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

Year of issue: 2005

Genre: Psychology

Format: PDF

Quality: OCR

Description: In the preparation of materials presented in the book "Effective therapy for post-traumatic stress disorder”, members of a special commission created to develop guidelines for the treatment of 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 Effective Therapy for Post-Traumatic Stress Disorder is a two-part book. The chapters of the first part are devoted to reviewing the results of the most important studies. The second part provides short description application of different therapeutic approaches in the treatment of PTSD. This guideline aims to inform clinicians of the developments we have identified as the best for treating 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 are repetitive reproduction of a traumatic event or its episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often associated with other psychiatric disorders and is a complex illness that can be associated with significant morbidity, disability, and important functions.

In developing this practice guide, a special commission confirmed that traumatic experiences can lead to the development of various disorders, such as general depression, specific phobias; disorder caused by acute stress, nowhere else defined (disorders of extreme stress not otherwise specified, DESNOS), personality disorders, such as borderline anxiety disorder and panic disorder. However, the main topic 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 illness(Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994) American Psychiatric Association.
The authors of the Effective Therapy for Post-Traumatic Stress Disorder acknowledge that the diagnostic scope for 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 others that contribute to impaired personal and social functioning. About successful treatment relatively few such patients are known. The consensus of clinicians, supported by empirical data, is that patients with this diagnosis require long-term and complex treatment. The Task Force also recognized that PTSD is often accompanied by other mental disorders, and these comorbidities require sensitivity, attention, and diagnosis from medical personnel throughout the treatment process. Disorders requiring particular attention are substance abuse and general depression as the most commonly reported comorbid conditions. Practitioners may refer to the guidelines for these disorders to develop treatment plans for individuals presenting with multiple disorders and to the comments in Chapter 27.
The Effective Therapy for Post Traumatic Stress Disorder guide is based on cases of adults, adolescents, and children with PTSD. The purpose of the manual is to assist the clinician in the management of these individuals. Since the treatment of PTSD is carried out by clinicians with different professional backgrounds, these chapters have been developed on the basis of a multidisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family counselors and other specialists. Accordingly, these chapters are directed to a wide range professionals involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently 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 who live in war zones, may also qualify for a diagnosis of PTSD. However, their treatment, as well as the associated legal and ethical issues significantly different from the treatment and problems of patients who have experienced traumatic events in the past. Patients who are directly in a traumatic situation need 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 clearly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is seen across many cultures and societies. However, there is a need for systematic research to determine whether treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western society will be effective in other cultures. In general, professionals should not limit themselves to only those approaches and techniques that are outlined in this manual. The creative integration of new approaches that have been shown to be effective in the treatment of other disorders and have sufficient theoretical basis in order to improve the results of therapy.

Effective Therapy for Post-Traumatic Stress Disorder (PTSD) is based on an analysis of the results of studies 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 management of such patients. Since PTSD therapy is carried out by specialists with different professional backgrounds, 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, and others. The chapters of the guide are addressed to a wide range of professionals 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 reviewing the results of the most important studies. The second part provides a brief description of the use of different therapeutic approaches for the treatment of PTSD.

"Effective therapy for post-traumatic stress disorder"

1. Diagnosis and evaluation

Approaches to the treatment of 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 a 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 processing through eye movements
6. group therapy
7. Psychodynamic Therapy
8. Treatment in a 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 conflicting statements, skepticism and even outright denial, both in academic circles and among practicing psychologists. At the same time, the rapid growth of the practice psychological help on the Internet does not allow to remain aloof.
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, most of the published research on the effectiveness of online counseling reports comparable success rates as if clients were working face-to-face with their therapists. Therefore, it can be concluded that internet based therapy , on average, also effective or almost as effective as face-to-face therapy.

To date, several hundred studies have been conducted, in which several tens of thousands of people have taken 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 Reporting studies (see Seligman, 1995), and meta-studies by Smith and Glass (1977), Wampold and colleagues (1997), and Luborsky and colleagues ( 1999).
In this article, I have summarized the research findings.

