Dysregulation of the behavioral approach system (BAS) in bipolar spectrum disorders: Review of theory and evidence

Abstract

In recent years, a call for increased research on bipolar disorder has been answered with methodologically diverse studies exploring goal striving, life events, cognitive style, decision-making, and neurobiological abnormalities in bipolar disorder. In order to further this spurt of research and to systematize our understanding of bipolar disorder, an integrative perspective is warranted. The behavioral approach system (BAS) dysregulation theory, proposed by Richard Depue and colleagues, provides such an integrated model for understanding psychosocial and biological aspects of bipolar disorder. In this paper, we review studies on life events, cognitive style and other psychosocial and neurobiological factors to examine whether the BAS dysregulation theory is supported by existing data. Then, we draw on recent advances in the study of emotion and motivation, and propose an expansion of the BAS dysregulation model of bipolar spectrum disorders to foster further biopsychosocial investigations of bipolar disorder. This expanded model provides greater specificity in predictions, especially about the nature of BAS dysregulation, environmental factors and psychological processes (e.g., appraisal processes) featured in a causal chain culminating in bipolar symptoms. Finally, we discuss the implications of the expanded BAS model for the course of bipolar spectrum disorders.

An evolutionary model of low mood states

“…There is strong evidence that the proximate mechanisms involved are those of behavioural approach systems, which facilitate reward pursuit and are associated with pleasure (Urosevic et al, 2008). However, emotional tone is not always positive during manic episodes, and patients can report high levels of negative emotions such as sadness, anxiety, irritability and aggression (Bauer et al, 1991;Cassidy et al, 1998;Goodwin and Jamison, 1990).…”

Childhood abuse, family history and stressors in older patients with bipolar disorder in relation to age at onset

“…Causal relationships between BD and psychosocial stressors are complex to assess, as it is often difficult to establish whether a stressor was the cause or consequence of the illness (Alloy et al, 2005;Hosang et al, 2012;Johnson, 2005). Still stressors contribute to the onset of bipolar disorder as well as to subsequent episodes (Tsuchiya et al, 2003;Urosevic et al, 2008). A recent study found that the numbers of stressful life events in childhood (including abuse) and in the year prior to the last episode of BD were significantly higher in more severe BD patients with an earlier onset (Post et al, 2013a).…”

Compassion Focused Therapy for People with Bipolar Disorder

“…Recovery efforts of people with BD are frequently hampered by a tendency to strive for high standards, which can lead to difficulties with the pacing of recovery, and the presence of an attacking self-to-self relational style, which can have a powerful negative impact on the ability to cope with setbacks. Within this article, processes associated with BD, as understood by the modified Behavioral Activation System dysregulation theory (Urosevic, Abramson, Harmon-Jones, & Alloy, 2008) and social rank theory (Gilbert, McEwan, Hay, Irons, & Cheung, 2007) are described, along with details of how Compassion Focused Therapy (CFT) can be used to help clients to strengthen their soothing systems, which is viewed as a key step in rebalancing mood states.…”