
- emotional regulation
- interpersonal effectiveness
- walking the middle path
what is mindfulness?
awareness of ones own thinking and irrational beliefs and prevent self-invalidation thoughts
distress tolerance:
recognize breakdown of emotions and recognize what’s happening sooner so you can prevent going 0 to 100 on an emotional scale
DBT 4 structural components:
- weekly individual therapy session
- skills group training
- in the moment telephone consultations
- therapy team consultation
what 2 things are involved with weekly individual therapy session?
- diary cards which track intensity of emotions, urges, did you use skills to cope, did you give in.
- behavioral chain analysis: if you acted on an urge, understand the precursors that led up to that and figure out what skills you could have used to cope with urge
in the moment telephone consultations:
on call services with therapist and has 24 hour rule: clients can call before urge but if they acted on urge, cannot call for 24 hours. figure out coping strategies on their own
therapy team consultation
therapy for therapists to prevent burnout
circadian/social rhythm disruption theory:
disruption in circadian rhythm trigger and lead to potential development of mood episodes
disrupted sleep is associated with:
worse course of illness and can present early warning sign for triggering the episodes
in circadian disruption theory, bipolar is a result of:
dysrehulated circadian rhythm and dysregulated social rhythm
Interpersonal and social rhythm therapy goal:
to regularize daily routines to stabilize moods and prevent episodes
Interpersonal interventions in IPSRT goal:
focus on resolution of current interpersonal problems and prevention of future problems
what is “grieving for the lost health self”
facilitate mourning for the life that patients might have had without BD. this increases recovery and lengthens time between episodes
chronotherapy:
shifting sleep-wake cycle using sleep phase advance/delays
chronotherapy goal:
to regularize daily routines, still controverial
Bright light therapy in chronotherapy:
for mania: bright light in middle of the day 12-2 pm. for depression: first thing in the morning for 30 minutes.
Dark light therapy:
constant darkness 8pm-6am