Issues of the effectiveness of online psychological assistance.

The main questions that the authors of the studies have consistently tried to answer are:
can online therapy be effective at all;
whether the therapy could be delivered effectively (i.e., achieve its therapeutic goals) via the Internet;
– was it 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 online therapy success rates in the group of middle-aged adults (19-39 years old) were higher than with older or younger clients. But this factor may also be due to the lower level of use of skills related to the Internet. 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, but most likely, it is due to the need for a person to simultaneously focus on several sources of information (several windows in 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.

With what problems is online psychotherapy effective?

In the studies, patients were treated for a variety of problems and psychological distress (sometimes medical problems such as lower back pain or headaches). They were able to classify and combine them into eight specific problems. Since 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 for the treatment of 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 also have psychological components). ).

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

Marital problems (Jedlicka and Jennings, 2001), sexual problems (Zahl, 2004), addictive behavior (Stofle, 2002), anxiety and social phobia (Przeworski and Newman, 2004) and eating disorders (Grunwald and Busse, 2003); and group therapy in the treatment of a variety of problems (eg, Barak & Wander-Schwartz, 2000; Colo`n, 1996; Przeworski & Newman, 2004; Sander, 1999).

B. Klein, K. Shendley, D. Austin, S. Nordin pilot study Panic Online as a Self-Administered Therapy for Panic Disorder
S.J. Linton, L. Von Knorring, L.G. Ost Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression

Is it worth it to seek 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 meet regularly in a psychologist's office, you should prefer this option. If this is not possible, or the option online help allows you to save a lot of money and time, of course, you should resort 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 turned out that group therapy is a completely different form of psychotherapy.

generic drug, with several important pharmacological effects:
- anxiolytic (calming and vegetotropic)
- nootropic
- stress-protective

Effective therapy of vegetovascular dystonia in patients young age

E. N. Dyakonova, doctor medical sciences, Professor
V. V. Makerova
GBOU VPO IvGMA 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 vegetovascular dystonia syndrome, during treatment and after withdrawal, the effectiveness and safety of therapy were evaluated.
Keywords Key words: vegetovascular 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 "vegetovascular dystonia" (VVD) is often understood as psychogenically caused polysystemic autonomic disorders, which can be an independent nosology, as well as act as secondary manifestations of somatic or neurological diseases. At the same time, the severity vegetative pathology aggravates the course of the underlying disease. The syndrome of vegetovascular dystonia significantly affects the physical and emotional condition patients, determining the direction of their appeal for medical care. In the structure of the general morbidity of vegetative disorders nervous system occupy one of the leading places (heading G90.8 according to ICD-10). Thus, the prevalence of vegetovascular dystonia in the general population, according to various authors, ranges from 29.1% to 82.0%.

One of key features VVD is a polysystemic clinical manifestations. As part of vegetovascular dystonia, three generalized syndromes are distinguished. The first is the 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 VVD. special clinical significance 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 daily practice shows, all patients with this kind of disorders are prescribed anxiolytic or sedative therapy. In particular, various tranquilizers are used: benzodiazepine, non-benzodiazepine, antidepressants. Anxiolytic therapy significantly improves the quality of life of these patients, contributes to their better compensation during treatment. 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. Considering the problems noted in last years Increasingly, there is a 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-addictive, safety, high efficiency) .

The properties and effects of releasing active antibodies to the brain-specific protein S-100 have been studied in many experimental studies. The preparations 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 RA-AT S-100 is a calcium-binding neurospecific protein S-100, which is involved in the pairing 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 Jurkat and MCF-7 cell lines, it was shown that PA-AT S-100 realize their 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 effect of Tenoten on various mediator systems, including GABAergic and serotonergic transmission.

It should be noted that, unlike traditional benzodiazepine anxiolytics, RA-AT S-100 does not cause sedation and muscle relaxation. In addition, RA-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 by chronic ischemia of the 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 regions and associated emotional disorders, it was found that the use of RA-AT S-100 can reduce anxiety. At the same time, the anxiolytic effect practically did not differ from the anti-anxiety effect of phenazepam, while the tolerability of the drug containing RA-AT S-100 turned out to be significantly better and, unlike the use of benzodiazepine derivatives, there were no side effects.

