# Motivation and emotion/Book/2020/Hypomania and motivation

* Multimedia presentation (3 min)

## Overview-

“What is hypomania?” is a common question that many people query about in our world today. This question will be discussed throughout this chapter, bringing to life the motivational characteristics and psychological theoretical explanations that come along side of it. Knowing the answer to this question may be beneficial to you, or a loved one, now or in the future. It is important to treat hypomania as it can have negative, crucial long term effects, for example if you or a loved one experienced the motivational characteristic hypersexuality, it may result in sexually transmitted infections (Kusumakar, 2009).
Hypomania can be defined as a mild form of mania characterized by elation and hyperactivity. Hypomania is a mood state that can be characterized by its abnormally revved-up state of mind that can influence an individual’s mood, thoughts, and behavior (Kusumakar, 2009). Throughout this book chapter you will discover and become familiar with what hypomania is, explore the motivational characteristics and the motivational theory and research behind these characteristics.
* Case Study-
* Sarah is a 42-year-old married woman who has a long history of both depressive and hypomanic episodes. Across the years she has had[grammar?]multiple diagnoses including major depression, borderline personality disorder, and most recently, bipolar disorder. A review of symptoms indicated that she indeed have multiple episodes of depression beginning in her late teens, but that clear hypomanic episodes later emerged. Her elevated interpersonal conflict, hyper-sexuality and alcohol use during her hypomanic episodes led to the provisional borderline diagnosis, but in the context of her full history, bipolar disorder appears the best diagnosis. Sarah notes that she is not currently in a relationship and that she feels alienated from her family. She has been taking mood stabilizers for the last year, but continues to have low level symptoms of depression. In the past, she has gone off her medication multiple times, but at present she says she is “tired of being in trouble all the time” and wants to try individual psychotherapy.
* SYMPTOMS:
* Alcohol Use
* Depression
* Elevated Mood
* Impulsivity
* Mania/Hypomania
* Mood Cycles
* Risky Behaviors
* Focus questions
* 1. What is hypomania?
* 2. What are the motivational characteristic's of hypomania?
* 3. What are the motivational causations of hypomania?
* 4. What is motivation?
* 5. How do motivation theories and studies link to the motivational characteristics of hypomania?

## What is hypomania?

Hypomania is often defined as a condition that is similar to mania; but less severe. Hypomania can be separated from mania as a condition as when as individual experiences hypomania there is no great functional impairment whereas, when an individual experiences mania, there is great potential for a significant functional impairment (Benazzi, 2017). The DSM-5[https://en.wikipedia.org/wiki/DSM-5] criteria suggests that the typical hypomania period is four days or longer and that, on the days that hypomania is occurring, it is typical for the elevated mood to be portrayed the majority of time for this period (Benazzi, 2017).
Hypomania is a feature of many disorders such as bipolar I and bipolar II, depression and also cyclothymia. When an individual is diagnosed with bipolar disorder, they often experience hypomanic as well as manic episodes. Cyclothymia, or sometimes called; cyclothymic disorder, is an uncommon mood disorder (Jonathan Savitz, 2008). An individual with cyclothymia may experience both depression and emotional ups and downs that can affect their wellbeing but is not as severe as those in bipolar I or II disorder (Kusumakar, 2009). There is also a range of conditions that co-occur with bipolar disorder, hence may be experienced with hypomania, for example, anxiety disorders, eating disorders, heart disease, diabetes and obesity (Kusumakar, 2009).
* Personal quotes from Shelby Manoukian.
* "It’s racing thoughts, it’s tossing and turning in your bed. It’s ripping your room apart at 1 in the morning"
* "Hypomania feels like you are in a room full of people, and every single one of them is trying to communicate to you"
* "It’s like having 10,000 web browsers open at once"

### What are the motivational causes associated with hypomania?

Firstly$^{(colloquial?)}$, alcohol and substance abuse can be a motivational causation of hypomania, drug and alcohol use $^{(repetition)}$ can make hypomania symptoms more severe (Goldberg, 2010). Stimulant drugs can also be dangerous for people experiencing hypomania as they often exaggerate the negative motivational characteristics including elevated mood and decreased sleep needs.
Secondly, another non-clinical motivational causation of hypomania is changes in an individual’s sleep patterns, whether it’s the case that the individual is sleeping too much, battling insomnia, or experiencing sleeplessness (Kusumakar, 2009).
Thirdly, the intake of caffeine has been evidently proven to be a motivational causation of hypomania (MD, 2015). Individuals with disorders such as bipolar are a lot more delicate to any substance that imitates that of an amphetamine, it encourages high levels of dopamine in the brain, which then encourages restlessness and anxiety, and finally influencing hypomania or mania (MD, 2015).

