An Assessment of Emotional Reactivity to Frustration of Goal Pursuit in Euthymic Bipolar I Disorder

CPXXXX10.1177/2167702614555412Edge et al.Reactivity to Frustration in Bipolar Disorder 555412research-article2014 Empirical Article Clinical Psychological Science 1 –16 An Assessment of Emotional Reactivity to © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav Frustration of Goal Pursuit in Euthymic DOI: 10.1177/2167702614555412 Bipolar I Disorder cpx.sagepub.com Michael D. Edge1, Sandy J. Lwi2, and Sheri L. Johnson2 1Department of Biology, Stanford University, and 2Department of Psychology, University of California, Berkeley Abstract Affective disturbance is a central feature of bipolar disorder. Many investigators have hypothesized that euthymic people with bipolar disorder might display elevated emotional reactivity, but laboratory studies of emotional reactivity have had mixed results. Drawing on theories of bipolar disorder that emphasize dysregulation of goal pursuit, we hypothesized that people with bipolar disorder might be emotionally hyperreactive to frustration of goal pursuit. Forty- seven euthymic participants with bipolar disorder and 43 control participants played a computer game for a monetary reward. To induce frustration, we programmed the game to respond inconsistently to user input during two periods. The frustration induction was successful as measured by self-report, physiological responding, and facial behavior, but contrary to the hypothesis of emotional hyperreactivity in bipolar disorder, the bipolar and control groups were equally reactive to frustration. Future studies will benefit from more specific hypotheses about how emotion might be altered in bipolar disorder. Keywords bipolar disorder, emotion, emotional reactivity, goal pursuit, mania Received 5/18/14; Revision accepted 9/18/14 Bipolar I disorder is defined by the presence of a single disorder might be more emotionally reactive to frustra- manic episode. Manic episodes, in turn, are defined by tion of goal pursuit, as measured via self-report, physiol- the presence of either elevated or irritable mood ogy, or behavior. As we explain later, we focus on anger (American Psychiatric Association, 2000). Because affec- in response to frustration of goal pursuit because it offers tive disturbance is a central feature of bipolar disorder, an underutilized opportunity to study approach-related psychologists studying bipolar disorder have focused on affect—which, for many reasons, is an interesting target emotion (for review, see Gruber, 2011a; Johnson, Gruber, for study in Bipolar I disorder—in a context in which & Eisner, 2007). Several theories suggest that emotional people with and without bipolar disorder may face simi- disturbance is a primary driver of bipolar disorder symp- lar pressure to regulate their emotions. toms (e.g., Strakowski et al., 2012; Townsend & Altshuler, Suggestions that people with bipolar disorder might 2012). Given the primacy of affect in many neurobiologi- display elevated emotional reactivity come from clinical cal and psychological conceptualizations of bipolar dis- experience (see M’Bailara et al., 2009) as well as from order, thorough characterization of affective responding empirical findings that show that people with bipolar dis- in bipolar disorder is a priority. order are more likely to experience manic episodes after Emotional reactivity—the degree or intensity of a rela- life events that involve goal attainment (Johnson et al., tively short-term emotional response to a stimulus—is one important component of affective responding. In this Corresponding Author: study, we test whether euthymic people with bipolar dis- Sheri L. Johnson, Department of Psychology, University of California, order are more emotionally reactive than control partici- Berkeley, 3210 Tolman Hall, Berkeley, CA 94720 pants. In particular, we test whether people with bipolar E-mail: [email protected] Downloaded from cpx.sagepub.com at Stanford University Libraries on December 21, 2014 2 Edge et al. 2000; Johnson et al., 2008; Nusslock, Abramson, Harmon- cues of reward. Several lines of evidence suggest that Jones, Alloy, & Hogan, 2007). People with bipolar disor- BAS sensitivity is elevated in Bipolar I disorder, including der report being more affectively labile and experiencing the correspondence of mania symptoms with BAS out- more intense affect than do control participants during puts, self-reports of BAS sensitivity, the tendency for euthymic periods (Henry et al., 2008; Kesebir et al., 2005), mania to occur after progress toward important goals, and some experience-sampling studies have suggested higher valuation of goals among people with bipolar dis- that individuals at risk for or diagnosed with bipolar disorder, and increases in confidence and effort after initial order