Affective and Cognitive Mechanisms of Emotion-Based Impulsivity in Bipolar Disorder: Linking Neural Oscillatory Dynamics to Real-World Outcomes

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Projective Summary/Abstract Individuals with bipolar disorder (BD) experience severe and persistent difficulties with impulsivity, especially when experiencing strong emotions. Emotion-based impulsivity is associated with increased hospitalizations, lost relationships, substance use, and suicide. Yet, mechanisms underlying emotion-based impulsivity are not well understood, limiting the design of effective interventions. To this end, the Candidate aims to use multimodal assessments to identify candidate mechanisms of emotion-based impulsivity in the lab and daily life. This K23 proposal has two goals: 1) to delineate neurophysiological indicators of cognitive control using electroencephalogram (EEG) and their association with real-world emotion-based impulsivity in daily life measured with ecological momentary assessment (EMA); and 2) To provide the Candidate with training in affective neuroscience and experimental psychopathology (training objective 1), EEG methods and analysis (training objective 2), and intensive longitudinal modeling (training objective 3), to accelerate clinical translational research (training objective 4) in BD. The proposed project will study 90 adults across the entire bipolar spectrum (30 healthy controls, 30 subclinical BD, and 30 diagnosed BD) drawn from the well-established Prechter Longitudinal Cohort ( n = 1,394) at the University of Michigan. Participants will complete trait measures of emotion-based impulsivity, an affective inhibition paradigm while undergoing an EEG, and a 28-day EMA protocol developed to assess momentary affective arousal, emotion regulation, and impulsivity. The research specific aims are to: 1) Identify neurophysiological components of cognitive control that are associated with trait and lab-based emotion-based impulsivity, and 2) Evaluate the extent to which these components are associated with emotion-based impulsivity in real-world settings. This proposed research is innovative in examining neural oscillations and synchrony embedded in EEG signals as a mechanism of emotion-based impulsivity and linking it with real-world behavior using ecological momentary assessment. It has significant implications because it could yield novel neural and cognitive treatment targets (e.g., neuromodulation of theta-band activity as an adjunct to psychosocial interventions) to improve emotion- based impulsivity in BD after further mechanistic studies. The Candidate is supported by a team of mentors and consultants who are leading experts in translational clinical science and areas of proposed training: Dr. Ivy Tso (Primary Mentor, EEG methods and analysis), Dr. Melvin McInnis (Co-Mentor, bipolar disorder, responsible conduct of research), Dr. David Fresco (Consultant: affective neuroscience, emotion regulation), Dr. Daniel McNeish (Statistical Consultant: intensive longitudinal modeling), Dr. Flavio Frohlich (Consultant: EEG time frequency analysis) and Dr. Sheri Johnson (Consultant: emotion-based impulsivity). This career development award is critical for advancing the Candidate’s independent program of research and long-term goal to identify and refine targets for personalized interventions in BD.