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STUDY OF THE EFFICACY LEVELS OF COGNITIVE BEHAVIORAL THERAPY
FOR BIPOLAR AFFECTIVE DISORDER
1
Dustmurodova Madina Ulug‘bek qizi
2
Egamberdiyev Boburjon Olimboyevich
3
Sharapova Dilfuza Nematillayevna
1-2
Student of group 509 of the medical faculty of Samarkand State Medical University,
Samarkand, Republic of Uzbekistan.
3
Course of Psychiatry, Clinical ordenator, Samarkand State Medical University, Samarkand,
Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.14749631
Abstract. Bipolar affective disorder is a disorder of biochemical processes in the brain
and, with psychotherapy, working with emotions in these patients can affect this "chemistry" and
successfully control the "change" of mood. Long-term remission in bipolar disorder is possible,
first of all, with adequate drug selection due to dysfunction of the brain's bar neurotransmitters,
dopamine, norepinephrine and serotonin systems. Cognitive behavioral therapy is important in
the treatment of this disorder, helping patients identify irrational thoughts, judgments, emotions
and successfully deal with them. Psychotherapy changes the work of the brain, affects changes in
its biochemistry.
Keywords: Bipolar affective disorder, psychotherapy, neurotransmitters, behavioral
therapy.
Introduction.
Famous British psychoanalyst M. Balint introduced the concept of" primary
defect “to define the primary”, verbal, and prenatal “level of damage to the psyche as a result of
the breakdown of the first" object” – a diadic relationship with the mother. He described this defect
as "a certain disorder in the mental apparatus, a deficiency that needs to be filled, the absence of
something at the moment or in almost the entire life of the patient" and argued that “if the missing
ingredients are found, the underlying defect can be cured” [1-3]. Apparently, he actually included
in his psychoanalytic model the idea of the endogeneity of the nature of schizophrenia, the
importance of the developmental effects of the environment in the early stages of a child's life, and
did this long before the appearance of the stressful model of diathesis-schizophrenia. If we talk
about the consequences of the “main defect”, then we again return to Ego deficiency. Let’s take a
closer look at them [4-7].
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Disadvantages involved in the main function of the ego (Z. Freud and A. According to
Freud) – to ensure the "principle of truth". Later, the range of Ego functions was expanded and
concretized, as a result of which the following functions were defined:
- formation of an attitude towards reality (adaptation to reality, testing reality, experience
or feeling reality);
- regulation and control of impulses and impulses (ability to delay the satisfaction of
desires, tolerance to despair, anxiety, depression);
- building an objective relationship (the ability to build a stable relationship with another
person, while simultaneously coping with individual negative emotions, hostile manifestations and
maintaining this connection in the future);
- the ability to carry out the thought process, that is, to perceive, understand, classify the
environment, give it a certain meaning using a symbolic form (that is, speech), analyze, think,
draw conclusions, as well as Remember, learn new things, plan, that is, carry out all kinds of
mental or intellectual activity;
- autonomic functions (primary autonomic innate abilities for perception, action,
memorization, and secondary stable behaviors formed on their basis);
- synthetic functions (combining all multilevel and heterogeneous manifestations into a
single experience of the individual for its target behavior);
- psychological defense mechanisms [8-12].
The last point has become a particularly popular area of development. The importance of
this aspect is determined by the following points. First, the deficit mechanisms of psychological
protection-preverbal, "primary" (for example, primitive isolation (including – autistic fantasy),
rejection, powerful control, primitive idealization-devaluation, primitive forms of projection and
introection, projective identification, division and detachment) are very important for diagnosing
ego disorders in serious personality pathology, including"psychotic personality". Secondly, they
provide an understanding of the direction of psychoanalytic treatment of patients, since improving
the mechanisms of psychological protection, equipping the ego with new methods of combating
unsatisfactory reality is the most important way of psychotic psychotherapy [13-15].
The second direction of research on psychosis psychotherapy was determined by theorists
among the creators of the theory of "object relations". Analysts of the" British school "tried to
systematically characterize the child's experience of early, verbal relationships with other people,"
transfer " to ordinary language (in the case of psychosis – unsatisfactory, nervous relationships).
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Later, only psychoanalytic data was added to observations, results from experimental
studies, data from ethological reports, and later neuroscience [17-19]. To date, there is no doubt
that the initial experience that the child receives from the interaction of people nearby, primarily
the mother, is very important for the formation of basic trust in the world, the ability to regulate
influences and socially influence. It is this experience of arousal, attachment, support and
sometimes moderate, portable and therefore hopeless development that is necessary to achieve
good functioning of object relationships, develop cognitive abilities, cope with stress and achieve
self-control skills. Therefore, the mother, as the first" object", acquires special importance in the
early period of the child's development and is the main person in the genesis of the child's
psychopathology [20-23].