### What are the motivational characteristics of hypomania?

Confidence: when an individual experiences hypomania they may have an inflated self-esteem and regard themselves quite highly. An example of this could be, telling friends or family how great one is or asking for a pay raise in work even when it might not be granted (Stanton, 2018).
Decreased need for sleep: this is when three hours of sleep may seem reasonable, influenced by uncontrolled restlessness (Goldberg, 2010).
Racing thoughts/ talkativeness: an in individual in a hypomania episode may not be able to help but think about a million things at once, they may struggle to communicate with others as they may be talking to fast or jumping from one subject to the other (Stanton, 2018).
Overindulgent participation in pleasurable activities: often during hypomania experiences an individual may be hypersexual or may take part in impulse activities such as spending excessive amount of money on a shopping spree.
Distractible/ill-tempered: during a hypomanic episode, an individual may struggle to pay attention and to prioritize correctly. They may also have a shorter temper fuse than usual; belligerence may be experienced (Stanton, 2018).

## What is motivation?

Motivation can be described as the reason behind the drive that initiates a person to behave the way that they do (Locke & Schattke, 2018). A persons motivation may be encouraged by outside forces (extrinsic motivation) or from within themselves (intrinsic motivation). Intrinsic motivation can be referred to as taking part in an activity because of want, interest and enjoyment where as extrinsic motivation can be referred to as taking part in an activity knowing previously there is potential to gain reward or avoid punishment or consequence (Locke & Schattke, 2018).

### Reinforcement Theory of Motivation

The reinforcement theory of motivation was presented by BF Skinner along with his associates. This theory explores what happens to an individual when he/she takes some action. BF Skinner holds the belief that the external environment should be designed effectively and positively to further motivate. Positive reinforcement identifies that behaviours that are met with positive outcomes, for example rewards, hoping to encourage similar behaviour again (Wikipedia, 2020).
A study that relates to this theory and encourages to explore the motivational characteristics of hypomania points out the differences in the neural processing of motivational information in individuals vulnerable to hypomania https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474792 (Liam Mason, 2012). This study recruited 49 right-handed individuals (male and female) that were studying at the University of Manchester. Three groups were formed, low, medium and high self reported hypomania traits, this was measured using the Hypomanic Personality Scale. Participants played a computerised card game, learning the reward possibilities of three different cues (Liam Mason, 2012). Responses were measured using the feedback-related negativity (FRN), an effective element presented in motivational outcome evaluation and reinforcement learning. The hypomania-prone group depicted results that showed reduced FRN for both outcomes (Liam Mason, 2012). This result was focused on rewards, consistent with recent electrophysiological evidence of hypersensitivity to sudden reward and clinical account that mania has a correlation to reward hypersensitivity. Results also depicted that the result of reduced FRN for losses intertwines with the reduced punishment sensitivity hypothesis of a range of disorders and may help to explain some of the motivational characteristics of hypomania, such as unrestrained spending sprees, substance use and unprotected sex (Liam Mason, 2012).

### Maslow’s Need Hierarchy Theory of Motivation

Abraham Maslow (1908 - 1970) was a psychology professor, Maslow was the first professor to found the Humanistic Psychology discipline. It was in 1943 his paper "A Theory of Human Motivation" was published, where first portrayed his hierarchy motivation theory of needs. Maslow’s need hierarchy theory is a well known theory of motivation. Maslow's theory focuses on human needs (Wikipedia, 2020). Maslow identifies all human needs and further classifies them into a hierarchical manner from the lower to the higher order. The human needs were grouped into five categories; physiological, safety, social, esteem and self actualization needs. Maslow believed that if the lower needs on the hierarchy have not been met, a person will automatically try satisfy those needs before trying to satisfy those needs which are on top of the hierarchy (Wikipedia, 2020).
A study that relates to this theory is the 'Hypomanic Personality, Stability of Self‐Esteem and Response Styles to Negative Mood' https://onlinelibrary-wiley-com.ezproxy.canberra.edu.au/doi/10.1002/cpp.780 (Tai, 2011). This study helps to explore the motivational characteristics of hypomania by bringing to life Maslow's need of esteem as the aim of the study is to depict the dysfunctional self‐schematic processes, abnormal coping styles and stability of self‐esteem in relation to subclinical hypomania (Tai, 2011). Three studies were conducted, the Hypomanic Personality Scale (HPS) was measured in study one, and the Dysfunctional Attitude Scale was measured in study two and three. One hundred and thirty‐six Manchester University students were recruited in the screening phase of the study, in the second phase, three groups of participants were invited to participate on the basis of their scores in the upper, lower and mid quintiles of the range of HPS scores (Tai, 2011). Participants were asked to complete a self esteem diary, they were asked to complete two Rosenberg (1965) scales each day for a period of 1 week at two separate times of the day. The second questionnaire for each day introduced a collection of life events and attributional questions, the participants were then asked to recall the most positive event and the most negative event they could remember happening each day. Results depicted that people with high hypomania scores portrayed greater fluctuations in self‐esteem than people with medium or low scores on the HPS (Tai, 2011). Results also showed that participants that scored high on both the HPS and the DAS were like to experience hypomania and bipolar symptoms (motivational characteristics). These participants also showed other indications of bipolar traits, in particular high levels of risk‐taking, rumination and negative affect. It was concluded in results of all studies that vulnerability to bipolar/hypomania symptoms and characteristics is robustly associated with unstable self‐esteem (Tai, 2011).

