Publications by authors named "Alyson Dodd"

29 Publications

  • Page 1 of 1

Student mental health research: moving forwards with clear definitions.

Authors:
Alyson L Dodd

J Ment Health 2021 Jun;30(3):273-275

Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle Upon Tyne, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638237.2020.1844873DOI Listing
June 2021

Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme).

Int J Bipolar Disord 2021 Jul 1;9(1):20. Epub 2021 Jul 1.

Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK.

Background: A subgroup of those with bipolar spectrum disorders experience ongoing mood fluctuations outside of full episodes. We conducted a randomised, controlled feasibility study of a Dialectical Behavioural Therapy-informed approach for bipolar mood fluctuations (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). Our study aimed to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme. Participants were required to meet diagnostic criteria for a bipolar spectrum disorder and report frequent mood swings outside of acute episodes. They were randomised to treatment as usual (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points were at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point. To evaluate feasibility and acceptability we examined recruitment and retention rates, completion rates for study measures, adverse events and feedback from participants on their experience of study participation and therapy.

Results: Of the target 48 participants, 43 were recruited (22 in the intervention arm; 21 in the control arm), with a recruitment rate of 3.9 participants per month. At 9 months 74% of participants engaged in research follow-up assessment, exceeding the pre-specified criterion of 60%. There were no serious concerns about the safety of the research procedures or the intervention. On one of the four candidate primary outcome measures, the 95% CI for the between-group mean difference score excluded the null effect and included the minimal clinically important difference, favouring the intervention arm, whilst on no measure was there evidence of deterioration in the intervention arm relative to the control arm. Attendance of the intervention (50% attending at least half of the mandatory sessions) was below the pre-specified continuation criterion of 60%, and qualitative feedback from participants indicated areas that may have hampered or facilitated engagement.

Conclusions: It is broadly feasible to conduct a trial of this design within the population of people with frequent bipolar mood swings. Changes should be made to the therapy to increase uptake, such as simplifying content and considering individual rather than group delivery. Trial registration ISRCTN: ISRCTN54234300. Registered 14th July 2017, http://www.isrctn.com/ISRCTN54234300.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40345-021-00226-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245616PMC
July 2021

Mental Well-Being in UK Higher Education During Covid-19: Do Students Trust Universities and the Government?

Front Public Health 2021;9:646916. Epub 2021 Apr 26.

Department of Sociology, Oklahoma State University, Stillwater, OK, United States.

This paper draws upon the concept of recreancy to examine the mental well-being of university students during the Covid-19 pandemic. Briefly, recreancy is loss of societal trust that results when institutional actors can no longer be counted on to perform their responsibilities. Our study of mental well-being and recreancy focuses on the role of universities and government regulators within the education sector. We surveyed 600 UK students attending 161 different public higher education providers in October 2020 during a time when many UK students were isolated in their residences and engaged in online learning. We assessed student well-being using the Short Warwick-Edinburgh Mental Well-being Scale (scored 7-35) and found the mean score to be 19.9 [95% confidence interval (CI) 19.6, 20.2]. This level of well-being indicates that a significant proportion of UK students face low levels of mental well-being. Structural equation modeling (SEM) analysis indicates that high recreancy-measured as a low trust in universities and the government-is associated with low levels of mental well-being across the student sample. While these findings are suggestive, they are also important and we suggest that government and university leaders should not only work to increase food and housing security during the Covid-19 pandemic, but also consider how to combat various sector trends that might intensify recreancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2021.646916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107392PMC
May 2021

Self-Regulatory Goal Motivational Processes in Sustained New Year Resolution Pursuit and Mental Wellbeing.

Int J Environ Res Public Health 2021 03 17;18(6). Epub 2021 Mar 17.

Faculty of Health and Life Sciences, School of Medicine, University of Liverpool, Liverpool L69 3GB, UK.

Recent research suggests people typically "give up" pursuing their New Year resolutions within the first month. The present study investigated goal features proposed to be implicated in promoting both mental wellbeing and sustained New Year resolution pursuit. Australian and UK participants ( = 182) took part in an online longitudinal study, including four timepoints over a two-month period. At baseline, participants listed the New Year resolution to which they were most committed, and completed self-report measures to assess mental wellbeing, goal flexibility and tenacity. At the follow-up surveys, participants completed the wellbeing measure and their New Year resolution commitment, effort and stickability. As predicted, flexibility predicted wellbeing across time, however, tenacity did not. Counter to prediction, neither flexibility nor tenacity reported at baseline predicted "sticking" with one's New Year resolution. The predicted interaction between flexibility and tenacity was not significant. New Year resolutions focused predominantly on "diet" and "exercise" were predominantly the same resolutions previously pursued and tended to be relatively abstract. Although goal flexibility predicted greater wellbeing, the findings overall tend to support the view that people are not particularly good at sticking with their New Year resolutions. Implications of the findings are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18063084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002459PMC
March 2021

Mood monitoring in bipolar disorder: Is it always helpful?

Bipolar Disord 2021 06 19;23(4):429-431. Epub 2021 Feb 19.