U. Bion introduced heuristic concepts of “container and containerized”, laying the
groundwork for understanding primary relationships with the mother (a small, pre-speech baby)
as communicative processes, in which the mother's ability to “accept” the content of the child's
experiences. and then returning to him this content in a modified and radically translated form is
in many ways mental well-being and the development of the child. To understand schizophrenia
from an analytical point of view, it is important that the mother has emotional support, the child's
failure to accept his emotions and perform the tasks of containerization, since this leads to the fact
that basic hatred, envy, fear literally destroy his mental apparatus, have the ability to integrate,
have a holistic experience. Note that for analytically oriented authors, the role of the mother in the
genesis of psychopathology at the psychotic level is universally recognized and the story of a
future patient with severe personality disorders and prone to psychotic states is “the story of a
person who does not have a normal relationship with the mother” [24-27].
The above conceptualization is important because they practically justify specific
psychotherapeutic interventions that are suitable for working with patients suffering from
psychotic, psychotic or bipolar affective disorder. When working with such patients, emotional
support," Feeding", empathic acceptance, refusal of criticism," educational communication",
etc.are of particular importance. such therapeutic interventions can be described based on what
was introduced by him. The bionome of the ideas of A-and b-processes, a step-by - step transition
from B-processes to figuratively existing A-processes, reflecting emotional impressions in a pure
form, not available for mastering the experience, with a real study of symbolism, as a result of a
series of containers; and this description is also suitable for conducting an ontogenetic
development process [28-30].
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Mastering all of the above, as well as many other ideas and models, modern psychoanalysis
has developed its own perspective on schizophrenia and schizophrenia psychotherapy. The author
of one of the famous monographs believes that "schizophrenia is an organized state of mind, a
psychologically unsuccessful defense against structurally complex but disruptive behavior", and
that the patient's experiences contain strong aggressive and libidous elements, as well as protection
that "protects the object from the release of volcanic aggression (narcissistic anger), but leads to
destruction. or risk of destruction) spiritual apparatus [31-33]. The secondary consequences of this
defense are the destruction of the object field of the psyche and the breakdown of the ego."It is
important that the desire of analysts to interpret the first year of life as the key to the formation of
response models that lead to future psychotic disorders does not exclude the possible sound of
other factors, in particular constitutional, organic ones, since they can be the main reason for the
violation of interaction with the mother.fatal for the development of the child's mental apparatus.
And here the psychoanalytic model successfully combines with other concepts, in
particular, the diathesis-stress model, which tries to connect biological, social, psychological
factors [34].
The controversy over the adequacy and validity of psychoanalytic theories and methods in
the treatment of schizophrenia in the pages of the" International Journal of psychoanalysis " has
led to the recognition of the need to continue the systematic psychoanalytically oriented research
currently taking place. Including, the unsuccessful attempts of researchers to combine the
psychoanalytic format with other traditions, such as experimental-Psychological, have been noted.
A psychoanalytic model of identity disorder has been investigated in patients with
schizophrenia. The author uses the concept of" identification level " to justify distinguishing five
possible levels of performance (degree of confusion, division and fragmentation, degree of
pseudointegration, holistic level, and integral level), and demonstrates gross identity disorder in
patients with paranoid schizophrenia using projective psychodiagnostic procedures [22-27]. As
diagnostic criteria for the level of identification integration, the qualifications of leading concerns,
concerns and psychological defense mechanisms were used. The specificity of patients with
Paranoid schizophrenia is characterized by instability, fragmentation, cleavage, and the specificity
of self-description, which has been assessed as a confusing level of identification involving
phenomena at the level of cleavage, fragmentation, and sometimes reaching the level of
pseudointegration [28-35]. An important component of this state is the images (or object-
representation) of other people. The identifiers of patients diagnosed with schizoaffective disorder
are closer to Optimals due to greater dynamism and plasticity.
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These and similar studies help not only to more accurately understand personality disorders
in schizophrenia, but also to set, justify psychotherapeutic goals when working with such patients,
to reflect psychotherapeutic in the process of their management [36-41].
As noted above, the psychodynamic theory of bipolar affective disorder and the practice of
psychotherapy have remained unclear and underdeveloped for a long time. The first significant
attempt to identify the possibilities and problems of therapeutic work with patients with manic-
depressive psychosis belongs to Frida Fromm-Reichman, the publication of which dates back to
1949. The American psychoanalyst tried to explain the small number of studies on psychodynamic
psychotherapy that manic-depressive psychosis and his colleagues did not want to take such
patients to therapy. He identified patients with bipolar affective disorder as unreliable, superficial,
and manipulative individuals who do not have stable and satisfactory interpersonal relationships
and therefore easily form therapist dependence [42-49]. At the same time, patients developed a
strong sense of hatred and, being more reserved and self-confident than patients with
schizophrenia, they openly showed negative feelings towards the therapist and found his
weaknesses. Related to the above considerations are F. Fromm-Reichman considered
psychoanalytic therapy more acceptable than schizophrenic patients with manic-depressive
psychosis.
Conclusions.
Later, attempts to treat patients were made by manic-depressive psychosis
psychoanalysts, but the effectiveness of psychoanalytic therapy was never confirmed by studies.
Currently, for patients with bipolar affective disorder, the use of a special type of
therapeutic relationship (rather supportive) from a rich arsenal of modern psychodynamic therapy
tools and the use of technology for the development of emotional regulation based on the
perception of hidden emotions rejected by patients is considered optimal.
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