Holmes Emily A, Geddes John R, Colom Francesc, Goodwin Guy M
University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
Behav Res Ther. 2008 Dec;46(12):1251-8. doi: 10.1016/j.brat.2008.09.005. Epub 2008 Oct 8.
Cognitions in the form of mental images have a more powerful impact on emotion than their verbal counterparts. This review synthesizes the cognitive science of imagery and emotion with transdiagnostic clinical research, yielding novel predictions for the basis of emotional volatility in bipolar disorder. Anxiety is extremely common in patients with bipolar disorder and is associated with increased dysfunction and suicidality, yet it is poorly understood and rarely treated. Mental imagery is a neglected aspect of bipolar anxiety although in anxiety disorders such as posttraumatic stress disorder and social phobia focusing on imagery has been crucial for the development of cognitive behavior therapy (CBT). In this review we present a cognitive model of imagery and emotion applied to bipolar disorder. Within this model mental imagery amplifies emotion, drawing on Clark's cyclical panic model [(1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470]. We (1) emphasise imagery's amplification of anxiety (cycle one); (2) suggest that imagery amplifies the defining (hypo-) mania of bipolar disorder (cycle two), whereby the overly positive misinterpretation of triggers leads to mood elevation (escalated by imagery), increasing associated beliefs, goals, and action likelihood (all strengthened by imagery). Imagery suggests a unifying explanation for key unexplained features of bipolar disorder: ubiquitous anxiety, mood instability and creativity. Introducing imagery has novel implications for bipolar treatment innovation--an area where CBT improvements are much-needed.
以心理意象形式存在的认知对情绪的影响比语言形式的认知更为强烈。本综述将意象与情绪的认知科学和跨诊断临床研究相结合，对双相情感障碍中情绪波动的基础得出了新的预测。焦虑在双相情感障碍患者中极为常见，且与功能障碍加剧和自杀倾向相关，但人们对其了解甚少且很少进行治疗。心理意象是双相情感障碍焦虑中一个被忽视的方面，尽管在创伤后应激障碍和社交恐惧症等焦虑症中，关注意象对认知行为疗法（CBT）的发展至关重要。在本综述中，我们提出了一个应用于双相情感障碍的意象与情绪认知模型。在这个模型中，心理意象会放大情绪，这借鉴了克拉克的周期性恐慌模型[（1986年）。恐慌的认知方法。行为研究与治疗，24，461 - 470]。我们（1）强调意象对焦虑的放大作用（第一个循环）；（2）认为意象会放大双相情感障碍的典型（轻）躁狂（第二个循环），由此对触发因素的过度积极误判会导致情绪高涨（被意象放大），增加相关的信念、目标和行动可能性（均被意象强化）。意象为双相情感障碍的关键未解释特征提供了一个统一的解释：普遍存在的焦虑、情绪不稳定和创造力。引入意象对双相情感障碍治疗创新具有新的意义——这是一个急需改进CBT的领域。
