Psychological Medicine

Original Articles

Sense of hyper-positive self, goal-attainment beliefs and coping strategies in bipolar I disorder

R. Leea1, D. Lama1 c1, W. Mansella1 and A. Farmera2

a1 Psychology Department, Institute of Psychiatry, King's College London, UK

a2 MRC SGPD Unit, Institute of Psychiatry, King's College London, UK


Background There is some evidence that cognitive therapy (CT) is beneficial in reducing relapses in bipolar disorder. However, not all bipolar patients benefit from it. A previous study found that a group of non-responders to CT shared common characteristics: they value some of the high goal-attainment beliefs and characteristics associated with being in a state of mild hypomania – a high ‘sense of hyper-positive self’ (SHPS). To promote of our understanding of this group of patients, the present study investigated the relationship between SHPS, preferred internal state, dysfunctional attitudes and coping with hypothetical manic prodromal scenarios.

Method Fifty-four bipolar I patients filled in self-report questionnaires that assess preferred mood state, coping with scenarios, dysfunctional attitudes and SHPS.

Results The Sense of Hyper-positive Self Scale Ideal score (SHPSS-Ideal) predicted patients' preferred internal state of mania. Coping with hypothetical scenarios was predicted by Dysfunctional Attitude Scale (DAS) goal-attainment scores: the higher the goal-attainment score, the higher the participant's tendency to identify with self-descriptors linked to hypomania and to engage in stimulating behaviours that may escalate the prodromal stage to mania.

Conclusions Clinicians should check and modify goal-attainment beliefs, particularly of those who exhibit features of SHPS. These patients' tendency to identify with hypomanic traits as self-descriptors should be dealt with by psychological techniques such as cognitive restructuring.

(Received March 18 2009)

(Revised July 29 2009)

(Accepted July 29 2009)

(Online publication September 15 2009)


c1 Address for correspondence: D. Lam, Ph.D., Department of Clinical Psychology, Hull York Medical School, University of Hull, Hull HU6 7RX, UK. (Email: