Conceptualizing a cycle of ascent into mania: A case report

This case study describes the collaborative development of an idiosyncratic cognitive model of the ascent into mania in a patient with bipolar affective disorder. The client held the belief that he could rise above his depression and feelings of low self-esteem through the pursuit of highly demanding goals and rewarding activity. While still depressed and anxious, small increases in positive mood and energy triggered hyper-positive thoughts about himself (e.g. "I am back to my attractive, intelligent and outgoing self again"). Consequently, he engaged in a range of "ascent" behaviours that were consistent with the pursuit of this self-view. The direct effects of these behaviours and their effects on other people led to further increases in positive mood and physiological activation, which in turn triggered more hyper-positive self-relevant thoughts. The client reported that he found the model an extremely useful component of cognitive behavioural therapy.