Journal of Affective Disorders 125 (2010) 27–34

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Journal of Affective Disorders

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Research report

Toward interaction of affective and cognitive contributors to creativity inbipolar disorders: A controlled study

Shefali Srivastava a, Meredith E. Childers a, Ji Hyun Baek b, Connie M. Strong a, Shelley J. Hill a,Kimberley S. Warsett a, Po W. Wang a, Hagop S. Akiskal c, Kareen K. Akiskal c, Terence A. Ketter a,⁎a Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USAb Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Koreac International Mood Center, San Diego, California, USA

a r t i c l e i n f o

⁎ Corresponding author. Stanford University SchoQuarry Road, Room 2124, Stanford, California 94305-57723 2515; fax: +1 650 723 2507.

E-mail address: tketter@stanford.edu (T.A. Ketter)

0165-0327/$ – see front matter © 2010 Elsevier B.V.doi:10.1016/j.jad.2009.12.018

a b s t r a c t

Article history:Received 29 October 2009Accepted 21 December 2009Available online 20 January 2010

Background: Enhanced creativity in bipolar disorder patients may be related to affective andcognitive phenomena.Methods: 32 bipolar disorder patients (BP), 21 unipolar major depressive disorder patients(MDD), 22 creative controls (CC), and 42 healthy controls (HC) (all euthymic) completed theRevised Neuroticism Extraversion Openness Personality Inventory (NEO), the TemperamentEvaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), the Myers-Briggs Type Inventory (MBTI); the Barron-Welsh Art Scale (BWAS), the Adjective Check ListCreative Personality Scale, and the Figural and Verbal Torrance Tests of Creative Thinking. Meanscores were compared across groups, and relationships between temperament/personality andcreativity were assessed with bivariate correlation and hierarchical multiple linear regression.Results: BP and CC (but not MDD) compared to HC had higher BWAS-Total (46% and 42% higher,respectively, pb0.05) and BWAS-Dislike (83% and 93% higher, pb0.02) scores, and higherMBTI-Intuition preference type rates (78% vs. 50% and 96% vs. 50%, pb0.05). BP, MDD, and CC,compared to HC, had increased TEMPS-A-Cyclothymia scores (666%, 451% and 434% higher,respectively, pb0.0001), and NEO-Neuroticism scores (60%, 57% and 51% higher, pb0.0001).NEO-Neuroticism and TEMPS-A Cyclothymia correlated with BWAS-Dislike (and BWAS-Total),while MBTI-Intuition continuous scores and NEO-Openness correlated with BWAS-Like (andBWAS-Total).Limitations: Relatively small sample size.Conclusions: We replicate the role of cyclothymic and related temperaments in creativity, aswell as that of intuitive processes. Further studies are needed to clarify relationships betweencreativity and affective and cognitive processes in bipolar disorder patients.

© 2010 Elsevier B.V. All rights reserved.

Keywords:CreativityMood disordersTemperamentPersonalityAffectCognition

1. Introduction

Creativity is a complex construct with affective (Jamison,1993) and cognitive (Barron and Harrington, 1981) compo-nents. The importance of the affective component has been

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demonstrated with increased rates of bipolarity in variousgroups of creative individuals (Akiskal and Akiskal, 1988;Andreasen and Glick, 1988; Jamison, 1989; Akiskal et al.,2005b), and increased “everyday” creativity in patients withbipolar disorders (Richards et al., 1988a,b; Santosa, Strong et al.,2007). The importance of the cognitive component is indicatedby studies linking creativity to divergent thinking and person-ality factors related to cognitive style (Fleenor andTaylor, 2004).

In priorworkbyour group, in anon-eminent creativity studyin euthymic individuals with and without mood disorders,

28 S. Srivastava et al. / Journal of Affective Disorders 125 (2010) 27–34

personality and affective temperament, specifically access tonegative emotion (Neuroticism) and changeability of mood(Cyclothymia), accounted for approximately 13%of thevariancein creativity, as assessed by Barron-Welsh Art Scale total(BWAS-Total) scores (Strong et al., 2007). In contrast, themore cognitive construct, Openness to experience, onlyaccounted for approximately 9% of the variance in BWAS-Likesubscale scores, but for approximately 21% of the variance inAdjective Check List Creative Personality Scale (ACL-CPS) scores.

