Effective therapy for post-traumatic stress disorder. Effective Therapy for Post-Traumatic Stress Disorder Edited by

Year of issue: 2005

Genre: Psychology

Format: PDF

Quality: OCR

Description: In preparing the materials presented in the book “Effective Therapy of Post-Traumatic stress disorder", members of a special commission created to develop guidelines on methods of treating PTSD were directly involved. This panel was organized by the Board of Directors of the International Society for Traumatic Stress Studies (ISTSS) in November 1997. Our goal was to describe the various treatments based on a review of the extensive clinical and research literature prepared by experts in each specific field. The book “Effective Therapy for Post-Traumatic Stress Disorder” consists of two parts. The chapters of the first part are devoted to an overview of the results of the most important studies. The second part contains short description the use of different therapeutic approaches in the treatment of PTSD. This guideline aims to inform clinicians of the developments we have identified as best for the treatment of patients diagnosed with post-traumatic stress disorder (PTSD). PTSD is a complex mental condition that develops as a result of experiencing a traumatic event. Symptoms that characterize PTSD include repeated replay of the traumatic event or episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often comorbid with other mental disorders and is a complex illness that can be associated with significant morbidity, disability, and impairment of life. important functions.

When developing this practical guide, a special commission confirmed that traumatic experiences can lead to the development of various disorders, such as general depression, specific phobias; disorders of extreme stress not otherwise specified (DESNOS), personality disorders, such as border anxiety disorder and panic disorder. However, the main focus of this book is the treatment of PTSD and its symptoms, which are listed in the Diagnostic and Statistical Manual, Fourth Edition. mental illness(Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994) of the American Psychiatric Association.
The authors of the Effective Treatments for Post-Traumatic Stress Disorder manual acknowledge that the diagnostic scope of PTSD is limited and that these limitations may be particularly evident in patients who have experienced childhood sexual or physical abuse. Often, patients diagnosed with DESNOS have a wide range of problems in relationships with other people, which contribute to impairments in personal and social functioning. About successful treatment Relatively little is known about such patients. The consensus among clinicians, supported by empirical data, is that patients with this diagnosis require long-term and complex treatment. The Special Commission also recognized that PTSD is often accompanied by other mental disorders, and these comorbidities require sensitivity, attention, and clarification of the diagnosis by medical personnel throughout the treatment process. Disorders requiring special attention are substance abuse and general depression as the most common comorbid conditions. Practitioners may refer to guidelines for these disorders to develop treatment plans for individuals demonstrating multiple disorders and to the comments in Chapter 27.
The Effective Treatment for Post-Traumatic Stress Disorder guideline is based on cases of adults, adolescents, and children suffering from PTSD. The purpose of the guide is to assist the clinician in treating these individuals. Because PTSD is treated by clinicians with a variety of backgrounds, these chapters were developed using an interdisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family consultants and other specialists. Accordingly, these chapters address wide range specialists involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently being subjected to violence or insults. These individuals (children who live with an abusive person, men and women who are abused and abused in their home), and those living in war zones may also meet criteria for a diagnosis of PTSD. However, their treatment, as well as the associated legal and ethical issues differ significantly from the treatment and problems of patients who have experienced traumatic events in the past. Patients directly in a traumatic situation require special attention from clinicians. These circumstances require the development of additional practical guides.
Very little is known about the treatment of PTSD in industrialized regions. Research and development on these topics is carried out mainly in Western industrialized countries. The Special Commission is keenly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is found across many cultures and societies. However, there is a need for systematic research to determine the extent to which treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western societies will be effective in other cultures. In general, practitioners should not limit themselves to only the approaches and techniques outlined in this manual. The creative integration of new approaches that have demonstrated effectiveness in treating other disorders and have sufficient evidence is encouraged. theoretical basis, in order to improve the results of therapy.

The book “Effective Therapy for Post-Traumatic Stress Disorder” is based on an analysis of the results of research on the effectiveness of psychotherapy for adults, adolescents and children suffering from post-traumatic stress disorder (PTSD). The purpose of the manual is to assist the clinician in the treatment of such patients. Since PTSD treatment is carried out by specialists with various professional training, the authors of the chapters of the manual took an interdisciplinary approach to the problem. The book as a whole brings together the efforts of psychologists, psychiatrists, social workers, art therapists, family counselors, etc. The chapters of the manual are addressed to a wide range of specialists involved in the treatment of PTSD.
The book “Effective Therapy for Post-Traumatic Stress Disorder” consists of two parts. The chapters of the first part are devoted to an overview of the results of the most important studies. Part two provides a brief description of the use of different therapeutic approaches to treat PTSD.

"Effective Therapy for Post-Traumatic Stress Disorder"

1. Diagnosis and evaluation

Treatment approaches for PTSD: a review of the literature

1. Psychological debriefing
2. Psychopharmacotherapy
3. Treatment of children and adolescents
4. Group therapy
5. Psychodynamic therapy
6. Treatment in hospital

Psychosocial rehabilitation

1. Hypnosis
2. Art therapy

Therapy Guide

1. Psychological debriefing
2. Cognitive behavioral therapy
3. Psychopharmacotherapy
4. Treatment of children and adolescents
5. Desensitization and reprocessing using eye movements
6. Group therapy
7. Psychodynamic therapy
8. Treatment in hospital
9. Psychosocial rehabilitation
10. Hypnosis
11. Marriage and family therapy
12. Art therapy

Conclusion and conclusions

Is online Skype psychotherapy as effective as traditional psychological help?

Until now, the very topic of online psychotherapy causes controversial statements, skepticism and even outright denial, both in academic circles and among practicing psychologists. At the same time, the rapid growth of practice psychological assistance the Internet does not allow you to remain on the sidelines.
Perhaps the most important question that interests potential clients and a number of psychologists with psychotherapists - this is how effective online psychotherapy is, compared to traditional methods(face to face) psychological help?

Looking ahead, I will say that most published studies on the effectiveness of online psychological assistance report comparable results of success as if clients were working face-to-face with their therapists. Therefore we can conclude that Internet-based therapy , on average, also effective or nearly as effective as face-to-face therapy.

To date, several hundred studies have been conducted, in which several tens of thousands of people took part. And there is no reason not to trust the data received. This conclusion is based on many comprehensive reviews of the effectiveness of psychotherapy, such as the Consumer Reports studies (see Seligman, 1995), and meta-studies conducted by Smith and Glass (1977), Wampold and colleagues (1997), and Luborsky and colleagues ( 1999).
In this article I have summarized research data.

Questions of the effectiveness of online psychological assistance.

The main questions that the authors of the studies consistently tried to answer:
can therapy delivered online be effective at all;
whether the therapy could be delivered effectively (that is, achieve its therapeutic goals) via the Internet;
– whether it was as effective as traditional therapy;
- And How various methods and variables associated with online therapy affected effectiveness?