School of Psychology, University of Exeter, Exeter, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bdi.13057DOI Listing
June 2021

University student well-being in the United Kingdom: a scoping review of its conceptualisation and measurement.

J Ment Health 2021 Jun 11;30(3):375-387. Epub 2021 Feb 11.

Department of Psychology, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, UK.

Background: Well-being is a multifaceted construct, and measuring well-being, both within particular groups and at a national level, is a priority for policy and practice. This national agenda on measuring well-being is mirrored in the Higher Education sector. This is the first conceptual review of how well-being is measured among university students in the UK.

Aims: The aims of the review were to identify (i) the definitions or conceptualisations of well-being guiding the selection of well-being indicators for research within this population and (ii) measures of well-being used in university students in the UK.

Methods: A scoping review method was used.

Results: Twenty-eight validated indicators used to measure well-being in UK students were identified. While many were direct measures of (primarily mental or psychological) well-being, indirect "proxy" indicators, including measures of mental health symptoms, were identified.

Conclusions: This review has highlighted that there are inconsistencies in defining and measuring university student well-being, and the measures that have been used in this population are focused on subjective experience. These findings are in line with reviews of well-being measures in the general population. Implications for further research are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638237.2021.1875419DOI Listing
June 2021

Are context-specific measures of positive emotion regulation more predictive of mania risk and mood symptoms than trait measures?

Behav Cogn Psychother 2021 Sep 9;49(5):596-611. Epub 2020 Dec 9.

Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK.

Background: A number of strategies used to regulate positive affect (i.e. dampening and positive rumination) have been identified as having particular relevance to hypomanic personality (a proxy measure of mania risk). However, previous findings have been mixed and it is suggested that this may be the result of lack of consideration of the context in which emotion regulation (ER) is occurring.

Aims: This study aimed to investigate (a) if use of specific ER strategies predicts mood across social- and goal-related contexts, and (b) if the relationship between hypomanic personality and mood is moderated by greater use of ER strategies.

Method: One hundred and seventy-four participants (mean age 20.77 years, SD = 2.2) completed an online survey assessing (i) hypomanic personality, (ii) self-reported tendencies to use ER strategies for positive emotion, (iii) tendencies to use these strategies in response to both high- and moderate-intensity positive affect in personally generated social- and goal-related contexts, and (iv) current affect.

Results: Trait use of ER strategies was more predictive of hypomanic personality and mood symptoms than context-specific measures; however, this relationship did not hold up for hypomanic personality and mood symptoms when accounting for current affect. Trait dampening was predictive of low mood symptoms but did not moderate the relationship between hypomanic personality and low mood.

Discussion: While trait measures of ER were more predictive of mania risk and mood symptoms than context-specific measures, further work is needed using experience sampling methods in order to capture the regulatory processes individuals are using in particular contexts, in real-time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1352465820000855DOI Listing
September 2021

Barriers to older adults' uptake of mobile-based mental health interventions.

Digit Health 2020 Jan-Dec;6:2055207620905422. Epub 2020 Feb 11.

Department of Psychology, Northumbria University, UK.

Background: To address increasing demand of mental healthcare treatments for older adults and the need to reduce delivery costs, healthcare providers are turning to mobile applications. The importance of psychological barriers have been highlighted in the uptake of mobile-based mental health interventions and efforts have been made to identify these barriers in order to facilitate initial uptake and acceptance. However, limited research has focused on older adults' awareness of these applications and factors that might be hindering their use.

Objective: The purpose of this study was to explore the perceived barriers that older adults experience in the uptake of mobile-based mental health interventions.

Methods: Semi-structured interviews were conducted with a sample of 10 older adults, 50 years or older (female = 7, mean age = 68 years), who experienced periods of low mood. National Health Service applications were demonstrated to facilitate conversation and explore participants' understanding of mental health and mobile-based mental health interventions. Thematic analysis was used to analyse the interview transcripts.

Results: The social ecological model was adopted as an organising framework for the thematic analysis which identified six distinct barriers to older adults' uptake of mobile-based mental health interventions: mental electronic-health (e-health) awareness, interaction with technology, discontinuation, 'seeing' facilitates therapeutic alliance, incongruent role of the general practitioner and privacy and confidentiality.

Conclusions: Older adults experience a number of barriers to uptake ranging from the individual level to a macro, organisational level. The practical implications of these barriers are discussed such as the need for increased awareness of mobile-based mental health interventions among older adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2055207620905422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016304PMC
February 2020

Emotion regulation strategies in mania risk: A systematic review.

J Clin Psychol 2019 12 6;75(12):2106-2118. Epub 2019 Aug 6.

Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.

Objectives: Difficulties in emotion regulation may contribute to the development of mania. This review aimed to assess how emotion regulation strategies reported by individuals at risk of mania compare with clinical and nonclinical controls.

Methods: Search terms relating to mania risk and emotion regulation were entered into three databases. Sixteen studies were included.

Results: Mania risk was typically associated with overall endorsement of emotion regulation strategies, particularly dampening, and positive and negative rumination.

