Wednesday, March 25, 2009

The bipolar phenotype: Excessive self-regulatory focus?

In my last post I had hinted that bipolar mania and depression may both be characterized by an excessive and overactive self-regulatory focus: with promotion focus being related to Mania and prevention focus being related to depression. It is important to pause and note that the bipolar propensity is towards more self-referential goal-directed activity resulting in excessive use of self-regulatory focus. To clarify, I am sticking my neck out and claiming that depression is marked by an excessive obsession with self-oriented goal directed activities- but with a preventive focus thus focusing more on self's responsibilities and duties , obligations etc with respect to other near and dear ones. Mania on the other hand, also has excessive self-oriented goal-directed focus, but the focus is promotional with obsession with hopes, aspirations etc, which are relatively more inward-focused and not too much dependent on significant others.

Thus, my characterization of depression as a state where regulatory reference is negative (one is focused on avoiding landing up in a negative end-state like being a burden on others), the regulatory anticipation is negative ( one anticipates pain as a result of almost any act one may perform and thus dreads day-to-day- activity) and the regulatory focus is negative (preventive focus whereby one is more concerned with duties and obligations to perform and security is a paramount need). The entire depressive syndrome can be summed up as an over activity of avoidance based mechanisms. However, please note that still there is an excess of self-referential/self-focused thinking and one is greatly motivated (although might be lacking energy) to bridge the differences between the real self and the 'ought' self. One can say that one's whole life revolves around trying to become the 'ought' self, or rather one conceptualizes oneself in terms of the 'ought' self.

Contrast this with Mania, where the regulatory reference is positive (one is focused on achieving something grandiose ) , regulatory anticipation is positive (one feels in control and believes that only good things can happen to the self) and regulatory focus is positive (promotional focus whereby one is more concerned with hopes, aspirations etc and growth / actualization needs). Still, juts like in depression there is an excess of focus on self and one is greatly motivated (and also has the energy) to bridge the difference between the real and the 'ideal' self. One can say that one's whole life revolves around trying to become the 'ideal' self , or rather one conceptualizes oneslef in terms of an 'ideal' self.

What can we predict from above: we know that brain's default network is involved in self-focused thoughts and ruminations. We can predict, and know for a fact, that the default network is overactive in schizophrenics (and thus by extension in bipolars who I believe have the same underlying pathology, at least as far as psychotic spectrum is concerned)and thus we can say with confidence that indeed the regulatory focus should be high for bipolars and this should be correlated with default network activity. We can also predict that during the Manic phase, the promotion focus related neural network should be more active and in depressive phase the prevention-related areas of the brain should be more active. this last hypothesis still needs experimentation, but lets backtrack a bit and first look at the neural correlates of the promotion and preventive regulatory self-focus.

For this, I refer the readers to an , in my view, important study that tried to dissociate the medial PFC and PCC activity (both of which belong to the default network) while people engaged in self-reflection. Here is the abstract of the study:

Motivationally significant agendas guide perception, thought and behaviour, helping one to define a ‘self’ and to regulate interactions with the environment. To investigate neural correlates of thinking about such agendas, we asked participants to think about their hopes and aspirations (promotion focus) or their duties and obligations (prevention focus) during functional magnetic resonance imaging and compared these self-reflection conditions with a distraction condition in which participants thought about non-self-relevant items. Self-reflection resulted in greater activity than distraction in dorsomedial frontal/anterior cingulate cortex and posterior cingulate cortex/precuneus, consistent with previous findings of activity in these areas during self-relevant thought. For additional medial areas, we report new evidence of a double dissociation of function between medial prefrontal/anterior cingulate cortex, which showed relatively greater activity to thinking about hopes and aspirations, and posterior cingulate cortex/precuneus, which showed relatively greater activity to thinking about duties and obligations. One possibility is that activity in medial prefrontal cortex is associated with instrumental or agentic self-reflection, whereas posterior medial cortex is associated with experiential self-reflection. Another, not necessarily mutually exclusive, possibility is that medial prefrontal cortex is associated with a more inward-directed focus, while posterior cingulate is associated with a more outward-directed, social or contextual focus.

