Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series

Abstract

Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).

An investigation of mental imagery in bipolar disorder: Exploring “the mind's eye”

“…Previous studies have investigated only selected stages of imagery‐related processing, with evidence of deficits in cognitive tasks of imagery generation and manipulation in depressed individuals and imagery generation in anxious individuals . The subjective domains relate to spontaneous imagery use, the presence of imagery‐related interpretation biases and emotional mental imagery and the phenomenological characteristics of mental imagery in different affective states …”

“…“Rediscovering” mental imagery in clinical practice can improve assessment . There is also emerging evidence of imagery as a valid target to reduce mood instability in BD . Therefore, a comprehensive evaluation of cognitive stages and subjective domains of mental imagery in BD could further inform our understanding of BD psychopathology and treatment development, by identifying problematic aspects of mental imagery in BD and refining treatment targets.…”

Remediating reduced memory specificity in bipolar disorder: A case study using a Computerized Memory Specificity Training

“…One potential interesting route is to adapt it to people with BD by taking into account unique characteristics of memory retrieval in BD (Barry, Chiu, et al, 2018). For example, as discussed previously, vivid mental imagery as part of episodic recall can act as an emotional amplifier of mood states in BD (Holmes et al, 2016). Holmes et al (2011) also discuss negative mental imagery of the future ("flashforwards") as a potential important process in BD.…”

“…Relatedly, it has been proposed that mental imagery (e.g., in vivid episodic recall) can act as an emotional amplifier in BD (Holmes et al, ). An emerging treatment approach is to target such mental imagery in BD to improve mood stability (Holmes et al, ). Recent guidelines for BD have called for innovations in psychological treatment, in particular interventions with a focus in on BD's mental imagery‐based memory (Goodwin et al, ).…”

“…Relatedly, it has been proposed that mental imagery (e.g., in vivid episodic recall) can act as an emotional amplifier in BD ). An emerging treatment approach is to target such mental imagery in BD to improve mood stability (Holmes et al, 2016).…”