The two theoretical approaches described recognise the importance of biological vulnerability in bipolar affective disorder, which may take the form of a genetic predisposition to the illness manifested as instability in biological systems such as the BAS and those governing circadian rhythms. However, both approaches propose a key role for cognitive biases in the maintenance of the condition. Attitudes towards—and processing of—reward and goal attainment have been indicated by a number of studies as possible sites of cognitive dysfunction in bipolar disorder, and these theories suggest several ways in which this dysfunction may operate. At present, the evidence for a causal link between reward sensitivity and the development of manic symptoms is largely correlational: more detailed experimental work investigating abnormal behavioural and emotional response to reward in euthymic bipolar individuals would aid in testing the model proposed.
In clinical practice, not all clients are observed to hold clear extreme goal-striving beliefs. It is possible that these beliefs characterise a subset of bipolar individuals, for whom the course of their illness is greatly affected by the unhelpful nature of such attitudes. Another possibility is that such attitudes are mood-state dependent: several studies report the level of dysfunctional attitudes to change significantly in affectively disordered individuals after both negative and positive mood induction (Miranda & Persons, 1988; Miranda et al., 1998). Thus, highly goal-striving attitudes may be active only when mood is raised. Again, experimental work could test this possibility in bipolar individuals. Finally, studies examining dysfunctional assumptions in bipolar disorder have employed a limited range of measures. Excessive goal-striving may be manifested in many different ways, and in many different spheres of life. While theoretical research can work to uncover the essential common elements of these beliefs within the bipolar population, therapists must expect great variation between individuals in the extent to which these cognitive biases dominate the course of the illness, and when and where they might be most harmful.
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