Bipolar Disorder and the Balancing Act of Emotions

Jasmine Mote

The United States is a culture deeply invested in the pursuit of happiness. But what if feeling excited or ambitious could lead to devastating consequences, such as going bankrupt, hospitalization, or harming yourself?

Bipolar disorder is a mental illness where people experience manic episodes, which for some are characterized by intense feelings of euphoria, pride, or excitement. In common parlance, people often use the terms “bipolar” or “manic” in a derogatory sense, to mean “crazy” (e.g., “She is totally bipolar”). But in reality, bipolar disorder is a serious psychiatric condition with specific symptoms surrounding waves of extreme positive emotion and waves of depression. You’d think that experiencing a lot of positive emotion would be a good thing, but it’s possible to have too much of a good thing.  Feeling too good can have negative consequences.

June Gruber at the University of Colorado, Boulder, among others, has shown that people with bipolar disorder experience more positive emotions and for a longer duration than people who do not, even if they are not experiencing a manic episode (for a review of this literature, go here). Manic episodes may also be characterized for others by intense feelings of irritability and general emotional instability. Overall, however, while manic episodes may feel good for some people, they also lead to an increase in engaging in risky behavior (such as reckless driving) and impulsivity, among other symptoms, and can damage interpersonal relationships, cause severe financial stress, or lead to suicide. Further, many people with bipolar disorder also experience depression between manic episodes, where they may feel sad, not enjoy things that they used to enjoy, find it hard to do everyday tasks, and also have thoughts of suicide.

Balancing ActBalancing emotions in bipolar disorder can be tricky when both feeling good and feeling bad have severe consequences, and some people may decide that it’s simply too risky to put themselves into situations that can cause too much happiness. Research has shown that some people with bipolar disorder try to reduce, or dampen, the positive emotions in their lives more than people without bipolar disorder. For example, they may try to not make a big deal out of positive experiences or avoid positive situations (such as pursuing romantic relationships) altogether to help them prevent a future manic episode. Such strategies lead people to report a lower quality of life and may ultimately put themselves at risk for depression.

So how can people with bipolar disorder stay healthy but also still experience the positive emotions that make life so enriching? As part of a team of researchers led by Sheri Johnson and Ann Kring at the University of California, Berkeley and Judy Moskowitz at Northwestern University, we are currently testing a group treatment intervention to increase healthy positive emotions in people with bipolar disorder. Based on Dr. Moskowitz’s work on interventions designed to increase positive emotion in other populations, such as in people with schizophrenia and people recently diagnosed with HIV, we have developed a 10-week group treatment intervention study called the Learning Affective Understanding for a Rich Emotional Life (LAUREL) Group. The group uses basic emotion research and teaches skills related to increasing positive emotions that have not been shown to significantly increase the risk of a manic episode, such as low activation positive emotions (e.g., calm, relaxation, serenity) and emotions focused on others (e.g., gratitude). Some examples of the skills we teach include emotion regulation strategies (e.g., changing the way we think to change the way we feel), mindfulness meditation, and self-compassion. The study is currently ongoing and we have already received a lot of positive feedback from previous group members. We hope that skills such as these can help people with bipolar disorder — in addition to their current treatments — navigate the balancing act of their emotions so that they can both stay healthy and feel good in their daily life.

Special thanks to Sheri Johnson, Ph.D., for her feedback on an earlier version of this post. 

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Can Disgust Be Anger for Kids?

Sherri Widen

Imagine you and a 2-year-old child are watching TV.  In the show, a man discovers that his soup contains sheep’s eyeballs.  You think to yourself, “Wow, that guy is really disgusted!”  The child says, “Wow, that guy is really mad!”  You are confident that, in fact, the guy is disgusted.  Does that mean that the child is wro2462987456_c9d17a5539_zng?  Most people assume that children and adults understand emotions in very similar ways.  But as this example shows, that may not be the case.

Although children begin using emotion words in conversation before the age of 2 and have a wide emotion vocabulary before the age of 5 years, studies of children’s use of emotion words find that they initially have two broad emotion categories: one for positive emotions and one for negative ones.  For example, 2-year-olds have been asked to say how people with different facial expressions feel.  The 2-year-olds used angry for facial expressions of anger, disgust, and sadness but not for facial expressions of happiness, surprise, or fear.  So, for young children, angry is a much broader category than it is for adults.  Older preschoolers are less likely to use angry for sadness facial expressions but it is not until children are at least 9 years old that they stop using angry for the disgust facial expression.

How do children go from two broad emotion categories (positive vs. negative) to more specific, adult-like categories?  In answering this question, it is helpful to think of emotions as “scripts” which include causes, consequences, and so on: for disgust, a person smells something foul (cause), wrinkles his or her nose (facial expression), covers his or her nose (behavior), and tries to get away from the source (consequence).  Which of these parts of the script might help children first understand that their broad negative emotion category is composed of distinct emotions?  From among all the causes, consequences, behaviors, etc., children need to notice that some things tend to co-occur.  For disgust, causes may provide that initial clue (eating or smelling something awful).  By 3 years, children know both the causes and words for disgust but it is not until they are much older that they connect the facial expression to the other parts of the disgust script.  In contrast, for sadness, by 4 years of age, children have connected the causes, consequences, facial expressions, and labels of the script.

As children move from preschool-aged to middle childhood, they learn about a wider variety of emotions, such as embarrassment, pride, and shame.  Just as younger children initially understand emotions like sadness, anger, and disgust in terms of positive vs. negative emotions, older children initially understand embarrassment, pride, and shame as a part of emotion categories that they already have.  Children (4-10 years) were asked to say how people felt when shown facial expression or told brief stories describing situations that cause these emotions.  Younger children labeled anger, contempt, disgust, and shame as angry and they labeled embarrassment as sad.  Gradually, children distinguished among the emotions and the oldest children used the expected label for all emotions (except contempt, which they labeled as angry).

So, when the 2-year-old in the sheep’s-eyeball-soup example we began with said that the man was angry, she was not wrong.  Within her understanding of emotions, the man was experiencing a negative emotion and her word for negative emotions is angry.  This response represents her current level of emotion understanding but it is also an opportunity for you to teach her something new – what disgust is.  A variety of school-based interventions work to explicitly teach children about emotions and to increase their emotion vocabulary and social skills.  Children are ready to learn about emotions and children who participate in these interventions develop stronger social and emotional skills and have improved grades than children who do not.

 Photo credit: Photo sourced from flickr via Creative Commons License