본 연구는 신경생물학적 취약성인 행동활성화체계(Behavioral Activation System: BAS)와 양극성 증상의 관계를 긍정 정서에 대한 인지적 반응 양식을 통해 설명하고자 했다. BAS 활성화에 의해 긍정 정서가 일어나면, 일차적으로 긍정반추(positive rumination)를 통해 고양되고, 이어서 찬물끼얹기(dampening)로 급히 진화함으로써 기분 기복과 양극성 증상이 만들어진다는 가정을 검증하였다. 이를 위해, 사이버대학생 227명을 대상으로 행동억제 및 활성화 척도, 확장판 긍정 정서 반응 척도, 그리고 양극성 증상을 측정하는 기분장애 질문지 등을 실시했다. BAS와 양극성 증상의 관계에서 긍정 정서에 대한 반응 양식인 긍정반추와 찬물끼얹기가 순차적으로 매개한다는 직렬 다중 매개모형을 검증하였다. 그 결과, BAS가 양극성 증상에 미치는 직접 효과가 유의한 것에 더하여, 예측대로 긍정반추와 찬물끼얹기를 차례로 경유해 양극성 증상에 이르는 간접 효과도 유의하여서, 부분 직렬 매개모형이 지지되었다. 반면에 긍정반추와 찬물끼얹기의 순서를 맞바꾼 직렬 매개모형은 지지되지 않아서, 긍정 정서에 대해 선(先) 상향화, 후(後) 하향화의 순서가 작용함을 확인할 수 있었다. BAS의 작용 기제를 인지적 시각으로 조명하면 긍정 정서를 먼저 증폭시키고 이어서 감쇄시키는 상반된 반응 양식이 양극성 장애의 기본 취약성인 기분기복으로 이어진다는 것이 드러난다. 양극성 장애의 긍정 정서 조절 곤란을 돕기 위한 임상적 시사점과 함께, 본 연구의 한계와 후속 연구의 방향에 대해 논의했다.
This study attempted to explain the influences that Behavioral Activation System (BAS) as neurobiological vulnerability has on bipolar symptom in terms of cognitive response style to positive affect. The hypotheses to be test were that after being activated by BAS the positive affect is firstly enhanced by positive rumination and then extinguished rapidly by dampening with such chain actions resulting in mood swings and bipolar symptom. A total of 227 students of Cyber University in Seoul participated to answer questionnaires on online that measure BAS sub-scales in BIS/BAS Scale, Extended Responses to Positive Affect Questionnaire (E-RPA), and Mood Disorder Questionnaire (MDQ). As results, the positive rumination and the dampening mediated sequentially the relationship between BAS and bipolar symptom. In terms of cognitive mechanism, the process through which the biological motivation system called BAS develops into bipolar symptom may consist of sequential joint actions of upward and downward cognitive modulations culminating in dysfunction of positive affect. In addition, clinical implications to help the control of positive affect for bipolar disorders are discussed, along with the limitations of current study and the directions for future ones.
김교헌, 김원식 (2001). 한국판 행동활성화 및 행동억제 체계 (BAS/BIS) 척도. 한국심리학회지: 건강, 6(2), 19-37.
김병수, 김성윤, 최재원, 주연호, 윤대현, 한내진, ... & 김선옥 (2010). 양극성 경향과 스트레스 취약성: 기분장애설문지 양성 반응군과 음성 반응군에서 지각된 스트레스, A형 행동, 그리고 생활습관의 비교. 정신신체의학, 18(1), 19-29
김빛나 (2016). 양극성 장애 위험군을 대상으로 한 행동활성화체계 모형의 검증. 서울대학교 박사학위논문.
김빛나, 권석만 (2014). 한국판 긍정 정서 반응 척도(K-RPA)의 예비 타당화 연구. Korean Journal of Clinical Psychology, 33(2), 243-260.
김원우, 권영준, 심세훈, 정희연, 권완준, 이화영 (2012). 주요우울장애 환자에서 기분장애 질문지를 이용한 양극성 스펙트럼장애 선별에 관한 연구. Journal of Korean Neuropsychiatric Association, 51, 291-299.
김윤석 (2012). 관해 또는 회복된 양극성 장애 환자에서 충동성과 삶의 질의 관련성에 관한 연구. 경상대학교대학원 석사학위논문.
박종영, 손인기, 남범우, 민경준, 함 웅 (2011). 관해기 양극성 외래 환자에서 한국형 기분장애 질문지 위음성군의 특성. Journal of Korean Neuropsychiatric Association, 50, 187-192.
