By Barnaby Nicolas, MSIS
In our monthly “Article Spotlight” series, we’re showcasing achievements of Mount Sinai faculty and researchers using Altmetrics. This month, we’re looking at an article by Dr. George Nitzburg, PhD, Clinical Psychology, Postdoctoral Fellow at the Icahn School of Medicine at Mount Sinai.
Citation: Nitzburg GC, Russo M, Cuesta-Diaz A, Ospina L, Shanahan M, Perez-Rodriguez M, et al. Coping strategies and real-world functioning in bipolar disorder. Journal of Affective Disorders. 2016;198:185-8
Article Summary: This recent study by Nitzburg et al. (2016) examined coping in 92 affectively-stable bipolar outpatients and found that the maladaptive strategies of “giving up” and “self-criticism” significantly predicted real-world disability levels, suggesting defeatist beliefs may impair functioning in bipolar disorder.
BACKGROUND: Bipolar patients encounter significant life adversity, which has contributed to bipolar disorder being a leading cause of disability worldwide. Studies suggest BD patients have more maladaptive coping strategies, some of which can impact their illness course. Yet research on which coping strategies most influence disability is lacking. Such research could inform cognitive-behavioral targets to improve functional outcomes. Thus, Nitzburg et al. (2016) studied the relations between coping strategies and real-world functioning in 92 affectively-stable BD outpatients. The study comprehensively measured not only coping strategies and real-world disability, but also current bipolar symptoms, bipolar illness chronicity, and neurocognitive functioning. Their results found that maladaptive coping significantly predicted disability while adaptive coping did not. More specifically, behavioral disengagement (i.e. giving up) and self-blame were uniquely predictive of real-world disability, even after controlling for age, sex, illness chronicity, current symptoms, and neurocognitive functioning. Their findings suggest that giving up and self-blame are significant predictors of real-world functioning beyond sub-threshold depressive symptoms. These results also suggest bipolar disorder may follow of downward spiral similar to that recently identified in schizophrenia, where bipolar patients’ initial deficits (cognitive, social and otherwise) can result in negative experiences that lead to defeatist beliefs about their capacity to productively engage in activities, which in turn may contribute to a worsening of bipolar illness and further strengthening of defeatist beliefs. In addition to mood-stabilizers, cognitive-behavioral interventions targeting defeatist and self-critical beliefs may serve as critical early interventions that can help prevent such downward spirals into disability.