Mania and hypomania are mood states characterized by abnormally and persistently elevated, expansive, or irritable mood paired with increased activity or energy levels.
They represent the “high” phase of bipolar disorder, during which people experience heightened and often disorganized goal-directed behavior, risk-taking, impulsivity, and euphoria intermixed with tension or anger outbursts.
While full-blown manic episodes involve severe impairment, hypomania refers to attenuated manic symptoms that do not significantly debilitate functioning.
Glas, R. V., de Kleijn, R. E., Regeer, E. J., Kupka, R. W., & Koenders, M. A. (2023). Do you feel up when you go up? A pilot study of a virtual reality manic‐like mood induction paradigm. British journal of clinical psychology. https://doi.org/10.1111/bjc.12445
Key Points
- The study tested a new virtual reality (VR) mood induction method to approximate hypomanic states by inducing excitement, goal-directedness, and tension.
- The VR mood induction effectively increased excitement and tension compared to a neutral condition.
- Participants with heightened hypomanic personality sensitivity showed stronger emotional reactivity, with increased irritation and attenuated excitement responses to the mood induction.
- The findings demonstrate the viability of using immersive VR environments to study psychological mechanisms involved in bipolar mood dysregulation. Further research is warranted using this paradigm.
Rationale
Bipolar disorder (BD) is characterized by fluctuations between depression and manic highs, with mania being the most distinctive symptom (Kessler et al., 2003).
To understand the mechanisms underlying manic mood states, research during active manic states is needed. However, inducing clinical mania ethically is not feasible.
A viable alternative is experimentally inducing manic-like moods in nonclinical groups to study psychological traits associated with BD (Vannucci et al., 2022).
However, previous mood induction methods show inconsistent effectiveness partially due to only inducing singular mood aspects, rather than the multidimensional nature of mania encompassing both pleasant (euphoric) and unpleasant (tense) affective features (Benazzi & Akiskal, 2003).
This study tested a new virtual reality paradigm targeting dual excitation of excitement and tension to approximate hypomanic states.
Method
This pilot study measured emotional reactivity in students to either a neutral or hypomania-activating VR environment.
The VR mood induction task was designed to elicit excitement, goal-directedness, and tension using immersive simulated scenarios.
Participants self-reported levels of various emotions, including excitement, happiness, irritation, and tension, before and after the 15-minute VR induction.
Changes in these affective states served to index emotional reactivity.
Additionally, all participants completed a standardized behavioral risk-taking task called the Balloon Analogue Risk Task (BART), modeled after real-world risky behavior.
In the BART, participants earn money by inflating balloons without allowing them to explode, with each pump associated with greater money earned and chance of explosion.
Risk-taking propensity is operationalized as average number of pumps on balloons that did not explode. The BART aimed to assess whether changes in mood states translated to measurable increases in actual risky or reward-driven behavior.
Sample
The sample comprised 65 university students without bipolar diagnoses. Trait hypomania risk was measured using the Hypomanic Personality Scale (HPS).
Statistical Analysis
Emotional reactivity was analyzed using 2 (condition: neutral, activating) x 2 (time: pre, post) x 2 (HPS group: high, low) ANOVAs. BART risk-taking was analyzed using condition x HPS ANOVAs.
Results
Emotional Reactivity:
- Excitement ratings significantly increased following the hypomania VR induction compared to the neutral VR condition. This provides evidence that the experimental paradigm successfully elicited core features of hypomanic mood states.
- Subjective tension levels were also higher in the hypomania VR group versus the control group. This further supports that the dual affective nature of mania, encompassing both euphoric and dysphoric emotions, was effectively modeled.
- Notably, examination of individual differences revealed that participants classified as high in hypomanic personality tendencies showed attenuated excitement reactivity relative to low scorers. This pattern suggests possible emotion regulation difficulties and aligns with theories that mania vulnerability involves blunted reward response capacities.
- For tension and irritation, the high hypomanic personality trait group demonstrated heightened reactivity overall. This fits conceptualizations of greater affective dysregulation in bipolar-prone individuals.
Risk-Taking Behavior:
- Performance on the Balloon Analogue Risk Task did not differ significantly as a function of the mood induction condition or as a result of individual differences in hypomanic tendencies. This implies the observed subjective and biological changes did not translate into measurable changes in actual risky behavior under controlled experimental conditions.
- It is possible there was insufficient power in this pilot study to detect group differences in behavioral impulsivity. Alternatively, the effects of VR mood induction on risk-taking may be subtle and manifest only over repeated provocations or in select high-vulnerability subgroups. Further research is required to clarify this.