## Hypomania motivational characteristics and motivation- Theoretical basis

A theoretical basis is crucial in understanding both the cause of hypomania and the motivational characteristics that surround it. Numerous theories have been offered to aid in justifying the motivational characteristics that are brought to life during a hypomania episode.

### Theory of mind

The theory of mind explores the ability to comprehend your own mental wellbeing and the mental states of others around you and also the capacity to recognize those mental states of others that may diverge from your own (SarahTerriena, 2014). Another one’s state of mind may consist of their intentions, aspirations, emotions, knowledge, and principles. There are many benefits that surround this theory for example, it develops social skills, encourages problem/conflict solving and aids in rationally predicting the behaviour of those around us (SarahTerriena, 2014). During a hypomanic episode alteration of social relationship can be clarified by the impairment of the functioning of theory of mind. Scarcity in theory of mind could be a significant motivational characteristic marker of a hypomanic episode (SarahTerriena, 2014).

### Reinforcement Sensitivity Theory

The reinforcement sensitivity theory offers three brain-behavioral systems. These brain-behavioral systems motivate individual differences in sensitivity to three factors; reward, punishment, and motivation (Kasey Stanton, 2018). The reinforcement sensitivity theory has been depicted to analyze and forecast anxiety, impulsivity, and extraversion (Kristy-Elizabeth M. Parker, 2007).
As discussed above, when an individual experiences hypomania, along with many of the motivational characteristics, distractible/ill-tempered is a significant factor often. This may involve the individual having a shorter temper fuse and becoming aggressive easily (Kasey Stanton, 2018). The reinforcement sensitivity theory in relation to this motivational characteristic depicts that upbeat and involuntary aggression experienced by an individual is motivated by a sequence of anxiety and rapid, approach-motivational personality traits (Kristy-Elizabeth M. Parker, 2007).

### Cognitive Behavioral $^{(spelling)}$ Theory

Cognitive behavioral therapy is a type of psychological treatment. It has been evidently portrayed to be significantly effective when trying to treat a wide variety of conditions, disorders and mental illnesses, for example depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness (Kaplan, 2013). It converges on altering dysfunctional emotions, behaviors, and thoughts by cross examining gloomy or irrational beliefs. This therapy highly regards the idea that an individuals thoughts and insights encourages their behavior (Kaplan, 2013).
Sleep disturbance and restlessness is a major motivational characteristic of hypomania experiences. Findings have indicated that both stimulus control and sleep restriction are highly persuasive and are often depicted through cognitive behavioral therapy. This further presents regularizing $^{(spelling)}$ bedtimes and rise times often are sufficient to bring about improvements in sleep (Kaplan, 2013).

### Intrinsic motivation

Intrinsic motivation refers to the act of doing something knowing there may be no external rewards, this act may be driven out of interest or excitement (Locke, 2019). This act is out of choice, there is no pressure that comes along with it, no limits or rewards. Goals that are driven from intrinsic motivation often derive from within leaving the results to satisfy your basic psychological needs for autonomy, competence, and relatedness. An example of intrinsic motivation could be reading a book on holidays because you are interested in the storyline and it relaxes you, instead of reading a book for the reward of receiving a successful grade. A second example of intrinsic motivation could be learning French as a new language because you find it intriguing instead of learning it because your current job requires it (Locke, 2019).
It has been hypothesised that those who experience increased creativity and hypomania do so because of an intrinsic motivation, this becomes evident in the peer reviewed article 'The link between hypomania risk and creativity: The role of heightened behavioral activation system (BAS) sensitivity' https://www.sciencedirect.com/science/article/abs/pii/S0165032716319668 (Na Kim, 2017). This study explored whether heightened behavioral activation system (BAS) sensitivity had any correlation to the relationship between bipolar/hypomania and creativity. The main goal of this study was to investigate the relationship between hypomania risk, BAS sensitivity and creativity (Na Kim, 2017). It was hypothesised that BAS sensitivity would be associated with creativity as well as hypomania risk and (hypo)manic symptoms. This study also investigated if BAS sensitivity mediated the correlation between hypomania risk and creativity to further examine the relationship. Universitiy students in South Korea were recruited for this study, 543 in total (Na Kim, 2017). The Hypomanic Personality Scale (HPS) was used to measure and further identify people at risk for (hypo)mania and bipolar. To measure individual differences the Behavioral Activation System (BAS) and the Adjective Checklist Creative Personality Scale was used. Results portrayed that hypomania risk indirectly enhances everyday creativity within an individual through BAS sensitivity. Results also depicted that the BAS-relevant personality trait, the tendency to set high aspiring goals, might give reason for the link between Bipolar and creativity (Na Kim, 2017).