At what age is online psychotherapy effective?

Among the four categories age groups The effectiveness of online therapy in a group of middle-aged adults (19-39 years old) was higher than with older or younger clients. But this factor may also be due to the lower level of use of Internet-related skills. Therefore, there is evidence of successful psychological assistance to children and the elderly.

What is more effective: individual online therapy or group therapy?

So far, the data is in favor. And although this advantage is insignificant, it is most likely due to the need for a person to simultaneously focus on several sources of information (several windows on the monitor), as a result, lower concentration, as well as emotional tension during the session, due to a situation of psychological insecurity.
In any case, online group therapy can be safely recommended as a way to solve a variety of problems.

What problems is online psychotherapy effective for?

In the studies, patients were treated for a variety of problems and psychological distress (sometimes related to medical problems such as lower back pain or headaches). They were able to classify and group them into eight specific problems. While post-traumatic stress disorder (PTSD) had the greatest effect from online therapy, weight loss received the least effective therapy.

Conclusions: online help is better suited to therapy for problems that are more psychological in nature - that is, dealing with emotions, thoughts and behavior - and less suitable for problems that are primarily physiological or bodily (although they obviously have psychological components as well ).

A short list of studies on the effectiveness of online psychotherapy.

Marital problems (Jedlicka and Jennings, 2001), sexual problems (Hall, 2004), addictive behaviors (Stofle, 2002), anxiety and social phobia (Przeworski and Newman, 2004), and eating disorders (Grunwald and Busse, 2003); and group therapy for a variety of problems (e.g., Barak & Wander-Schwartz, 2000; Colo`n, 1996; Przeworski & Newman, 2004; Sander, 1999).

B. Klein, K. Shendley, D. Austin, S. Nordin Pilot study"Panic Online" program as self-guided therapy for Panic Disorder
S.J. Linton, L. von Knorring, L.G. Ost Computer-Based Cognitive Behavioral Therapy for Anxiety Disorders and Depression

Is it worth seeking online psychological help?

As you can see, there are practically no serious arguments against online therapy. Whether to turn to traditional forms of working with a psychologist face to face, or, is up to you. If you have the opportunity to regularly meet in a psychologist’s office, you should prefer this option. If this is not possible, or option online help allows you to significantly save money and time; of course, it’s worth resorting to the help of the Internet.

Like any new phenomenon in life, it takes time to recognize new forms and methods of work. Once upon a time, the professional community did not want to recognize the emerging group therapy, calling it “psychoanalysis for the poor,” however, over time, it became clear that group therapy is a completely different form of psychotherapy.

A universal drug having several important pharmacological effects:
- anxiolytic (sedative and vegetotropic)
- nootropic
- stress-protective

Effective therapy for vegetative-vascular dystonia in patients young

E. N. Dyakonova, doctor medical sciences, Professor
V. V. Makerova
State Budgetary Educational Institution of Higher Professional Education IvSMA Ministry of Health of the Russian Federation, Ivanovo Summary. Approaches to the treatment of vegetative-vascular dystonia in young patients in combination with anxiety and depressive disorders are considered. The study included 50 patients aged 18 to 35 years with vegetative-vascular dystonia syndrome; the effectiveness and safety of therapy were assessed during treatment and after discontinuation.
Keywords : vegetative-vascular dystonia, anxiety-depressive disorders, asthenia.

Abstract. The treatment of vegetative-vascular dystonia in young patients in combination with anxiety and depressive disorders was discussed. The study included 50 patients aged 18 to 35 years with a syndrome of vegetative-vascular dystonia. In the course of the treatment and after its cancellation, the efficacy and safety of the therapy were evaluated.
Keywords: vegetative-vascular dystonia, anxiety and depressive disorders, asthenia.

The term “vegetative-vascular dystonia” (VSD) is often understood as psychogenically caused multisystem autonomic disorders, which can be an independent nosology, and also act as secondary manifestations of somatic or neurological diseases. At the same time, the severity vegetative pathology aggravates the course of the underlying disease. Vegetative-vascular dystonia syndrome significantly affects the physical and emotional condition patients, determining the direction of their appeal for medical care. In the structure of the general incidence of autonomic disorders nervous system occupy one of the leading places (category G90.8 according to ICD-10). Thus, the prevalence of vegetative-vascular dystonia in the general population, according to various authors, ranges from 29.1% to 82.0%.

One of the most important features VSD is a polysystemic clinical manifestation. Vegetative-vascular dystonia includes three generalized syndromes. The first is psychovegetative syndrome (PVS), which is manifested by permanent paroxysmal disorders caused by dysfunction of nonspecific brain systems (suprasegmental autonomic systems). The second is the syndrome of progressive autonomic failure and the third is the vegetative-vascular-trophic syndrome.

Anxiety spectrum disorders are observed in more than half of patients with VSD. special clinical relevance they acquire in patients with a somatic profile, including functional pathology, since in these cases there are always anxious experiences varying degrees severity: from psychologically understandable to panic or to generalized anxiety disorder (GAD). As everyday practice demonstrates, all patients with this type of disorder are prescribed anxiolytic or sedative therapy. In particular, various tranquilizers are used: benzodiazepines, non-benzodiazepines, antidepressants. Anxiolytic therapy significantly improves the quality of life of these patients and contributes to their better compensation during the treatment process. However, not all patients tolerate these drugs well due to the rapid development side effects in the form of lethargy, muscle weakness, impaired attention, coordination, and sometimes symptoms of addiction. Taking into account the noted problems in last years There is an increasing need for drugs with an anxiolytic effect of a non-benzodiazepine structure. These may include the drug Tenoten, which contains antibodies to the brain-specific protein S-100, which have undergone technological processing during the production process. As a result, Tenoten contains release-active antibodies to the brain-specific protein S-100 (PA-AT S-100). It has been shown that release-active drugs have a number of typical characteristics that allow them to be integrated into modern pharmacology (specificity, non-addiction, safety, high efficiency) .

The properties and effects of release-active antibodies to the brain-specific protein S-100 have been studied in many experimental studies. Drugs created on their basis are used in clinical practice as anxiolytic, vegetostabilizing, stress-protective agents for the treatment of anxiety and autonomic disorders. Molecular target PA-AT S-100 is a calcium-binding neurospecific protein S-100, which is involved in the coupling of information and metabolic processes in the nervous system, signal transmission by second messengers (“mediators”), processes of growth, differentiation, apoptosis of neurons and glial cells. In studies on the Jurkat and MCF-7 cell lines, it was shown that PA-AT S-100 exerts its action, in particular, through the sigma1 receptor and the glycine site of the NMDA glutamate receptor. The presence of such an interaction may indicate the influence of the drug Tenoten on various mediator systems, including GABAergic and serotonergic transmission.

