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Emotion regulation in bipolar disorder type I: an fMRI study

Published online by Cambridge University Press:  22 May 2015

F. Corbalán
Douglas Mental Health University Institute, Montreal, Canada
S. Beaulieu
Douglas Mental Health University Institute, Montreal, Canada Department of Psychiatry, McGill University, Montreal, Canada
J. L. Armony*
Douglas Mental Health University Institute, Montreal, Canada Department of Psychiatry, McGill University, Montreal, Canada Centre for Research on Brain, Language and Music, Montreal, Canada
* Address for correspondence: J. Armony, M.Sc., Ph.D., Douglas Institute–Research, 6875 LaSalle boulevard, Verdun, QC, Canada H4H 1R3. (Email:



Bipolar disorder type I (BD-I) is associated with emotion dysregulation. However, experimentally controlled studies of emotion regulation (ER), particularly those examining the brain correlates of the putative deficits, are scarce and their results inconsistent.


Nineteen euthymic BD-I patients and 17 healthy controls (HC) underwent functional magnetic resonance imaging while performing a visual ER 2 × 2 factorial task, with instruction (Look or Decrease) and valence (Negative or Neutral) as within-subject factors. Emotional ratings were collected after each picture presentation to assess regulation success.


BD-I patients were successful at downregulating their emotions, although to a lesser degree than HC. Both groups engaged brain regions previously implicated in ER; however, unlike HC, patients engaged some of those regions, particularly the ventrolateral prefrontal cortex (VLPFC) in the Negative Look and Neutral Decrease conditions. Moreover, patients failed to show the reduced amygdala activation in the Negative Decrease condition observed in HC.


Our findings suggest that BD-I patients are able to downregulate their emotions when instructed to do so. However, they also appear to engage their ER network, particularly the VLPFC, even when not required to do so. These findings may help explain their often-reported difficulty in regulating emotions in everyday life despite their attempts to do so.

