Understanding Bipolar Disorder: A Psychological Perspective from Cognitions to Emotions

Year 2014, Volume: 1 Issue: 3, 1 - 16, 01.09.2014

Başak Safrancı

https://doi.org/10.31682/ayna.470599

Abstract

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.

Keywords

Bipolar disorders, cognitions, emotions, psychotherapy

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.

Keywords

Bipolar bozukluk, bilişler, duygular, psikoterapi

References

• Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory based subtype of depression. Psychological Review, 96, 358–372.
• Akhtar, S. (1992). Broken structures: severe personality disorders and their treatment. Northvale, NJ: Jason Aronson.
• Akiskal, H. S. (1984). Characterologic manifestations of affective disorders: Toward a new conceptualization. Integrating Psychiary, 2, 83-88.
• Alatiq, Y., Crane, C., Williams, J.M.G, & Goodwin, G.M. (2010). Dysfunctional beliefs in bipolar disorder: Hypomanic vs. depressive attitudes. Journal of Affective Disorders, 122, 294-300.
• Alloy, L.B., Abramson, L.Y., Walshaw, P.D., Keyser, J., & Gerstein, R.K. (2010). Adolescent-onset bipolar spectrum disorders: A cognitive vulnerability-stress perspective. In Understanding Bipolar
• Disorder: A Developmental Psychopathology Perspective, ed. David J. Miklowitz & Dante Cicchetti (pp. 282-331). New York: The Guilford Press. Alloy, L.B., Abramson, L.Y., Urosevic, S. Nusslock, R. & Jager-Hyman, S. (2010). Course of early-onset bipolar spectrum disorders during the college years: a behavioral approach system dysregulation perspective. In Understanding Bipolar Disorder: A Developmental Psychopathology
• Perspective, ed. David J. Miklowitz & Dante Cicchetti (pp. 166-191). New York: The Guilford Press. Alloy, L.B., Reilly-Harrington, N.A., Fresco, D.M., & Flannery-Schroeder (2006). Cognitive vulnerability to bipolar spectrum disorders. In Cognitive Vulnerability to Emotional Disorders, ed.
• Lauren B. Alloy & John H. Riskind (pp. 93-134). New Jersey: Lawrence Erlbaum. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders,
• (4th ed., text revision). Washington, DC. American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159 (4), 1-50.
• Angst, J. (2006). Do many patients with depression suffer from bipolar disorder? Canadian Journal of Psychiatry, 51, 3-5.
• Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.
• Beck, A. T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy, 1, 5-37.
• Bentall, R.P., Myin-Germeys, I., Smith, A.,Knowles, R., Jones, S.H., Smith, T., & Tai, S.J. (2011).
• Hypomanic personality, stability of self-esteem and response styles to negative mood. Clinical Psychology and Psychotherapy, 18, 397-410. Brieger, P. (2005). Comorbidity in mixed states and rapid-cycling forms of bipolar disorder. In
• Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms, ed. Andreas Marneros ve Frederick Goodwin (pp. 262-277). UK: Cambridge University Press. Chen, S.H., & Johnson, S.L. (2012). Family influences on mania relevant cognitions and beliefs: a cognitive model of mania and reward. Journal of Clinical Psychology, 68(7), 829-842.
• Christensen, E.M., Gjerris, A., Larsen, J.K., Bendtsen, B.B, Larsen, B.H., Rolff, H., Ring, G., & Schaumburg, E. (2003). Life events and onset of a new phase in bipolar affective disorder. Bipolar Disorders, 5, 356-361.
• Coulston, C.M., Bargh, D.M., Tanious, M., Cashman, E.L., Tufrey, K., Curran, G., Kuiper, S., Morgan, H., Lampe, L., & Malhi G.S. (2012). Is coping well a matter of personality? A study of euthymic unipolar and bipolar patients. Journal of Affective Disorders (in press).
• Dilbaz, N. (2013). İki uçlu depresyonda doğru tanı koymak: Tek uçlu ve iki uçlu depresyon ayrımı. Journal of Mood Disorders, 3(1), 545-547.
• Engstrom, C., Brandstrom, S., Sigvardsson, S., Cloninger, C.R., & Nylander, P.O. (2004). Bipolar disorder. III: harm avoidance a risk factor for suicide attempts. Bipolar Disorders, 6, 130-138.
• Freud, S. (1923). The ego and the id. Standard Edition, 18, 7-64.
• George, E.L., Miklowitz, D.J., Richards, J.A., Simoneau, T.L., & Taylor, D.O. (2003). The comor- bidity of bipolar disorder and axis II personality disorders: prevalence and clinical correlates.
• Bipolar Disorders, 5, 115–122. Goodwin, F.K. & Jamison, K.R. (2007). Manic Depressive Illness (2nd ed). New York:Oxford University Press.
• Gruber, J., Harvey, A.G., & Johnson, S.L. (2009). Reflective ruminative processing of positive emotional memories in bipolar patients and healthy controls. Behavior Research and Therapy, 47, 704.
• Harmer, C.J., Grayson, L., & Goodwin, G.M. (2002). Enhanced recognition of disgust in bipolar illness. Society of Biological Psychiatry, 51, 298-904.
• Hawke, L.D. & Provencher, M.D. (2012). Early maladaptive schemas among patients diagnosed with bipolar disorder. Journal of Affective Disorders, 136, 803-811.
• Hirschfeld, R.M., Lewis L, & Vornik, L.A. (2003). Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic– depressive associa- tion 2000 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(1), 61-74.