Although Openness is the most controversial factor of theFive Factor Model of personality, with some authors prefer-ring to describe this factor with terms such as intelligence orintellect (Digman, 1990), even alternative conceptualizationsrelate this factor to creativity (Johnson, 1994; Ostendorf andAngleitner, 1994). Hence, the adjectives most closely relatedto the Openness factor include original, creative, daring, andimaginative (McCrae and Costa, 1987). Although somestudies suggest relationships between Neuroticism and(particularly artistic) creativity (Kemp, 1981; Andreasenand Glick, 1988; Bakker, 1991; Hammond and Edelmann,1991; Marchant-Haycox andWilson, 1992), in meta-analysis,Openness but not Neuroticism was associated with scientificand artistic creativity (Feist, 1998a,b). Indeed, it has beencontended that most personality variables related to creativ-ity measure aspects of Openness (McCrae and Costa, 1989).

Intuition refers to a cognitive construct that does not relyupon conscious application of sensory, ideational, or affectiveinformation (i.e. independent of sensing, thinking, or feelingfunctions in Jung's terminology) (Jung, 1962). Thus, intuitiveprocessing may be considered to be “unconscious”, ordevelopment of a feeling of knowing related to implicitmemory processing (Metcalfe, 2000). Psychometric instru-ments have been devised to address the challenge ofoperationalizing the study of this sort of cognitive processing.One such self-report instrument, the Myers-Briggs TypeInventory (MBTI) (Myers and McCaulley, 1985), strives toassess intuitive (N) as opposed to sensing (S), as well asthinking (T) as opposed to feeling (F) cognitive functions, andintroverted (I) as opposed to extraverted (E) and judging (J)as opposed to perceiving (P) orientations. Individuals with anintuitive type preference on the MBTI tend to process newinformation using abstract concepts, ideas, and associations,while those with the sensing type prefer to focus on detailsand concrete, directly observable facts (Myers andMcCaulley,1985). Of interest, the MBTI may assess a holistic type ofintuition that is neutral with respect to affect (Pretz and Totz,2007).

The MBTI, which emphasizes healthy personality, hasbeen used extensively by organizational and industrialpsychologists (Hirsh, 1985; Fitzgerald and Kirby, 1997), buthas been viewed more skeptically by personality psycholo-gists (McCrae and Costa, 1989). For example, some empiricaldata do not support the MBTI categorical approach thatinvolves four major dichotomous preferences (Sensing-Intuition, Extraversion-Introversion, Thinking-Feeling, andJudging-Perceiving) and 16 qualitatively distinct types(Stricker and Ross, 1964; McCrae and Costa, 1989; Arnauet al., 2003). This potential limitation may be addressed byuse of dimensional (continuous score) preference data(McCrae and Costa, 1989; Pittenger, 1993). It has beenproposed that such an approach yields indices that measure

four of the five major dimensions of personality as assessedby the Five Factor Model (McCrae and Costa, 1989). Thus,considering MBTI continuous scores in terms of the FiveFactor Model using the Neuroticism Extraversion OpennessPersonality Inventory (NEO) (Costa and McCrae, 1985),Sensing-Intuition correlates highly with Openness, andExtraversion-Introversion with Extraversion, while to a lesserextent, Thinking-Feeling correlates with Agreeableness, andJudging-Perceiving with Conscientiousness (McCrae andCosta, 1989). In contrast, consistent with the MBTI emphasison healthy personality, the MBTI lacks a counterpart toNeuroticism (McCrae and Costa, 1989; Myers et al., 1995).Thus, the MBTI may be of particular interest in efforts toassess non-affective contributors to creativity.

Intuition has been consistently and Perceiving has beenfrequently linked to creativity in diverse samples (e.g. includingarchitects,mathematicians, scientists, andwriters) thatwere orwere not selected for creative achievement (Mackinnon, 1962;Hall and MacKinnon, 1969; Helson and Crutchfield, 1970;Helson, 1971; Thorne and Gough, 1991). In addition, Intuition(and in most instances Perceiving) has been related toinnovative style on theKirtonAdaptation-Innovation Inventory(KAI) among managers and management students (Carne andKirton, 1982; Jacobson, 1993; Gryskiewicz and Tullar, 1995;Fleenor, 1997) and employees, students, and organizationmembers (Houtz et al., 2003; Isaksen et al., 2003). However, ithas been suggested that Intuition may be the better predictoracross creativity metrics, with the apparent relationshipbetween Perceiving and creativity being an artifact of thecorrelation between Perceiving and Intuition (Dollinger et al.,2004a). Additional studies have linked Intuition to otheraspects of creativity (Helson, 1965; Helson, 1966; Myers et al.,1998). For example, Intuitive (rather than Sensing) preferenceaccounted for 91% (104/114) of members of an artists' guild inSan Diego (Simon, 1979).

The current report, by assessing relationships betweenIntuition and creativity, extends our prior findings, to suggestthat creativity in patients with bipolar disorder may berelated not only to negative and changeable feelings but alsoto intuitive thinking.

