RU2223796C1 - Method for correcting psychotherapeutic resistance and personal rigidity - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves detecting pathological disadaptive cognitive behavior stereotypes when analyzing patient anamnesis. Concepts dominating role of psychological inertia and rigidity in retaining pathological deviations are suggested in process of rational and suggestive psychotherapy application. General training of psychological process plasticity in areas not associated to proper pathologic changes is administered at the first stage when keeping patient in awareness state by changing maximum broad range of habitual cognitive behavior patterns using role training, grotesque and absurdity techniques. The second stage involves applying special-purpose psychological process plasticity training in areas associated to the pathologic changes by destabilizing the built ideas of factors injuring psychics by applying versions of contrasting positive interpretation and subjective modification of their cognitively logical, verbally semantic, symbolic, sensory and spatially plastic features. The total treatment course is 3-5 sessions long. Curative manipulations are applied daily 10-20 times a day. EFFECT: enhanced effectiveness of treatment; stable treatment result.

Description

 The invention relates to medicine, namely to psychotherapy.

 Psychotherapeutic resistance and personal rigidity - various types of psychological resistance and persistent stereotypes of maladaptive behavior, are the main causes of difficulties in psychotherapeutic work.

 A known method of correction of mental rigidity during psychotherapeutic treatment (RF application 96108580/14, class IPC: A 61 M 21/00, 1997), including hypnosis. A representative system for perceiving information by the patient is preliminarily determined, the text of the suggestion is composed using the terms of the main representative system, and the main formula of the suggestion is using secondary systems, the treatment session is carried out in a darkened room, the patient's attention is focused on a luminous point, the flickering of which is synchronized with the rhythm of the text of the suggestion, after achieving a state of relaxation and the appearance of signs of transformation of the patient’s consciousness is immersed in a state of hypnotic trans After which the suggestion was continued imperative form, after the patient's suggestion program is converted into a state of physiological sleep and left him alone to self-awakening. A luminous, flickering dot is presented in green. A sign of achieving a state of relaxation and transformation of consciousness is the smoothness of the nasolabial folds and a decrease in muscle tone of the face. The course of treatment includes 8-10 sessions, which are carried out in 2-3 days.

 However, the method does not have high efficiency, because relies on insufficiently studied and proven provisions on representative systems. It requires special conditions and technical devices for conducting. The complexity and duration of execution reduces its functionality.

 As the closest analogue, the method adopted by M. Erickson for the correction of psychotherapeutic resistance ("A seminar with a doctor of medicine Milton G. Erickson. - M .: Class, 1994, pp. 13-304), including an anamnesis analysis, rational psychotherapy and suggestive effect. In it use the technique of “encouraging resistance” and “suggesting the worst option.” In the first case, they create the appearance of accepting and approving the patient’s undesirable behavior using the appropriate statements (“this is good,” “while it’s best to leave everything as it is,” “for you this is riant ", etc.). In the second case, they require the implementation of labor-intensive tasks, linking them with the preservation of the symptom, thereby prompting the person to abandon negative behavior (for example, the appointment of special nightly physical exercises or exercises for neurotic insomnia can make it In addition, hidden suggestions in the form of "negative negative commands" are used in Ericksonian psychotherapy, in which the "not" particle is used, which usually stimulates the desire to do the opposite ("don’t be too get well soon "), as well as" choice without a choice "(" Would you like to plunge into a trance quickly or slowly? ") and" consistent adoption "(a set of statements, the patient will certainly agree with the first of which and further" by inertia "will accept the statement beneficial for therapy). In addition, this method includes the widespread use of hypnotic trance states and the use of stories, metaphors containing hidden meanings and inserted messages in which the model of getting rid of the problem is encrypted.

 The disadvantages of this method are: the need to use trance states for the implementation of most suggestions, which limits its capabilities in connection with different suggestibility and hypnability of patients; long terms of treatment; unstable therapeutic effect. The lack of humanity of the above-described manipulations hidden to the human consciousness is also of significance.

 The objective of the invention is to provide a highly effective method for the correction of psychotherapeutic resistance and personal rigidity, with wider functionality and versatility, which allows to obtain a more stable therapeutic effect in a short time.

