Question 1

What is emotion-related impulsivity? Does it relate to all types of emotions?

Sheri Johnson · Accepted Answer

Emotion-related impulsivity is the tendency to say or do things or to have trouble controlling one's emotion-related thinking during states of high emotion. Intriguingly, people who struggle with this type of impulsivity often don't have problems with being impulsive unless they are experiencing intense emotions. Many respond to both negative and positive emotions with actions they later regret. You can see the items we use to assess emotion-related impulsivity here: 
https://calm.berkeley.edu/3-factor/

Question 2

Can people who have experienced mania become wary and avoiding of positive emotions? How can we help people who are presenting with this have a life with a full range of emotional experiences?

Sheri Johnson · Accepted Answer

Yes, sadly, I think this is so. We developed a scale to ask people how much they tended to dampen their positive emotions (e.g., by saying things to themselves like "this will never last"). We also developed a scale to ask people how often they tend to avoid chasing very rewarding outcomes in their lives (E.g., starting a new romantic relationship, going after an award) because they fear that they could become manic. We found that people with diagnoses of bipolar disorder endorsed both. You can see more about the items we used to assess dampening positive emotions here: https://calm.berkeley.edu/pog/

We think this is a sign that people with bipolar disorder should develop and practice good skills for regulating their positive emotions and their joy—so that they feel like they can enjoy the good, but also down-regulate and head to sleep when they want to.

Question 3

How important is regulating sleep cycles and routines in stabilizing mood and emotions? Are there any specific resources that you could recommend for helping patients with this? I've heard that morning sunlight can help...

Sheri Johnson · Accepted Answer

Sleep is so important. Sleep helps everyone regulate their emotions, and it seems particularly important for people living with bipolar disorder. Allison Harvey and her colleagues found that treating insomnia among people with bipolar disorder could help reduce the chances of new manic symptoms emerging. Here is an interesting article about her work: https://www.apa.org/science/about/psa/2015/02/improve-sleep

Question 4

Is there a prodromal phase with bipolar disorder and what does it look like?

Sheri Johnson · Accepted Answer

Many people with bipolar disorder report that they have always been someone with more intense emotions. Sometimes, they report having minor manic symptoms that never became a full episode. About 10% of people who experience hypomanic episodes will develop full-blown manic episodes.

Question 5

Is hypomania always a problem? Especially since some people finally feel better and like being productive?

Sheri Johnson · Accepted Answer

By definition, hypomania does not lead to major problems in functioning. So a key question for a person is whether they or their family and friends notice problems. It is worth thinking about whether something that is only a minor problem when it happens once is more of concern if it keeps happening. For example, a person who spends an extra $100 one week when hypomanic might be able to recover from that financially, but it will be harder to recover from that if it happens every month.

Question 6

Is there a link between ADHD and mania/bipolar?

Sheri Johnson · Accepted Answer

Yes, there is. Many people with bipolar disorder report that they experienced ADHD symptoms as children. This may be because the regions of the brain that are involved in the two conditions have some overlap.

Question 7

How long can manic periods last?

Sheri Johnson · Accepted Answer

Most manic episodes last 2 months or less. Sometimes milder periods with some manic symptoms last longer.

Question 8

Are compulsive thoughts a symptom of bi-polar disorder?

Sheri Johnson · Accepted Answer

Great question. Sometimes we find that people with bipolar disorder find it hard to disengage from an idea or a goal. In that way, their thoughts can feel compulsive. Often, we find the thoughts are about dreams and goals, which is a little different than what sometimes happens for other people with compulsive patterns.

Question 9

When are compulsive over-spending, binging on food, and feelings of euphoria contrasted with feelings of lethargy, possible signs of bipolar disorder?

Sheri Johnson · Accepted Answer

To think about whether euphoria, over-spending and engaging in other pleasurable activities to a point that could create problems should be thought about as mania (which is the defining feature of bipolar disorder), it is important to consider if other symptoms are present. Some of the other key symptoms include anger and aggression, lack of need for sleep, talking too much, excessive energy/difficulty sitting still, feeling overly self-confident, difficulty focusing attention, and willingness to take risks one would not typically take. We look for these signs to all happen at the same time, to last for a week or longer (or be so intense that they create severe problems), and to be a distinct shift from how a person typically is. You can read more about mania and bipolar disorder here:
https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

In a very parallel way, before we think of lethargy as being part of depression, we look to see if a person has had other signs and symptoms of depression at the same time. This might involve changes like low self-confidence, feeling hopeless, lack of appetite and/or weight loss, and difficulty sleeping.

Question 10

Dr Johnson, I'm interested to hear which psychological interventions that you see as having potential for impacting the link between positive emotions and impulsivity?

Sheri Johnson · Accepted Answer

We have tested a very simple online intervention that focuses on a couple of key skills:

•	Recognizing the triggers for emotions
•	Choosing and  practicing skills to feel calmer
•	Leaving a scene where trouble could happen until one feels calmer.

People learned the skills, and they reported that they experienced less impulsivity at the end of treatment. We've only tested this in a very small group, and we want to test it in the future in a larger group of people, with better comparison against a control group.

Question 11

I am 58 years old and believe I am facing a change in longtime depression to bipolar 2. Is that possible?

Sheri Johnson · Accepted Answer

Bipolar disorder can change across the lifetime. Most of the time, it starts in early adulthood. But it can come on later in life. Other medical conditions should be ruled out whenever a person develops these symptoms (e.g., thyroid conditions). So it is a good idea to see a doctor to see if there are other conditions that might be contributing.

Understanding Mania