2. Methods

The study was conducted in the Bipolar Disorders Clinic atStanford University and approved by the Stanford Adminis-trative Panel on Human Subjects. Prior to participation in thisstudy, all subjects provided oral and written informedconsent. Inclusion criteria and assessments (with the excep-tion of the MBTI) are described in detail in earlier reports(Nowakowska et al., 2005; Santosa et al., 2007; Strong et al.,2007).

Mood disorder participants were euthymic for at least fourweeks and had a diagnosis of Bipolar Disorder Type I, II, or NotOtherwise Specified (BP), or Major Depressive Disorder(MDD). Beck Depression Inventory (BDI) (Beck et al., 1961)score on the day of the studywas used to quantify the severityof any subsyndromal depressive symptoms. The BP groupincluded a mixture of one-quarter unmedicated and three-quarters heterogeneously medicated patients. Healthy con-trols (HC) had no personal or first-degree relative history ofpsychiatric disorder, substance abuse, or neurological illness;

Table 1Sample description.

HC MDD BP CC

N 42 21 32 22% Female 61.9 61.9 62.5 63.6Age 34.3±14.8 33.3±12.3 35.3±10.5 29.5±3.9Education 5.6±1.7 6.6±1.55 a 5.9±1.7 7.6±0.5 ⁎⁎⁎

BDI 0.8±1.4 7.6±3.2 b 4.7±3.4 ⁎⁎⁎⁎ 6.4±3.7 ⁎⁎⁎⁎

BP=bipolar disorder patients; MDD=(unipolar) major depressive disorderpatients; CC=creative discipline graduate student controls; HC=healthycontrols. BDI=Beck Depression Inventory.

a pb0.05 versus HC.b pb0.01 versus BP.⁎⁎⁎ pb0.0001 versus BP, HC.⁎⁎⁎⁎ pb0.0001 versus HC.

29S. Srivastava et al. / Journal of Affective Disorders 125 (2010) 27–34

had no major medical illnesses; and were taking no medi-cations. Creative controls (CC) were volunteers with nocurrent syndromal psychiatric or substance abuse problems,recruited from graduate programs in Creative Writing, FineArts, and Product Design at Stanford University.

As described in earlier reports, participants were adminis-tered self-report temperament/personality measures: theRevised NEO Personality Inventory (NEO) (Costa and McCrae,1992; McCrae and Costa, 1997), and the TemperamentEvaluation of the Memphis, Pisa, Paris, and San DiegoAutoquestionnaire (TEMPS-A) (Akiskal et al., 2005a). Thecurrent report includes data from the subset of patients whowere also administered the Myers-Briggs Type Inventory FormM, a 93-item self-report assessment of types and attitudes asproposed by Jung (Myers et al., 1998). Participants were alsoadministered creativity measures: the Barron-Welsh Art Scale(BWAS) (Barron, 1963), the Adjective Checklist CreativePersonality Scale (ACL-CPS) (Gough, 1979; Gough and Heil-brun, 1983), and the Torrance Tests of Creative Thinking –

Figural (TTCT-F) and Verbal (TTCT-V) versions (Torrance,1990), as described previously (Santosa, Strong et al., 2007).

Mean scores for six creativity parameters (BWAS-Total,BWAS-Like, BWAS-Dislike, ACL-CPS, TTCT-F, TTCT-V) werecompared across BP, CC, MDD, and HC groups, using analysisof variance and post-hoc t-tests. Mean scores for four MBTIcontinuous scores (Sensing-Intuition, Extraversion-Introver-sion, Thinking-Feeling, and Judging-Perceiving) and percen-tages of four MBTI preference types (Intuition, Introversion,Feeling, and Perceiving) were compared across BP, CC, MDD,

Table 2Creativity scores across groups.

HC MDD

N 42 21BWAS-Total 18.6±9.7 23.0±12.9BWAS-Dislike 8.1±7.3 14.0±10.1BWAS-Like 10.7±6.8 9.0±6.5ACL-CPS 57.1±9.3 60.4±9.6TTCT-F 111.8±22.4 104.0±14TTCT-V 99.8±15.9 97.9±14.3

BP=bipolar disorder patients; MDD=(unipolar) major depressive disorder patienBWAS=Barron-Welsh Art Scale; ACL-CPS=Adjective Check List Creative PersoV=Torrance Tests of Creative Thinking-Verbal.

a pb0.05 versus BP.⁎ pb0.05 versus HC.⁎⁎ pb0.01 versus HC.

and HC groups. Based upon our earlier findings (Strong et al.,2007), and the MBTI-Intuition and creativity literaturedescribed above, bivariate correlation and hierarchical mul-tiple linear regression were used to assess relationshipsbetween four hypothesized parameters (NEO-Neuroticism,TEMPS-A-Cyclothymia, NEO-Openness, and MBTI-Intuition)and creativity measures. Means (± standard deviations) arereported, unless otherwise indicated. Statistical analyseswere performed using SPSS 17.0 (SPSS Inc., Chicago, Illinois).