However, there are not enough works reflecting the effectiveness of Tenoten in the correction of autonomic disorders in young people.

The aim of this work was to evaluate the efficacy and safety of Tenoten in the treatment of vegetovascular dystonia in young patients (18–35 years old).

Materials and methods of research

In total, the study included 50 patients (8 males and 42 females) aged 18 to 35 years (mean age 25.6 ± 4.1 years) with vegetative dystonia syndrome, emotional disorders, decreased performance.

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 the history, physical examination and/or laboratory and instrumental tests, which could prevent participation in the program and affect the results.

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

All patients were diagnosed with vegetative disorders according to the Wayne table (more than 25 points indicates the presence of vegetative-vascular dystonia); anxiety level assessment - 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 condition of patients 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. Veyna, HADS anxiety/depression, as well as the SF-36 questionnaire (Russian version, created and recommended by the CICG), which allows you 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 determined according to the CGI-I scale.

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

• 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 oscillations reflecting steam activity sympathetic department autonomic nervous system;
• LF "low frequency" - low-frequency oscillations reflecting the activity of the sympathetic division 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 that affect heartbeat(cerebral ergotropic, humoral-metabolic influences, etc.);
• LF/HF - indicator reflecting the balance of sympathetic and parasympathetic influences, measured in normalized units;
• VLF%, LF%, HF% - relative indicators reflecting the contribution of each spectral component to the spectrum of neurohumoral regulation.

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

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

Results and its discussion

All patients complained of a decrease in working capacity, 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 mm Hg). Headaches in 72% of patients were not permanent and were associated with increased mental or emotional stress. In 24%, pain was periodically noted in the scalp and on palpation of the pericranial muscles. Sleep disorders had 72% of patients, cardialgia and sensations of interruptions in the work of the heart - 18%. Hyperhidrosis of the palms, feet, persistent red dermographism, 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 examined had a stress factor. In a survey, 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 subclinical anxiety in 26% of patients, and clinical anxiety in 46%. Half of the patients (50%) often experienced tension and fear; 6% of patients constantly felt a sense of internal tension and anxiety. Panic attacks occurred in 16% of respondents. 10% of patients had subclinical and clinically expressed depression.

According to the SF-36 questionnaire, violations of the psychological component of health (MH) were significant, 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, according to 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%) who initially had vegetative disorders with a clear positive dynamics according to the results of HRV after the 30th day of taking Tenoten. They were patients without signs of clinically pronounced depression. The initial data for this group of patients were: the number of points on the Wayne 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 the 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 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 (*р) Further analysis of the dynamics of indicators within the scales in the first group showed that the largest and significantly significant changes in the condition occurred after 30 days from the start of Tenoten administration. There was a positive trend in the form of a decrease in the number and the severity of symptoms of vegetative-vascular dystonia: according to 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. Wayne scale in patients of the first group (*p)

Rice. 3. Dynamics of indicators of physical (PF) and mental (MH) health 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 fear. During the observation period, there were no periods of increased blood pressure in patients of the first group. Patients did not present active complaints of pain in the area of ​​the pericranial muscles, however, after focusing on this area, they noted rare headaches.Dermographism remained unchanged.Infrequent interruptions in the work of the heart 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 effect obtained from taking the drug was preserved.

