Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jul 19, 2022; 12(7): 929-943
Published online Jul 19, 2022. doi: 10.5498/wjp.v12.i7.929
Believing processes during the COVID-19 pandemic in individuals with bipolar disorder: An exploratory study
Sophie Tietz, Jolana Wagner-Skacel, Hans-Ferdinand Angel, Michaela Ratzenhofer, Frederike T Fellendorf, Eva Fleischmann, Christof Körner, Eva Z Reininghaus, Rüdiger J Seitz, Nina Dalkner
Sophie Tietz, Christof Körner, Institute of Psychology, University of Graz, Graz 8010, Austria
Sophie Tietz, Michaela Ratzenhofer, Frederike T Fellendorf, Eva Fleischmann, Eva Z Reininghaus, Nina Dalkner, Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz 8036, Austria
Jolana Wagner-Skacel, Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz 8036, Austria
Hans-Ferdinand Angel, Department of Catechetics and Religious Education, University of Graz, Graz 8010, Austria
Rüdiger J Seitz, Department of Neurology, Centre of Neurology and Neuropsychiatry Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf D-40629, Germany
Author contributions: Tietz S and Fleischmann E wrote the first draft of the manuscript; Dalkner N supervised the study procedure; Wagner-Skacel J, Angel H-F, Ratzenhofer M, Fellendorf FT, Körner C, Reininghaus EZ, Seitz RJ and Dalkner N edited the manuscript and gave important intellectual input.
Institutional review board statement: The study was reviewed and approved by the local ethics committee in accordance with the current revision of the Declaration of Helsinki, ICH guideline for Good Clinical Practice and current regulations (Medical University of Graz, Austria; individuals with BD were from the BIPLONG study, EK-number: 25-335 ex 12/13; data was collected in the course of a new study, EK number: 32-363 ex 19/20).
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE guidelines and the manuscript was prepared and revised according to the STROBE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nina Dalkner, MSc, PhD, Senior Scientist, Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, Graz 8036, Austria. nina.dalkner@medunigraz.at
Received: December 20, 2021
Peer-review started: December 20, 2021
First decision: March 13, 2022
Revised: March 27, 2022
Accepted: June 23, 2022
Article in press: June 23, 2022
Published online: July 19, 2022
Processing time: 210 Days and 15.2 Hours
Research background

Believing, or “credition,” refers to psychological processes that integrate the cognitions and emotions influencing our behavior. Angel and Seitz created a model consisting of four credition parameters: proposition, certainty, emotion and mightiness. Believing processes are postulated to be influenced by external or environmental circumstances, such as the coronavirus disease 2019 (COVID-19) pandemic.

Research motivation

As empirical evidence about believing processes is lacking, studies examining this field of research are needed. Investigating credition during a crisis, such as the COVID-19 pandemic, will hopefully provide valuable insight into the mind of individuals with bipolar disorder (BD) and might be able to offer implications for treatment.

Research objectives

The purpose of this study was to explore credition in individuals with BD as well as healthy controls (HC) during the COVID-19 pandemic.

Research methods

Euthymic individuals with BD (n = 52) and age- and sex matched HC (n = 52) from Austria participated in an online survey taking place from April 9th to June 4th, 2020. The following questionnaires were completed: Brief Symptom Inventory-18, Beck Depression Inventory-II, Altman Self-Rating Mania Scale, Pittsburgh Sleep Quality Index and a Believing Questionnaire assessing four parameters of credition (proposition, certainty, emotion and mightiness). The MAXQDA software was used to analyze data about believing processes. Statistical analyses included analyses of variance, a multivariate analysis of variance and a multivariate analysis of co-variance.

Research results

Individuals with BD showed significantly more negative propositions and negative emotions, whereas HC reported significantly more positive propositions and emotions. Moreover, individuals with BD showed a higher incongruence between their propositions and emotions. Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression, anxiety and sleep quality.

Research conclusions

During the COVID-19 pandemic, believing parameters were associated with psychiatric symptoms in BD and differed from HC. Results demonstrate the sensitivity of believing processes to external influences in individuals with BD.

Research perspectives

Believing processes should be further examined in future studies, especially regarding cognitive treatment approaches in psychotherapy.