3. Results

3.1. Subjects

MBTI data were available for 76.5% (117/153) of subjectsin the original cohort, and participants with compared towithout MBTI data did not differ significantly overall orwithin diagnostic groups with respect to demographic (age,gender, education) or affective (BDI) parameters.

Thus, a total of 117 euthymic subjects had MBTI data; 32BP, 21MDD, 22 CC and 42 HC (Table 1). The 32 BP consisted of18 subjects with bipolar I disorder, 12 with bipolar II disorder,and 2 with bipolar disorder not otherwise specified. As therewere no significant differences between these bipolar sub-groups with respect to demographic parameters, creativitymeasures, or temperament/personality measures, these sub-groups were combined into a single BP group. Twelve of the22 CC (54.5%) had a past psychiatric disorder, with history ofa major depressive episode being the most common (seen in11). In addition, and in some instances comorbid with de-pression, 4 had a history of anxiety disorders (primarily panicdisorder), 3 had a history of alcohol/substance abuse, and 3had a history of eating disorder. Ten had no history of mentaldisorder. None of the CC subjects had a history of hypomania,mania, or psychosis.

As in the original cohort, among patients with MBTI data,these diagnostic groups had similar demographics to oneanother, with the notable exceptions that CC had moreeducation compared to BP (F(3,113)=10.6, pb=0.0001,Tukey) and HC (pb0.0001, Tukey). Also, subsyndromaldepressive symptoms as assessed by the BDI were greaterthan in HC in BP (F(3, 113)=33.8, pb=0.0001, Tukey), MDD(pb0.0001, Tukey), and CC (pb0.0001, Tukey), and weregreater in MDD than in BP (p=0.003, Tukey).

BP CC

32 2227.2±12.8 ⁎⁎ 26.4±8.6 ⁎

⁎ 14.8±10.4 ⁎ 15.6±10.9 ⁎

12.3±6.8 10.8±5.655.9±9.8 59.0±7.7

.8 102.3±17.7 117.2±16.0 a

101.2±13.6 98.7±10.5

ts; CC=creative discipline graduate student controls; HC=healthy controls.nality Scale; TTCT-F=Torrance Tests of Creative Thinking-Figural; TTCT-

Table 3MBTI continuous scores across diagnostic groups.

HC MDD BP CC

N 42 21 32 22Sensing–Intuition 102.3±24.1 111.7±15.2 116.5±21.4 ⁎ 114.3±10.8Extraversion–Introversion 97.9±22.3 100.2±12.9 102.8±24.3 100.4±14.0Thinking–Feeling 95.2±24.7 103.4±14.9 108.3±17.0 ⁎ 104.1±9.6Judging–Perceiving 96.2±25.2 105.4±13.0 103.3±26.0 106.3±13.5

BP=bipolar disorder patients; MDD=(unipolar) major depressive disorder patients; CC=creative discipline graduate student controls; HC=healthy controls.MBTI=Myers-Briggs Type Inventory.⁎ pb0.05 versus HC.

Table 4MBTI preferences across groups.

HC MDD BP CC

N 42 21 32 22Intuition (vs. Sensing, %) 50.0 71.4 78.1 * 95.5 a,***Introversion (vs. Extraversion, %) 40.5 47.6 43.8 54.5Feeling (vs. Thinking, %) 50.0 57.1 68.8 63.6Perceiving (vs. Judging, %) 38.1 66.7 59.4 77.3 **

a pb0.05 versus MDD; * pb0.05; ** pb0.01; *** pb0.001; versus HC.BP=bipolar disorder patients; MDD=(unipolar) major depressive disorderpatients; CC=creative discipline graduate student controls; HC=healthycontrols. MBTI=Myers-Briggs Type Inventory.

30 S. Srivastava et al. / Journal of Affective Disorders 125 (2010) 27–34

3.2. Creativity and temperament

The pattern of creativity and temperament findings inparticipants with MBTI data was similar to that previouslyreported for the original cohort (Nowakowska et al., 2005;Santosa et al., 2007; Strong et al., 2007). Thus, among patientswith MBTI data, mean BWAS-Total scores compared to HCwere significantly higher in BP (46% higher, F(3,113)=4.4,p=0.007, Tukey) and in CC (42% higher, p=0.04, Tukey)but not in MDD (Table 2). Similarly, mean BWAS-Dislikescores compared to HC were significantly higher in BP (83%higher, F(3, 112)=4.5, p=0.017, Tukey) and in CC (93%higher, p=0.018, Tukey). In addition, CC had higher meanTTCT-F scores compared to BP (F(3,103)=3.3, p=0.036,Tukey). In contrast, for BWAS-Like, ACL-CPS, and TTCT-Vthere were no significant group differences. Mean TEMPS-A-Cyclothymia scores compared to HC, were significantly higherin BP (666% higher, F(3,112)=23.5, pb0.0001, Tukey), MDD

Table 5Bivariate correlations with creativity metrics.