• Jabben, N., Arts, B., Jongen, E.M.M., Smulders, F.T.Y., & vanOs, J. (2012). Cognitive processes and attitudes in bipolar disorder: A study into personality dysfunctional attitudes and attention bias in patients with bipolar disorder and their relatives. Journal of Affective Disorders (in press).
• Johnson, S. L. (2005). Life events in bipolar disorder: Toward more specific models. Clinical Psychology Review, 25, 1008-1027
• Johnson, S. L., McKenzie, G., & McMurrich, S. (2008). Ruminative responses to negative and positive affect among students diagnosed with bipolar disorder and major depressive disorder.
• Cognitive Therapy and Research, 32, 702-713. Jones, S. (2004). Psychotherapy in bipolar disorder: a review. Journal of Affective Disorders, 80, 114.
• Jones, S.H., Sellwood, W., & McGovern, J. (2005). Psychological therapies for bipolar disorder: the role of model-driven approaches to therapy integration. Bipolar Disorders, 7, 22–32.
• Judd, L.L. & Akiskal, H.S. (2003). The prevalence and disability of bipolar spectrum disorders in the US population: Re-analysis of the ECA database taking into account subtreshold cases, Journal of Affective Disorders, 73, 123-131.
• Kim, B., Joo, Y.H., Kim, S.Y., Lim, J.H. & Kim, E.O. (2011). Personality traits and affective morbidity in patients with bipolar I disorder: The five factor model perspective. Psychiatric Research, 185, 135-140.
• Kessing, LV., Agerbo, E. & Mortensen, P.B. (2004). Major stressful life events and other risk factors for first admission with mania. Bipolar Disorders, 6, 122-129.
• Klein, M. (1994). Mourning and its relation to manic-depressive state. In Essential Papers on
• Object Loss, ed. Rita V. Frankiel (pp. 95-122). New York ve London: New York University Press. Knowles, R., Tai, S., Jones, S. H., Highfield, J., Morris, R., & Bentall, R. P. (2007). Stability of self-esteem in bipolar disorder: comparisons among remitted bipolar patients, remitted unipolar patients and healthy controls. Bipolar DisorderS, 9, 490-495.
• Lozano, B. E., ve Johnson, S. L. (2001). Can personality traits predict increases in manic and depressive symptoms? Journal of Affective Disorders, 63, 103–111.
• Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A., & Hirschfeld, R.M. (1994). The nation- al depressive and manic-depressive association (National DMDA) survey of bipolar members.
• Journal of Affective Disorders, 31, 281-294. Maçkalı, Z. & Tosun A. (2001). Bipolar Bozuklukta Bilişsel Davranışçı Terapi. Psikiyatride
• Güncel Yaklaşimlar, 3(4), 571-594. Martin, E. (2007). Bipolar Expectations: Mania and Depression in American Culture. UK: Prince- ton University Press.
• McWilliams, N. (2010). Psikanalitik Tanı: Klinik Süreç içinde Kişilik Yapısını Anlamak. İstanbul:
• İstanbul Bilgi Üniversitesi Yayınları. Miklowitz, D.J., Wisniewski, S. R., Miyahara, S., Otto, M.W., & Sachs, G.S. (2005). Perceived criticism from family members as a predictor of the one-year course of bipolar disorder. Psychiat- ric Research, 136,101-111.
• Nery, F.G., Hatch, J. P., Glahn, D.C., Nicoletti, M.A., Serap Monkul, E., Najt, P., Fonseca, M., Bowden, C.L., Robert-Cloninger, C., & Soares, J.C. (2008). Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders.
• Journal of Psychiatric Research, 42, 569-577. Perich, T., Manicavasagar, V., Mitchell, P.B., & Ball, J.R. (2011). Mindfulness, response styles and dysfunctional attitudes in bipolar disorder. Journal of Affective Disorders, 134, 126-132.
• Power, M. & Dalgleish, T. (1997). Cognition and Emotion: From Order to Disorder. UK: Psychol- ogy Press.
• Smith, D.J., Muir, W.J., & Blackwood, D.H.R (2005). Borderline personality disorder characteris- tics in young adults with recurrent mood disorders: A comparison of bipolar and unipolar depres- sion. Journal of Affective Disorders, 87, 17-23.
• Solomon, D. A., Shea, M. T., Leon, A. C., Mueller, T. I., Coryell, W., Maser, J. D., Endicott, J., ve Keller, M. B. (1996). Personality traits in subjects with bipolar I disorder in remission. Journal of
• Affective Disorders, 40, 41-48. Strong, C. M., Nowakowska, C., Santosa, C. M., Wang, P. W., Kraemer, H. C., & Ketter, T. A. (2007). Temperament-creativity relationships in mood disorder patients, healthy controls and highly creative individuals. Journal of Affective Disorders, 100, 41-48.
• Sullivan, A.E., Judd, C.M., Axelson, D.A., & Miklowitz, D.J. (2012). Family functioning and the course of adolescent bipolar disorder, Behavior Therapy (in press).
• Sütçigil, L. & Cansever, A. (2006). Bipolar bozuklukta psikoterapötik ve psikososyal girişimler.
• Türkiye Klinikleri Journal of Internal Medical Sciences, 2(29), 46-51. Tamam, L. (2007). Bipolar bozukluk ile anksiyete bozukluğu birlikteliği: Bir gözden geçirme.
• Türk Psikiyatri Dergisi, 18(1), 59-71. Watson, D. & Hubbard, B. (1996). Adaptational style and dispositional structure: coping in the context of the five-factor model. Journal of Personality, 64, 737-774
• Youngstrom, E., van Meter, A., & Algotra, G.P. (2010). The bipolar spectrum: myth or reality? Current Psychiatry Reports, 12, 479-489.