J.M.G. Williams’s research while affiliated with University of Oxford and other places

Remitted bipolar patients were compared to remitted unipolar patients and healthy controls on a self concept task assessing degree of self-compartmentalization (clustering of self-aspects based on valence) and self-complexity (the degree of relatedness versus differentiation across self-aspects). Similar to the findings of Taylor et al. (Cognitive Therapy and Research, 31(1), 83-96, 2007) the bipolar and unipolar groups showed higher levels of self compartmentalization than healthy controls. No differences were found on the self complexity measure. KeywordsBipolar disorder-Self-Compartmentalization-Self-complexity

Studies on self-representation in bipolar disorder have mainly focused on the single dimension of self-esteem and recruited patients either in episode or in remission. The aim of the study was to examine multi-dimensional aspects of the self (discrepancy between actual- and ideal-selves and between actual- and feared-selves) in a student sample with a history of significant experience of hypomania (with or without experience of major depression) as compared to healthy control students. Bipolar students and healthy control students completed the Self-Discrepancy Questionnaire (SDQ: Carver, Lawrence, & Scheier, 1999). The degree of similarity to, and the perceived likelihood of ideal-self and feared-self characteristics were assessed. The difference between the groups in level of ideal-self similarity was at trend level. Students with prior hypomania but no history of depression showed higher similarity to their feared-self than healthy controls and also rated themselves as more likely to have these feared-self characteristics in the future. The small sample size, especially in the bipolar group with no history of depression, limits the power of the study. The presence of ideal-self discrepancy was not convincingly demonstrated in this sample and it is possible that where it has been identified in previous studies it may, at least in part, represent a scar of previous episodes of depression or mania rather than a predisposing factor. However a sub-sample of students who had experienced hypomania in the absence of history of depression were distinguished from healthy controls in perceived closeness to the feared-self qualities. The feared-self concept warrants further investigation in bipolar patients.

To date the effect of cognitive behavioural therapy modified for bipolar disorder has been inconsistent and sometimes disappointing. However studies exploring cognitive style in bipolar disorder have not identified the unique patterns of beliefs specific to bipolar disorder. The current study examines whether Mansell's hypomania-related dysfunctional belief scale specifically identifies bipolar disorder patients. Forty remitted bipolar patients, twenty remitted unipolar patients and twenty healthy controls completed the Hypomanic Attitudes and Positive Prediction Inventory (HAPPI) and the Dysfunctional Attitude Scale (DAS). The remitted bipolar group scored higher than the unipolar and healthy control groups on the HAPPI scale overall score and on three subscales that measured self-catastrophic beliefs, beliefs related to negative responses from other people when in elevated mood and beliefs related the response style to activation and elevation. The study finds evidence of unique dysfunctional beliefs elevated only in remitted bipolar patients. Such findings could be used to inform the development of a specific cognitive behavioural therapy for bipolar disorder.

Bipolar disorder is highly recurrent and rates of comorbidity are high. Studies have pointed to anxiety comorbidity as one factor associated with risk of suicide attempts and poor overall outcome. This study aimed to explore the feasibility and potential benefits of a new psychological treatment (Mindfulness-based Cognitive Therapy: MBCT) for people with bipolar disorder focusing on between-episode anxiety and depressive symptoms. The study used data from a pilot randomized trial of MBCT for people with bipolar disorder in remission, focusing on between-episode anxiety and depressive symptoms. Immediate effects of MBCT versus waitlist on levels of anxiety and depression were compared between unipolar and bipolar participants. The results suggest that MBCT led to improved immediate outcomes in terms of anxiety which were specific to the bipolar group. Both bipolar and unipolar participants allocated to MBCT showed reductions in residual depressive symptoms relative to those allocated to the waitlist condition. Analyses were based on a small sample, limiting power. Additionally the study recruited participants with suicidal ideation or behaviour so the findings cannot immediately be generalized to individuals without these symptoms. The study, although preliminary, suggests an immediate effect of MBCT on anxiety and depressive symptoms among bipolar participants with suicidal ideation or behaviour, and indicates that further research into the use of MBCT with bipolar patients may be warranted.

The authors investigated whether the re-emergence of hopeless/suicidal cognitions over time can be explained within a differential activation framework. Studies 1 (N=146) and 2 (N=136) showed that individuals who reported suicidal ideation when depressed in the past had higher scores on the hopelessness/suicidality subscale of a measure assessing cognitive reactivity to low mood, the LEIDS. Study 3 (N=32) demonstrated that self-reports on this subscale predicted changes in generativity for positive future events, an experimental measure of processes underlying hopelessness/suicidality, following sad mood induction. The results provide preliminary evidence that history of suicidal ideation is related to a specific cognitive response pattern, which may be reactivated by mild fluctuations in mood.

Mindfulness-based Cognitive Therapy (MBCT) is a class-based programme designed for use in the prevention of relapse of major depression. Its aim is to teach participants to disengage from those cognitive processes that may render them vulnerable to future episodes. These same cognitive processes are also known to maintain depression once established, hence a clinical audit was conducted to explore the use of MBCT in patients who were currently actively depressed, and who had not responded fully to standard treatments. The study showed that it was acceptable to these patients and resulted in an improvement in depression scores (pre-post Effect Size=1.04), with a significant proportion of patients returning to normal or near-normal levels of mood.

In recent years it has become clear that depression is a recurrent disorder, with the risk of recurrence in those with two or more episodes being as high as 90%. This has prompted interest in the consistency of individual depressive symptoms across consecutive episodes, an issue that is important for symptoms such as suicidal ideation, where a past history may give important indicators of future behaviour. We prospectively examined 69 individuals with a history of Major Depression, over 12 months, 38 of whom experienced a recurrence of major depression during the follow-up period. Spearman's rank order correlations between severity ratings of each symptom of major depression during a previous episode and severity ratings at recurrence showed significant associations for suicidality, guilt or worthlessness and thinking difficulties only. Weighted kappa coefficients indicated relatively low levels of agreement across episodes for most diagnostic symptoms, with suicidality showing the strongest relationship. Using a broad definition of suicidality-- any reporting of thoughts of death or suicide during episode-- a much higher level of agreement (kappa = .64) was found, with 83% of individuals falling into the same category (suicidal/non-suicidal) at both episodes. This study was based on a relatively small sample and examines re-emergence of suicidal ideation in the absence of suicidal behaviour. This study provides preliminary evidence of cross-episode consistency in the recurrence of suicidal ideation, in line with the differential activation theory of suicidality in depression.