BWAS-Total BWAS-Dislike

Age −.340 ⁎⁎⁎ −.219 ⁎

BDI .233 ⁎ .365 ⁎⁎⁎⁎

NEO-Neuroticism .382 ⁎⁎⁎⁎ .420 ⁎⁎⁎⁎

TEMPS-A Cyclothymia .367 ⁎⁎⁎⁎ .363 ⁎⁎⁎⁎

NEO-Openness .187 ⁎ .047MBTI-Intuition .310 ⁎⁎⁎ .175

Pearson r correlation coefficients. Hierarchical multiple linear correlations for relaWelsh Art Scale; ACL-CPS=Adjective Check List Creative Personality Scale; BDI=BePersonality Inventory; TEMPS-A=Temperament Evaluation of the Memphis, Pisa, P

⁎ pb0.05.⁎⁎ pb0.01.⁎⁎⁎ pb0.001.⁎⁎⁎⁎ pb0.0001.

(451% higher, pb0.0001, Tukey) and CC (434% higher,pb0.0001, Tukey). Also, mean NEO-Neuroticism scorescompared to HC, were significantly higher in BP (60%higher, F(3,113)=3.6, pb0.0001, Tukey), MDD (57% higher,pb0.0001, Tukey) and CC (51% higher, pb0.0001, Tukey).Finally, there was only a trend in the analysis of variance(F(3,113)=2.2, p=0.09), and mean NEO-Openness scorescompared to HC, were only non-significantly higher in BP(8% higher, p=0.173, Tukey), and CC (9% higher, p=0.118,Tukey).

3.3. Myers-Briggs Type Inventory

Mean MBTI-Intuition continuous scores compared to HCwere significantly higher in BP (14% higher, F(3,113)=3.6,p=0.016, Tukey), but not in CC and MDD (Table 3). Rates ofMBTI-Intuition type preference compared to HC were sig-nificantly higher in BP (78.1% vs. 50.0%, overall Chi-Square=15.8, df=3 post-hoc Chi-Square=6.1, df=1, p=0.008) and inCC (95.5% vs. 50.0%, post-hoc Chi-Square=13.2, df=1, Fisher'sexact p=0.0002), but not in MDD (Table 4). The HC typepreference rates were consistent with (i.e. within 10% of)expected rates in the general population, with the exceptionsthat in the general population, the expectedMBTI-Intuition typerate is lower (25%), and theexpectedMBTI-Introverted type ratemay be lower (25%, controversial) (Myers, 1962; Myers andMcCaulley, 1985).

In the entire sample, MBTI-Intuition continuous scorescorrelated with BWAS-Total (r=0.310, N=117, p=0.0006),BWAS-Like (r=0.282,N=117, p=0.0021), ACL-CPS (r=0.375,N=117, pb0.0001), TTCT-F (r=0.237, N=106, p=0.0136)and TTCT-V (r=0.224,N=106, p=0.0210) scores, as described

BWAS-Like ACL-CPS TTCT-F TTCT-V

−.267 ⁎⁎ −.007 −.117 −.061−.141 −.059 −.025 −.192 ⁎

.036 −.153 −.055 .014

.102 −.047 −.125 −.104

.258 ⁎⁎ .492 ⁎⁎⁎⁎ .120 .227 ⁎

.282 ⁎⁎ .375 ⁎⁎⁎⁎ .237 ⁎ .224 ⁎

tionships in boldface are represented graphically in Fig. 1. BWAS=Barron-ck Depression Inventory; NEO=Revised Neuroticism Extraversion Opennessaris, and San Diego Autoquestionnaire; MBTI=Myers-Briggs Type Inventory

.

Fig. 1. Relationships between affect (NEO-Neuroticism, TEMPS-A Cyclothy-mia) and cognition (NEO-Openness, MBTI-Intuition) and creativity (BWAS-Total, BWAS-Dislike, BWAS-Like). Data as in Table 6, with arrow thicknessreflecting size of R2 change. Relationships in figure are statistically significant(pb0.05) with bivariate correlations (Table 5), and (albeit less robust, andwith the exception of NEO-Openness versus BWAS-Total, dashed line,p=0.08) with hierarchical multiple linear regression, accounting for effectsof age and Beck Depression Inventory scores (Table 6). BWAS-Total=Bar-ron-Welsh Art Scale-Total Score. BWAS-Dislike=BWAS-Dislike Subscale.BWAS-Like=BWAS-Like Subscale. NEO=Revised NEO Personality Invento-ry. TEMPS-A=Affective Temperament Evaluation of Memphis, Pisa, Parisand San Diego. MBTI=Myers-Briggs Type Inventory.