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

The data before the start of therapy for this group of patients were: the number of points on the Wayne scale 41–63 (mean 51.80 ± 8.70); on the HADS anxiety scale 9–18 (13.40 ± 3.36); on the 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 the 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 Wayne scale - from 51.8 to 43.4 points; anxiety and 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 index (MH) increased from 24.72 to 33.16, the physical health index (PF) - 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 expressed 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 pronounced anxiety and depression in one of the groups, which initially did not differ significantly from the bulk of the respondents. Analysis of the dynamics of indicators on the main scales after a month of taking Tenoten 1 tablet 3 times a day in this group did not reveal significant differences. The anxiolytic and vegetostabilizing effects of Tenoten in the group of clinically pronounced anxiety and depression with the usual (1 tablet 3 times a day) therapy 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. Therefore, the data obtained indicate the need to select various schemes 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 drug withdrawal. In 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 baseline, p In the spectral analysis in the process of conducting an active orthostatic test after therapy, a lower reactivity of the sympathetic division of the autonomic nervous system (ANS) was noted compared to the baseline data , this is evidenced by the values ​​of indicators LF/HF and %LF, 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 baseline, p Thus, in the first group, when conducting HRV after 30 days of taking Tenoten, there is an increase in the total power of the spectrum due to an increase in the influence of HF- component, as well as the normalization of sympathetic-parasympathetic influences during the background test.In the active orthostatic test, the same trends persist, but to a lesser extent.An analysis of the dynamics of the coefficient 30/15 suggests an increased reactivity parasympathetic department VNS and, consequently, an increase in the adaptive potential as a result of the therapy in patients of the first group (Table 1).

Table 1
Spectral indices of HRV at rest and during 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
By 30/15	1.26 ± 0.18	1.32±0.16	1.44 ± 0.11	1.44 ± 0.11

Note. *Significance of differences: compared with baseline, 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 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 completion" remained unchanged (Fig. 6, 7 ).

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

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

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

table 2
Spectral indices of HRV at rest and during 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
By 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 VVD in combination with clinically severe depression. However, the duration of treatment of 30 days for this group of patients is insufficient, which serves as a basis for continuing treatment or using an alternative regimen of 2 tablets 3 times a day.

Conclusion

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

• In the course of the study, it was recorded that Tenoten leads to the normalization (stabilization) of the autonomic balance in any type of vegetative-vascular dystonia (sympathetic-tonic, parasympathetic-tonic), an increase in the autonomic provision of the body's regulatory functions and an increase in adaptive potential.
• Tenoten has a pronounced anti-anxiety and vegetostabilizing effect.
• During therapy with Tenoten, the level of mental and physical health (according to the SF-36 questionnaire) became significantly higher, which indicates an improvement in the quality of life of patients.
• Reception of Tenoten by patients with clinically pronounced signs anxiety and depression require differentiated approach to the scheme of therapy 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 dystonia in young patients (18–35 years old).

Literature

1. Amosov M. L., Saleev R. A., Zarubina E. V., Makarova T. V. The use of tenoten in the treatment of emotional disorders in patients with transient disorders cerebral circulation// Russian psychiatric journal. 2008; 3:86–91.
2. Neurology. National leadership / Ed. E. I. Guseva, A. N. Konovalova, V. I. Skvortsova et al. M.: GEOTAR-Media, 2010.
3. Wayne A. M. et al. Autonomic disorders. Clinic, treatment, diagnosis. M.: Medical Information Agency, 1998. 752 p.
4. Vorobieva O. V. Vegetative dystonia What is 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. functional diseases CNS // Attending Doctor. 2008; 8:18–23.
7. Epshtein OI, Beregovoi NA, Sorokina NS et al. Influence of different dilutions of potentiated antibodies to the brain-specific S-100 protein on the dynamics of post-tetanic potentiation in surviving sections of the hippocampus // Bulletin of Experimental Biology and Medicine. 1999; 127(3): 317–320.
8. Epshtein OI, Shtark MB, Dygai AM et al. Pharmacology of ultra-low doses of antibodies to endogenous function regulators: monograph. Moscow: RAMN Publishing House, 2005.
9. Epshtein O. I. Ultra-low doses (history of one study). Experimental Study ultra-low doses of antibodies to the S-100 protein: monograph. M.: RAMN Publishing House, 2005. S. 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 the S-100 protein 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. Involvement of the GABA-B system in the mechanism of action of antibodies to the S-100 protein in ultra-low doses // Bulletin of Experimental Biology and Medicine. 2008; 145(5): 552–554.