Insight
This study demonstrates an effective method of inducing relevant emotional features resembling hypomanic states using immersive VR technology.
The attenuated excitement response seen in the high HPS group aligns with theories that mania-prone individuals have a blunted hedonic capacity.
The tensions induction also replicates the dual affective nature of mania.
The paradigm provides a more ecologically valid and ethically acceptable means of studying BD mood instability than pharmacological provocations or clinical inductions.
Strengths
- The study utilized an innovative virtual reality (VR) mood induction paradigm designed to closely approximate key features of hypomanic emotional states. Specifically, it induces excitement, goal-directedness, and tension simultaneously to replicate the experience of hypomania. This overcomes a key limitation in previous research relying on more simplistic singular mood inductions.
- The inclusion of the Hypomanic Personality Scale allowed the researchers to distinguish between participants with high versus low trait-based sensitivities to manic states. This enabled the examination of individual differences in reactivity based on stable vulnerability markers.
- The study measured changes across biological, subjective, and behavioral response systems by including psychophysiological measurements, emotion self-reports, and a behavioral risk-taking task. This provides a more complete assessment of state changes following the mood induction.
- The student sample was sufficiently powered to detect differences in emotional reactivity between the neutral and hypomania VR conditions. The adequate sample size for a pilot study enhances confidence in the reliability of results.
Limitations
- As the sample comprised university students without diagnosed bipolar disorder, generalizability to clinical bipolar populations is limited. Replicating this study in a patient sample is important.
- The lack of a clinical bipolar comparison group means conclusions cannot be drawn about whether the observed reactivity patterns are abnormal or pathological. A patient control group would allow this comparison.
- There is the possibility of experimenter bias effects, given the novel and stimulating nature of the VR hypomania induction, which may have inadvertently influenced participant reactions and responses. Attempts to minimize researcher biases should be implemented in future studies.
Implications
This proof-of-concept study demonstrates the utility of immersive VR environments for studying psychological mechanisms involved in bipolar mood dysregulation.
The mood induction effectively approximated key emotional features of hypomania. Individual differences in reactivity suggest stable trait-based mood sensitivity patterns.
The findings support reward hypersensitivity models of BD.
Further research should replicate this study in bipolar samples to establish clinical relevance.
Clinically, the paradigm could aid development of novel psychological interventions targeting mania escalation.
References
Primary reference
Glas, R. V., de Kleijn, R. E., Regeer, E. J., Kupka, R. W., & Koenders, M. A. (2023). Do you feel up when you go up? A pilot study of a virtual reality manic‐like mood induction paradigm. British journal of clinical psychology. https://doi.org/10.1111/bjc.12445
Other references
Benazzi, F., & Akiskal, H. S. (2003). The dual factor structure of self-rated MDQ hypomania: energized-activity versus irritable-thought racing. Journal of Affective Disorders, 73(1-2), 59-64.
Carpenter, R. W., Stanton, K., Emery, N. N., & Zimmerman, M. (2020). Positive and Negative Activation in the Mood Disorder Questionnaire: Associations with psychopathology and emotion dysregulation in a clinical sample. Assessment, 27(2), 219-231. https://doi.org/10.1177/1073191119851574
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., … & Wang, P. S. (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Jama, 289(23), 3095-3105. https://doi.org/10.1001/jama.289.23.3095
Vannucci, C., Bonsall, M. B., Di Simplicio, M., Cairns, A., Holmes, E. A., & Burnett Heyes, S. (2022). Positive moods are all alike? Differential affect amplification effects of ‘elated’versus ‘calm’mental imagery in young adults reporting hypomanic-like experiences. Translational psychiatry, 12(1), 453. https://doi.org/10.1038/s41398-022-02213-4
Keep Learning
Here are some suggested Socratic discussion questions about this paper for a college class:
- This study used VR to induce a hypomanic state in a nonclinical sample. What are some ethical considerations of trying to induce mania-like states? How might this differ in a clinical bipolar sample?
- The high and low HPS groups showed divergent emotion reactivity patterns following the mood induction. What theories might account for these individual differences in affective vulnerability?
- What are other methods used in research to elicit changes in mood states? What are the advantages and limitations of different mood induction techniques?
- How could this VR mood induction paradigm be used to study other psychological traits hypothetically linked to bipolar disorder, like reward sensitivity, impulsivity or risk-taking? What would you hypothesize?