Table 6Hierarchical multiple linear regression of creativity metrics.

Predictor variable R2 change Standardized β F

BWAS-TotalStep 1 – 0.202 14.435 ⁎⁎⁎⁎

Age −0.390 ⁎⁎⁎⁎

BDI 0.274 ⁎⁎⁎

Step 2 –

2A: NEO-Neuroticism 0.043 0.269 ⁎ 12.219 ⁎⁎⁎⁎

2B: TEMPS-A Cyclothymia 0.052 0.262 ⁎⁎ 12.679 ⁎⁎⁎⁎

2C: NEO-Openness 0.022 0.150 10.890 ⁎⁎⁎⁎

2D: MBTI-Intuition 0.049 0.227 ⁎⁎ 12.641 ⁎⁎⁎⁎

BWAS-DislikeStep 1 – 0.202 14.336 ⁎⁎⁎⁎

Age −0.265 ⁎⁎

BDI 0.396 ⁎⁎⁎⁎

Step 2 –

2A: NEO-Neuroticism 0.035 0.242 ⁎ 11.618 ⁎⁎⁎⁎

2B: TEMPS-A Cyclothymia 0.033 0.193 ⁎ 11.384 ⁎⁎⁎⁎

2C: NEO-Openness 0.001 0.023 9.505 ⁎⁎⁎⁎

2D: MBTI-Intuition 0.009 0.094 9.979 ⁎⁎⁎⁎

BWAS-LikeStep 1 – 0.083 5.139 ⁎⁎

Age −0.254BDI −0.112Step 2 –

2A: NEO-Neuroticism 0.007 0.107 3.701 ⁎

2B: TEMPS-A Cyclothymia 0.015 0.174 4.019 ⁎⁎

2C: NEO-Openness 0.053 0.231 ⁎⁎ 5.888 ⁎⁎⁎

2D: MBTI-Intuition 0.066 0.261 ⁎⁎ 6.516 ⁎⁎⁎⁎

ACL-CPSStep 1 – 0.004 0.201Age 0.000BDI −0.059Step 2 –

2A: NEO-Neuroticism 0.023 −0.200 1.0502B: TEMPS-A Cyclothymia 0.000 −0.029 0.1652C: NEO-Openness 0.244 0.497 ⁎⁎⁎⁎ 12.416 ⁎⁎⁎⁎

2D: MBTI-Intuition 0.151 0.397 ⁎⁎⁎⁎ 6.888 ⁎⁎⁎⁎

TTCT-FStep 1 – 0.014 0.725Age −0.115BDI −0.013Step 2 –

2A: NEO-Neuroticism 0.007 −0.118 0.7542B: TEMPS-A Cyclothymia 0.017 −0.167 1.0782C: NEO-Openness 0.011 0.107 0.8812D: MBTI-Intuition 0.049 0.227 ⁎ 2.289±

TTCT-VStep 1 – 0.038 2.061Age −0.041BDI −0.188Step 2 –

2A: NEO-Neuroticism 0.028 0.220 2.3862B: TEMPS-A Cyclothymia 0.003 −0.022 1.4222C: NEO-Openness 0.048 0.221 ⁎ 3.218 ⁎

2D: MBTI-Intuition 0.057 0.244 ⁎ 3.558 ⁎

Relationships in boldface represented graphically in Fig. 1. ACL-CPS=AdjectiveCheck List Creative Personality Scale; BDI=Beck Depression Inventory. TTCT-F=Torrance Tests of Creative Thinking-Figural; TTCTV=Torrance Tests ofCreative Thinking-Verbal. Other acronyms as in Fig. 1.±pb0.1.

⁎ pb0.05.⁎⁎ pb0.01.⁎⁎⁎ pb0.001.⁎⁎⁎⁎ pb0.0001.