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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 the material in this book, in whole or in part
without the permission of the copyright holder is prohibited
Edited by E
DAYS
Foa. Terence M. Keane, Matthew Friedman
Translation from English under general editorship 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. Kalmykov- chapters 9, 21 EL. misco- 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.: "Kogito-Center", 2005. - 467 p. (Clinical psychology)
UDC 159.9.07 BBK88
This guide is based on an analysis of the results of studies on 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 management of such patients.
Since PTSD therapy is carried out by specialists with different professional backgrounds, 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, and others. The chapters of the guide are addressed to a wide range of professionals involved in the treatment of PTSD.
The book consists of two parts. The chapters of the first part are devoted to reviewing the results of the most important studies. The second part provides a brief description of the use of different therapeutic approaches for the treatment of PTSD.
© Translation into Russian "Cogito-Center", 2005 © The Guilford Press, 2000
ISBN 1-57230-584-3 (English) ISBN 5-89353-155-8 (Russian)

Content i. Introduction.............................................................................................................7
2. Diagnosis and assessment...........................................................................................28
Terence M. Keane, Frank W. Wethers and Edna B. Foa
I. Treatment approaches for PTSD: a review of the literature
3. Psychological debriefing...................................................................51
Jonathan I. Bisson, Alexander S. McFarlane, Susanna Ros
4. ...............................................75
5. Psychopharmacotherapy......................................................................... 103
6. Treatment of children and adolescents................................................................ 130
7. Desensitization and processing through 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 a hospital.............................................................................239
AND. Psychosocial rehabilitation.......................................................270
12. Hypnosis.............................................................................................................298
Etzel Cardena, José Maldonado, Otto van der Hart, David Spiegel
13. ....................................................336
David S. Riggs
^.Art therapy..............................................................................................360
David Reid Johnson

II. Therapy Guide
15. Psychological debriefing................................................................377
Jonathan I. Bisson, Alexander MacFarlane, Suzanne Ros
16. Cognitive Behavioral Therapy............................................381
Barbara Olasow 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 recycling
with 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. Cudler, Arthur S. Blank Jr., Janice L. Krapnick
22. Treatment in a hospital.............................................................................408
Christine A. Kurti, Sandra L. Bloom
23. Psychosocial rehabilitation.......................................................414
Walter Penk, Raymond B. Flannery Jr.
24. Hypnosis.............................................................................................................418
Etzel Cardena, José Maldonado, Otto van der Hart, David Spiegel
25. Marriage and family therapy....................................................423
David S. Riggs
26. Art therapy..............................................................................................426
David Reid Johnson
27. Conclusion and Conclusions.............................................................................429
Arie W. Shalev, Matthew J. Friedman, Edna B. Foa, Terence M. Keane
Subject index
457

1
Introduction
Edna B. Foa, Terence M. Keane, Matthew J. Friedman
Members of a special commission set up to develop guidelines for the treatment of PTSD took direct part 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 reviewing 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 the best for treating 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 are repetitive reproduction of a traumatic event or its episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often accompanied by other psychiatric disorders and is a complex illness that can be associated with significant morbidity, disability, and impairment of vital functions.

8
In developing this practice guide, the Task Force confirmed that traumatic experiences can lead to the development of various disorders such as general depression, specific phobias; disorder caused by acute stress, not defined anywhere else (disorders of extreme stress not otherwise specified, DESNOS), personality disorders such as borderline anxiety disorder and panic disorder. However, the main topic 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 Illness. (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994)
American Psychiatric Association.
The authors of the guidelines acknowledge that the diagnostic scope for PTSD is limited and that these limitations may be particularly evident in the case of patients who experienced childhood sexual or physical abuse. Often, patients diagnosed with DESNOS have a wide range of problems in relationships with others that contribute to impaired personal and social functioning. Relatively little is known about the successful treatment of these patients. The consensus of clinicians, supported by empirical data, is that patients with this diagnosis require long-term and complex treatment.
The Task Force also recognized that PTSD is often accompanied by other mental disorders, and these comorbidities require sensitivity, attention, and diagnosis from medical personnel throughout the treatment process.
Disorders requiring particular attention are substance abuse and general depression as the most commonly reported comorbid conditions.
Practitioners may refer to the guidelines for these disorders to develop treatment plans for individuals presenting with multiple disorders and to the comments in Chapter 27.
This guide is based on cases of adults, adolescents and children with PTSD. The purpose of the manual is to assist the clinician in the management of these individuals. Since the treatment of PTSD is carried out by clinicians with different professional backgrounds, these chapters have been developed on the basis of a multidisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family counselors and other specialists actively participated in the development process. Accordingly, these chapters are addressed to a wide range of professionals involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently subjected to violence or insults. These individuals (children who live with an abusive person, men

