Mental imagery and mood instability in patients with bipolar disorder

This dissertation examined the role of mental imagery, or nonverbal thinking, on mood instability in patients with bipolar vulnerability, a mental illness with limited treatment options and high suffering. At the center was Emily Holmes' cognitive model that suggests that mood instability in patients with bipolar vulnerability is associated with mental imagery and anxiety. Several studies in this dissertation examined mental imagery. One questionnaire study compared aspects of mental imagery in different groups. The association between mental imagery, anxiety and mania and depression was examined in a network study. In addition, a newly developed variant of cognitive behavioral therapy with a focus on mental imagery (ImCT) was compared with psychoeducation. Finally, a case study was described in which ImCT was used to treat manic symptoms. ImCT proved to be an effective treatment. Altogether, these findings support a new conceptualization of bipolar vulnerability in which mood instability is associated with mental imagery and anxiety. This appears to allow for more effective psychological treatment options.