 The essence of the invention lies in the fact that in the method of psychotherapeutic influence, including the analysis of the anamnesis, rational psychotherapy and suggestive impact, in the analysis of the anamnesis the patient reveals pathological maladaptive cognitive-behavioral strategies, in the process of rational and suggestive psychotherapy explain and inculcate the concept of the leading role psychological inertness and rigidity in maintaining pathological abnormalities, identified maladaptive stereotypes are corrected, recommending and suggesting the optimal strategies of thinking and behavior, assess the degree of psychological resistance and personal rigidity by identifying patient responses, develop an individual scheme for activating plasticity in various areas of thinking, perception and processing of information (verbal-conceptual-logical, analog-figurative and practical), forming for each of them is a set of individually acceptable actions and operations that have neuro correction value and metaphorical, hidden meaning (suggestion of initiation and implementation changes), on this basis, a sequential suggestive effect is further carried out, which at the first stage is aimed at activating the plasticity of mental processes in areas that do not affect the pathology itself (general plasticity training), by changing the widest possible range of habitual cognitive-behavioral patterns using role-playing training techniques , grotesque and absurdization, at the second stage - with a special training in the plasticity of mental processes - the existing idea of psycho is destabilized equalizing factors by using a positive interpretation and subjective modification of their cognitive-logical, verbal-semantic, symbolic, sensory and volume-plastic characteristics, all manipulations are carried out daily from 10 to 20 times a day, the course of treatment includes from 3 to 5 sessions, combined with homework, the acquired skills are then independently used by patients to improve social adaptation.

 Using the invention allows to obtain the following technical result.

 The method is highly effective. The achieved effect is stable. The onset of a positive effect in the form of increased psychological plasticity and psychotherapeutic accessibility is observed in all patients already at the first session, in the future it is steadily increasing and supplemented by positive changes in behavior.

 The method is implemented in the waking state of the patient, if necessary, can be carried out in a state of hypnosis.

 The method has a wide range of indications: neurotic disorders, personality and behavior disorders, affective disorders, psychosomatic disorders, anorexia nervosa and bulimia, states of dependence on psychoactive substances, any other disorders associated with psychogenic factors, bad habits, psychoprophylaxis of borderline mental disorders and dependence on psychoactive substances.

 Another direction of using this method is the prevention of such disorders and the development of adaptive abilities in mentally healthy individuals, psychological plasticity and, at the same time, stability in maintaining the most beneficial positive behavioral strategies to overcome stresses and psycho-injuries that are inevitable in the life of every person. The skills acquired during the treatment are aimed at applying them in real life, including imperceptibly to others, without stopping the main activity or communication, especially in situations of direct exposure to traumatic factors that trigger abnormal behavior.

 Contraindications are only acute psychotic conditions and dementia.

 The method has no age restrictions, is available to most people - both patients with borderline mental disorders and practically healthy ones.

 It is implemented in the form of sessions and psychological trainings, includes special homework that the patient performs, and can be used independently or in combination therapy due to its good compatibility with any other types of psychotherapy, psychocorrection and psychopharmacotherapy.

 The method is harmless, gives no side effects, economical, does not require any material costs and can be used in medical and psychological institutions of any type.

 The technical result is achieved due to the multilevel model proposed by the author to neutralize psychotherapeutic resistance and personal rigidity, encompassing both the neurophysiological and personality levels - verbal-conceptual-logical, analog-figurative and practical. At the same time, highly effective psychocorrectional and psychotherapeutic technologies are used, aimed at encouraging the patient to change negative existence strategies, destabilizing rigid disadaptive behavioral stereotypes, neutralizing the overvalued attitude to psycho-traumatic influences or objects of dependence, and developing plasticity of mental processes. The neuro-correctional effect itself is complemented by a psychological one, positive changes affect both the neurophysiological and personality levels, forming a favorable basis for the assimilation of new adaptive behavioral strategies.

 The method is as follows.