It should be noted that, unlike traditional benzodiazepine anxiolytics, PA-AT S-100 does not cause sedation and muscle relaxation. In addition, PA-AT S-100 contributes to the restoration of neuronal plasticity processes.

S. B. Shvarkov et al. found that the use of RA-AT S-100 for 4 weeks in patients with psychovegetative disorders, including those caused chronic ischemia brain, led not only to a significant decrease in the severity of anxiety disorders, but also to a noticeable decrease in autonomic disorders. This gave the authors the opportunity to consider Tenoten not only as a mood corrector, but also as a vegetative stabilizer.

M. L. Amosov et al. when observing a group of 60 patients with transient ischemic attacks in various vascular territories and accompanying emotional disorders, they found that the use of RA-AT S-100 can reduce anxiety. The anxiolytic effect was practically no different from the anti-anxiety effect of phenazepam, while the tolerability of the drug containing PA-AT S-100 turned out to be significantly better and, unlike the use of benzodiazepine derivatives, there were no side effects.

However, there is not enough work demonstrating the effectiveness of Tenoten in the correction of autonomic disorders in young people.

The purpose of this work was to evaluate the effectiveness and safety of the drug Tenoten in the treatment of vegetative-vascular dystonia in young patients (18–35 years).

Materials and research methods

A total of 50 patients (8 males and 42 females) aged 18 to 35 years (average age 25.6 ± 4.1 years) with autonomic dystonia syndrome, emotional disorders, and decreased performance were included in the study.

The study did not include patients taking psychotropic and vegetotropic drugs during the previous month; pregnant women during lactation; with signs of severe somatic diseases according to anamnesis, physical examination and/or laboratory and instrumental tests, which could interfere with participation in the program and affect the results.

All patients received Tenoten orally, according to the instructions for medical use of the drug, 1 tablet 3 times a day for 4 weeks (28–30 days) without food intake, sublingually. During the study, the use of vegetotropic, sleeping pills, sedatives, as well as tranquilizers and antidepressants.

All patients were identified for autonomic disorders according to the Wein table (more than 25 points indicate the presence of vegetative-vascular dystonia); assessment of the level of anxiety - according to the HADS anxiety scale (8–10 points - subclinically expressed anxiety; 11 or more points - clinically expressed anxiety); depression - according to the HADS depression scale (8–10 points - subclinically expressed depression; 11 or more points - clinically expressed depression). During the study period, the patients' condition was assessed 4 times: 1st visit - before starting the drug, 2nd visit - after 7 days of therapy, 3rd visit - after 28–30 days of treatment, 4th visit - after 7 days from the end of therapy (37th day from the start of therapy). At each stage, the neurological status, heart rate variability (HRV) and condition were assessed on the following scales: autonomic dysfunction A. M. Veina, HADS anxiety/depression, as well as the SF-36 questionnaire (Russian version created and recommended by the ICCI), which allows us to determine the level of physical functioning (PF) and psychological health (MH). After the 30th day of taking Tenoten, the effectiveness of the therapy was additionally assessed on the CGI-I scale.

HRV analysis was carried out for all subjects initially in a supine position and under conditions of an active orthostatic test (AOP) in accordance with the “Recommendations working group European Society of Cardiology and North American Society of Stimulation and Electrophysiology" (1996) on the VNSspectr device. The study was carried out no earlier than 1.5 hours after eating, with the obligatory cancellation of physical procedures and drug treatment taking into account the timing of drug removal from the body after a 5-10 minute rest. Vegetative status was studied by analyzing HRV using 5-minute recordings of cardiointervalogram (CIG) in a state of relaxed wakefulness in a supine position after 15 minutes of adaptation and during an orthostatic test. Only stationary sections of rhythmograms were taken into account, i.e., recordings were allowed for analysis after eliminating all possible artifacts and if the patient had sinus rhythm. The spectral characteristics of the heart rhythm were studied, which make it possible to identify periodic components in heart rate fluctuations and quantify their contribution to the overall dynamics of the rhythm. Spectra of variability of R-R intervals were obtained using the Fourier transform. When conducting spectral analysis, the following characteristics were assessed:

• TP “total power” - the total power of the spectrum of neurohumoral regulation, characterizing the total effect of all spectral components on sinus rhythm;
• HF “high frequency” - high-frequency vibrations reflecting steam activity sympathetic division autonomic nervous system;
• LF “low frequency” - low-frequency oscillations reflecting the activity of the sympathetic part of the autonomic nervous system;
• VLF “very low frequency” - very low frequency oscillations, which are part of the spectrum of neurohumoral regulation, which includes a complex of various factors influencing heartbeat(cerebral ergotropic, humoral-metabolic influences, etc.);
• LF/HF - an indicator reflecting the balance of sympathetic and parasympathetic influences, measured in normalized units;
• VLF%, LF%, HF% are relative indicators that reflect the contribution of each spectral component to the spectrum of neurohumoral regulation.

All of the above parameters were recorded both at rest and during active orthostatic test.

Statistical analysis of the study results was carried out using Statistics 6.0 using parametric and non-parametric methods (Student's, Mann-Whitney tests). As a threshold level statistical significance a value of p = 0.05 was accepted.

Results and its discussion

All patients complained of decreased performance, general weakness, fatigue, fluctuations in blood pressure (in 72% it was reduced and amounted to 90–100/55–65 mm Hg; in 10%, blood pressure periodically increased to 130–140/90 –95 mmHg). Headaches in 72% of patients were not constant and were associated with increased mental or emotional stress. 24% periodically experienced pain in the scalp and upon palpation of the pericranial muscles. 72% of patients had sleep disturbances, 18% had cardialgia and a feeling of interruptions in heart function. Hyperhidrosis of the palms and feet, persistent red dermographism, and acrocyanosis were noted by half of the patients. Clinical manifestations functional disorders of the gastrointestinal tract (GIT) (constipation, flatulence, abdominal pain) were recorded in 10% of the total number of patients examined.

Analysis of anamnestic data showed that about 80% of the subjects had a stress factor. When surveyed, 30% of patients associated stress with professional activity, 25% - with studies, 10% - with family and children, 35% - with personal relationships.

Analysis of the Hospital Anxiety and Depression Scale (HADS) revealed subclinically expressed anxiety in 26% of patients, and clinically significant anxiety in 46% of patients. Half of the patients (50%) often experienced tension and fear; 6% of patients constantly felt a feeling of internal tension and anxiety. Panic attacks occurred in 16% of respondents. 10% of patients had subclinical and clinically significant depression.

Violations in the psychological component of health (MH) were significant according to the SF-36 questionnaire, and they were associated with increased level anxiety. At the same time, physical functioning (PF) did not affect the daily activities of the subjects.

Evaluation of the effectiveness and safety of treatment showed a clear prevalence positive results when using the drug Tenoten.

Subsequently, based on the results of a dynamic study of heart rate variability, all patients were retrospectively divided into two groups.

