Emotion regulation in bipolar disorder type I: an fMRI study

Abstract

Our findings suggest that BD-I patients are able to downregulate their emotions when instructed to do so. However, they also appear to engage their ER network, particularly the VLPFC, even when not required to do so. These findings may help explain their often-reported difficulty in regulating emotions in everyday life despite their attempts to do so.

Altered frontal‐amygdala effective connectivity during effortful emotion regulation in bipolar disorder

“…BD patients showed no differences in activation while reappraising compared to HC. Previous studies have shown mixed results in BD patients, including heightened, lower and no differences in activation. Various differences between these studies could account for these mixed results; for example, differences in the patient sample size (n = 13, 15, 19, 22 and 30), the length of the regulation phase (4 s~10 s), the paradigm used (eg, early‐ vs late‐cueing paradigm) and statistical thresholds.…”

“…Our behavioral data showed that reappraising decreased the elicited negative emotional feeling, suggesting more control over the negative emotion. BD patients often report more difficulty in reappraising, and diminished reappraisal success compared to HC . Therefore, we propose that the disturbed DLPFC‐amygdala effective connectivity in BD patients indicates inadequate prefrontal control during reappraisal, which may be associated with regulation inefficiency as often seen in BD.…”

“…That we did not observe behavioral differences might be explained by the following possibilities. First, BD patients have been shown to be able to perform reappraisal under instruction, although less efficiently compared to controls . It could be that BD patients retain the ability to perform the reappraisal task as instructed, while they show differences on the neural level.…”

“…Reappraisal involves forming a reconceptualization of the situation to decrease emotional intensity . Behavioral evidence has shown that BD patients report more effort to achieve reappraisal, and are less successful in reappraisal compared to healthy individuals, although not consistently . Interestingly, better reappraisal ability has been shown to predict fewer depressive symptoms over time in BD .…”

Functional Neuroimaging in Psychopathy

“…Patients with bipolar disorder hyperactivate their vlPFC when exposed to emotional tasks [45]; interestingly, goal directedness is one of the symptoms found in bipolar disorder during the manic phase, so the inability to deactivate the vlPFC might represent a common pathway of this symptom to manifest itself in both disorders. The dysfunctional recruitment of the amygdala in response to relevant emotional cues (during the pursue of immediate goals) may be related to a more general ‘lateral PFC-instantiated attention bottleneck' that results in the peripheral information processing deficit [44].…”