박혜정 (2010). 정신분열병과 양극성장애 환자의 삶의 질 비교. 이화여자대학교대학원 석사학위논문.
배승오, 윤보현, 박원명, 김문두, 김희철, 서정석, ... & 김태운 (2009). 고등학생을 대상으로 한 양극성 장애의 선별검사. Journal of Korean Neuropsychiatric Association, 48, 502-509.
이대보 (2013). 한국판 양극성 장애 삶의 질 질문지의 신뢰도와 타당도. 원광대학교대학원 석사학위논문.
이아롱 (2013). 경조성 성격 성향에 따른 우울집단의 행동활성화체계 조절곤란. 서울대학교 석사학위논문.
임종길, 강태욱, 문은수, 박제민, 이병대, 이영민, ... & 박영민 (2017). 우울장애 환자에서 양극성 기분성향에 따른 불안민감성과 공황증상 비교. 생물치료정신의학, 23(3), 230-239.
전덕인, 윤보현, 정한용, 하규섭, 신영철, 박원명 (2005). 한국형 기분장애 질문지의 타당화 연구. 신경정신의학, 44, 583-590.
정영인 (2008). 양극성 장애의 새로운 개념: 혼재성 상태를 중심으로. 신경정신의학, 47(2), 119-125.
조용래 (2007). 정서조절곤란의 평가. Korean Journal of Clinical Psychology, 26(4), 1015-1038.
허원무 (2013). 매개효과 분석 방법의 최근 트렌드. 한국비즈니스리뷰, 6(3), 43-59.
허정선, 주해원, 현명호 (2016). 향유와 심리적 건강과의 관계. 스트레스硏究, 24(4), 303-308.
Abraham, K. (1911). Notes on the psycho-analytic investigation and treatment of manic-depressive insanity and allied conditions. In E. Jones (ed.), in Selected papers of Karl Abraham. London: Hogarth.
Alatiq, Y., Crane, C., Williams, J. M. G., & Goodwin, G. M. (2010). Dysfunctional beliefs in bipolar disorder: Hypomanic vs. depressive attitudes. Journal of Affective Disorders, 122(3), 294-300.
Alloy, L. B., Bender, R. E., Whitehouse, W. G., Wagner, C. A., Liu, R. T., Grant, D. A., ... & Abramson, L. Y. (2012). High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: A prospective behavioral high-risk design. Journal of Abnormal Psychology, 121(2), 339-351.
Balconi, M., Vanutelli, M. E., & Grippa, E. (2017). Resting state and personality component (BIS/BAS) predict the brain activity (EEG and fNIRS measure) in response to emotional cues. Brain and Behavior, 7(5), e00686.
Carl, J. R., Soskin, D. P., Kerns, C., & Barlow, D. H. (2013). Positive emotion regulation in emotional disorders: A theoretical review. Clinical Psychology Review, 33(3), 343-360.
Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: the BIS/BAS scales. Journal of Personality and Social Psychology, 67(2), 319-333.
Chou, C. C., Lee, I. H., Yeh, T. L., Chen, K. C., Chen, P. S., Chen, W. T., ... & Yang, Y. K. (2012). Comparison of the validity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and Mood Disorder Questionnaire (MDQ) for the detection of bipolar disorder in medicated patients with major depressive disorder. International Journal of Psychiatry in Clinical Practice, 16(2), 132-137.
Davidson, R. J. (2000). Affective style, psychopathology, and resilience: brain mechanisms and plasticity. American Psychologist, 55(11), 1196.
Dempsey, R. C., Gooding, P. A., & Jones, S. H. (2011). Positive and negative cognitive style correlates of the vulnerability to hypomania. Journal of Clinical Psychology, 67(7), 673-690.
Depue, R. A., & Iacono, W. G. (1989). Neurobehavioral aspects of affective disorders. Annual Review of Psychology, 40(1), 457-492.
Dodd, A. L., Mansell, W., Morrison, A. P., & Tai, S. (2011). Extreme appraisals of internal states and bipolar symptoms: The Hypomanic Attitudes and Positive Predictions Inventory. Psychological Assessment, 23(3), 635.
Edge, M. D., Miller, C. J., Muhtadie, L., Johnson, S. L., Carver, C. S., Marquinez, N., & Gotlib, I. H. (2013). People with bipolar I disorder report avoiding rewarding activities and dampening positive emotion. Journal of Affective Disorders, 146(3), 407-413.