show higher or more variable affect across time success in bipolar disorder (Johnson et al., 2012; Urošević (Hofmann & Meyer, 2006; Knowles et al., 2007; Myin- et al., 2008). If BAS sensitivity is elevated in Bipolar I Germeys et al., 2003; but for different results, see disorder, it is natural to predict that reactivity to positive Havermans, Nicolson, Berkhof, & deVries, 2011; Lovejoy emotional stimuli might also be elevated. & Steuerwald, 1995). Finally, some—but not all—neuro- But findings regarding emotional reactivity to positive imaging studies of emotion processing in bipolar disor- stimuli have been deeply mixed, with some evidence for der have suggested that euthymic bipolar disorder is heightened positive emotional reactivity in euthymic associated with increased activity in areas associated with bipolar disorder (Gruber, Harvey, & Purcell, 2011; emotional reactivity during viewing and labeling of emo- Pavlova et al., 2011), other studies finding no difference tional faces (for review, see Delvecchio et al., 2012; between people with bipolar disorder and control par- Phillips & Swartz, 2014; Townsend & Altshuler, 2012). ticipants (Farmer et al., 2006; Gruber et al., 2014; Hayden Although suggestive, these lines of evidence do not et al., 2008; Mansell & Lam, 2006; Wright et al., 2005), establish whether euthymic people with bipolar disorder and at least one study finding diminished reactivity in are more emotionally reactive than are control partici- bipolar disorder (Lomax & Lam, 2011). The pattern of pants. To answer this question, researchers have turned mixed results for positive emotional reactivity is not to laboratory studies using standardized emotion explained by sample size, mode of emotional respond- inductions. ing measured, or the type of procedure used for emotion induction. Laboratory Studies of Emotional One possible explanation for these mixed findings is that elevated positive emotional reactivity in individuals Reactivity in Bipolar Disorder with bipolar disorder is masked by heightened motiva- Studies of emotional reactivity in bipolar disorder can be tion to regulate positive emotions. As a consequence of divided into studies of negative and of positive affect. the major life disruptions that accompany mania, people Most studies of negative affect have used sad or aversive with bipolar disorder report being motivated to down- stimuli and have not shown reactivity differences between regulate positive emotions (Edge et al., 2012). If control euthymic people with bipolar disorder and control par- participants are not motivated to downregulate positive ticipants (Aminoff, Jensen, Lagerburg, Andreassen, & emotions or are motivated to upregulate positive emo- Melle, 2011; Cuellar, Johnson, & Ruggero, 2009; Gruber, tions, then a difference in reactivity may be cancelled by Hay, & Gross, 2014; Mansell & Lam, 2006; Ruggero & an opposing difference in motivation to regulate. Johnson, 2006; Townsend et al., 2013; Wright, Lam, & With these considerations in mind, what sort of emo- Newsom-Davis, 2005; but see Pavlova, Uher, Dennington, tion should one use to test the theory that euthymic peo- Wright, & Donaldson, 2011, for an exception).1 ple with bipolar disorder are more emotionally reactive Despite the lack of group differences in reactivity to than are control participants? To test the theory, one negative stimuli, there are at least two reasons to predict might seek an emotion that is related to bipolar symp- that euthymic people with bipolar disorder might be toms, that is approach related, and that people with and more reactive to positive stimuli. First, elevated mood is without bipolar disorder face similar pressures to regu- a cardinal symptom of mania, which suggests disruptions late. We argue that anger—especially anger in response in positive affect that may persist during euthymia. to frustration of goal pursuit—is such an emotion. Second, reactivity to positive stimuli is a form of approach- related affect. Interest in approach-related affect stems Anger as a Key Emotion in Bipolar from psychological theories of mania based on the Disorder behavioral approach system (BAS; for review, see Johnson, Edge, Holmes, & Carver, 2012; Urošević, Elevated or positive mood may be the most widely appre- Abramson, Harmon-Jones, & Alloy, 2008). The BAS is ciated symptom of mania, but it is not the only cardinal conceptualized as a system that guides the organism in symptom of mania—irritable mood is an equally central the pursuit of goals by integrating and responding to part of the disorder. Although elevated and irritable Downloaded from cpx.sagepub.com at Stanford University Libraries on December 21, 2014 Reactivity to Frustration in Bipolar Disorder 3 moods have differing valences, they are both

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