The first group consisted of 45 people (90%), initially having autonomic disorders with clear positive dynamics according to HRV results after the 30th day of taking Tenoten. They were patients without signs of clinically significant depression. The initial data for this group of patients were: the number of points on the Wein scale - 25–64 (average 41.05 ± 12.50); on the HADS anxiety scale - 4–16 (9.05 ± 3.43); on the HADS depression scale - 1–9 (5.14 ± 2.32). When assessing quality of life on the SF-36 scale, the level physical health(PF) was 45.85 ± 7.31 and the level mental health(MH) 33.48 ± 12.

After seven days of taking Tenoten, all patients subjectively noted an improvement in their well-being, however, the average numerical values ​​revealed significant differences in this group only on the HADS anxiety scale (p
Rice. 1. Dynamics of scores on the HADS anxiety scale in patients of the first group (*p). Further analysis of the dynamics of indicators within the scales in the first group showed that the greatest and most significant changes in the state occurred after 30 days from the start of taking Tenoten. Positive dynamics were observed in the form of a decrease in the number and severity of symptoms of vegetative-vascular dystonia: on the Wayne scale, the number of points significantly decreased to 8–38 (average 20.61 ± 9.52) (p
Rice. 2. Dynamics of scores on the A. M. Wein scale in patients of the first group (*p The mental health (MH) indicator increased significantly to 54.6 ± 4.45 points (p

Rice. 3. Dynamics of physical (PF) and mental (MH) health indicators in patients of the first group (*p Analysis of the HADS anxiety scale showed that 68% did not experience tension at all versus 100% who experienced tension before treatment; in 6%, the number of points remained unchanged; in the remaining 26%, the number of points decreased (patients no longer felt a sense of fear). During the observation period, no periods of increased blood pressure were observed in patients of the first group. Patients did not present active complaints of soreness in the area of ​​the pericranial muscles, however, after focusing attention on this area, they noted rare headaches. Dermographism remained unchanged. Rare interruptions in heart function were noted by 4% of patients. In 26 out of 40 people, sleep returned to normal.

A study conducted on the 37th day (seven days after discontinuation of the drug) did not reveal significant differences from the indicators on the 30th day of taking Tenoten, i.e., the resulting effect from taking the drug persisted.

The second group included 5 people with weak positive dynamics in heart rate variability study indicators. They were patients who initially had signs of clinically significant anxiety and depression.

Data before the start of therapy for this group of patients were: the number of points on the Wein scale 41–63 (average 51.80 ± 8.70); HADS anxiety scale 9–18 (13.40 ± 3.36); HADS depression scale 7–16 (10.60 ± 3.78). When assessing the quality of life on the SF-36 scale, these patients had a significantly reduced level of physical health, which was 39.04 ± 7.88, as well as a level of mental health - 24.72 ± 14.57. Analysis of the dynamics of indicators in the second group after 30 days of taking Tenoten revealed a trend towards a decrease in autonomic dysfunction on the Wein scale - from 51.8 to 43.4 points; anxiety-depressive symptoms on the HADS anxiety/depression scale - from 13.4 to 10.4 points and from 10.6 to 8.6 points, respectively; according to SF-36, the mental health (MH) score increased from 24.72 to 33.16, and the physical health (PF) score increased from 39.04 to 43.29. However, these values ​​did not reach statistically significant differences, which indicates the need for individual selection of the duration and regimen of therapy in patients with clinically significant anxiety and depression.

Thus, a retrospective division of patients into two groups during an in-depth examination made it possible to identify signs of clinically significant anxiety and depression in one of the groups, which initially did not differ significantly from the majority of respondents. Analysis of the dynamics of indicators on the main scales after a month of taking Tenoten, 1 tablet 3 times a day, did not reveal significant differences in this group. The anxiolytic and vegetostabilizing effects of Tenoten in the group of clinically severe anxiety and depression with the usual (1 tablet 3 times a day) treatment regimen appeared only in the long term, which can serve as a justification for correcting the treatment regimen and prescribing 2 tablets 3 times a day. Consequently, the data obtained indicate the need to select different regimens for the use of Tenoten depending on the severity of anxiety and depressive symptoms, which provides an individual approach for each patient, forming a high adherence to treatment.

Analysis of heart rate variability in patients of the first group showed significantly significant changes after 30 days of taking Tenoten, which persisted 7 days after discontinuation of the drug. In the spectral analysis at the end of a month of therapy, the absolute values ​​of the power of the LF and HF components, and due to this the total power of the spectrum (TP), were significantly higher than in the study before taking the drug (from 1112.02 ± 549.20 to 1380. 18 ± 653.80 and from 689.16 ± 485.23 to 1219.16 ± 615.75, respectively, p

Rice. 4. Spectral indicators of HRV at rest in patients of the first group (* significance of differences: compared with the initial indicator, p During spectral analysis during an active orthostatic test after therapy, a lower reactivity of the sympathetic division of the autonomic nervous system (ANS) was noted compared with the initial data , this is evidenced by the values ​​of the LF/HF and %LF indicators, namely LF/HF - 5.89 (1.90–11.2) and 6.2 (2.1–15.1), respectively, %LF - 51 .6 (27–60) and 52.5 (28–69) (p

Rice. 5. Spectral indicators of HRV during an orthostatic test in patients of the first group (* significance of differences: compared with the initial indicator, p Thus, in the first group, when performing HRV after 30 days of taking Tenoten, there is an increase in the total power of the spectrum due to the increased influence of HF- component, as well as normalization of sympathetic-parasympathetic influences during the background test. In the active orthostatic test, the same trends remain, but less pronounced. Analysis of the dynamics of the coefficient 30/15 suggests increased reactivity parasympathetic division VNS and, consequently, an increase in adaptive potential as a result of therapy in patients of the first group (Table 1).

Table 1
Spectral indicators of HRV at rest and during an orthostatic test in patients of the first group