The authors then touch upon something similar to what I have said above, that one can be too much planful or goal-directed (bipolar propensity) , but it would still make sense to find whether the focus is promotional or preventive. To quote:

The idea of variation in individuals’ regulatory focus highlights the difference between agendas and traits; two people could both be described by the trait ‘planful’, but planful about what? A person with a predominantly promotion focus would be more likely to be planful about attaining positive rewards or outcomes, while a person with a predominantly prevention focus would be more likely to be planful about avoiding negative events or outcomes. Although a promotion or prevention focus may dominate, the aspects of the self that are active change dynamically across situations (e.g. Markus and Wurf, 1987), thus most individuals have both promotion and prevention agendas. For example, the same person can hold both the hope of becoming rich (a promotion agenda) and the duty to support an aging parent (a prevention agenda), or the aspiration to be a good citizen and the obligation to be a well-informed voter. As individuals, hopes and aspirations and duties and obligations make up a large part of our mental life and constitute the motivational scaffolding for much of our behaviour.

Now comes the study design:

The present studies investigated neural activity when participants were asked to think about self-relevant agendas related to either a promotion (think about your hopes and aspirations) or prevention (think about your duties and obligations) focus. We compared neural activity associated with thinking about these two different types of self-relevant agendas and with thinking about non-self-relevant topics (distraction). We expected greater activity in anterior and/or posterior medial regions associated with these two self-reflection conditions compared with the distraction control condition because thinking about one's agendas, like thinking about one's traits, is self-referential. Such a finding would also be consistent, for example, with Luu and Tucker's (2004) proposal that both anterior cingulate and posterior cingulate cortex contribute to action regulation by representing goals and expectancies.

And this is what they found:

A double dissociation was found when participants were cued to think about promotion and prevention agendas on different trials for the first time during scanning (Experiment 2) and when they spent several minutes thinking about either promotion or prevention agendas before scanning (Experiment 1), indicating that it results from what participants are thinking about during the scan and not from some general effect (e.g. mood) carried over from the pre-scan period of self-reflection,

Here is what they discuss:

In short, the double dissociation between medial PFC and anterior/inferior medial posterior areas and our two self-reflection conditions indicates that these brain areas serve somewhat different functions during self-focus. There are a number of interesting possibilities that remain to be sorted out. Differential activity in these anterior medial and posterior medial regions as a function of the types of agendas participants were asked to think about could reflect: (i) differences in the representational content in the specific features of agendas, schemas, possible selves and so forth that constitute hopes and aspirations on the one hand and duties and obligations on the other (cf. Luu and Tucker, 2004); (ii) differences in the type(s) of component processes these agendas are likely to engage and/or the representational content they are likely to activate, for example, discovering new possibilities (hopes) vs retrieving episodic memories (e.g. Maddock et al., 2001) of past commitments (duties); (iii) differences in affective significance of hopes and aspirations (attaining the positive) and duties and obligations (avoiding the negative, Higgins, 1997; 1998); (iv) different aspects of the subjective experience of self, such as the subjective experience of control (an instrumental self) vs the subjective experience of awareness (an experiential self; Johnson, 1991; Johnson and Reeder, 1997; compare, e.g. Searle, 1992 and Weiskrantz, 1997, vs Shallice, 1978 and Umilta, 1988); (v) differences in the social significance of hopes and aspirations (more individual) and duties and obligations (involving others). This last possibility is suggested by findings linking the posterior cingulate with taking the perspective of another (Jackson et al., 2006). It may be that thinking about duties and obligations (a more outward focus) tends to involve more perspective-taking than does thinking about hopes and aspirations (a more inward focus). The greater number of mental/emotional references from the promotion group on the pre-scan essay and the tendency for a greater number of references to others from the prevention group are consistent with the hypothesis that medial PFC activity is associated with a more inward focus whereas posterior cingulate/precuneus activity is associated with a more outward, social focus. Clarifying the basis of the similarities and differences between neural activation associated with thinking about hopes and aspirations vs duties and obligations would begin to help differentiate the relative roles of brain regions in different types of self-reflective processing.