Conclusions: Findings were limited by overall lack of evidence for individual strategies, lack of consideration of key mediating factors and reliance upon self-report designs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jclp.22841DOI Listing
December 2019

Beliefs about the automaticity of positive mood regulation: examination of the BAMR-Positive Emotion Downregulation Scale in relation to emotion regulation strategies and mood symptoms.

Cogn Emot 2020 03 7;34(2):384-392. Epub 2019 Jun 7.

Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.

Emotion regulation is a topic of great interest due to its relevance to navigating everyday life, as well as its relevance to psychopathology. Recent research indicates that beliefs about the automaticity of mood regulation are critical to psychological health. In the present study we assessed beliefs about the automaticity of positive mood regulation in relationship to self-reported mood symptoms and explicit emotion regulation strategies. Participants (  200) completed an online survey including a scale assessing beliefs about automatic downregulation of positive emotions (i.e. BAMR-PED), beliefs about automatic mood regulation for negative emotions, mood symptoms, and emotion regulation strategies. Results suggested that beliefs about automatic positive emotion regulation were associated with unhelpful emotion regulation strategies and reduced negative affect as well as fewer depressive, manic, and anxiety symptoms. Test-retest of the novel BAMR-PED measure was tested with a further sample ( = 46) and found to be acceptable. Future research should explore how these automatic beliefs have relevance to clinical disorders characterised by positive emotion disturbance, such as bipolar disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02699931.2019.1626700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898727PMC
March 2020

Web-based indicated prevention of common mental disorders in university students in four European countries - Study protocol for a randomised controlled trial.

Internet Interv 2019 Apr 15;16:35-42. Epub 2018 Mar 15.

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom.

Background: Mental disorders and their symptoms are highly prevalent in the university student population, and the transition from secondary to tertiary education is associated with a rise in mental health problems. Existing web-based interventions for the prevention of common mental disorders in student populations often focus on just one disorder and have not been designed specifically for students. There is thus a need for transdiagnostic, student-specific preventative interventions that can be widely disseminated. This two-arm, parallel group randomised controlled trial aims to evaluate the effectiveness and cost-effectiveness of a web-based transdiagnostic mental health problem prevention programme (PLUS) across several universities in four countries.

Method: Students ( = 5550) will be recruited through a variety of channels and asked to complete a personality assessment to determine whether they are at high risk for developing common mental disorders. Students at high risk will be randomly allocated to either PLUS or a control intervention, which provides practical support around issues commonly experienced at university. Students at low risk will be allocated to the control intervention. Both intervention groups will be assessed at baseline, 4 weeks, 3 months, 6 months and 12 months after randomisation. Depression and generalised anxiety, assessed using the Patient Health Questionnaire and the Generalised Anxiety Disorder scales, will form the primary outcomes in this study. Secondary outcome measures include alcohol and drug use, eating behaviour, self-esteem, and quality of life. The cost-effectiveness of the intervention will also be evaluated.

Conclusions: This study will contribute to understanding the role of transdiagnostic indicated web-based interventions for the prevention of common mental disorders in university students. It will also be one of the first studies to investigate the cost-effectiveness of such interventions.

Trial Registration: This trial was registered in the ISRCTN register (ISRCTN15570935) on 12th February 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.invent.2018.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364328PMC
April 2019

Emotion regulation strategies in bipolar disorder: A systematic and critical review.

J Affect Disord 2019 03 18;246:262-284. Epub 2018 Dec 18.

Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, UK; Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK.

Background: Theoretical frameworks emphasise associations between interpretations and responses to affect and bipolar disorder (BD). This review (PROSPERO CRD42016043801) investigated which emotion regulation (ER) strategies have been applied to BD, are elevated in BD compared to clinical and non-clinical controls, and are associated with clinical and functional outcomes in BD METHODS: Search terms relating to emotion regulation, coping and bipolar disorder were entered into Embase, MedLine and PsycInfo. Quantitative studies investigating relationships between ER strategies and BD were eligible for this narrative synthesis RESULTS: A large volume of research (n = 47) investigated specific ER strategies in BD. Maladaptive strategies such as rumination and dampening were elevated in BD compared to controls and these particular strategies had a detrimental impact on outcomes such as mood symptoms. BD had a similar profile of ER strategies to unipolar depression, but there was limited comparison to other clinical groups. People with BD did not generally have deficits in using adaptive strategies, as evidenced by comparisons with controls and experimental studies LIMITATIONS: Methodological heterogeneity and a lack of ecologically valid ER assessments CONCLUSIONS: Empirical literature is critiqued in line with contemporary theories of BD and of emotion regulation more generally, in order to inform future research recommendations. This includes investigation of the importance of context in the impact of ER strategies, and discrepancies between trait and state use of ER strategies, particularly through experience sampling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2018.12.026DOI Listing
March 2019

The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study.

Trials 2018 Oct 16;19(1):560. Epub 2018 Oct 16.

Department of Psychology, University of Southampton, Southampton, UK.

