Ayna Klinik Psikoloji Dergisi; 2014;1(3):1-16
Bipolar bozuklukta Etkin Olan Psikolojik Mekanizmaların Anlaşılması: Duygusal ve Bilişsel Süreçler Üzerine bir Vaka Örneği
B Safrancı
Orta Doğu Teknik Üniversitesi, Ankara
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.
Understanding Bipolar Disorder: A Psychological Perspective from Cognitions to Emotions
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.