Psychological Behaviorism Theory of Bipolar Disorder
Riedel, Helmut P. R., Heiby, Elaine M., Kopetskie, Stephen, The Psychological Record
This review addresses the etiology of bipolar disorder and presents the literature within a psychological behaviorism framework (Staats, 1996; Staats & Heiby, 1985). The proposed theory attempts to provide an integrative developmental approach that is grounded in established behavioral principles. The bipolar theory posits 15 hypotheses based on past and concurrent biological and situational factors as well as their interactions with an individual's basic behavioral repertoires. Implications for subclassification and treatment research are noted.
During the past several decades, there has been a proliferation of psychological theories of adult unipolar depression that have been extended to children (e.g., Abramson, Seligman, & Teasdale, 1978; Beck, 1967; Ferster, 1973; Lewinsohn, 1974; Rehm, 1977; Staats & Heiby, 1985). Meanwhile, there has been a paucity of psychological theories of bipolar disorder since Kraepelin (1921) observed mania not only among adults but also among 3% of his child and adolescent patients.
The apparent assumption of most of the research evaluating the etiology and treatment of bipolar disorder has been that this is primarily a biological condition for which primarily biological interventions are indicated. Biological bias has left the psychological aspects of bipolar disorder largely unexplored and the biological research poorly integrated with advances in other areas of investigation (Depue & lacono, 1989). Fortunately, a number of investigators have expressed concern about this state of affairs (e.g., Akiskal, 1986; Bebbington, 1986; Depue & lacono, 1989; O'Connell, 1986; Perris, 1986; Rehm & Tyndall, 1993).
The recent developments of psychosocial (Craighead, Miklowitz, Vajk, & Frank, 1998), cognitive behavioral (Basco & Rush, 1996), and family (Miklowitz & Goldstein, 1997) treatments for bipolar disorder are promising but have focused primarily on enhancement of medication compliance. They are extensions of treatments developed for unipolar depression and chronic and severe disorders. These treatments are not based upon a psychological theory of the development of bipolar disorder and are not designed as behavioral prevention and change alternatives to psychoactive substances.
It is the purpose of this paper to suggest an integration of the bipolar literature on vulnerability factors in childhood and maintenance factors in adulthood. The guiding theoretical framework for this integration is Staats' (1975) social behaviorism, later referred to as paradigmatic (e.g., Staats, 1986) and more recently psychological behaviorism (Staats, 1996). The theory is an extension of classical and operant conditioning as well as developmental and cumulative human learning principles. Each revision of the theory was accompanied with a broader integration of levels of analysis (e.g., inclusion of organic factors) and additional behavioral principles (e.g., self-administered verbal-emotional stimuli that have directive, affective, and reinforcing effects). Psychological behaviorism (PB) was selected because it has been shown to have heuristic value for organizing the disparate research on intelligence (Leduc, Dumais, & Evans, 1990), unipolar depression (Heiby & Staats, 1990; Staats & Heiby, 1985), anx iety disorders (Hekmat, 1990), and other forms of psychopathology for which there is no generally accepted theory (Eifert & Evans, 1990; Staats, 1996). Although the application of PB theory to unipolar depression includes some mention of bipolar disorder, the utility of the theory for integration of the bipolar literature has not been evaluated previously.
First, bipolar disorder will be described. Second, a summary of general PB theory will be presented. Third, the research investigating the childhood and adult etiology of bipolar disorder will be organized according to the situational, behavioral, and organic factors proposed in PB theory. …