9 and women who are abused and abused in their home), as well as those who live in war zones, may also meet the criteria for diagnosis.
PTSD. However, their treatment and the associated legal and ethical issues differ significantly from those of patients who have experienced traumatic events in the past. Patients who are directly in a traumatic situation need 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 clearly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is seen across many cultures and societies. However, there is a need for systematic research to determine whether treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western society will be effective in other cultures.
In general, professionals should not limit themselves to only those approaches and techniques that are outlined in this manual. The creative integration of new approaches that have been shown to be effective in the treatment of other disorders and have a sufficient theoretical basis, in order to improve the results of therapy.
THE GUIDANCE PROCESS
The development process for this guide was as follows. Co-Chairs
A special commission identified specialists in those 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 during a series of meetings.
The co-chairs instructed the members of the Special Commission to prepare an article for each area of ​​therapy. Each article was to be written by a recognized expert with the support of an assistant, whom he independently chose from among other members of the commission or clinicians.

10
Articles were to contain a review of the literature on research in this field and clinical practice.
Literature reviews for each topic were compiled using online search engines such as the Published International Literature on traumatic stress» (Published
International Literature on Traumatic Stress, PILOTS), MEDLINE, and PsycLIT In the final draft, articles were standardized and limited in length. Authors cited relevant literature, presented clinical developments, critically reviewed the scientific basis for a particular approach, and presented papers 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 the chapters of this book.
Based on the articles and a careful study of the literature, a set of concise practical recommendations was developed for each therapeutic approach. It can be found in Part II.
Each therapeutic approach or modality in the guidelines was assigned a rating according to the effectiveness of its therapeutic intervention. These ratings have been 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 existing scientific advances.
The guidelines were reviewed by all members of the Special Commission, agreed upon and then presented to the ISTSS Board of Directors, submitted for review to a number of professional associations, 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 have also been included in the manual.
Published research on PTSD, as well as other mental disorders, contain certain restrictions. In particular, most studies apply inclusion and exclusion criteria to determine if a diagnosis is appropriate for a particular case; therefore, each study may not fully represent the spectrum of patients seeking treatment. Studies of PTSD, for example, very often do not include patients with drug addictions. chemical substances, suicidal risk, neuropsychological impairment, developmental delays, or cardiovascular diseases. This guideline covers studies that do not address these patient populations.

11
CLINICAL PROBLEMS Type of injury
Most randomized clinical trials conducted on veterans of the wars (mainly Vietnam) showed that for this population, treatment was less effective compared with people who did not participate in combat operations, whose PTSD was associated with other traumatic experiences (for example, with rape, accidents incidents, natural disasters). Therefore, some experts believe that war veterans with PTSD respond less well to treatment than those who have experienced other types of trauma. Such a conclusion is premature. The difference between veterans and other PTSD patients may be due to the greater severity and chronic nature of their PTSD than to the specific features of war trauma. In addition, low rates of effectiveness in the treatment of veterans may be associated with the characteristics of the sample, since groups are sometimes formed from volunteers - veterans, chronic patients with multiple disorders. In general, on this moment it cannot be definitively concluded that PTSD after certain traumas may be more resistant to treatment.
Single and multiple injuries
No studies have been performed among patients with PTSD clinical research to answer the question whether the number of previous traumas can affect the course of treatment for PTSD. Since most of the research has been done on either war 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 could be of great interest, since it could be found out how much better the former are expected to respond to treatment. However, conducting such studies can be quite difficult, as factors such as concomitant diagnoses, severity and severity would have to be controlled for. chronic PTSD, and each of these factors may be a stronger predictor of treatment outcome than the number of traumas experienced.

