Low working memory capacity in euthymic bipolar I disorder: No relation to reappraisal on emotion regulation

BACKGROUND: Emotion regulation (ER) applies behavioral and cognitive strategies to modify the appearance and intensity of emotions. Working memory capacity (WMC) plays an important role in the ER process, particularly through its influence on the efficiency of ER strategies. METHODS: We investigated interactions between WMC and three ER strategies, namely cognitive reappraisal, expressive suppression, and rumination, in 43 euthymic patients with bipolar I disorder and 48 healthy control subjects. We used the Korean versions of the Operation Span Task, Emotion Regulation Questionnaire, Ruminative Response Scale, and Difficulties in Emotion Regulation Scale. RESULTS: WMC modulated the efficacy of cognitive reappraisal in healthy controls with high WMC, but not in patients with bipolar disorder. There were no significant interactions between WMC and expressive suppression or rumination in either group. LIMITATIONS: These include the small sample size, use of neutral words to evaluate negative emotion, use of self-administered questionnaires, and relatively high cut-off for the definition of euthymic states. A number of uncontrolled factors may have influenced our results including patients' duration of remission, number of episodes, psychiatric family history, and current psychiatric medications. CONCLUSIONS: Our findings suggest that working memory does not function effectively in the reappraisal process during ER in patients with bipolar disorder. This may indicate that top-down regulation of emotion is impaired in bipolar disorder. Cognitive interventions aimed at improving ER in such patients may be ineffective.restrictio