Bipolar disorder and schizophrenia are both complex mental health disorders that can have a profound negative impact on a person’s ability to live a full and satisfying lifestyle.
Although there are clear distinctions between these two disorders, they do share certain characteristics. For example, people who have either bipolar disorder or schizophrenia may experience symptoms such as the following:
- Disrupted sleep patterns
- Problems with focus and concentration
- Impulsive, reckless, or otherwise dangerous behaviors
- Suicidal thoughts and actions
- Hallucinations and/or delusions
Recent research efforts have explored two other fundamental similarities between bipolar disorder and schizophrenia: insufficient cognitive control and poor emotion regulation.
What Is Cognitive Control?
In a 2015 article in the journal Frontiers in Psychology, Matthew L. Dixon of the University of British Columbia defined cognitive control as “the intentional selection of thoughts, emotions, and behaviors based on current task demands and social context, and the concomitant suppression of inappropriate habitual actions.”
In other words, cognitive control refers to a person’s ability to organize their thoughts and actions to meet specific goals while also conforming to social norms and expectations.
In a January 2007 article on the website of the American Psychological Association, cognitive neuroscientist Todd Braver, PhD, used the following two examples to explain his theory that cognitive control can be either proactive or reactive:
- A person can exhibit proactive cognitive control by planning to stop at the grocery store on their way home from work, keeping this plan in mind as they approach the turnoff to the store, and steering their car into the correct lane to make the turn.
- If the person forgets about their plan to stop at the grocery store, but they are reminded to do so when the car in front of them signals a turn as they are approaching the turnoff to the store, this would be an example of reactive control.
“Proactive control is generally more effective, but also demands more energy and is more vulnerable to interruptions,” wrote Erika Packard, the author of the January 2007 article. “Reactive control, though, is more susceptible to interference effects, but is also less demanding than proactive control.”
Emotions & Cognitive Control
The December 2021 edition of the Journal of Affective Disorders Reports included a research paper titled Emotions and cognitive control: A comparison of bipolar disorder and schizophrenia.
“Cognitive impairment is a central feature of both disorders and a key predictor of functional outcome,” the team that wrote this paper reported. “Patients with one or other disorder tend to exhibit similar patterns of neuropsychological impairments compared with controls, and the same underlying cognitive factor structure.”
The goal of the team’s research was to determine how the cognitive control processes of people with bipolar disorder and schizophrenia are impacted by the processing of emotional information. The team studied 86 people between the ages of 18-58:
- 21 subjects had bipolar disorder
- 23 subjects had schizophrenia
- 42 subjects had no mental health disorders
The subjects completed a clinical interview and a neuropsychological test. They were then subjected to a “conditioning procedure” that involved viewing images of faces expressing a variety of emotions. They followed this up by participating in an activity known as a Stroop task.
The study’s results included the following:
- The participants from the schizophrenia group showed the most significant impairments in cognitive processes.
- Subjects with schizophrenia exhibited deficiencies in verbal fluency, working memory, and sustained attention.
- The members of the bipolar disorder group demonstrated mild cognitive impairments, primarily in the areas of working memory and cognitive flexibility.
- In the area of sustained attention, those in the bipolar disorder group performed equal to the group with no mental health disorders.
“Our results highlighted difficulty initiating emotional cognitive control in the [bipolar disorder and schizophrenia] groups,” the research team wrote, “indicating that it is more difficult for individuals with [schizophrenia or bipolar disorder] to inhibit irrelevant emotional stimuli during a cognitive task.”
Emotion Regulation & Schizophrenia
As noted in the research paper discussed in the previous section, cognitive control deficiencies among people with bipolar disorder and schizophrenia may be exacerbated by insufficient emotion regulation.
The term emotion regulation refers to the processes a person uses to control their emotions and respond to emotional experiences. Emotion regulation strategies can be either healthy or maladaptive.
As described in a December 2021 article about poor emotion regulation among people with schizophrenia, “People regulate their emotions to get from one feeling to a more preferred state, whether that is a return to calm, a move toward happiness, not feeling quite as angry, or leveraging a different emotion entirely.”
The December 2021 article described a study from the University of Georgia. The Georgia researchers found that people who have schizophrenia can effectively regulate negative emotions during times of low-level struggles. However, as their negative emotions increase, their attempts to regulate them appear to wane. This is contrary to what is typically observed in healthy individuals, who make more concerted efforts to regulate their emotions as their stress levels rise.
“That’s really the abnormality,” said the study’s lead author, Ian Raugh, “that people with schizophrenia don’t seem to be trying to manage their emotions as much when their emotions are really high.”
Emotion Regulation & Bipolar Disorder
A January 2021 report in the International Journal of Bipolar Disorders explored the prevalence of poor emotion regulation among people who have bipolar disorder and other mood disorders.
The authors of this report noted the following:
- People who have bipolar disorder are more likely to use maladaptive emotion regulation strategies, which usually have the effect of increasing their distress.
- People with bipolar disorder are also more likely to exhibit emotion-related impulsivity, which can elevate the intensity of manic symptoms.
- People who have bipolar disorder and other mood disorders are less likely to incorporate mindfulness-based emotion regulation skills into their daily lives.
“Increased emotion regulation difficulties, decreased mindfulness, and increased emotion-driven impulsivity may be transdiagnostic across mood disorders and states,” the study’s authors wrote, “and that impulsivity may be particularly impaired during periods of mania.”
Treatment Options for People with Bipolar Disorder & Schizophrenia
Insufficient cognitive control and poor emotion regulation are two of the many symptoms that can make life so difficult for people who have bipolar disorder or schizophrenia. But both of these disorders are treatable conditions. When people receive the focused services that align with their specific needs, they can achieve improved health and better quality of life.
Depending on how an individual has been impacted by bipolar disorder or schizophrenia, the following elements of care may be beneficial for them:
- Medication management
- Cognitive behavioral therapy (CBT)
- Trauma-focused cognitive behavioral therapy (TF-CBT)
- Acceptance and commitment therapy (ACT)
- Dialectical behavior therapy (DBT)
- Cognitive remediation therapy (CRT)
- Solution-focused brief therapy (SFBT)
- Mindfulness groups
Although cognitive control and emotion regulation come naturally to many people, these skills can be taught to those with bipolar disorder, schizophrenia, and other mental health concerns. An appropriate combination of medication, therapy, instruction, and wraparound support can have a significant positive impact on the ability of a person with bipolar disorder or schizophrenia to live a productive and fulfilling life.
Gianna Melendez
Jodie Dahl, CpHT