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    Rights statement: This is the peer reviewed version of the following article: Palmier-Claus, J. E., Dodd, A., Tai, S., Emsley, R. and Mansell, W. (2016), Appraisals to affect: Testing the integrative cognitive model of bipolar disorder. Br J Clin Psychol, 55: 225–235. doi:10.1111/bjc.12081 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/bjc.12081/abstract/. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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Appraisals to affect: testing the integrative cognitive model of bipolar disorder

Research output: Contribution to journalJournal article

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<mark>Journal publication date</mark>09/2016
<mark>Journal</mark>British Journal of Clinical Psychology
Issue number3
Volume55
Number of pages11
Pages (from-to)225-235
Publication statusPublished
Early online date27/03/15
Original languageEnglish

Abstract

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.

Bibliographic note

This is the peer reviewed version of the following article: Palmier-Claus, J. E., Dodd, A., Tai, S., Emsley, R. and Mansell, W. (2016), Appraisals to affect: Testing the integrative cognitive model of bipolar disorder. Br J Clin Psychol, 55: 225–235. doi:10.1111/bjc.12081 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/bjc.12081/abstract/. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.