Background: In bipolar spectrum disorder, some individuals experience ongoing, frequent fluctuations in mood outside of affective episodes. There are currently no evidence-based psychological interventions designed to address this. This feasibility study is a phase II evaluation of a dialectical behavioural therapy-informed approach (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). It seeks to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme.

Methods/design: Patients will be randomised 1:1 to either treatment as usual only (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points will be at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point for the candidate primary outcome measures. We aim to recruit 48 individuals meeting diagnostic criteria for a bipolar spectrum disorder and reporting frequent mood swings outside of acute episodes, through primary and secondary care services and self-referral. To evaluate feasibility and acceptability, we will examine recruitment and retention rates, completion rates for study measures and feedback from participants on their experience of study participation and therapy.

Discussion: Proceeding to a definitive trial will be indicated if the following criteria are met: (1) trial participation does not lead to serious negative consequences for our participants; (2) any serious concerns about the acceptability and feasibility of the trial procedures can be rectified prior to a definitive trial; (3) follow-up data at 9 months are available for at least 60% of participants; (4) at least 60% of patients in the ThrIVe-B arm complete treatment.

Trial Registration: ISRCTN, ISRCTN54234300 . Registered on 20 July 2017.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-018-2926-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192204PMC
October 2018

Internalised stigma in mental health: An investigation of the role of attachment style.

Psychiatry Res 2018 12 21;270:1001-1009. Epub 2018 Mar 21.

Division of Health Research, Lancaster University, Lancaster, UK.

Internalised stigma is associated with a range of negative outcomes, yet little is known about what determines the internalisation of stigma. In this study we examined the potential role of adult attachment style in the internalisation process in a transdiagnostic sample of adults with experience of recent mental health service use (n = 122), using an online survey. Associations between internalised stigma and perceived public stigma were tested. We also examined whether anxious and avoidant (insecure) attachment styles were positively associated with a significant amount of variance in internalised stigma when controlling for other variables, and whether the relationship between perceived public stigma and internalised stigma was moderated by anxious and avoidant attachment. We found that internalised stigma, perceived public stigma and insecure attachment were commonly reported and that internalised stigma was positively associated with perceived public stigma. However, neither anxious or avoidant attachment were associated with a significant amount of variance in internalised stigma and we found no moderating effect on the relationship between perceived public stigma and internalised stigma for insecure attachment. Despite mixed results, the strength of association between anxious attachment and internalised stigma suggests further research, which addresses some limitations of the current study, is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2018.03.047DOI Listing
December 2018

Users' experiences of an online intervention for bipolar disorder: important lessons for design and evaluation.

Evid Based Ment Health 2017 Nov;20(4):133-139

Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK.

Background: The evidence base for digital interventions for physical and mental health, including severe and enduring mental health difficulties, is increasing. In a feasibility trial, web-based Enhanced Relapse Prevention (ERPonline) for bipolar disorder demonstrated high recruitment and retention rates. Relative to participants in the waitlist control group, those who received ERPonline showed increased monitoring for early warning signs of relapse and had developed more positive illness models.

Objective: To understand users' motivations and barriers for taking part in an online/telephone-based trial, and for engagement with ERPonline.

Methods: Participants from the trial who had been allocated to receive ERPonline were purposively sampled to participate in telephone-based, in-depth qualitative interviews about their experiences. Interviews (n19) were analysed using framework analysis to identify themes relevant to study aims.

Findings: Participants took part due to the convenient, flexible and rewarding aspects of the trial design, as well as a desire to improve the mental health of themselves and others. Barriers included extensive assessments, practical difficulties and mood. ERPonline was was generally considered to be accessible, relevant and straightforward, but there were individual preferences regarding design, content and who it was for. Several participants reported positive changes, but there was a sense that digital interventions should not replace routine care.

Conclusions: There are a number of barriers and facilitators to consider when evaluating and implementing digital interventions. Individual preferences and human contact were key factors for both trial design and engagement with an online intervention.

Clinical Implications: Digital interventions should be co-produced, personalised, interactive and embedded as one component in a broader package of care.

Trial Registration Number: ISRCTN56908625; Post-results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/eb-2017-102754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750409PMC
November 2017

"When my Moods Drive Upward There Is Nothing I Can Do about It": A Review of Extreme Appraisals of Internal States and the Bipolar Spectrum.

Front Psychol 2017 4;8:1235. Epub 2017 Aug 4.

School of Psychological Sciences, Faculty of Medical and Human Sciences, University of ManchesterManchester, United Kingdom.

The integrative cognitive model provides a comprehensive account of bipolar disorder (BD) that, if empirically supported, has important potential implications for psychological therapies. This article is the first to review the evidence for this model. We evaluate the evidence (up to 2017) for four hypotheses derived uniquely from the model: extreme positive and negative appraisals of internal states are associated with (1) risk of developing BD; (2) BD diagnosis; (3) relevant clinical and functional outcomes including hypomanic and depressive mood symptoms; and (4) outcomes over time. Research involving individuals with diagnosed mood disorders as well as non-clinical populations is reviewed. The hypotheses were broadly supported and several consistent findings were not accounted for by alternative psychological models of BD. The evidence base is limited by a relative paucity of prospective studies; only 6 of the 31 studies identified. Implications for theory, research and clinical practice are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyg.2017.01235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543079PMC
August 2017

Structured group psychoeducation in patients with bipolar disorder delays time to mania and time to any episode compared with a peer support group.

