The role of coping flexibility with behavioral approach system (BAS) activating life events : a prospective longitudinal study involving people with and without bipolar disorder

Abstract

Researchers have demonstrated the impact of life events in causing mood fluctuation among people with bipolar disorder (BD). By integrating the Behavioral Approach System (BAS) dysregulation theory and coping flexibility framework, this thesis aims to identify the additional role of coping with life events by measuring the associations between BAS sensitivity level, psychosocial functioning level, coping flexibility, and mood states in a sample of community-dwelling individuals with and without BD. The investigation was carried out through three interrelated studies. Study 1: Using a cross-sectional study design, 90 participants with remitted BD were recruited. Each individual was presented with four different BAS- activating life-event scenarios. Respective scales and questionnaires were used for the corresponding measurements. Different styles of coping flexibility were identified using the hierarchical clustering method. Further examinations of the mediating and moderating roles of coping were also performed. Findings showed that a low degree of coping flexibility matched with low levels of both BAS sensitivity and psychosocial functioning protected people with BD from detrimentally accentuating mood states when encountering BAS-activating life events. Moreover, the mediating and moderating roles of coping were confirmed. Study 2: Extending study 1, this study made a further comparison between participants with (n = 90) and without (n = 90) BD. Multivariate analysis of covariance (MANCOVA) was used to examine group differences. The added value of coping was determined using sequential multiple regression. The mediating and moderating roles of coping were also identified for the entire sample. Findings indicated significant between-group differences in all major variables. Coping flexibility had an additional value in predicting mood states beyond BAS sensitivity and psychosocial functioning levels. In addition, emotion-focused and behavioral-activation/emotion-amplifying coping were suggested to mediate the relationship between BAS sensitivity level and mood states. Furthermore, perceived controllability was shown to alleviate the effects of BD diagnosis, BAS sensitivity level, and psychosocial functioning level on mood states. Study 3: Using a 12-month prospective cohort observational design, this study examined the changes in coping flexibility and mood states at 6-month and 12-month follow-ups for the entire sample. Hierarchical linear modeling (HLM) was performed to test the individual growth model by studying repeatedly measured data. The findings showed fluctuations in different components of coping flexibility and mood states across time. It confirmed the amplified emotionality characteristics of BD as compared with the healthy control group. Moreover, coping flexibility took precedence over BAS sensitivity and psychosocial functioning levels in predicting mood states. Reducing the perceived controllability and number of coping strategies seemed to be effective in regulating the over-elevated mood states among people with BD. In conclusion, the three interrelated studies supplement each other to show the role of coping flexibility in affecting mood states across time. Theoretically, the present thesis helps to integrate the concept of coping flexibility into the BAS dysregulation theory by applying to a new context of BD. It also has practical implications for the improvement of stress management programs. In particular, judicious use of coping in enhancing mindfulness practice and the personal recovery process are discussed.