Attentional Processing of Threat in Bipolar Disorder: Going Beyond Mood-Congruency

Emotional processing in bipolar disorder (BD) entails a complex attentional pattern not merely restricted to happy or sad biases, but also directed towards threatening information. This study examined threat-related bias on attentional orienting when participants were not instructed about the presentation of emotional stimuli (i.e., implicit instructions). An emotional dot-probe task in which an emotional face (i.e., threat, sad, happy) is simultaneously displayed with a neutral face was applied to BD individuals in their different episodes: mania (n = 26), depression (n = 24), and euthymia (n = 28) as well as to a group of healthy controls (n = 28). Symptomatic BD patients (i.e., in a manic or depressive episode) showed an attentional orienting bias toward threatening faces but not for happy or sad faces, while euthymic BD patients did not exhibit any attentional bias for emotional stimuli. A bias toward happy faces was found in the control group. Threat-related bias was not related to the severity of affective and anxiety symptoms in BD. When attention is not explicitly directed to emotional information, threat-related bias may characterize attentional orienting during mania and depression, but may be attenuated during euthymia.