31S. Srivastava et al. / Journal of Affective Disorders 125 (2010) 27–34

in greater detail below (Table 5). MBTI-Intuition type preference(categorical) was associated with 38% higher BWAS-Totalscores (t=3.1, df=115, p=0.003), 48% higher BWAS-Likescores (t=3.0, df=114, p=0.003), 13% higher ACL-CPS scores(t=4.0, df=115, pb0.0001), and 10% higher TTCT-F scores(t=2.4, df=105, pb0.017). Also, in the entire sample, MBTI-Intuition continuous scores correlated with NEO-Opennessscores (r=0.61, N=117, pb0.0001), and MBTI-Intuition typewas associated with 24% higher NEO-Openness scores (t=8.3,df=115, pb0.0001). MBTI-Intuition also had significant but lessrobust relationships with NEO-Neuroticism (e.g. r=0.28,N=117, pb0.0023). The MBTI Creativity Index (to whichMBTI-Intuition is the largest contributor, and which correlatedwith MBTI-Intuition, r=0.92, N=117, pb0.0001) and MBTI-Perceiving (which correlated with MBTI-Intuition, r=0.48,N=117, pb0.0001) had patterns of relationships to BWAS andNEO resembling those seen with MBTI-Intuition. These relation-ships were not observed with the other MBTI preferences(Extroversion-Introversion and Thinking-Feeling).

3.4. Individual bivariate correlations and hierarchical multiplelinear regression for creativity

Individual bivariate correlation analyses suggested statisti-cally significant relationships between the four hypothesizedparameters (NEO-Neuroticism, TEMPS-A-Cyclothymia, NEO-Openness, MBTI-Intuition) and BWAS-Total scores (Table 5;Fig. 1, Center). Also, therewere statistically significant relation-ships between two hypothesized parameters (NEO-Neuroti-cism, TEMPS-A-Cyclothymia) and BWAS-Dislike scores(Table 5; Fig. 1, Left), and between two other hypothesizedparameters (NEO-Openness, MBTI-Intuition) and BWAS-Likescores and ACL-CPS scores (Table 5; Fig. 1, Right) as well asTTCT-V scores (Table 5). In addition, MBTI-Intuition correlatedwithTTCT-F scores (Table 5). Therewere statistically significantcorrelations with age and BDI (but not gender or education)compared to BWAS-Total, BWAS-Dislike, BWAS-Like (for age

32 S. Srivastava et al. / Journal of Affective Disorders 125 (2010) 27–34

only), and TTCT-V (for BDI only), but not compared to ACL-CPSand TTCT-F scores (Table 5). Hierarchical multiple linearregression, accounting for the effects of age and BDI scores,generally confirmed the significance of the above relationships,although they were less robust (Table 6, Fig. 1).

Restricting all of the above analyses to subjects no olderthan age 40 years retained the entire CC group, yielded HC,BP, and MDD subgroups with similar mean ages, and did notalter the above pattern of findings. Restricting the aboveanalyses to subjects with education scores of at least 7retained the entire CC group, yielded HC, BP, and MDDsubgroups with similar mean education scores, and did notalter the above pattern of findings.

4. Discussion

Thefindingsof this study suggest affective (NEO-Neuroticismand TEMPS-A-Cyclothymia) and cognitive (NEO-Openness andMBTI-Intuition) factors may differentially contribute to compo-nents of creativity captured by the BWAS-Dislike and the BWAS-Like (and the ACL-CPS and TTCT). This has substantive potentialimplications.

One potential implication is that there appears to be animportant affective temperament/personality (NEO-Neuroti-cism and TEMPS-A-Cyclothymia) component to creativity.Converging data suggest relationships between Cyclothymiaand creativity (Kretschmer, 1931; Andreasen, 1987; AkiskalandAkiskal, 1988; Richards et al., 1988a,b; Akiskal et al., 2005b)that have been previously confirmed with respect to the BWASby our group (Strong et al., 2007). There also is evidence of aconnection between Neuroticism and creativity (Kemp, 1981;Andreasen and Glick, 1988; Bakker, 1991; Hammond andEdelmann, 1991;Marchant-Haycox andWilson, 1992) that hasalso been previously confirmed with respect to the BWAS byour group (Strong et al., 2007). Thus, changeable and negativeaffective processing may contribute to creativity by enhancingnegative discrimination (i.e. NEO-Neuroticism and TEMPS-A-Cyclothymia scores correlatewithhigher BWAS-Dislike scores).

Anotherpotential implication is that therealsoappears tobeasubstantive cognitive temperament/personality (NEO-Opennessand MBTI-Intuition) component to creativity. Relationshipsbetween NEO-Openness and creativity are well established(McCrae, 1987; King et al., 1996; Feist 1998a,b; Dollinger et al.,2004b) andhave beenpreviously confirmedwith respect to bothBWAS and ACL-CPS by our group (Strong et al., 2007). In thecurrent study, MBTI-Intuition correlated significantly withBWAS-Total scores, replicating previous observations (r=0.40in 373males, r=0.33 in200 females) (ThorneandGough, 1991).We also found that MBTI-Intuition correlated significantly withACL-CPS, consistent with previous observations (r=0.45 in 99males, r=0.35 in 99 females) (Thorne andGough, 1991). Indeed,in the current study, MBTI-Intuition had the broadest pattern ofcorrelations with creativity, having significant bivariate associa-tionswithfiveof six creativitymetrics (Table5, bottomrow). Thecurrent study extends our prior observations by suggesting thatintuitive cognitive processing may contribute to creativity byenhancing positive discrimination (i.e. MBTI-Intuition correlateswith higher BWAS-Like scores).

