Implicit emotion regulation in bipolar disorder: Negative attentional bias persists across the lifespan

Principal Investigator: Katherine E. Burdick, PhD

Authors: Alexandra M. Adamis BS; Caitlin Millet, PhD; Candice Roquemore Bonner, MS; Alexandra A. Corrigan MD; Stephan T. Palm, BS; Faith M Gunning PhD; Katherine E. Burdick, PhD
Lay Abstract

Emotion regulation describes the ability to effectively manage one’s response to an emotional situation. Usually, people’s emotion regulation abilities improve as they get older. For instance, individuals in mid- to late-life tend to unconsciously switch from attending more towards negative information to attending more towards positive information. Bipolar disorder (BD) is a debilitating mental illness characterized by impaired emotion regulation. In this study, we looked at emotion regulation in BD patients across the lifespan to see whether BD patients displayed the improvements in emotion regulation that are typically seen as people grow older. We compared 215 BD patients and 55 healthy controls in early (20-40 years), mid- (41-50 years), and late life (51-65 years) according to their scores on an emotion recognition test. Healthy control subjects demonstrated a steep increase in their ability to recognize happiness in late life, but BD patients did not. These results suggest that BD patients are unconsciously biased towards negative information across the lifespan. This bias towards negative emotional stimuli may contribute to a depressed mood and poorer outcomes for aging BD patients. Future treatments could focus on emotion regulation strategies to help improve the clinical outcomes and well-being of aging BD patients.

Scientific Abstract

Emotion regulation (ER) is the ability to flexibly respond to affectively-valenced stimuli in the service of goal-directed behavior. ER typically improves across the lifespan. A positivity effect, or a switch from negative to positive attentional bias, usually emerges in mid- to late-life. Bipolar disorder (BD) is defined by ER deficits, including an exaggerated, mood-congruent negativity bias. This cross-sectional study investigated ER across the lifespan in BD. 215 BD patients and 55 healthy controls (HC) completed the CANTAB Emotion Recognition Task to measure implicit ER. Using a multivariate ANOVA, we evaluated the sample across three age cohorts to represent early (20-40 years); mid- (41-50 years) and late life (51-65 years). We found a significant main effect of age on the recognition of sadness, indicating a negativity bias in younger cohorts that declined with age. There was a significant interaction between diagnosis and age for the recognition of happiness: HC, but not BD subjects, evidenced a positivity effect (a steep increase in capacity to recognize happiness in late life). Results suggest that across the lifespan, negative stimuli are more salient in BD patients than in HCs. This negativity bias may contribute to mood episodes and could be a target for future interventions.

Clinical Implications
Emotion regulation, specifically one’s tendency to attend more towards positive versus negative information, may be an important point of intervention for aging bipolar disorder patients who fail to experience the typical protective effects of adaptive emotion regulation later in life.

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