Edvardsen, J., Torgersen, S., Røysamb, E., Lygren, S., Skre, I., Onstad, S., & Øien, P. A. (2008). Heritability of bipolar spectrum disorders. Unity or heterogeneity?. Journal of Affective Disorders, 106(3), 229-240.
Feldman, G. C., Joormann, J., & Johnson, S. L. (2008). Responses to positive affect: A self-report measure of rumination and dampening. Cognitive Therapy and Research, 32(4), 507-525.
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured Clinical Interview for DSM-5-Research Version (SCID-5- RV). Arlington, VA: American Psychiatric Association.
Fletcher, K., Parker, G. B., & Manicavasagar, V. (2013). Coping profiles in bipolar disorder. Comprehensive Psychiatry, 54(8), 1177-84.
Gilbert, K. E., Nolen-Hoeksema, S., & Gruber, J. (2013). Positive emotion dysregulation across mood disorders: How amplifying versus dampening predicts emotional reactivity and illness course. Behaviour Research and Therapy, 51(11), 736-741.
Gitlin, M. J., Swendsen, J., Heller, T. L., & Hammen, C. (1995). Relapse and Impairment in Bipolar Disorder. American Journal of Psychiatry, 152(11), 1635-1640.
Gray, J. A. (1981). A critique of Eysenck’s theory of personality. In H. J. Eysenck (Ed), A model for personality (pp. 246-276). Berlin: Springer-Verlag.
Gray, J. A. (1982). The neuropsychology of anxiety: an inquiry into the functions of the septo-hippocampal system. NY: Oxford University Press.
Gruber, J. (2011). Can feeling too good be bad? Positive emotion persistence (PEP) in bipolar disorder. Current Directions in Psychological Science, 20(4), 217-221.
Gruber, J., Eidelman, P., Johnson, S. L., Smith, B., & Harvey, A. G. (2011). Hooked on a feeling: Rumination about positive and negative emotion in inter-episode bipolar disorder. Journal of Abnormal Psychology, 120(4), 956-961.
Hanssen, I., Regeer, E. J., Schut, D., & Boelen, P. A. (2018). Ruminative and dampening responses to positive affect in bipolar disorder and major depressive disorder. Comprehensive Psychiatry, 85, 72-77.
Healy, D., & Williams, J. M. (1989). Moods, misattributions and mania: an interaction of biological and psychological factors in the pathogenesis of mania. Psychiatric Developments, 7(1), 49-70.
Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck Jr, P. E., ... & Russell, J. M. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873-1875.
Hopkins, W. G. (1997). [On-Line]. New view of statistics. Retrieved August 23, 2002 from http://www.sportsci.org/resource/stats/effectmag.html.에서 2019. 7. 14 자료 얻음.
Ives-Deliperi, V. L., Howells, F., & Horn, N. (2016). The Effects of Mindfulness-Based Cognitive Therapy in Bipolar Disorder. In Mindfulness-Based Cognitive Therapy (pp. 155-161). Switzerland: Springer International Publishing.
Johnson, S. L., Edge, M. D., Holmes, M. K., & Carver, C. S. (2012). The behavioral activation system and mania. Annual Review of Clinical Psychology, 8, 243-267.
Johnson, S. L., Fulford, D., & Carver, C. S. (2012). The double‐edged sword of goal engagement: consequences of goal pursuit in bipolar disorder. Clinical Psychology & Psychotherapy, 19(4), 352-362.
Johnson, S. L., McKenzie, G., & McMurrich, S. (2008). Ruminative responses to negative and positive affect among students diagnosed with bipolar disorder and major depressive disorder. Cognitive Therapy and Research, 32(5), 702-713.
Jones, S. H. (2001). Circadian rhythms, multilevel models of emotion and bipolar disorder—an initial step towards integration?. Clinical Psychology Review, 21(8), 1193-1209.
Judd, L. L., Akiskal, H. S., Schettler, P. J., Endicott, J., Maser, J., Solomon, D. A., ... & Keller, M. B. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59(6), 530-537.
Kelly, R. E., Dodd, A. L., & Mansell, W. (2017). “When my Moods Drive Upward There Is Nothing I Can Do about It”: A Review of Extreme Appraisals of Internal States and the Bipolar Spectrum. Frontiers in Psychology, 8, 1235.
Kelly, R. E., Mansell, W., Wood, A. M., Alatiq, Y., Dodd, A., & Searson, R. (2011). Extreme positive and negative appraisals of activated states interact to discriminate bipolar disorder from unipolar depression and non-clinical controls. Journal of Affective Disorders, 134(1), 438-443.