Parameter	1st visit (screening)	2nd visit (7 ± 3 days)	3rd visit (30 ± 3 days)	4-visit (36 ± 5 days)
Background recording
TP, ms²	2940.82 ± 1236.48	3096.25 ± 1235.26	4103.11 ± 1901.41*	3932.59 ± 1697.19*
VLF, ms²	1139.67 ± 729.00	1147.18 ± 689.00	1503.68 ± 1064.69*	1402.43 ± 857.31*
LF, ms²	1112.02 ± 549.20	1186.14 ± 600.97	1380.18 ± 653.80*	1329.98 ± 628.81*
HF, ms²	689.16 ± 485.23	764.34 ± 477.75	1219.16 ± 615.75*	1183.57 ± 618.93*
LF/HF	2.08 ± 1.33	1.88 ± 1.12	1.28 ± 0.63*	1.27 ± 0.62*
VLF, %	36.93 ± 16.59	35.77 ± 15.45	35.27 ± 11.44	35.14 ± 11.55
LF, %	38.84 ± 11.62	38.61 ± 11.54	34.25 ± 8.40	34.39 ± 8.51
HF, %	24.16 ± 11.90	25.50 ± 11.69	30.45 ± 10.63*	30.43 ± 10.49*
Orthostatic test
TP, ms²	1996.98 ± 995.85	2118.59 ± 931.04	3238.68 ± 1222.61*	3151.52 ± 1146.54*
VLF, ms²	717.18 ± 391.58	730.91 ± 366.16	1149.43 ± 507.10*	1131.77 ± 504.30*
LF, ms²	1031.82 ± 584.41	1101.43 ± 540.25	1738.68 ± 857.52*	1683.89 ± 812.51*
HF, ms²	248.00 ± 350.36	269.93 ± 249.64	350.59 ± 201.57*	336.05 ± 182.36*
LF/HF	6.21 ± 3.69	5.27 ± 2.68	5.93 ± 3.37	5.59 ± 2.68
VLF, %	36.82 ± 10.69	34.64 ± 9.80	36.93 ± 13.33	36.93 ± 12.72
LF, %	51.64 ± 12.20	52.34 ± 11.23	52.48 ± 12.16	52.27 ± 11.72
HF, %	11.51 ± 9.71	12.69 ± 7.60	10.50 ± 4.09	10.75 ± 3.671
K 30/15	1.26 ± 0.18	1.32 ± 0.16	1.44 ± 0.11	1.44 ± 0.11

Note. *Significance of differences: compared with the original indicator, p

In patients of the second group, spectral analysis of heart rate variability indicators (background recording and active orthostatic test) at the end of a month of therapy did not reveal any significantly significant dynamics in the numerical values ​​of the power indicators of the LF and HF components, and due to this, the total power of the spectrum (TP) . All patients had hypersympathicotonia and high sympathetic reactivity before the start of therapy and a slight decrease in numerical values ​​at the end of therapy, however, the percentage contribution of the sympathetic division of the ANS “before”, “during therapy” and “after its end” remained unchanged (Fig. 6, 7 ).

Rice. 6. Spectral indicators of HRV at rest in patients of the second group

Rice. 7. Spectral indicators of HRV during an orthostatic test in patients of the second group

Analysis of the dynamics of the coefficient 30/15 suggests low parasympathetic reactivity and reduced adaptive potential before the start of therapy with Tenoten and increased reactivity and, therefore, an increase in adaptive potential as a result of treatment in patients of the second group by the end of therapy (Table 2).

table 2
Spectral indicators of HRV at rest and during an orthostatic test in patients of the second group

Background recording	1st visit (screening)	2nd visit (7 ± 3 days)	3rd visit (30 ± 3 days)	4-visit (36 ± 5 days)
TP, ms²	2573.00 ± 1487.89	2612.80 ± 1453.45	2739.60 ± 1461.93	2589.80 ± 1441.07
VLF, ms²	1479.40 ± 1198.51	1467.80 ± 1153.00	1466.60 ± 1110.23	1438.00 ± 1121.11
LF, ms²	828.80 ± 359.71	862.60 ± 369.07	917.60 ± 374.35	851.60 ± 354.72
HF, ms²	264.60 ± 153.49	282.40 ± 150.67	355.40 ± 155.11	300.20 ± 132.73
LF/HF	4.06 ± 3.02	3.86 ± 2.76	3.10 ± 2.21	3.36 ± 2.37
VLF, %	50.80 ± 15.01	50.00 ± 14.40	48.00 ± 13.29	49.60 ± 14.42
LF, %	35.00 ± 5.79	35.40 ± 5.94	35.80 ± 5.81	35.40 ± 6.15
HF, %	14.20 ± 9.55	14.60 ± 9.50	16.20 ± 9.01	15.00 ± 8.92
K 30/15	1.16 ± 0.12	1.22 ± 0.08	1.31 ± 0.08	1.35 ± 0.04
Orthostatic test
TP, ms²	1718.80 ± 549.13	1864.00 ± 575.61	1857.00 ± 519.17	1793.40 ± 538.21
VLF, ms²	733.80 ± 360.43	769.60 ± 370.09	759.40 ± 336.32	737.40 ± 338.08
LF, ms²	799.00 ± 341.97	881.20 ± 359.51	860.60 ± 307.34	826.20 ± 326.22
HF, ms²	186.20 ± 143.25	213.20 ± 119.58	237.00 ± 117.84	229.80 ± 123.20
LF/HF	6.00 ± 3.56	5.36 ± 3.32	4.60 ± 2.92	4.64 ± 2.98
VLF, %	42.00 ± 11.00	40.40 ± 9.45	40.00 ± 9.38	40.20 ± 9.28
LF, %	45.60 ± 12.46	46.60 ± 12.22	46.20 ± 11.54	45.80 ± 12.24
HF, %	12.40 ± 11.33	13.20 ± 10.28	14.00 ± 9.08	14.20 ± 9.98

Thus, the drug Tenoten had positive influence on the state of the autonomic nervous system in patients with VSD in combination with clinical severe depression. However, a treatment duration of 30 days is insufficient for this group of patients, which serves as a basis for continuing treatment or using an alternative regimen of 2 tablets 3 times a day.

Conclusion

Tenoten is a sedative and vegetative stabilizing drug with a proven high level of safety. The use of Tenoten seems extremely promising in young patients with vegetative-vascular dystonia.

• The study recorded that Tenoten leads to normalization (stabilization) of the autonomic balance in any type of vegetative-vascular dystonia (sympathetic-tonic, parasympathetic-tonic), increased autonomic support of the body’s regulatory functions and increased adaptive potential.
• Tenoten has a pronounced anti-anxiety and vegetative-stabilizing effect.
• During Tenoten therapy, the level of mental and physical health (according to the SF-36 questionnaire) became significantly higher, indicating an improvement in the quality of life of patients.
• Reception of Tenoten by patients with clinical pronounced signs anxiety and depression requires differentiated approach to the treatment regimen and its duration.
• The study noted that Tenoten does not cause side effects and is well tolerated by patients.
• Tenoten can be used as monotherapy for vegetative-vascular dystonia in young patients (18–35 years).