Evid Based Ment Health 2017 08 8;20(3):e15. Epub 2017 Jul 8.

Northumbria University, Newcastle upon Tyne, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/eb-2017-102648DOI Listing
August 2017

Psychological mechanisms and the ups and downs of personal recovery in bipolar disorder.

Br J Clin Psychol 2017 Sep 22;56(3):310-328. Epub 2017 May 22.

Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health & Medicine, Lancaster University, UK.

Background: Personal recovery is recognized as an important outcome for individuals with bipolar disorder (BD) and is distinct from symptomatic and functional recovery. Recovery-focused psychological therapies show promise. As with therapies aiming to delay relapse and improve symptoms, research on the psychological mechanisms underlying recovery is crucial to inform effective recovery-focused therapy. However, empirical work is limited. This study investigated whether negative beliefs about mood swings and self-referent appraisals of mood-related experiences were negatively associated with personal recovery.

Design: Cross-sectional online survey.

Method: People with a verified research diagnosis of BD (n = 87), recruited via relevant voluntary sector organizations and social media, completed online measures. Pearson's correlations and multiple regression analysed associations between appraisals, beliefs, and recovery.

Results: Normalizing appraisals of mood changes were positively associated with personal recovery. Depression, negative self-appraisals of depression-relevant experiences, extreme positive and negative appraisals of activated states, and negative beliefs about mood swings had negative relationships with recovery. After controlling for current mood symptoms, negative illness models (relating to how controllable, long-term, concerning, and treatable mood swings are; β = -.38), being employed (β = .39), and both current (β = -.53) and recent experience of depression (β = .30) predicted recovery.

Limitations: Due to the cross-sectional design, causality cannot be determined. Participants were a convenience sample primarily recruited online. Power was limited by the sample size.

Conclusions: Interventions aiming to empower people to feel able to manage mood and catastrophize less about mood swings could facilitate personal recovery in people with BD, which might be achieved in recovery-focused therapy.

Practitioner Points: Personal recovery is an important outcome for people living with bipolar disorder More positive illness models are associated with better personal recovery in bipolar disorder, over and above mood symptoms Recovery-focused therapy should focus on developing positive illness models Recovery-focused therapy should address personally meaningful goals such as gaining employment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bjc.12140DOI Listing
September 2017

Do Non-Reflective Thinkers Apply Extreme Personal Meanings to their Activated Moods?

Behav Cogn Psychother 2017 Sep 26;45(5):483-496. Epub 2017 Apr 26.

Department of Psychology,Northumbria University,Newcastle upon Tyne NE1 8ST,UK.

Background: The integrative cognitive model of mood swings proposes that mood symptoms are driven by extreme, self-referent appraisals. For example, if activated mood is appraised positively, this prompts selection of mood regulation strategies that act to up-regulate mood. Appraisals are driven by fast and automatic Type 1 cognitive processes, which, left unchecked, can cause activated mood to escalate.

Aims: It was hypothesized that greater propensity to override these automatic processes by engaging in reflective (Type 2) thinking would be negatively associated with extreme appraisals of activation and activation.

Method: Study 1 (n = 150) was a cross-sectional survey consisting of measures of activation, extreme appraisals, and an objective performance-based measure of the propensity to engage in reflective thought (cognitive reflection test; CRT). In Study 2 (n = 241) participants completed these measures plus three alternative measures of effortful cognitive engagement (CRT-2, Need for Cognition and Actively Open-Minded Thinking).

Results: In Study 1, propensity to engage in reflective thought (higher CRT scores) was not significantly associated with activated mood or extreme appraisals, but activated mood and extreme appraisals were positively correlated. In study 2, the association between activation and extreme appraisals was replicated. Predicted associations between alternative measures of reflective thinking, activated mood, and extreme appraisals were not found.

Conclusions: Extreme appraisals of internal states may be a psychological mechanism underlying activated mood. Propensity to reflect on and override default cognitions was unrelated to these extreme appraisals and activated mood. Further research in a clinical sample using mood-relevant measures of reflective thinking is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1352465817000248DOI Listing
September 2017

Assessing Feasibility and Acceptability of Web-Based Enhanced Relapse Prevention for Bipolar Disorder (ERPonline): A Randomized Controlled Trial.

J Med Internet Res 2017 03 24;19(3):e85. Epub 2017 Mar 24.

Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.

Background: Interventions that teach people with bipolar disorder (BD) to recognize and respond to early warning signs (EWS) of relapse are recommended but implementation in clinical practice is poor.

Objectives: The objective of this study was to test the feasibility and acceptability of a randomized controlled trial (RCT) to evaluate a Web-based enhanced relapse prevention intervention (ERPonline) and to report preliminary evidence of effectiveness.

