“I can’t control my high moods”
: The relationship between cognitions about internal states and adolescent bipolar symptoms

Student thesis: Doctoral ThesisDoctor of Clinical Psychology


Background: In adults, research has demonstrated that extreme appraisals of internal states and their consequences correlate with and prospectively predict mood symptoms. Consistent with a cognitive model of problematic mood swings, extreme, personalised, and conflicting appraisals of activated and depressed states discriminate individuals with bipolar disorder from individuals with unipolar depression and nonclinical controls. This study sought to examine whether these findings could be replicated in adolescents (aged 14-15).

Methods: A non-clinical sample (n=98) completed measures of mood symptoms, appraisals, risk for future mania, impulsivity, and responses to positive affect. At 3-month follow up, these measures were re-administered alongside a measure of negative life events.

Results: Extreme, personalised appraisals of internal states were significantly associated with activation (hypomania), depression and irritability symptoms. These associations were robust and maintained when controlling for impulsivity and responses to positive affect. Positive appraisals of activated (high) mood states were uniquely associated with hypomania, whilst negative appraisals of activated states were uniquely associated with depression and irritability symptoms. The interaction between positive and negative cognitions about activated internal states significantly differentiated individuals scoring more highly on an index of risk for bipolar disorder from those at low risk, such that individuals who appraised activated states as both extremely positive and extremely negative were more likely to be at high or moderate likelihood of caseness. However, appraisals did not prospectively predict mood symptoms.

Conclusions: This study is the first to demonstrate associations between appraisals of internal states, analogue mood symptoms and mania risk in adolescents. Further research investigating the role of extreme appraisals at different points of the bipolar spectrum and across a broader age range is warranted, to establish whether the cognitive model of problematic mood swings and corresponding psychological interventions for mood swings and bipolar disorder may be applicable to children and adolescents.

Date of Award2014
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorPatrick Smith (Supervisor)

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