Kieseppä, T., Partonen, T., Haukka, J., Kaprio, J., & Lönnqvist, J. (2004). High concordance of bipolar I disorder in a nationwide sample of twins. American Journal of Psychiatry, 161(10), 1814-1821.
Kiken, L. G., Lundberg, K. B., & Fredrickson, B. L. (2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness, 8(5), 1280-1290.
Kline, R. B. (2005). Principles and practice of structural equationmodeling(2nd Ed.). New York: Gulford Press.
Lam, D., & Wong, G. (2005). Prodromes, coping strategies and psychological interventions in bipolar disorders. Clinical Psychology Review, 25(8), 1028-1042.
Lam, D., Wong, G., & Sham, P. (2001). Prodromes, coping strategies and course of illness in bipolar affective disorder-a naturalistic study. Psychological Medicine, 31(8), 1397-402.
Lauren B., A., Lyn Y., A., Patricia D., W., Alex, C., Jeannette M., S., Amy M., N., & ... Robin, N. (2006). Behavioral Approach System (BAS) Sensitivity and Bipolar Spectrum Disorders: A Retrospective and Concurrent Behavioral High-Risk Design. Motivation and Emotion, 30(2), 143-155.
Lazarus, R. S. (1991). Cognition and motivation in emotion. American Psychologist, 46(4), 352-367.
Mansell, W., & Jones, S. H. (2006). The Brief-HAPPI: A questionnaire to assess cognitions that distinguish between individuals with a diagnosis of bipolar disorder and non-clinical controls. Journal of Affective Disorders, 93(1-3), 29-34.
Mansell, W., Morrison, A. P., Reid, G., Lowens, I., & Tai, S. (2007). The interpretation of, and responses to, changes in internal states: An integrative cognitive model of mood swings and bipolar disorders. Behavioural and Cognitive Psychotherapy, 35(5), 515-539.
Mansell, W., Paszek, G., Seal, K., Pedley, R., Jones, S., Thomas, N., ... & Dodd, A. (2011). Extreme appraisals of internal states in bipolar I disorder: A multiple control group study. Cognitive Therapy and Research, 35(1), 87-97.
McGuffin, P., Rijsdijk, F., Andrew, M., Sham, P., Katz, R., & Cardno, A. (2003). The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of General Psychiatry, 60(5), 497-502.
Meyer, T. D., Bernhard, B., Born, C., Fuhr, K., Gerber, S., Schaerer, L., ... & Schöttle, D. (2011). The Hypomania Checklist-32 and the Mood Disorder Questionnaire as screening tools-going beyond samples of purely mood-disordered patients. Journal of Affective Disorders, 128(3), 291-298.
Meyer, B., Johnson, S. L., & Winters, R. (2001). Responsiveness to threat and incentive in bipolar disorder: Relations of the BIS/BAS scales with symptoms. Journal of Psychopathology and Behavioral Assessment, 23(3), 133-143.
Nallet, A., Weber, B., Favre, S., Gex-Fabry, M., Voide, R., Ferrero, F., ... & Aubry, J. M. (2013). Screening for bipolar disorder among outpatients with substance use disorders. European Psychiatry, 28(3), 147-153.
Neale, J. M. (1988). Defensive functions of manic episodes. In T. F. Oltmanns & B. A. Maher (Eds.), in Delusional beliefs(pp. 138-156). New York: Wiley.
Özgürdal, S., Van Haren, E., Hauser, M., Ströhle, A., Bauer, M., Assion, H. J., & Juckel, G. (2009). Early mood swings as symptoms of the bipolar prodrome: preliminary results of a retrospective analysis. Psychopathology, 42(5), 337-342.
Quoidbach, J., Berry, E. V., Hansenne, M., & Mikolajczak, M. (2010). Positive emotion regulation and well-being: Comparing the impact of eight savoring and dampening strategies. Personality and Individual Differences, 49(5), 368-373.
Ruggero, C. J., Bain, K. M., Smith, P. M., & Kilmer, J. N. (2015). Dysfunctional cognitions among offspring of individuals with bipolar disorder. Behavioural and Cognitive Psychotherapy, 43(4), 449-464.
Salavert, J., Caseras, X., Torrubia, R., Furest, S., Arranz, B., Duenas, R., & San, L. (2007). The functioning of the Behavioral Activation and Inhibition Systems in bipolar I euthymic patients and its influence in subsequent episodes over an eighteen-month period. Personality and Individual Differences, 42(7), 1323-1331.