Methods: A single-blind, parallel, primarily online RCT (n=96) over 48 weeks comparing ERPonline plus usual treatment with "waitlist (WL) control" plus usual treatment for people with BD recruited through National Health Services (NHSs), voluntary organizations, and media. Randomization was independent, minimized on number of previous episodes (<8, 8-20, 21+). Primary outcomes were recruitment and retention rates, levels of intervention use, adverse events, and participant feedback. Process and clinical outcomes were assessed by telephone and Web and compared using linear models with intention-to-treat analysis.

Results: A total of 280 people registered interest online, from which 96 met inclusion criteria, consented, and were randomized (49 to WL, 47 to ERPonline) over 17 months, with 80% retention in telephone and online follow-up at all time points, except at week 48 (76%). Acceptability was high for both ERPonline and trial methods. ERPonline cost approximately £19,340 to create, and £2176 per year to host and maintain the site. Qualitative data highlighted the importance of the relationship that the users have with Web-based interventions. Differences between the group means suggested that access to ERPonline was associated with: a more positive model of BD at 24 weeks (10.70, 95% CI 0.90 to 20.5) and 48 weeks (13.1, 95% CI 2.44 to 23.93); increased monitoring of EWS of depression at 48 weeks (-1.39, 95% CI -2.61 to -0.163) and of hypomania at 24 weeks (-1.72, 95% CI -2.98 to -0.47) and 48 weeks (-1.61, 95% CI -2.92 to -0.30), compared with WL. There was no evidence of impact of ERPonline on clinical outcomes or medication adherence, but relapse rates across both arms were low (15%) and the sample remained high functioning throughout. One person died by suicide before randomization and 5 people in ERPonline and 6 in WL reported ideas of suicide or self-harm. None were deemed study related by an independent Trial Steering Committee (TSC).

Conclusions: ERPonline offers a cheap accessible option for people seeking ongoing support following successful treatment. However, given high functioning and low relapse rates in this study, testing clinical effectiveness for this population would require very large sample sizes. Building in human support to use ERPonline should be considered.

Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 56908625; http://www.isrctn.com/ISRCTN56908625 (Archived by WebCite at http://www.webcitation.org/6of1ON2S0).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/jmir.7008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384993PMC
March 2017

Extreme cognitions are associated with diminished ability to use disconfirming evidence.

Psychol Psychother 2017 03 30;90(1):70-83. Epub 2016 May 30.

Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK.

Objectives: An Integrative Cognitive Model of mood swings and bipolar disorder proposes that cognitive styles characterized by extreme self-referent appraisals of internal states (e.g., 'If I have a bad night's sleep it means that I am about to have a breakdown') interfere with mood regulation. The aim of this study is to determine whether strong endorsement of such appraisals is predicted by a diminished ability to access disconfirming counterexamples.

Design: We examined whether the ability to access two different categories of counterexample (known as Disabling Conditions and Alternative Causes) would predict endorsement of extreme appraisals (measured by the Hypomanic Attitudes and Positive Predictions Inventory; HAPPI) and mania risk (measured by the Hypomanic Personality Scale; HPS).

Method: A non-clinical sample of 150 students completed the HAPPI, the HPS and a conditional reasoning task that indexed the ability to access Disabling Conditions and Alternative Causes. Current mood was controlled for using the Internal States Scale.

Results: The ability to make use of disabling counterexamples during the reasoning task was inversely related with scores on the HAPPI (r = -.19, p < .05); participants that were less able to make use of disabling counterexamples endorsed extreme self-referent appraisals to a greater extent. There was no association between the use of alternative cause counterexamples and the HAPPI, and no association between either measure of counterexample generation and the HPS.

Conclusions: A diminished ability to use disconfirming evidence when reasoning about the world may reinforce problematic cognitive styles such as extreme, personalized appraisals of experience, which can interfere with mood regulation.

Practitioner Points: Problematic cognitive styles such as extreme, personalized appraisals of experience may be reinforced by the inability to produce or access evidence that disconfirms these maladaptive beliefs. This reasoning bias may be associated with cognitive styles underlying psychopathology. There may be clinical utility in exploring the use of disabler generation in psychological interventions, to help disconfirm maladaptive beliefs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/papt.12096DOI Listing
March 2017

Diagnostic efficiency of the SDQ for parents to identify ADHD in the UK: a ROC analysis.

Eur Child Adolesc Psychiatry 2016 Sep 14;25(9):949-57. Epub 2016 Jan 14.

Department of Psychology and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey (N = 18,232 youths 5-15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00787-015-0815-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990620PMC
September 2016

Appraisals to affect: Testing the integrative cognitive model of bipolar disorder.

Br J Clin Psychol 2016 Sep 27;55(3):225-35. Epub 2015 Mar 27.

Section for Clinical & Health Psychology, School of Psychological Science, University of Manchester, UK.

