Risk-taking behaviours in Bipolar Disorder (BD) still pose significant challenges in clinical practice and are a major barrier to recovery for people diagnosed with BD. The majority of studies on risk-taking in bipolar disorder have been focused only on the association between risk and “trait impulsivity,” defined in research as a “predisposition to action without regard for consequences.”
Thus, according to this definition, people diagnosed with bipolar disorder share a common inherent trait — impulsivity — which leads them to engage in risky behaviours (e.g., unprotected sex, gambling) without taking into account the consequences that could result from these.
In the United Kingdom bipolar disorder is usually managed through a combination of medication and psychological therapy. This joint approach is thought to contribute to recovery. Nonetheless, very few psychotherapeutic treatments seem to specifically target risk-taking behaviour (other than via reducing impulsivity).
Considering the negative impact of risk-taking behaviours (e.g. familial, economical), and the lack of specific interventions to minimise its occurrence, we decided to evaluate a really interesting theory of decision making called Fuzzy Trace Theory (FTT).
Fuzzy Trace Theory (FTT) was proposed by Dr Valerie Reyna from Cornell University; she puts forward that people make sense of their daily experiences by forming “mental representations” of what happens around them. When people need to make a decision, they then retrieve the stored “mental representations” of past events to decide on the most favourable option for them among the ones presented (e.g. whether to engage in unprotected sex or not).
In studies conducted with adults and adolescents, it has been shown that these two populations rely on two different types of mental representations to make decisions. Adults use what Dr Reyna defines as “gist” representations, as in representations that capture the bottom-line meaning of a past event; adolescents tend to rely on “verbatim” representations, as in more detailed representations of a past event.
For example, consider that there is a 1% chance to contract HIV when engaging in unprotected sex. Adolescents are more likely to assume that it is okay to engage in unprotected sex, because the actual possibility (based on numbers) to contract HIV is quite low (1% means that it is quite rare). However, what they don’t consider is the bottom-line meaning of that 1% — that “it only takes one infected person to contract HIV” and we don’t know when this infected person will come along (it could be the first and only person you ever have unprotected sex with).
Adults, on the other hand, are more likely to rely on “gist” representations, and therefore on the bottom-line meaning “it only takes one to contract HIV from unprotected sex;” therefore, they are generally less likely to engage in unprotected sex (or other types of risk-taking behaviours).
Of particular interest are some preliminary studies based on FTT with adolescents, which have shown that risk-taking behaviours can be reduced via a particular intervention that educates people to modify the way they make decisions.
During my time at the Doctorate in Clinical Psychology at Lancaster University, I conducted a study in collaboration with the Spectrum Centre for Mental Health Research, with the aim to characterise risk-taking behaviours in a group of 58 people with Bipolar Disorder using ideas from fuzzy trace theory (FTT). We tested whether measures of FTT (verbatim and gist-based thinking) were predictive of risk-taking intentions in BD, after controlling for mood and impulsivity. We hypothesised that FTT scales would be significant predictors of risk-taking intentions even after accounting for mood and impulsivity.
Interestingly, we found that fuzzy trace theory gist and verbatim representations were both independent predictors of risk-taking intentions, even after controlling for mood and impulsivity. The results offer an innovative conceptualisation of the mechanisms behind risk-taking in BD. The preliminary results of our study suggest that risk-taking behaviour in bipolar disorder is not just a consequence of impulsivity, as it is overwhelmingly suggested by the available literature.
Interested to know more? Further information is available below:
Click here to read the full blog on the CREST-BD website.
Click here to access the full publication on the Psychology and Psychotherapy BPS Journal.
Click here to access a follow-up article by my co-author, Julia Lukacs.