Literature

1. Amosov M. L., Saleev R. A., Zarubina E. V., Makarova T. V. The use of the drug tenoten in the treatment of emotional disorders in patients with transient disturbances cerebral circulation// Russian Psychiatric Journal. 2008; 3:86–91.
2. Neurology. National leadership / Ed. E. I. Guseva, A. N. Konovalova, V. I. Skvortsova, etc. M.: GEOTAR-Media, 2010.
3. Wayne A. M. et al. Autonomic disorders. Clinic, treatment, diagnosis. M.: Medical Information Agency, 1998. 752 p.
4. Vorobyova O. V. Autonomic dystonia- what is hidden behind the diagnosis? // Difficult patient. 2011; 10.
5. Mikhailov V. M. Heart rate variability. Ivanovo, 2000. 200 p.
6. Shvarkov S. B., Shirshova E. V., Kuzmina V. Yu. Ultra-low doses of antibodies to protein S100 in the treatment of autonomic disorders and anxiety in patients with organic and functional diseases CNS // Attending Physician. 2008; 8:18–23.
7. Epshtein O. I., Beregovoi N. A., Sorokina N. S. et al. The influence of various dilutions of potentiated antibodies to the brain-specific protein S-100 on the dynamics of post-tetanic potentiation in surviving slices of the hippocampus // Bulletin of Experimental Biology and Medicine. 1999; 127(3):317–320.
8. Epshtein O. I., Shtark M. B., Dygai A. M. et al. Pharmacology of ultra-low doses of antibodies to endogenous function regulators: monograph. M.: Publishing house RAMS, 2005.
9. Epshtein O.I. Ultra-low doses (the story of one study). Experimental study ultra-low doses of antibodies to protein S-100: monograph. M.: Publishing house of the Russian Academy of Medical Sciences, 2005. pp. 126–172.
10. Kheifets I. L., Dugina Yu. L., Voronina T. A. et al. Participation of the serotonergic system in the mechanism of action of antibodies to protein S-100 in ultra-low doses // Bulletin of Experimental Biology and Medicine. 2007; 143(5):535–537.
11. Kheifets I.A., Molodavkin G.M., Voronina T.A. et al. Participation of the GABA-B system in the mechanism of action of antibodies to protein S-100 in ultra-low doses // Bulletin of Experimental Biology and Medicine. 2008; 145(5):552–554.

Associated with this file 50 file(s). Among them: strukturirovannie_tehniki_terapii_sherman.doc, Effektivnaya_terapia_posttravmaticheskogo_stressovogo.pdf, A_Lengle_Yavlyaetsya_li_lyubov_schastyem.pdf, Gorbatova E.A. - Theory and practice of psychological training (Ps and 40 more file(s).
Show all linked files

Effective therapy for post-traumatic stress disorder
disorders
Edited by
Edna B. Foa Terence M. Keane Matthew J. Friedman
Moscow
"Cogito-Center"
2005

UDC 159.9.07 BBK88 E 94
All rights reserved. Any use of materials from this book in whole or in part
without permission of the copyright holder it is prohibited
Edited by E
BOTTOM
Foa. Terence M. Keane, Matthew Friedman
Translation from English under general editing N. V. Tarabrina
Translators: V.A. Agarkov, SA. Pitt- chapters 5, 7, 10, 17, 19, 22, 27 O.A. Crow - chapter 1,
2,11,12,14,15,16, 23, 24, 26 E.S. Kalmykova- chapters 9, 21 EL. Misko- chapters 6, 8, 18, 20 ML.
Padun- chapters 3, 4, 13, 25
E 94 Effective therapy for post-traumatic stress disorder / Ed. Edna Foa,
Terence M. Keane, Matthew Friedman. - M.: “Cogito-Center”, 2005. - 467 p. (Clinical psychology)
UDC 159.9.07 BBK88
This guide is based on an analysis of research into the effectiveness of psychotherapy for adults, adolescents, and children with post-traumatic stress disorder (PTSD). The purpose of the manual is to assist the clinician in the treatment of such patients.
Since PTSD treatment is carried out by specialists with various professional training, the authors of the chapters of the manual took an interdisciplinary approach to the problem. The book as a whole brings together the efforts of psychologists, psychiatrists, social workers, art therapists, family counselors, etc. The chapters of the manual are addressed to a wide range of specialists involved in the treatment of PTSD.
The book consists of two parts. The chapters of the first part are devoted to an overview of the results of the most important studies. Part two provides a brief description of the use of different therapeutic approaches to treat PTSD.
© Translation into Russian by Cogito Center, 2005 © The Guilford Press, 2000
ISBN 1-57230-584-3 (English) ISBN 5-89353-155-8 (Russian)

Contents i. Introduction.............................................................................................................7
2. Diagnosis and assessment...........................................................................................28
Terence M. Keane, Frank W. Wethers, and Edna B. Foa
I. Approaches to the treatment of PTSD: a review of the literature
3. Psychological debriefing...................................................................51
Jonathan E. Bisson, Alexander S. McFarlane, Suzanne Ros
4. ...............................................75
5. Psychopharmacotherapy......................................................................... 103
6. Treatment of children and adolescents................................................................ 130
7. Desensitization and reprocessing using eye movements.... 169
8. Group therapy...................................................................................189
David W. Foy, Shirley M. Glynn, Paula P. Schnurr, Mary K. Jankowski, Melissa S. Wattenberg,
Daniel S. Weiss, Charles R. Marmar, Fred D. Guzman
9. Psychodynamic therapy..............................................................212
10. Treatment in hospital.............................................................................239
AND. Psychosocial rehabilitation.......................................................270
12. Hypnosis.............................................................................................................298
Etzel Cardena, Jose Maldonado, Otto van der Hart, David Spiegel
13. ....................................................336
David S. Riggs
^.Art therapy..............................................................................................360
David Reed Johnson

II. Therapy Guide
15. Psychological debriefing................................................................377
Jonathan E. Bisson, Alexander Macfarlane, Suzanne Ros
16. Cognitive behavioral therapy............................................381
Barbara Olasov Rothbaum, Elizabeth A. Meadows, Patricia Resick, David W. Foy
17. Psychopharmacotherapy.........................................................................389
Matthew J. Friedman, Jonathan R.T. Davidson, Thomas A. Mellman, Stephen M. Southwick
18. Treatment of children and adolescents...............................................................394
Judith A. Cohen, Lucy Berliner, John S. March
19. Desensitization and processing
using eye movements......................................................................398
Cloud M. Chemtob, David F. Tolin, Bessel A. van der Kolk, Roger C. Pitman
20. Group therapy...................................................................................402
David W. Foy, Shirley M. Glynn, Paula P. Schnurr, Mary K. Jankowski, Melissa S. Wattenberg,
Daniel S. Weiss, Charles R. Marmar, Fred D. Guzman
21. Psychodynamic therapy..............................................................405
Harold S. Kadler, Arthur S. Blank Jr., Janice L. Krapnick
22. Treatment in hospital.............................................................................408
Christine A. Curti, Sandra L. Blum
23. Psychosocial rehabilitation.......................................................414
Walter Penk, Raymond B. Flannery Jr.
24. Hypnosis.............................................................................................................418
Etzel Cardena, Jose Maldonado, Otto van der Hart, David Spiegel
25. Marriage and family therapy....................................................423
David S. Riggs
26. Art therapy..............................................................................................426
David Reed Johnson
27. Conclusion and conclusions.............................................................................429
Aryeh W. Shalev, Matthew J. Friedman, Edna B. Foa, Terence M. Keene
Subject index
457