Objective: Cognitive models have suggested that extreme appraisals of affective states and maladaptive affect regulation strategies are important in the development of bipolar symptomatology. Little is known about the pathway by which these appraisals and behaviours interact in the formation of activated and depressed affective states. This study tested the predictions that (1) ascent behaviours mediate the relationship between positive appraisals of activated mood and activation; and (2) descent behaviours mediate the relationship between negative appraisals of activated mood and depression.

Method: A total of 52 individuals with a DSM-IV diagnosis of bipolar I or II disorder (confirmed by structured interview) completed biweekly assessments of affect regulation behaviours and mood for 4 weeks. Positive and negative appraisals of affective states were assessed at baseline through the Hypomanic Attitudes and Positive Prediction Inventory. Multilevel mediation analysis was used to explore the data.

Results: Ascent behaviours partially mediated the relationship between positive appraisals of activated mood and activation. Descent behaviours, but not negative appraisals of activated mood, predicted levels of depression indicating the absence of a mediation effect.

Conclusion: The results suggest that positive appraisals of activated mood can escalate activation in individuals with bipolar disorder. Such appraisals may be inherently rewarding and reinforcing directly elevating levels of activation, whilst increasing individuals' use of ascent behaviours. The results are consistent with the view that appraisals and behaviours should be targeted during cognitive behavioural therapy for bipolar disorder.

Practitioner Points: It may be beneficial to target positive appraisals of activated mood in cognitive behavioural therapy for mania. Cognitive behavioural therapists may also wish to focus on identifying and targeting individuals' use of ascent behaviours to reduce highly activated states.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bjc.12081DOI Listing
September 2016

Response styles, bipolar risk, and mood in students: The Behaviours Checklist.

Psychol Psychother 2015 Dec 8;88(4):412-26. Epub 2015 Jan 8.

Department of Psychology, Lancaster University, UK.

Objectives: An Integrative Cognitive Model of mood swings and bipolar disorder proposes that extreme positive and negative appraisals about internal states trigger ascent and descent behaviours, contributing to the onset and maintenance of mood swings. This study investigated the reliability and validity of a new inventory, the Behaviours Checklist (BC), by measuring associations with appraisals, response styles to positive and negative affect, bipolar risk, mania, and depression.

Design: Correlational analogue study.

Methods: Students (N = 134) completed the BC alongside measures of appraisals, response styles to positive and negative mood, mania, depression, and hypomanic personality (bipolar risk).

Results: The BC was of adequate reliability and showed good validity. Ascent behaviours and appraisals predicted bipolar risk, whereas descent behaviours and appraisals were associated with depression.

Conclusions: Appraisals, ascent, and descent behaviours may play an important role in the development and maintenance of mood swings. Limitations and research recommendations are outlined.

Practitioner Points: Extreme positive and negative appraisals of internal states, and subsequent behavioural responses (ascent and descent behaviours), are associated with bipolar risk and bipolar mood symptoms in a student sample. These processes are involved with mood dysregulation in clinical populations as well as bipolar risk in students, with implications for mood management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/papt.12052DOI Listing
December 2015

Development and validation of a new multidimensional measure of inspiration: associations with risk for bipolar disorder.

PLoS One 2014 26;9(3):e91669. Epub 2014 Mar 26.

Department of Psychology, Yale University, New Haven, Connecticut, United States of America.

Background: Individuals at risk for, and diagnosed with, bipolar disorder (BD) appear to have heightened levels of creativity. Although inspiration is creativity, the ways in which individuals appraise and respond emotionally to inspiration in BD remain unexplored.

Method: The present study reports on a new measure of inspiration (External and Internal Sources of Inspiration Scale--EISI). The reliability and validity of EISI were explored along with associations between EISI and BD risk.

Results: Among a cross-national student sample (N = 708) 5 inspiration factors were derived from EISI (self, other, achievement, prosocial and external inspiration). Reliability, concurrent validity and convergent/divergent validity were good. Total EISI and all subscales were associated with increased positive rumination, and total EISI and the achievement EISI subscale were associated with impulsivity. Total EISI, self and prosocial EISI subscales were independently associated with BD risk and current mania symptoms.

Conclusion: This new measure of inspiration is multidimensional, reliable and valid. Findings suggest that self and prosocial focused inspiration are particularly associated with risk for BD after controlling for current manic symptoms. Future studies in clinical populations may illuminate the relationships between inspiration and creativity in BD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091669PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966762PMC
December 2015

Bipolar vulnerability and extreme appraisals of internal states: a computerized ratings study.

Clin Psychol Psychother 2011 Sep-Oct;18(5):387-96. Epub 2011 Sep 2.

All School of Psychological Sciences, University of Manchester, UK.