As Avicenna said, the doctor has three main tools: the word, the medicine and the knife. In the first place, of course, is the word - the most powerful way to influence the patient. That doctor is bad, after a conversation with which the patient did not feel better. A spiritual 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 of all to psychotherapists.

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

Psychotherapy can be used either alone or in combination with medication. Greatest effect psychotherapy has on 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 behavioral)
• Existential-humanistic

All of them have different mechanisms of influence on the patient, but their essence is the same - the focus is not on the symptom, but on the whole person.

Depending on the desired purpose practical psychotherapy May be:

• supportive. Its essence is to strengthen, support the patient's defenses, as well as the development of behavior patterns that will help stabilize the emotional and cognitive balance.
• Retraining. Full or partial reconstruction of negative skills that impair the quality of life and adaptation in society. The work is carried out by supporting and approving positive forms of behavior in the patient.

According to the number of participants, psychotherapy is individual and group. Each option has its pros and cons. Individual psychotherapy is a springboard for patients who are not prepared for group lessons or refuse to participate in them due to their 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 joint work with two spouses.

Spheres of therapeutic influence in psychotherapy

Psychotherapy is good method treatment through three areas of influence:

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

Cognitive. There is an awareness, "intellectualization" of one's own actions and aspirations. At the same time, the psychotherapist acts as a mirror that reflects the patient himself.

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

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

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 oppression of the needs and requirements of the individual. The task of the psychotherapist was the transfer of unconscious stimuli and their awareness by the client, due to which adaptation was achieved. In the future, Freud's students and many of his followers found their own schools of psychoanalysis with principles that differ 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 dealing with neurosis to the works of K. Jung, A. Adler, E. Fromm. The most common version of this direction is person-centered psychotherapy.

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

Behavioral Psychotherapy

Unlike supporters of the psychodynamic theory, behavioral psychotherapists see the cause of neurosis as incorrectly formed habits of behavior, and not hidden stimuli. Their concept says that a person's behavior patterns can be changed, depending on which his state can be transformed.

Methods of behavioral psychotherapy are effective in the treatment of various disorders (phobias, panic attacks, obsessions, etc.). Worked well in practice confrontation and desensitization technique. Its essence lies in the fact that the doctor determines the cause of the client's fear, its severity and connection with external circumstances. Then the psychotherapist conducts verbal (verbal) and emotional influences by means of implosion or flooding. In this case, the patient mentally represents his fear, trying to paint his picture 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 excite him, that is, desensitization occurs.

Another type of behavioral technique is rational-emotional psychotherapy. Here the work is carried out in several stages. The first one defines the situation and emotional connection person with her. The doctor determines the irrational motives of the client and ways of his way out of a difficult situation. Then evaluates key points, after which he clarifies (specifies, explains) them, analyzes each event together with the patient. Thus, irrational actions are realized and rationalized by the person himself.

Existential-humanistic psychotherapy

Humanistic therapy is the newest method of verbal influence on the patient. Here, an analysis is made not of deep motives, but of the formation of a person as a person. Emphasis is placed on highest values(self-improvement, development, achievement of the meaning of life). A major role in existentialism was made by Viktor Frankl, who is the main reason human problems I saw the lack of realization of personality.

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

Logotherapy- a method of dereflection and paradoxical intention, founded by W. Frankl, which allows you to effectively deal with phobias, including social ones.

Client Centered Therapy – special technique in which the main role in the 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 the mind and find peace.

Empiric Therapy- the patient's attention is focused on the deepest emotions experienced by him earlier.

The main feature of all the above practices is that the line in the doctor-patient relationship is blurred. The therapist 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, art therapy, which help them relieve stress, show their Creative skills and open up.

Clinical Psychotherapy: Conclusions

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