Moment-to-moment interaction between affectivity and coping behaviours in bipolar disorder and the role of cognitive appraisals

Background Individuals with bipolar disorder respond to affective symptoms with a range of coping behaviours, which may further maintain the symptoms. Aims To examine moment-to-moment dynamics between affective states and coping behaviours, and to evaluate the role of cognitive appraisals of internal states as moderators. Method Forty-six individuals with bipolar disorder completed a clinical interview and an experience sampling assessment over 6 days. Time-lagged analyses were conducted by multilevel regression modelling. Results A total of 1807 momentary entries were analysed. Negative affect predicted an increase in rumination at the subsequent time point (beta = 0.21, s.e. = 0.08, P = 0.009, 95% CI 0.05-0.36), and vice versa (beta = 0.03, s.e. = 0.01, P = 0.009, 95% CI 0.01-0.05). Positive affect predicted an increase in adaptive coping (beta = 0.26, s.e. = 0.11, P = 0.018, 95% CI 0.04-0.47), and vice versa (beta = 0.02, s.e. = 0.01, P = 0.019, 95% CI 0.00-0.03). Positive affect also predicted a decrease in rumination (beta = -0.15, s.e. = 0.06, P = 0.014, 95% CI -0.26 to -0.03), and vice versa (beta = -0.03, s.e. = 0.01, P = 0.016, 95% CI -0.06 to -0.01). Extreme cognitive appraisals predicted stronger associations between affective states and coping behaviours. Conclusions Feedback loops between affective states and coping behaviours were revealed in the daily life of individuals with bipolar disorder, which were moderated by extreme cognitive appraisals.