They do discuss clinical significance of their studies , but not in terms I would have loved to. I would like to see, whether there is state/trait hyperactivity and dissociation between the mPFC and PCC activation when the variable of depressive episode or manic episode subject is introduced. I'll place my bets that there would be an interaction between the type of episode and the over activity in the corresponding default-brain regions; but would like to see that data collected.

So my thesis is that the self-reflective and focused default network is overactive in biploar/psychotic spectrum people, but a bias or tilt towards promotion or preventive focus leads to their recurring and periodic episdoes of mania and depression.

Lastly let me touch upon affect in these state and what Higgins had to say about this in his paper covered yesterday. Higgins proposed that bipolar is due to a promotional focus, with mania induced when there is not much mismatch (or awareness of mismatch) between the ideal and real self; while depression or sadness and melancholia induced when one becomes aware of the discrepancy between the ideal and the real self. He proposes that 'ought' and real self discrepancy leads to anxiety and nervousness/ agitation; while a preventive focus and congruency between 'ought' and real leads to calmness/quiescence.

I disagree with his formulations, in as much as I differentiate between a regulatory focus and the corresponding awareness of discrepancies in that direction. To Higgins they are the same; if someone has a promotional focus , he would also be more aware of the discrepancies between his ideal and real self and thus be saddened. I disagree. I believe that if one has a promotional focus one is driven by goals to make the resl self as close to the ideal self as possible and if one is not able to do so, one would use defense mechanisms to delude oneself , but will not admit to its reality, as the reality of incongruence along the focused dimension is too painful. However, because on is consciously focused on promotions, one would be aware of trade-offs and will acknowledge to himself that his 'ought' self, which anyway is not too important for his self-concept, is not congruent to the real self. Thus, one wit a predominant promotion focus may be painfully aware of the discrepancy between his 'ought' and real self and thus might be nervous, agitated/ irritable- all symptoms of Mania.

A depressive person on the other hand has a predominant preventive focus and all actions/ ruminations are driven by responsibilities and obligations. Here acknowledging to oneself that one has failed in meeting obligations may be catastrophic so one will try to delude oneself that one is closer to the 'ought' self than is the case. However, one may not require any defense mechanisms when judging the discrepancy between the 'ideal' and real self as that 'ideal' self is no longer a matter of life and death! One would be aware that one is not focusing too much on hopes and aspirations and thus feel despondent/ sad/ melancholic - again classical symptoms of depression. Yet, despite the affect of sadness, all rumination would be focused on 'ought' self and thus the content be of guilt, duties, burden, responsibilities, etc.

I'm sure there is some grain of truth in my formulation, but wont be able to state emphatically unless the above proposed dissociation study involving default region and bipolar people is done. If one of you decide to do that, do let me know the results, even if they contradict the thesis.
Johnson, M. (2006). Dissociating medial frontal and posterior cingulate activity during self-reflection Social Cognitive and Affective Neuroscience, 1 (1), 56-64 DOI: 10.1093/scan/nsl004
Higgins, E. T. (1997). Beyond pleasure and pain American Psychologist (52), 1280-1300

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Ward said...

Very in-depth and interesting post - definitely got me thinking.


I will save this post for further digestion.

Abysmal Musings said...

Yes, fascinating read. Thanks.

Mandy said...

As someone with bipolar diagnosis am interested in other's views on it, particulary others with bipolar.

My own experiences are that when mania prevails I am in a constant state of doing, not achieving much..flitting mainly and in depression, there is much more internal infighting going on, whilst externally not much is forthcoming.

Recently, someone said told me they thought depression was introverted anger. Could be...all I know is when I am in it all I want to do is get out of it.