Original Articles
Copyright © Cambridge University Press 2015 

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Armony, JL (2013). Current emotion research in behavioral neuroscience: the role(s) of the amygdala. Emotion Review 5, 104115.CrossRefGoogle Scholar
Bauer, MS, McBride, L, Shea, N, Gavin, C, Holden, F, Kendall, S (1997). Impact of an easy-access VA clinic-based program for patients with bipolar disorder. Psychiatric Services 48, 491496.Google ScholarPubMed
Buhle, JT, Silvers, JA, Wager, TD, Lopez, R, Onyemekwu, C, Kober, H, Weber, J, Ochsner, KN (2014). Cognitive reappraisal of emotion: a meta-analysis of human neuroimaging studies. Cerebral Cortex 24, 29812990.CrossRefGoogle ScholarPubMed
Delvecchio, G, Sugranyes, G, Frangou, S (2013). Evidence of diagnostic specificity in the neural correlates of facial affect processing in bipolar disorder and schizophrenia: a meta-analysis of functional imaging studies. Psychological Medicine 43, 553569.CrossRefGoogle ScholarPubMed
Diekhof, EK, Geier, K, Falkai, P, Gruber, O (2011). Fear is only as deep as the mind allows: a coordinate-based meta-analysis of neuroimaging studies on the regulation of negative affect. Neuroimage 58, 275285.CrossRefGoogle ScholarPubMed
Eippert, F, Veit, R, Weiskopf, N, Erb, M, Birbaumer, N, Anders, S (2007). Regulation of emotional responses elirefd by threat-related stimuli. Human Brain Mapping 28, 409423.CrossRefGoogle ScholarPubMed
Elliott, R, Ogilvie, A, Rubinsztein, JS, Calderon, G, Dolan, RJ, Sahakian, BJ (2004). Abnormal ventral frontal response during performance of an affective go/no go task in patients with mania. Biological Psychiatry 55, 11631170.CrossRefGoogle ScholarPubMed
Fagiolini, A, Kupfer, DJ, Masalehdan, A, Scott, JA, Houck, PR, Frank, E (2005). Functional impairment in the remission phase of bipolar disorder. Bipolar Disorders 7, 281285.CrossRefGoogle ScholarPubMed
Ferrier, IN, Thompson, JM (2002). Cognitive impairment in bipolar affective disorder: implications for the bipolar diathesis. British Journal of Psychiatry 180, 293295.CrossRefGoogle ScholarPubMed
Frank, DW, Dewitt, M, Hudgens-Haney, M, Schaeffer, DJ, Ball, BH, Schwarz, NF, Hussein, AA, Smart, LM, Sabatinelli, D (2014). Emotion regulation: quantitative meta-analysis of functional activation and deactivation. Neuroscience & Biobehavioral Review 45C, 202211.CrossRefGoogle Scholar
Friston, KJ, Worsley, KJ, Frackowiak, RS, Mazziotta, JC, Evans, AC (1994). Assessing the significance of focal activations using their spatial extent. Human Brain Mapping 1, 210220.CrossRefGoogle ScholarPubMed
Green, MJ, Lino, BJ, Hwang, EJ, Sparks, A, James, C, Mitchell, PB (2011). Cognitive regulation of emotion in bipolar I disorder and unaffected biological relatives. Acta Psychiatrica Scandinavica 124, 307316.CrossRefGoogle ScholarPubMed
Gross, JJ (1998 a). Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology 74, 224237.CrossRefGoogle ScholarPubMed
Gross, JJ (1998 b). The emerging field of emotion regulation: an integrative review. Review of General Psychology 2, 271299.CrossRefGoogle Scholar
Gross, JJ (2008). Emotion regulation. In Handbook of Emotions, 3rd edn (ed. Lewis, M., Haviland-Jones, J. M. and Feldman Barrett, L.), pp. 497512. Guilford: New York.Google Scholar
Gross, JJ, Thompson, RA (2007). Emotion regulation: conceptual foundations. In Handbook of Emotion Regulation (ed. Gross, J. J.), pp. 324. Guilford: New York.Google Scholar
Gruber, J (2011). A review and synthesis of positive emotion and reward disturbance in bipolar disorder. Clinical Psychology & Psychotherapy 18, 356365.CrossRefGoogle ScholarPubMed
Gruber, J, Harvey, AG, Gross, JJ (2012). When trying is not enough: emotion regulation and the effort-success gap in bipolar disorder. Emotion 12, 9971003.CrossRefGoogle Scholar
Gruber, J, Hay, AC, Gross, JJ (2014). Rethinking emotion: cognitive reappraisal is an effective positive and negative emotion regulation strategy in bipolar disorder. Emotion 14, 388396.CrossRefGoogle ScholarPubMed
Gruber, J, Purcell, AL, Perna, MJ, Mikels, JA (2013). Letting go of the bad: deficit in maintaining negative, but not positive, emotion in bipolar disorder. Emotion 13, 168175.CrossRefGoogle Scholar
Hafeman, DM, Chang, KD, Garrett, AS, Sanders, EM, Phillips, ML (2012). Effects of medication on neuroimaging findings in bipolar disorder: an updated review. Bipolar Disorders 14, 375410.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.CrossRefGoogle Scholar
Houenou, J, Frommberger, J, Carde, S, Glasbrenner, M, Diener, C, Leboyer, M, Wessa, M (2011). Neuroimaging-based markers of bipolar disorder: evidence from two meta-analyses. Journal of Affective Disorders 132, 344355.CrossRefGoogle ScholarPubMed
Hummer, TA, Hulvershorn, LA, Karne, HS, Gunn, AD, Wang, Y, Anand, A (2012). Emotional response inhibition in bipolar disorder: a functional magnetic resonance imaging study of trait- and state-related abnormalities. Biological Psychiatry 73, 136143.CrossRefGoogle ScholarPubMed
Jackson, DC, Malmstadt, JR, Larson, CL, Davidson, RJ (2000). Suppression and enhancement of emotional responses to unpleasant pictures. Psychophysiology 37, 515522.CrossRefGoogle ScholarPubMed
Kim, SH, Hamann, S (2012). The effect of cognitive reappraisal on physiological reactivity and emotional memory. International Journal of Psychophysiology 83, 348356.CrossRefGoogle ScholarPubMed
Kohn, N, Eickhoff, SB, Scheller, M, Laird, AR, Fox, PT, Habel, U (2014). Neural network of cognitive emotion regulation – an ALE meta-analysis and MACM analysis. Neuroimage 87, 345355.CrossRefGoogle ScholarPubMed
