55. Affect Instability in Bipolar Disorder: A Meta-Analysis of Ecological Momentary Assessment Studies

Bipolar disorder (BD) is defined by its mood episodes, but the disorder is also associated with variability in short-term affect. The majority of research suggesting this association has come from cross-sectional surveys, or longitudinal designs with lengthy intervals between assessments. More recently, ecological momentary assessment (EMA) methods and improved technology have made it easier to study affective patterns in ecologically valid ways. This work has advanced to the point where a meta-analysis can now better characterize affective patterns in the disorder. The present study reports a meta-analysis nine EMA studies of BD versus healthy controls to assess differences in mean level and variability of positive and negative affect. Importantly, the samples were either in episode remission or were at-risk samples with no episodes. When compared to healthy controls, individuals with BD or at risk for the disorder had lower daily positive affect (Hedge’s g = -0.40) and higher daily negative affect (g = 0.86). Furthermore, both their positive and negative affect showed greater daily instability (g = 0.98 and g = 0.82, respectively). Additional analyses test for moderators of these effects. Results highlight the need for enhancing and emphasizing emotion regulation strategies in individuals with BD. Ecological Momentary Interventions may provide novel approaches to addressing affect instability.