1
Introduction
Edna B. Foa, Terence M. Keane, Matthew J. Friedman
Members of a special commission created to develop guidelines for treatment methods for PTSD were directly involved in the preparation of the materials presented in this book. This commission was organized by the Board of Directors of the International Society for Traumatic Stress Studies (ISTSS) in November 1997.
Our goal was to describe the various therapies based on a review of the extensive clinical and research literature prepared by experts in each specific field. The book consists of two parts. The chapters of the first part are devoted to an overview of the results of the most important studies. The second part provides a brief description of the use of different therapeutic approaches in the treatment of PTSD. This guideline aims to inform clinicians of the developments we have identified as best for the treatment of patients diagnosed with post-traumatic stress disorder (PTSD). PTSD is a complex mental condition that develops as a result of experiencing a traumatic event. Symptoms that characterize PTSD include repeated replay of the traumatic event or episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often comorbid with other mental disorders and is a complex illness that can be associated with significant morbidity, disability, and impairment of vital functions.

8
In developing this practical guide, the Special Commission confirmed that traumatic experiences can lead to the development of various disorders, such as general depression, specific phobias; disorders of extreme stress not otherwise specified (DESNOS), personality disorders such as borderline anxiety disorder and panic disorder. However, the main focus of this book is the treatment of PTSD and its symptoms, which are listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994)
American Psychiatric Association.
The guideline authors acknowledge that the diagnostic scope of PTSD is limited and that these limitations may be particularly evident in patients who have experienced childhood sexual or physical abuse. Often, patients diagnosed with DESNOS have a wide range of problems in relationships with other people, which contribute to impairments in personal and social functioning. Relatively little is known about the successful treatment of these patients. The consensus among clinicians, supported by empirical data, is that patients with this diagnosis require long-term and complex treatment.
The Special Commission also recognized that PTSD is often accompanied by other mental disorders, and these comorbidities require sensitivity, attention, and clarification of the diagnosis by medical personnel throughout the treatment process.
Disorders requiring special attention are substance abuse and general depression as the most common comorbid conditions.
Practitioners may refer to guidelines for these disorders to develop treatment plans for individuals demonstrating multiple disorders and to the comments in Chapter 27.
This guide is based on cases of adults, adolescents and children suffering from PTSD. The purpose of the guide is to assist the clinician in treating these individuals. Because PTSD is treated by clinicians with a variety of backgrounds, these chapters were developed using an interdisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family counselors and other specialists actively participated in the development process. Accordingly, these chapters address a wide range of professionals involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently being subjected to violence or insults. These individuals (children who live with an abusive person, men

9 and women who experience abuse and violence in their home), as well as those living in war zones, may also meet the criteria for diagnosis
PTSD. However, their treatment, and the associated legal and ethical issues, differ significantly from the treatment and problems of patients who have experienced traumatic events in the past. Patients directly in a traumatic situation require special attention from clinicians. These circumstances require the development of additional practical guidelines.
Very little is known about the treatment of PTSD in industrialized regions. Research and development on these topics is carried out mainly in Western industrialized countries.
The Special Commission is keenly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is found across many cultures and societies. However, there is a need for systematic research to determine the extent to which treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western societies will be effective in other cultures.
In general, practitioners should not limit themselves to only the approaches and techniques outlined in this manual. The creative integration of new approaches that have demonstrated effectiveness in the treatment of other disorders and have a sufficient theoretical basis is encouraged in order to improve treatment outcomes.
PROCESS OF WORK ON THE GUIDE
The development process for this guide was as follows. Co-Chairs
A special commission identified specialists in the main therapeutic schools and methods of therapy that are currently used in working with patients suffering from
PTSD. As new effective methods of therapy were found, the composition of the Special Commission expanded. Thus, the Special Commission included specialists from various approaches, theoretical orientations, therapeutic schools, as well as vocational training. The focus of the Guide and its format were determined by the Special Commission over a series of meetings.
The co-chairs instructed the members of the Special Commission to prepare an article on each area of ​​therapy. Each article had to be written by a recognized expert with the support of an assistant, whom he independently selected from among other panel members or clinicians.

10
Articles were required to review the literature on research in the field and clinical practice.
Literature reviews on each topic are compiled using online search engines such as Published International Literature on traumatic stress» (Published
International Literature on Traumatic Stress, PILOTS), MEDLINE and PsycLIT In the final version, articles were reduced to a standard format and limited in length. The authors cited literature on the topic, presented clinical developments, provided a critical review of the scientific basis for a particular approach, and presented the articles to the chair. The completed articles were then distributed to all members of the Special Commission for comments and active discussion. The results of the reviews with modifications turned into articles and subsequently became chapters of this book.
Based on the articles and careful review of the literature, a set of short practical recommendations for each therapeutic approach has been developed. It can be found in Part II.
Each therapeutic approach or modality in the guideline was rated according to its therapeutic effectiveness. These ratings were standardized according to a coding system adapted by the Agency for Health Care Policy and Research (AHCPR).
The rating system below is an attempt to formulate recommendations for practitioners based on available scientific advances.
The manual was reviewed by all members of the Special Committee, agreed upon and then presented to the ISTSS Board of Directors, submitted to a number of professional associations for review, presented at the ISTSS Annual Convention Public Forum, and posted on the website
ISTSS for comments from lay members of the scientific community. Materials resulting from this work were also included in the manual.
Published research on PTSD, as well as other mental disorders, contain certain restrictions. In particular, most studies use inclusion and exclusion criteria to determine whether the diagnosis is appropriate for a particular case; therefore, each study may not fully represent the spectrum of patients seeking treatment. PTSD studies, for example, often do not include patients with addictions. chemical substances, suicidal risk, neuropsychological impairment, developmental delays or cardiovascular diseases. This guideline covers studies that do not involve these patient populations.

11
CLINICAL PROBLEMS Type of injury
Most randomized clinical trials conducted on veterans of wars (mostly Vietnam) found that treatment was less effective for this population compared with non-combat veterans whose PTSD was associated with other traumatic experiences (eg, rape, accidents). accidents, natural disasters). This is why some experts believe that war veterans suffering from PTSD are less responsive to treatment than those who have experienced other types of trauma. This conclusion is premature. The difference between veterans and other patients with PTSD may be due to the greater severity and chronicity of their PTSD rather than to characteristics specific to military trauma. In addition, low rates of treatment effectiveness for veterans may be associated with the characteristics of the sample, since groups are sometimes formed from volunteer veterans, chronic patients with multiple impairments. Overall on this moment It cannot be definitively concluded that PTSD following certain traumas may be more resistant to treatment.
Single and multiple injuries
No studies have been conducted among patients with PTSD. clinical trials to answer the question of whether the number of previous traumas may influence the course of treatment for PTSD. Because most studies have been conducted on either military veterans or sexually abused women, most of whom have experienced multiple traumas, it has been found that much of what is known about the effectiveness of treatment applies to people who have had multiple traumatic experiences. Studies of individuals with single and multiple traumatization would be of great interest to determine whether the former are expected to respond better to treatment. However, conducting such studies can be quite complex, since it would be necessary to control for factors such as concomitant diagnoses, severity and chronic nature PTSD, and each of these factors may be a more significant predictor of treatment outcome than the amount of trauma experienced.