Sanchez‐Moreno, J., Villagran, J. M., Gutierrez, J. R., Camacho, M., Ocio, S., Palao, D., ... & EDHIPO (Hypomania Detection Study) Group. (2008). Adaptation and validation of the Spanish version of the Mood Disorder Questionnaire for the detection of bipolar disorder. Bipolar Disorders, 10(3), 400-412.
Sasdelli, A., Lia, L., Luciano, C. C., Nespeca, C., Berardi, D., & Menchetti, M. (2013). Screening for bipolar disorder symptoms in depressed primary care attenders: comparison between Mood Disorder Questionnaire and Hypomania Checklist (HCL-32). Psychiatry Journal, Article ID 548349, 9 pages.
Searson, R., Mansell, W., Lowens, I., & Tai, S. (2012). Think Effectively About Mood Swings (TEAMS): A case series of cognitive- behavioural therapy for bipolar disorders. Journal of Behavior Therapy and Experimental Psychiatry, 43(2), 770-779.
Soares, O. T., Moreno, D. H., Moura, E. C. D., Angst, J., & Moreno, R. A. (2010). Reliability and validity of a Brazilian version of the Hypomania Checklist (HCL-32) compared to the Mood Disorder Questionnaire (MDQ). Revista Brasileira de Psiquiatria, 32(4), 416-423.
Stange, J. P., Shapero, B. G., Jager-Hyman, S., Grant, D. A., Abramson, L. Y., & Alloy, L. B. (2013). Behavioral approach system (BAS)-relevant cognitive styles in individuals with high versus moderate bas sensitivity: A behavioral high-risk design. Cognitive Therapy and Research, 37(1), 139-149.
Tavormina, G. (2010). The temperaments and their role in early diagnosis of bipolar spectrum disorders. Psychiatria Danubina, 22(1), 15-17.
Twiss, J., Jones, S., & Anderson, I. (2008). Validation of the Mood Disorder Questionnaire for screening for bipolar disorder in a UK sample. Journal of Affective Disorders, 110(1-2), 180-184.
Urošević, S., Alloy, L. B., Abramson, L. Y., Jager-Hyman, S., Nusslock, R., Whitehouse, W. G., & Hogan, M. (2012). Progression along the bipolar spectrum: A longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders. Journal of Abnormal Psychology, 121(1), 16-27.
Van Dijk, Sheri, Segal, & Zindel V. (2015). 조울병의 변증법적 행동치료 워크북 [The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder. USA, New Harbinger Publications]. (김원 역). 서울: 시그마프레스. (원전은 2009년에 출판)
Wagner, K. D., Hirschfeld, R. M. A., Emslie, G. J., Findling, R. L., Gracious, B. L., & Reed, M. L. (2006). Validation of the Mood Disorder Questionnaire for Bipolar Disorders in Adolescents. The Journal of Clinical Psychiatry, 67(5), 827-830.
Wang, Y. Y., Xu, D. D., Liu, R., Yang, Y., Grover, S., Ungvari, G. S., ... & Xiang, Y. T. (2019). Comparison of the screening ability between the 32-item Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ) for bipolar disorder: A meta-analysis and systematic review. Psychiatry Research, 273, 461-466.
Wang, Y. T., Yeh, T. L., Lee, I. H., Chen, K. C., Chen, P. S., Yang, Y. K., & Lu, R. B. (2009). Screening for bipolar disorder in medicated patients treated for unipolar depression in a psychiatric outpatient clinic using the Mood Disorder Questionnaire. International Journal of Psychiatry in Clinical Practice, 13(2), 117-121.
Wheeler, R. E., Davidson, R. J., & Tomarken, A. J. (1993). Frontal brain asymmetry and emotional reactivity: A biological substrate of affective style. Psychophysiology, 30(1), 82-89.
Wood, J. V., Heimpel, S. A., & Michela, J. L. (2003). Savoring versus dampening: self-esteem differences in regulating positive affect. Journal of Personality and Social Psychology, 85(3), 566-580.
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: reliability, validity and sensitivity. The British Journal of Psychiatry, 133(5), 429-435.
Zimmerman, M., Galione, J. N., Ruggero, C. J., Chelminski, I., Young, D., Dalrymple, K., & McGlinchey, J. B. (2010). Screening for bipolar disorder and finding borderline personality disorder. Journal of Clinical Psychiatry, 71(9), 1212-1217.
Zimmerman, M., & Morgan, T. A. (2013). Problematic boundaries in the diagnosis of bipolar disorder: the interface with borderline personality disorder. Current Psychiatry Reports, 15(12), 422.