Considering the above two potential implications togetheryields an integrative model that includes affective andcognitive components to creativity, similar to those suggested

by other investigators (Russ, 1993; Eysenck, 1995). Thus,creativity in patients with bipolar disorder may be related notonly to negative and changeable feelings but also to intuitivethinking (Fig. 1). However, it is likely that there are multipleadditional substantive contributors to creativity, such as an-thropological, behavioral, developmental, ecological, andsocial factors (Runco and Albert, 1990).

An important question raised by our observations is: Whatis the relative importance of the contributions of affective andcognitive components to creativity? Our findings suggestthat at least in some samples, the affective compared to thecognitive component could be at least as robust if not morerobust, but this remains tobeassessed in a systematic fashion. Itappears likely that the high proportion of participants withmood disorders (bipolar andmajor depressive disorder groupsaccounted for 45% of the entire sample) could contribute to theprominence of the affective component in our observations.

Limitations of this study include the use of a highlyeducated sample and the mixture of unmedicated and het-erogeneously medicated patients in the sample. The BP groupconsisted of subjects with bipolar I disorder, bipolar IIdisorder, and bipolar disorder not otherwise specified.However, as there were no significant differences betweenthese bipolar subgroups with respect to demographic para-meters, creativity measures, or temperament/personalitymeasures, it does not appear that combining these subgroupsinto a single BP group was problematic. Our CC group wasyounger and more educated than other groups. As BWAScorrelated inversely with age in the entire group, an age effectcould have yielded an overestimate of CC BWAS scorescompared to other groups. However, restricting the analysesto subjects no older than age 40 years yielded subgroups withsimilar mean ages, and did not alter the pattern of findings,suggesting that our findings involving comparisons with theCC group are valid in subjects up to age 40 years. Additionalstudies are needed to confirm that the results of ourcomparisons between CC and other groups apply to subjectsover age 40 years. As BWAS did not correlate with educationin the entire group, it is less likely that this could haveconfounded comparisons of BWAS in CC compared to othergroups. Also, restricting the analyses to subjects with themost education yielded subgroups with similar mean educa-tion scores, and did not alter the pattern of findings.Nevertheless, additional studies are needed to confirm thatthe results of our comparisons between CC and other groupsapply to subjects with less education. Indeed, given the higheducation level of all subgroups, additional studies areneeded to confirm all of our findings apply to subjects withless education. Our CC group was heterogeneous with respectto history of mood disorder (or any psychiatric disorder).However, CC with compared to CC without such histories,although having lower mean ACL-CPS scores, did not differsignificantlywith respect to anyother creativity parameter, andthe pattern of between-group creativity findings was notaltered by restricting analyses to CC with or without a historyof mood disorder, or CC with or without a history of anypsychiatric disorder. The sample included a relatively smallnumber of participants, so statistical power limitations couldaccount for some of our negative findings, and particularly limitour ability to assess creativity in the subgroups of the CC and BPgroups. Finally, although limiting the sample to euthymic

33S. Srivastava et al. / Journal of Affective Disorders 125 (2010) 27–34

subjects removed theconfoundofmoodstate, the current studycannot inform us of the effect of mood state on relationshipsbetween temperament/personality and creativity.

In spite of the above limitations, this study is one of the firstexploring the interaction of affective and cognitive contributorsto creativity across diverse groups (BP, UP, HC, CC), andprovides preliminary insights into the importance of both affectand cognition for creativity. Further studies including largersample sizes and groups of “clinicallywell” artists are indicatedto clarify mechanisms of creativity and their relationship toaffective and cognitive processes and bipolar disorders.

Role of funding sourceFunding for this study was provided by The National Alliance for

Research in Schizophrenia and Depression, and The Stanley FoundationResearch Awards Program; The National Alliance for Research in Schizo-phrenia and Depression, and The Stanley Foundation Research AwardsProgram had no further role in study design; in the collection, analysis andinterpretation of data; in the writing of the report; and in the decision tosubmit the paper for publication.

Conflict of interestThe authors do not have conflicts of interest related to the content of this

article.

Acknowledgements

The authors would like to express thanks to the StanfordUniversity Joint Program in Design, the Department of Art andArt History, and the Stegner Fellowship program for theirassistance in recruiting subjects. The authors also thank Jean-Frédéric Aboudarham, and Annemarie Hier for assistance indata collection and processing.

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