Lagopoulos, J, Malhi, GS (2007). A functional magnetic resonance imaging study of emotional Stroop in euthymic bipolar disorder. Neuroreport 18, 15831587.CrossRefGoogle ScholarPubMed
MacQueen, GM, Young, LT, Joffe, RT (2001). A review of psychosocial outcome in patients with bipolar disorder. Acta Psychiatrica Scandinavica 103, 163170.CrossRefGoogle ScholarPubMed
Malhi, GS, Lagopoulos, J, Sachdev, PS, Ivanovski, B, Shnier, R (2005). An emotional Stroop functional MRI study of euthymic bipolar disorder. Bipolar Disorders 7 (Suppl. 5), 5869.CrossRefGoogle ScholarPubMed
Mann-Wrobel, MC, Carreno, JT, Dickinson, D (2011). Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disorders 13, 334342.CrossRefGoogle ScholarPubMed
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382389.CrossRefGoogle ScholarPubMed
Morris, RW, Sparks, A, Mitchell, PB, Weickert, CS, Green, MJ (2012). Lack of cortico-limbic coupling in bipolar disorder and schizophrenia during emotion regulation. Translational Psychiatry 2, e90.CrossRefGoogle ScholarPubMed
Nichols, T, Brett, M, Andersson, J, Wager, T, Poline, JB (2005). Valid conjunction inference with the minimum statistic. Neuroimage 25, 653660.CrossRefGoogle ScholarPubMed
Ochsner, KN, Bunge, SA, Gross, JJ, Gabrieli, JD (2002). Rethinking feelings: an FMRI study of the cognitive regulation of emotion. Journal of Cognitive Neuroscience 14, 12151229.CrossRefGoogle ScholarPubMed
Ochsner, KN, Gross, JJ (2005). The cognitive control of emotion. Trends in Cognitive Science 9, 242249.CrossRefGoogle ScholarPubMed
Ochsner, KN, Ray, RD, Cooper, JC, Robertson, ER, Chopra, S, Gabrieli, JD, Gross, JJ (2004). For better or for worse: neural systems supporting the cognitive down- and up-regulation of negative emotion. Neuroimage 23, 483499.CrossRefGoogle ScholarPubMed
Pan, L, Keener, MT, Hassel, S, Phillips, ML (2009). Functional neuroimaging studies of bipolar disorder: examining the wide clinical spectrum in the search for disease endophenotypes. International Review of Psychiatry 21, 368379.CrossRefGoogle ScholarPubMed
Phan, KL, Fitzgerald, DA, Nathan, PJ, Moore, GJ, Uhde, TW, Tancer, ME (2005). Neural substrates for voluntary suppression of negative affect: a functional magnetic resonance imaging study. Biological Psychiatry 57, 210219.CrossRefGoogle ScholarPubMed
Phillips, ML, Ladouceur, CD, Drevets, WC (2008 a). A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Molecular Psychiatry 13, 829, 833857.CrossRefGoogle ScholarPubMed
Phillips, ML, Swartz, HA (2014). A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. American Journal of Psychiatry 171, 829843.CrossRefGoogle Scholar
Phillips, ML, Travis, MJ, Fagiolini, A, Kupfer, DJ (2008 b). Medication effects in neuroimaging studies of bipolar disorder. American Journal of Psychiatry 165, 313320.CrossRefGoogle ScholarPubMed
Ray, RD, Zald, DH (2012). Anatomical insights into the interaction of emotion and cognition in the prefrontal cortex. Neuroscience & Biobehavioral Review 36, 479501.CrossRefGoogle ScholarPubMed
Rowland, JE, Hamilton, MK, Lino, BJ, Ly, P, Denny, K, Hwang, EJ, Mitchell, PB, Carr, VJ, Green, MJ (2013). Cognitive regulation of negative affect in schizophrenia and bipolar disorder. Psychiatry Research 208, 2128.CrossRefGoogle ScholarPubMed
Sanchez-Moreno, J, Martinez-Aran, A, Tabares-Seisdedos, R, Torrent, C, Vieta, E, Ayuso-Mateos, JL (2009). Functioning and disability in bipolar disorder: an extensive review. Psychotherapy and Psychosomatics 78, 285297.CrossRefGoogle Scholar
Sergerie, K, Chochol, C, Armony, JL (2008). The role of the amygdala in emotional processing: a quantitative meta-analysis of functional neuroimaging studies. Neuroscience & Biobehavioral Review 32, 811830.CrossRefGoogle ScholarPubMed
Silvers, JA, Wager, TD, Weber, J, Ochsner, KN (2015). The neural bases of uninstructed negative emotion modulation. Social, Cognitive and Affective Neuroscience 10, 1018.CrossRefGoogle ScholarPubMed
Slotnick, SD, Moo, LR, Segal, JB, Hart, J Jr. (2003). Distinct prefrontal cortex activity associated with item memory and source memory for visual shapes. Brain Research Cognitive Brain Research 17, 7582.CrossRefGoogle ScholarPubMed
Strakowski, SM, Adler, CM, Almeida, J, Altshuler, LL, Blumberg, HP, Chang, KD, DelBello, MP, Frangou, S, McIntosh, A, Phillips, ML, Sussman, JE, Townsend, JD (2012). The functional neuroanatomy of bipolar disorder: a consensus model. Bipolar Disorders 14, 313325.CrossRefGoogle ScholarPubMed
Strakowski, SM, DelBello, MP, Adler, CM (2005). The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings. Molecular Psychiatry 10, 105116.CrossRefGoogle ScholarPubMed
Townsend, J, Altshuler, LL (2012). Emotion processing and regulation in bipolar disorder: a review. Bipolar Disorders 14, 326339.CrossRefGoogle ScholarPubMed
Townsend, JD, Torrisi, SJ, Lieberman, MD, Sugar, CA, Bookheimer, SY, Altshuler, LL (2013). Frontal-amygdala connectivity alterations during emotion downregulation in bipolar I disorder. Biological Psychiatry 73, 127135.CrossRefGoogle ScholarPubMed
Wessa, M, Houenou, J, Paillere-Martinot, ML, Berthoz, S, Artiges, E, Leboyer, M, Martinot, JL (2007). Fronto-striatal overactivation in euthymic bipolar patients during an emotional go/nogo task. American Journal of Psychiatry 164, 638646.CrossRefGoogle ScholarPubMed
Wolkenstein, L, Zwick, JC, Hautzinger, M, Joormann, J (2014). Cognitive emotion regulation in euthymic bipolar disorder. Journal of Affective Disorders 160, 9297.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435.CrossRefGoogle ScholarPubMed
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