 An analysis is made of the anamnesis, personality traits and cognitive activity (the style of perceiving and understanding problems, processing impressions associated with contacts with the outside world or introspection). Pathological maladaptive cognitive-behavioral strategies are identified. On this basis, rational psychotherapy and suggestive influence are carried out, explaining, convincing and suggesting the concept of the leading role of psychological inertness and rigidity in maintaining and maintaining pathological deviations, as well as the need and desirability of getting rid of negative stereotypes and adopting, developing positive, adaptive strategies of thinking and behavior . In the process of rational psychotherapy, the patient is informed that the purpose of the method is to destabilize the pathological dominant, increase the mobility of the nervous system and thought processes to free oneself from established stereotypes that are an obstacle to a harmonious life, and increase readiness for the assimilation of new, positive cognitive-behavioral patterns. In parallel, the degree of psychotherapeutic resistance and personal rigidity is assessed. This is done by identifying and analyzing the patient’s reactions to the proposed recommendations, beliefs and suggestions, and recording the rate of transformation of negative stereotypes into positive ones. They develop an individual scheme for activating plasticity in the conceptual-logical, verbal-semantic, sensory (visual, auditory, olfactory, kinesthetic), analog-shaped, symbolic and practical spheres of thinking, perception and processing of information. For each of them, they form a set of accessible, individually acceptable actions and operations, including both having a neuro-correctional basis and a metaphorical meaning, the hidden meaning is the suggestion of the initiation and implementation of changes.

 Then, in accordance with the developed scheme, a sequential phased suggestive effect is carried out in the patient’s wakefulness state.

 At the first stage, they conduct a general plasticity training - change stereotypes of behavior in areas that do not affect the pathology itself, covering the widest possible range of behavioral reactions, recommending "change everything that can be changed." At the same time, absurdization, grotesque, humor are used, which are used in special questions-answers and homework. The patient is instructed to make statements and respond, deviating from generally accepted schemes, for example, changing the voice or knowingly incorrectly, is absurd to questions asked by the therapist, and at home - to oneself or to suitably trained parents or other family members. These questions and statements may relate to name, age, gender, race, occupation of the patient, time of year, situation in the country, composition of the government, etc.

 In addition, “reverse actions” are trained: using the left hand instead of the right (for right-handed people) when eating food, brushing teeth, performing other actions, unusual walking options (sideways, backward, on tiptoe, with jumping on one leg, etc. P.).

 They change the usual localization in the space of the apartment, the doctor’s office and other places, change the interior in the apartment and at the patient’s workplace.

 Modify within the available limits the style of self-presentation - hairstyle, hair color, manner of dressing and speaking, pantomime stereotype.

 At the second stage - a special training in plasticity - the existing idea of psycho-traumatic objects or subjects is destabilized - various interpretations and subjective modifications of these factors are used here, respectively, specialization of various cognitive and sensory systems.

 Verbal-logical and semantic modifications-interpretations are developed - they relate to the new construction of phrases related to the patient’s disease, with negative interpretations reinforcing previously pathological symptoms, usually starting with the words "How terrible that ...", " I’m not so lucky that ... "they are replacing the positive:" How good that ... "; "Thank God that ..."; "How lucky I am that ...", etc. For example, with phobias: "How good that there is something that scares me so much - it allows me to more fully appreciate other moments of life - moments of peace or joy." In order for the interpretation to act in a desirable way, the patient must believe in it, this is ensured by previous cognitive-rational training. In addition, they rename psycho-traumatic objects and situations - their new name should carry a positive emotional charge. It can be, for example, diminutive or humorous names. The style of the story about these objects and situations is changed accordingly, and they find a positive meaning in what has happened and is happening.

 Form visual modifications. They represent non-standard visualizations - the visual imagination of psycho-traumatic situations and objects with any additions or exceptions, foreshortening, reduction in size or color saturation, the imaginary distance to them, using grotesque, humor, etc. Visual and practical modifications include unusual graphic, application, sculptural (modeling from plasticine) and other images of psycho-traumatic situations or objects.

 With such non-stereotypical types of “handling” with them, it is important to give these modifications a contrasting, positive character with respect to the initial negative perception of the situation and objects. The specific options for breaking the patterns depend on the age, intellectual level and degree of development of the patient’s sense of humor; it is important that they are safe and morally acceptable.

 All manipulations are carried out daily from 10 to 20 times a day, the course of treatment includes from 3 to 5 sessions, the acquired skills are then independently used by patients to improve social adaptation, including before traumatic situations and when you are in them.