As Avicenna said, a doctor has three main tools: words, medicine and a knife. In the first place, undoubtedly, is the word - the most powerful way to influence the patient. A bad doctor is the one whose conversation with him does not make the patient feel better. A sincere phrase, support and acceptance of a person with all his vices and shortcomings - this is what makes a psychiatrist a true healer of the soul.

The above applies to all specialties, but most importantly to psychotherapists.

Psychotherapy is healing technique verbal influence, which is used in psychiatry and narcology.

Psychotherapy can be used either alone or in combination with medication. Greatest effect psychotherapy provides treatment to patients with neurotic spectrum disorders (anxiety-phobic and obsessive-compulsive disorders, panic attacks, depression, etc.) and psychogenic diseases.

Classification of psychotherapy

Today there are three main areas of psychotherapy:

• Dynamic
• Behavioral (or behavioural)
• Existential-humanistic

They all have different mechanisms of influence on the patient, but their essence is the same - focusing not on the symptom, but on the whole personality.

Depending on the required purpose practical psychotherapy May be:

• Supportive. Its essence is to strengthen and support the patient’s existing defenses, as well as to develop behavioral patterns that will help stabilize emotional and cognitive balance.
• Retraining. Complete or partial reconstruction of negative skills that worsen the quality of life and adaptation in society. The work is carried out by supporting and approving positive behaviors in the patient.

Depending on the number of participants, psychotherapy can be individual and group. Each option has its pros and cons. Individual psychotherapy is a springboard for patients who are not prepared for group classes or refuse to participate in them due to character traits. In turn, the group option is much more effective in terms of mutual communication and exchange of experience. A special variety is family psychotherapy, which implies working together with two spouses.

Areas of therapeutic influence in psychotherapy

Psychotherapy is good method treatment thanks to three areas of influence:

Emotional. The patient is provided with moral support, acceptance, empathy, and the opportunity to express own feelings and not be judged for it.

Cognitive. There is awareness and “intellectualization” of one’s own actions and aspirations. In this case, the psychotherapist acts as a mirror that reflects himself to the patient.

Behavioral. During psychotherapy sessions, habits and behavior patterns are developed that will help the patient adapt to the family and society.

A good combination of all the above areas is practiced in cognitive- behavioral psychotherapy(CBT).

Types and methods of psychotherapy: characteristics

One of the pioneers of psychotherapy and psychoanalysis was the famous Austrian psychiatrist and neurologist Sigmund Freud. He formed the psychodynamic concept of the emergence of neuroses based on the suppression of the needs and demands of the individual. The psychotherapist’s task was to transfer unconscious stimuli and make the client aware of them, thereby achieving adaptation. Subsequently, Freud's students and many of his followers founded their own schools of psychoanalysis with principles that differed from the original doctrine. This is how the main types of psychotherapy that we know today arose.

Dynamic psychotherapy

We owe the formation of dynamic psychotherapy as an effective method of combating neuroses to the works of K. Jung, A. Adler, E. Fromm. The most common variant of this direction is person-centered psychotherapy.

The treatment process begins with a long and scrupulous psychoanalysis, during which the patient’s internal conflicts are clarified, after which they move from the unconscious to the conscious. It is important to bring the patient to this point, and not just voice the problem. For effective treatment The client needs long-term cooperation with the doctor.

Behavioral psychotherapy

Unlike proponents of psychodynamic theory, behavioral psychotherapists see the cause of neurosis as incorrectly formed behavioral habits, and not hidden incentives. Their concept states that a person’s behavior patterns can be changed, depending on which his condition can be transformed.

Behavioral psychotherapy methods are effective in treating various disorders (phobias, panic attacks, obsessions, etc.). Showed itself well in practice confrontation and desensitization technique. Its essence is that the doctor determines the cause of the client’s fear, its severity and connection with external circumstances. Then the psychotherapist carries out verbal (verbal) and emotional influences through implosion or flooding. At the same time, the patient mentally imagines his fear, trying to paint a picture of it as brightly as possible. The doctor reinforces the patient’s fear so that he feels the reason and gets used to it. A psychotherapy session lasts about 40 minutes. Gradually, a person gets used to the cause of the phobia, and it ceases to worry him, that is, desensitization occurs.

Another subtype of behavioral technique is rational-emotive psychotherapy. Here the work is carried out in several stages. First, the situation is determined and emotional connection person with her. The doctor determines the client’s irrational motives and ways to get out of a difficult situation. Then evaluates key points, after which he clarifies (clarifies, explains) them, analyzes each event together with the patient. Thus, irrational actions are recognized and rationalized by the person himself.

Existential-humanistic psychotherapy

Humanistic therapy is the newest method of verbal influence on the patient. What is being analyzed here is not the deepest motives, but the formation of a person as an individual. The emphasis is on highest values(self-improvement, development, achieving the meaning of life). Viktor Frankl contributed a major role to existentialism, who was the main reason human problems saw a lack of personal fulfillment.

There are many subtypes of humanitarian psychotherapy, the most common of which are:

Logotherapy– a method of dereflection and paradoxical intention, founded by V. Frankl, which allows you to effectively cope with phobias, including social ones.

Client-centered therapy – special technique, in which the main role in treatment is played not by the doctor, but by the patient himself.

Transcendental Meditation– a spiritual practice that allows you to expand the boundaries of your mind and find peace.

Empirical therapy– the patient’s attention is focused on the deep emotions he experienced earlier.

The main feature of all of the above practices is that the line in the doctor-patient relationship is blurred. The psychotherapist becomes a mentor, as equal as his client.

Other types of psychotherapy

In addition to the verbal method of communication with the doctor, patients can attend classes in music, sand, and art therapy, which help them relieve stress and express their Creative skills and open up.

Clinical psychotherapy: conclusions

Psychotherapy has an invaluable influence on the patient during treatment and rehabilitation. Neurotic spectrum disorders are more effectively amenable to drug correction if it is combined with the work of a psychotherapist or psychologist, and sometimes even without taking medications; psychotherapy can lead to the complete disappearance of painful manifestations. In the future, patients move from taking medications to using the skills acquired in psychotherapy sessions. In this case, it acts as a step from pharmacotherapy to self-control over painful manifestations (phobias, panic attacks, obsessions) and the patient’s mental state. Therefore, work with a psychotherapist must be carried out with patients and their relatives.