Investigation of the relationship between cognitive flexibility, theory of mind and creative thinking in patients with bipolar disorder

Abstract

Background This study aimed to analyse the differences in creative thinking dispositions between patients with bipolar disorder (BD) and healthy controls (HCs) and to examine the potential role of cognitive flexibility (CF) and theory of mind (ToM) as mediators of this relationship. Methods Fifty patients diagnosed with BD in remission and fifty HCs participated in the study. The participants completed the Wisconsin Card Sorting Test (WCST), the Reading the Mind in the Eyes Test (RMET), the Dokuz Eylul Theory of Mind Index (DEToMI) and the Marmara Creative Thinking Dispositions Scale (MCTDS). Results There was no significant difference between the groups in terms of creative thinking dispositions, t(98)=-0.99, p =.323. However, patients performed worse in several areas, such as the number of perseverative errors (PEs) t(98) = 4.84, p <.001, number of completed categories (z=-4.38, p <.001), DEToMI total score t(98)=-3.51, p <.001, and RMET score t(98)=-2.77, p <.007, than HCs. In the patient group, correlations were found between innovation search and irony scores (r (48) = 0.44, p =.001) and between innovation search and the DEToMI total score (r [(48) = 0.44, p =.002). In the HC group, associations were found between PEs and innovation search, r (48)=-0.33, p =.019; PEs and inquisitive, r (48)=-0.29, p =.044; SOFB and inquisitive, r (48) = - 0.30, p =.034; doubt and irony, r (48) = 0.29, p =.043; and the RMET score and courage, r (48)=-0.31, p =.027. In the HC group, 44% of the MCTDS score was explained by the model variables at a statistically significant level. Limitations Not all factors affecting creative thinking dispositions and cognitive functions were examined. Conclusions The relationship between creativity and BD varies depending on the research approach; however, consistent with the current literature, our study found no significant differences in creative thinking dispositions between the groups. While CF and ToM predicted creative thinking in healthy individuals, they do not predict these dispositions in BD patients. Therefore, focusing on other cognitive factors related to creativity in individuals with BD may help clarify this issue. Our study contributes to the limited literature by investigating the effects of CF and ToM on creative thinking dispositions in BD patients.