 Example: Patient S., 26 years old, complaints of low mood, anxiety, fatigue, disturbed night sleep, lack of appetite, weight loss. The diagnosis is neurotic personality development, anxiety-depressive syndrome. In the anamnesis - upbringing with hyper-care, depended heavily on the father, idealized him. Parents instilled somewhat exaggerated views on the positive and negative aspects of life. I grew up with a sense of my own inferiority - there were false ideas about my own unattractiveness and uninterestingness - both external and internal. From older adolescence, she was afraid that, due to her appearance and character, she would not be able to marry a worthy person, there was a fear of communication with people of the opposite sex. At the same time, the idea was formed of the impossibility and meaninglessness of life alone and without offspring. At the end of her studies at the university in a hurry, after a week of acquaintance, she married a random person who paid attention to her - she was afraid that there would be no other case. With a sense of compulsion, she lived with him for about 6 years, there were insurmountable difficulties in psychological and intimate relations, in the end, could not stand it and got divorced. Six months later, not without reciprocity, she fell in love with an employee of the company in which she worked, the same problematic person, shy and proud, who had a fear of communicating with the female sex. During the year, both tormented each other with their own indecision, and things did not go beyond talking with half-hints in the office at the desk and in the corridor. Unable to withstand, quit, “struck him out of her life”, but often recalls this man. Lives alone, retains ideas about their own inferiority, uncommunicative. He thinks about the possibility of having a child “from some good and healthy person” and raising him out of wedlock. The above complaints have been growing in the last 3 years.

 An analysis of the patient’s anamnesis revealed a parenting style that forms a dependent, insecure person, in addition, the resulting idealization of the father raised the bar for men who are candidates for husbands, and the strong influence of the family formed only one standard of their own future as a wife and mother. The cognitive style of perceiving and comprehending problems, processing impressions was presented by a pathological maladaptive cognitive-behavioral strategy related to the dominance of an inadequate concept of one’s own inferiority and the idea of a single normal way of living, living in one’s own complete family. All other options for the future were considered by the patient as negative, the future without a family and a child seemed bleak and meaningless, ideas about suicide with such a development of fate arose. On this basis, rational psychotherapy and suggestive effects were carried out, during which the patient was explained the nature and essence of her illness and cognitive-behavioral constructions, the inadequacy and disadaptive role of her concepts about herself and the future was demonstrated. In addition, a concept was suggested about the leading role of psychological inertness and rigidity in preserving and maintaining pathological deviations, as well as the need and desirability of getting rid of negative stereotypes of thinking and behavior and adoption, development of positive, adaptive strategies. As the latter, broader views on options for one’s own existence, acceptability and even greater profitability of life without a husband or partner in general, with a child or without a child were proposed. Family life was presented as mostly disharmonious, given the real prevalence of conflicting couples and disintegrating families. The birth and upbringing of children was presented as a problematic, thankless task, fraught with the risk of giving birth or raising inferior or disharmonious offspring, doomed to torment, and as a result, like all living things, to death. Her own life experience was consistent with these suggestions. In the process of rational psychotherapy, the patient was informed that the goal of the method is to destabilize the pathological dominant, increase the mobility of the nervous system and thought processes to free from established negative stereotypes that are an obstacle to a harmonious life, and increase readiness for the assimilation of new, positive cognitive-behavioral patterns . In parallel, the degree of psychotherapeutic resistance and personal rigidity was assessed. This was done by identifying and analyzing the patient's reactions to the proposed recommendations, beliefs and suggestions, and registering the pace of the transformation of negative stereotypes into positive ones. Resistance and rigidity were moderately pronounced. Next, an individual scheme for activating plasticity was developed in the conceptual-logical, verbal-semantic, sensory (visual, auditory, olfactory, kinesthetic), analog-shaped, symbolic and practical spheres of thinking, perception and processing of information. For each of them, a set of accessible, individually acceptable actions and operations was formed, including both having a neuro-correctional basis and a metaphorical meaning, the hidden meaning is the suggestion of the initiation and implementation of changes.

 Then, in accordance with the developed scheme, a sequential phased suggestive effect was carried out in the patient’s wakeful state.

 At the first stage, a general plasticity training was conducted - behavior stereotypes were changed in areas that did not affect the pathology itself, covering the widest possible range of behavioral reactions, and it was recommended to "change everything that can be changed." At the same time, techniques of absurdization, grotesque, humor, which were used in special questions-answers and homework, were used. The patient was instructed to make statements and respond, deviating from generally accepted schemes, changing her voice or knowingly incorrectly, absurdly to questions posed by a therapist, and at home - to herself or to suitably trained parents or other family members. These questions and statements concerned the name, age, gender, race, occupation of the patient, time of year, situation in the country, composition of the government, etc.

 In addition, "reverse actions" were practiced: using the left hand instead of the right when eating food, brushing your teeth, performing other actions, unusual walking options (sideways, backwards, on tiptoe, with jumping on one leg, etc.).

