Bipolar bozuklukta Etkin Olan PsikolojikMekanizmalarınAnlaşılması: Duygusal ve BilişselSüreçler Üzerine bir Vaka Örneği

Abstract

Bipolar bozukluk günümüzde iş yaşamı, sosyal yaşam ve insan ilişkileri üzerinde oldukça yıkıcı etkileri olan yaygın ve kronik bir durum olarak kabul edilmektedir. Klinik raporlarda kaydedilen geç ya da yanlış tanı oranının yüksekliği, başarısız tedavi sonuçları, eşlik eden diğer sorunların sıklığı ve yüksek intihar oranları, bipolar bozukluğun tanı ve tedavisinde devam eden sorunlara işaret etmektedir. Bu sorunları çözme amacıyla yapılan çalışmalar, sadece biyolojiye indirgenen bir bakış açısının bu hastalığı anlamada yeterli olmadığını göstermekte, sınırlı bilgiyle yapılan farmakolojik tedavilerin de yetersiz kaldığını vurgulamaktadır. Bu amaçla, bu çalışmada bipolar bozuklukta bilişsel ve duygusal faktörleri içeren psikolojik dinamiklerin rolü ve bu roller üzerinden yapılandırılan psikoterapinin bipolar bozukluk seyrindeki etkisi araştırılmış ve vaka örnekleri verilmiştir.Bipolar disorder is a common chronic condition that is associated with major impairments in daily, occupational and relational functioning. The high rates of misdiagnoses or delayed diagnoses, poor treatment outcomes, comorbid conditions; and also suicide attempts in clinical reports point to important problematic issues about definition and management of bipolar disorder. Recent studies discussing these controversial issues indicate that one sided dimension focusing only on biological mechanisms does not provide a comprehensive framework and this deficiency lead to poor prognosis in spite of aggressive pharmacotherapy. On the basis of these problems, in the current study a literature review was conducted in order to investigate psychological dynamics in bipolar disorder from cognitions to emotions in an attempt to explore the effectiveness of psychotherapy based on these dynamics.From cognitive perspective dysfunctional thoughts, maladaptive coping strategies such as avoidance, rumination, cognitive distortion and catastrophizing are found to be significant in both development and maintenance of bipolar episodes. In addition, hypersensitivity in a motivational system called Behavioral Activation System (BAS) is considered as an important vulnerability factor which may include setting too high and unrealistic goals, attitudes of too harsh self-criticism and attitudes of perfectionism; eventually these features may trigger manic or depressive episodes resulting from unfulfilled expectations and negative life events. The common point of these cognitive and motivational dynamics indicates the presence of maladaptive schemas; and consistently, the studies revealed that approval seeking, recognition, emotional inhibition and abandonment are especially significant in these patients.Another important psychological mechanism in bipolar disorder is related to emotional structure. In bipolar depression, self-disgust and guilt have an important role in the evaluation of self-worth that results from introjection of unacceptable emotions and needs. In contrast to a common view, mania is not considered the opposite pole of the depression, but rather, it is an ego defense facet for these depressive and painful emotions.From the point of these theoretical perspectives, psychotherapy application focusing on maladaptive cognitive mechanisms and inhibited negative emotions have important implications for preventing bipolar attacks, increasing functioning as well as interpersonal relations for a long term period.