title: An investigation of mental imagery in bipolar disorder: Exploring "the mind's eye".
abstract: Mental imagery abnormalities occur across psychopathologies and are hypothesized to drive emotional difficulties in bipolar disorder (BD). A comprehensive assessment of mental imagery in BD is lacking. We aimed to test whether (i) mental imagery abnormalities (abnormalities in cognitive stages and subjective domains) occur in BD relative to non-clinical controls; and (ii) to determine the specificity of any abnormalities in BD relative to depression and anxiety disorders.
  
  
  
  Participants included 54 subjects in the BD group (depressed/euthymic; n=27 in each subgroup), subjects with unipolar depression (n=26), subjects with anxiety disorders (n=25), and non-clinical controls (n=27) matched for age, gender, ethnicity, education, and premorbid IQ. Experimental tasks assessed cognitive (non-emotional) measures of mental imagery (cognitive stages). Questionnaires, experimental tasks, and a phenomenological interview assessed subjective domains including spontaneous imagery use, interpretation bias, and emotional mental imagery.
  
  
  
  (i) Compared to non-clinical controls, the BD combined group reported a greater impact of intrusive prospective imagery in daily life, more vivid and "real" negative images (prospective imagery task), and higher self-involvement (picture-word task). The BD combined group showed no clear abnormalities in cognitive stages of mental imagery. (ii) When depressed individuals with BD were compared to the depressed or anxious clinical control groups, no significant differences remained-across all groups, imagery differences were associated with affective lability and anxiety.
  
  
  
  Compared to non-clinical controls, BD is characterized by abnormalities in aspects of emotional mental imagery within the context of otherwise normal cognitive aspects. When matched for depression and anxiety, these abnormalities are not specific to BD-rather, imagery may reflect a transdiagnostic marker of emotional psychopathology.
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Martina
authors.identifier: 0000-0001-5701-9659
authors.initials: M
authors.lastname: Di Simplicio
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Fritz
authors.initials: F
authors.lastname: Renner
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.|Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
authors.forename: Simon E
authors.initials: SE
authors.lastname: Blackwell
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Mitchell
authors.affiliation: Highfield Inpatient Adolescent Unit, Warneford Hospital, Oxford, UK.
authors.forename: Hannah J
authors.initials: HJ
authors.lastname: Stratford
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Watson
authors.affiliation: Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK.|Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Myers
authors.affiliation: Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Oxford, UK.|Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Nobre
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Lau-Zhu
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.|Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Holmes
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007092:Imagination; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D011446:Prospective Studies; D011599:Psychopathology; D013223:Statistics as Topic; D011795:Surveys and Questionnaires
keywords: affective lability; anxiety; bipolar disorder; cognitive functioning; depression; mental imagery