 The usual localization and interior in the space of the apartment and the patient’s office was changed - furniture was rearranged, the weight of paintings was changed. In the doctor’s office, the patient was seated every time in a new place. The style of self-presentation was modified - the hairstyle, hair color, dressing style were changed - the style of the “classy lady” was changed to a more free, youth one. The stereotype of utterances and pantomimics from depressed-constrained autistic was transformed into optimistic-expressive.

 At the second stage - a special plasticity training - the prevailing idea of psycho-traumatic objects or subjects was destabilized - here again in various variants it was positively interpreted and modified as a profitable concept of independent life, regardless of the possibility of marriage or the presence of a partner, the presence or absence of a child.

 This concept took shape according to the specialization of various cognitive and sensory systems. At the same time, verbal-logical and semantic modifications-interpretations were developed - they concerned the new construction of phrases related to the patient’s problem - negative interpretations that reinforced previously pathological symptoms, usually starting with the words “How terrible that ...”, "I’m not so lucky that ..." was replaced by positive ones: "How good that ..."; "Thank God that ..."; "How lucky that ...", etc. For example: "It’s good that I can live on my own, this will allow me to avoid many disappointments, resentments, humiliations and stresses, to keep myself visually and internally young, attractive and healthy " The positive effect of this interpretation was provided by the previous cognitive-rational preparation of the patient at the first stage. In addition, psycho-traumatic situations were renamed with a positive emotional charge giving their new names. So “loneliness” was replaced by “independence”, “freedom from slavery in front of another person”, “a way to avoid disappointment and humiliation”, etc. They also used diminutive and humorous names - "dog-boys", "libido victims", "partner", "husband and wife", etc. The style of the story about problem situations changed accordingly, highlighting the positive meaning in what happened and is happening.

 Visual modifications were also used. They were non-standard visualizations - the visual imagination of traumatic situations with any additions or exceptions, camera angles, reduction in size or color saturation, the imaginary distance to them, using grotesque, humor, etc. So, the traumatic charge of ideas about the first husband and about the lover following him was neutralized by the addition to their visual image of enlarged ears and nose with a decrease in the size of the trunk and limbs, in addition, their representation was transparent, decreasing and moving away to the infinity of space, to where there isn’t return. At the same time, the patient presented herself, independent and successful, as close, beautifully effective, filling the entire space of the future.

 Visual-practical modifications included unusual graphic images of traumatic situations. In this case, serial sequential drawing of them from the largest to the smallest with the subsequent tearing and discarding of these patterns was used.

 For all these non-stereotypical types of “treatment” with psycho-traumatic experiences, their modifications were given a contrasting, positive character with respect to the initial negative perception.

 In addition to classes with a psychotherapist, the patient independently carried out proven therapeutic manipulations in the form of homework daily from 10 to 20 times a day. The course of treatment included 5 sessions, which required 2 weeks. The acquired skills were then independently used by the patient to improve social adaptation.

 During the treatment, the patient's condition improved, the previously presented complaints gradually disappeared, calmly and optimistic about any options for the development of her fate. Dynamic observation during the year showed the sustainability of the results.

Claims (1)

A method for the correction of psychotherapeutic resistance and personal rigidity, including an anamnesis analysis, rational psychotherapy and suggestive impact, characterized in that when analyzing the anamnesis the patient reveals pathological maladaptive cognitive-behavioral stereotypes, in the process of rational and suggestive psychotherapy explain the role of psychology and explain the role of and rigidity in maintaining pathological abnormalities, revealed pathological stereotypes are corrected, p Recommending and suggesting optimal strategies of thinking and behavior, then they carry out a sequential phased suggestive effect in the patient’s wakeful state, at the first stage they conduct training in the plasticity of mental processes in areas that do not affect the pathology itself, by destabilizing the widest range of habitual cognitive-behavioral schemes using role-playing techniques training, grotesque and absurdization, non-standard questions and answers, training of reverse actions, self-style changes esentations, inviting the patient to change the maximum possible amount of behavioral stereotypes, at the second stage, they conduct plasticity training of mental processes in areas related to pathology by reforming the prevailing ideas about psycho-traumatic factors using contrasting positive interpretations and subjective modifications of their cognitive-logical, verbal-semantic , symbolic, sensory and volume-plastic characteristics, the course of treatment includes 3-5 sessions, therapeutic ma nipulations are performed daily from 10 to 20 times a day.