A recent integrative cognitive model proposed that multiple, extreme, personalized, positive and negative appraisals of internal states predispose to maintain and exacerbate bipolar symptoms. This study aimed to directly assess conviction in a range of positive and negative appraisals of internal states suggested by the model, by using a laboratory-based computerized task. In a student sample (n = 68), a history of hypomania was associated with more positive and less negative appraisals of internal states, and a history of depression was associated with more negative appraisals and less positive appraisals of internal states. The sample was then split into three groups for comparison: bipolar risk (n = 18), depression risk (n = 20) and controls (n  = 30). Relative to controls, the bipolar risk group made more extreme ratings of catastrophic appraisals of low activation states and tended to make more extreme ratings of appraisals of high activation states. The depression risk group scored higher on a range of negative appraisals of low activation states. These findings provide tentative support for the role of both positive and negative, extreme, personalized appraisals of internal states in hypomania and depression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/cpp.779DOI Listing
February 2012

Extreme positive and negative appraisals of activated states interact to discriminate bipolar disorder from unipolar depression and non-clinical controls.

J Affect Disord 2011 Nov 16;134(1-3):438-43. Epub 2011 Jun 16.

University of Manchester, United Kingdom.

Background: This research aimed to test whether positive, negative, or conflicting appraisals about activated mood states (e.g., energetic and high states) predicted bipolar disorder.

Methods: A sample of individuals from clinical and control groups (171 with bipolar disorder, 42 with unipolar depression, and 64 controls) completed a measure of appraisals of internal states.

Results: High negative appraisals related to a higher likelihood of bipolar disorder irrespective of positive appraisals. High positive appraisals related to a higher likelihood of bipolar disorder only when negative appraisals were also high. Individuals were most likely to have bipolar disorder, as opposed to unipolar depression or no diagnosis, when they endorsed both extremely positive and extremely negative appraisals of the same, activated states.

Limitations: Appraisals of internal states were based on self-report.

Conclusions: The results indicate that individuals with bipolar disorder tend to appraise activated, energetic internal states in opposing or conflicting ways, interpreting these states as both extremely positive and extremely negative. This may lead to contradictory attempts to regulate these states, which may in turn contribute to mood swing symptoms. Psychological therapy for mood swings and bipolar disorder should address extreme and conflicting appraisals of mood states.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2011.05.042DOI Listing
November 2011

Extreme appraisals of internal states and bipolar symptoms: the Hypomanic Attitudes and Positive Predictions Inventory.

Psychol Assess 2011 Sep;23(3):635-645

School of Psychological Sciences, University of Manchester.

The Hypomanic Attitudes and Positive Predictions Inventory (HAPPI; W. Mansell, 2006) was developed to assess multiple, extreme, self-relevant appraisals of internal states. The present study aimed to validate the HAPPI in a clinical sample. Participants (N = 50) with a diagnosis of bipolar disorder (confirmed by a structured clinical interview) completed a series of questionnaires pertaining to clinical factors, reward motivation, cognitive style, symptoms, and functioning at baseline, in addition to the HAPPI. Over the following 4 weeks, participants were asked to complete self-report measures of symptoms (activation, perceived conflict, depression, and well-being), as well as work and social functioning, twice weekly. The authors hypothesized that the HAPPI would be associated with prospective bipolar symptoms and functioning, when controlling for baseline symptoms and potentially confounding measures. The HAPPI was positively, independently associated with activation and conflict after 4 weeks. Furthermore, individual HAPPI factors were associated with activation, conflict, and depression. The results provided preliminary support for the predictive validity of the HAPPI in a clinical sample. The HAPPI could be used in the future as a tool in cognitive behavioral therapy for bipolar disorder to identify problematic beliefs and guide formulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/a0022972DOI Listing
September 2011

Principal components analysis of the hypomanic attitudes and positive predictions inventory and associations with measures of personality, cognitive style and analogue symptoms in a student sample.

Behav Cogn Psychother 2010 Jan 27;38(1):15-33. Epub 2009 Oct 27.

University of Manchester, UK.

Background: An integrative cognitive model proposed that ascribing extreme personal appraisals to changes in internal state is key to the development of the symptoms of bipolar disorder. The Hypomanic Attitudes and Positive Predictions Inventory (HAPPI) was developed to measure these appraisals.

Aims: The aim of the current study was to validate an expanded 61-item version of the HAPPI.

Method: In a largely female student sample (N = 134), principal components analysis (PCA) was performed on the HAPPI. Associations between the HAPPI and analogue bipolar symptoms after 3 months were examined.

Results: PCA of the HAPPI revealed six categories of belief: Self Activation, Self-and-Other Critical, Catastrophic, Extreme Appraisals of Social Approval, Appraisals of Extreme Agitation, and Loss of Control. The HAPPI predicted all analogue measures of hypomanic symptoms after 3 months when controlling for baseline symptoms. In a more stringent test incorporating other psychological measures, the HAPPI was independently associated only with activation (e.g. thoughts racing) at 3 months. Dependent dysfunctional attitudes predicted greater conflict (e.g. irritability), depression and reduced well-being, hypomanic personality predicted self-reported diagnostic bipolar symptoms, and behavioural dysregulation predicted depression.

Conclusions: Extreme beliefs about internal states show a modest independent association with prospective analogue bipolar symptoms, alongside other psychological factors. Further work will be required to improve the factor structure of the HAPPI and study its validity in clinical samples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1352465809990476DOI Listing
January 2010
-->