### Extrinsic motivation

Extrinsic motivation refers to behavior that is driven by external factors, this type of motivation arises from outside a person. It is an environmentally-created reason to engage in an action or activity (Locke, 2019). These external factors are often a reward or avoidance of negative outcomes such as money, fame and grades. People who experience hypomania episodes and bi polar disorder often set higher goals in laboratory tasks than other people, thus having a higher drive for these external factors (Locke, 2019). An example of extrinsic motivation could be; an army instructor barks orders and commands to get recruits’ immediate compliance, the recruits motivation is driven by the knowledge that if they do not comply immediate punishment will be rewarded, such as extra harsh physical training (Locke, 2019).
Extrinsic motivation in relation to the motivational characteristic's of hypomania is depicted in the peer reviewed article 'Extreme Goal Setting and Vulnerability to Mania Among Undiagnosed Young Adults' https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829854/ (Sheri L. John, 2006). This article explores whether persons vulnerable to disorders such as bi polar and episodes of hypomania and mania set elevated goals in their lives. This study depicts that people with bipolar disorder and others vulnerable to this disorder or other experiences such as hypomania and mania appear to set high goals and focus greatly on achievement (Sheri L. John, 2006). Two studies were conducted, both recruited a range of young adults that were studying at the University of Miami. Results portrayed that a scale of lifetime vulnerability to hypomania characteristics had a strong correlation to three types of high motivational goals, including popular fame, political influence, and financial success (Sheri L. John, 2006).

## A significant motivational characteristic of hypomania- Caffeine $^{(rephrase?)}$

Caffeine is a great contributor of hypomania episodes as it has strong relationship with the motivational characteristic of hypomania; sleep disturbance. Caffeine often disrupts bipolar patients sleep cycles, contributing to episodes of mania and hypomania (Young, 2020). For a long time now, professionals have been aware that bipolar patients are adversely affected by caffeine, they have stated that it created insomnia. Caffeine can be seen as a motivational characteristic of hypomania as it can help trigger or escalate a mania or hypomania episode (Young, 2020).
A study that explores caffeine as a motivational characteristic of hypomania is 'The impact of caffeine consumption on clinical symptoms in patients with bipolar disorder: A systematic review' https://onlinelibrary-wiley-com.ezproxy.canberra.edu.au/doi/10.1111/bdi.12990 (Young, 2020). A systematic review was conducted to access the impact of this characteristic, PubMed, Embase and PsycINFO were searched, further analyzing and recording all data on individuals with bipolar and those who experience hypomania/mania (Young, 2020). The measure of caffeine was compared with illness severity holding symptoms of hypomania, mania, depression, psychosis, anxiety and sleep. 1678 records and studies were reviewed, including 10 case reports, 1 retrospective cohort study, 5 cross‐sectional studies, 1 interventional study (Young, 2020). Results portrayed that the findings of this study depict the relationship between the quantities of caffeine that individuals with bipolar consume and the severity of symptoms and motivational characteristics experienced. Results showed an acute increase in caffeine consumption encourages the occurrence of hypomanic episodes in patients with bipolar, affecting sleep patterns and further preceding other motivational characteristics of the condition such as; restlessness, nervousness, excitement, insomnia and rambling flow of thought and speech (Young, 2020).

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## Conclusion

Hypomania is a mood state that can be characterized by its abnormally revved-up state of mind that can influence an individual’s mood, thoughts, and behavior. It is important to treat hypomania as it can have negative, crucial long term effects. It can be concluded from the above research and studies that hypomania has many motivational characteristics such as; reduced need for sleep, confidence, aspiring goals, ill- temper, racing thoughts and many more (Liam Mason, 2012). Motivation of these motivational characteristics can have both extrinsic and intrinsic factors (Locke, 2019). High ambitious goals, high expectations, unstable self-esteem and caffeine can encourage to motivate the above characteristics. There is a range of theories and research that make this evident, some of these theories are; the reinforcement theory and Maslow's hierarchy of needs (Liam Mason, 2012).