RU2233179C1 - Method for increasing psychological tolerance and stress-resistance - Google Patents

Abstract

FIELD: medicine, psychiatry.

SUBSTANCE: one should analyze anamnesis, rational psychotherapy and suggestive impact, moreover, at analyzing anamnesis one should detect specific disadaptive cognitive-behavioral strategies. Due to rational and suggestive psychotherapy one should explain and suggest a concept on the leading role of intolerance to stresses in appearance and keeping pathological deviations. At awakening state and during hypnotic trance one should remove detected disadaptive stereotypes to fix optimal adaptive strategies of thinking and behavior. At the first stage, patient is taught psychosensoromental self-regulation and successive systematic self-control. At the second stage, one should carry out training of psychophysiological sensitivity at increased threshold of sensitivity to negative somatoautonomic and psychosensory factors. At the third stage, it is necessary to actualize personal resources at approbation and selection of psychological defense. At the fourth stage, one should conduct cognitive correction of patient's personality, sympathetic suggestion of adaptive-plastic cognitive type of personality and aversion suggestion of disadaptive cognitype. At the fifth stage it is necessary to discuss and train the models of behavior in situations of psychological losses and grief, study visual-verbal self-programming and cognitive-sensory self-regulation. At the sixth stage, specific tolerance towards psycho-traumatizing factors actual for a patient is increased due to cognitive-vector self-regulation. At the seventh stage, one should check up the results of therapy conducted under real conditions along with dynamic survey, therapy course includes about 7-10 seances. The method enables to increase efficiency in correcting low tolerance to psychological stressors and psychic traumas to obtain more stable effect in more shortened period of time.

EFFECT: higher efficiency.

1 ex

Description

 The invention relates to medicine, namely to psychotherapy. Low tolerance to psychological stressors and psychological trauma - various types of psychological vulnerability and persistent stereotypes of maladaptive behavior - are the main causes of psychogenic disorders. Intolerance of this kind is associated with the specific characteristics of the personality and its history. Life in modern society is replete with stress, saturated with negative emotions. At present, it is almost impossible to find a place in which one could get rid of negative mental influences. The development of means of communication and transport, the increasing complexity of the information-psychological side of life, the migration of the population and the growth of its well-being bring together living conditions in the city and rural areas. The threat to mental health is evened out - in both regions there is a tendency towards an increase in borderline mental pathology and states of dependence on psychoactive substances, which are indicators of socio-psychological ill-being of society.

In this regard, the urgent problem of the formation of tolerance to traumatic factors and increase stress tolerance. However, to date, there are no sufficiently effective methods with a similar focus.

A known method of suggestion and hypnosis suggestion. Its classic version assumes a direct directive suggestion of what should happen, directly determines the behavior of a person in certain situations, and forms the basis for a focused response. The effect of such a suggestion depends on how the psychotherapist demonstrates the strength of his personality and the patient obeys him (V.M. Bekhterev. Hypnosis. Suggestion. Telepathy. - M.: Thought, 1994, p. 47-310). Modern suggestions of suggestion are addressed to the unconscious part of the personality and include suggestions veiled in one way or another. These hidden influences are inserted messages (words or phrases with a thematic focus included in the masking text) or stories and metaphors whose plot corresponds to the model for resolving the patient’s problem. (A seminar with a doctor of medicine Milton G. Erickson. - M .: Klass, 1994, p.13-304). The disadvantages of this method are: the lack of humanity of such manipulations, especially hidden for human consciousness, the need to use trance states to implement most suggestions, the dependence of the effect on suggestibility and hypnability of patients, long periods of treatment, as well as an unstable therapeutic effect.

There is also known a method of systematic desensitization (desentization) J. Volpe (A.A. Alexandrov. Modern psychotherapy. - St. Petersburg: Academic project, 1997, S. 67-69). Its feature is a stepwise, phased visualization of contact with a problem situation or a traumatic factor against the background of muscle relaxation according to the method of I. Jacobson. Contact with these negative influences is presented in the form of a hierarchical sequence from the most minimal, distant degree, causing slight negative emotions, to the degree of maximum interaction, which can provoke severe anxiety, fear or other negative experiences. Transitions from minimum to maximum are allowed only after the removal of negative emotions in the previous stages.

The disadvantages of this method are: an insignificant representation of cognitive-rational influences, in connection with which the patient does not fully understand the causes and essence of his illness, and the orientation towards visualization, which is not available to everyone.

The closest analogue is the method for visualizing problem situations used in neuro-linguistic programming (D.O. Connor, D. Seymor. Introduction to NLP. - Chelyabinsk: Version, 1997, pp. 171-177, 213-222), including analysis history and indirect suggestive effect. At the same time, associated or dissociated visualization is used as the main technique. In the first case, the problem situation is visually represented “as in life”, “from the inside”, in the second case they visualize themselves (their copy) in this situation. In addition, they represent psycho-traumatic objects smaller, distant, fuzzy, colorless or quickly replace negative images with positive ones - larger, closer, colored. In addition, methods of changing the parameters of other sensory-specific characteristics of psycho-traumatic objects are used. A variant of this method is the visualization of the “line of life” - a visual representation of a conditional line located most often on the floor, symbolically reflecting the past, present and future. On one or several of these segments, depending on the characteristics of the problems, conflict, psycho-traumatic zones are imagined. Further on these zones get up and revitalize the resource psychological state experienced earlier - calm, confidence, etc. Such manipulations with the removal and changing the image of negative factors can reduce their undesirable psychological impact, gradually adapt to them and thereby selectively increase tolerance. However, this method does not have high efficiency. It relies on the insufficiently studied and poorly proven provisions of neuro-linguistic programming about representative systems, does not affect the cognitive-rational part of the personality and, in addition, requires a good development of the ability to reproduce sensory-defined images, mainly visual ones, which limits the possibilities of its use.

The objective of the invention is to provide a highly effective method for correcting low tolerance to psychological stressors and mental injuries, with wider functionality and versatility, which allows to obtain a more stable therapeutic effect in a short time.

The essence of the invention consists in a method of increasing psychological tolerance and stress resistance, including anamnesis analysis, rational psychotherapy and suggestive action, characterized in that when analyzing the anamnesis of a patient, individually specific maladaptive cognitive-behavioral strategies are associated with which pathologically reduced tolerance and stress tolerance are associated , with the help of rational and suggestive psychotherapy, explain and inspire the concept of the leading role of intolerance to stress in the occurrence and preservation of pathological abnormalities, then in a state of wakefulness and hypnotic trance, the identified maladaptive stereotypes are eliminated and optimal adaptive strategies of thinking and behavior are fixed by a sequential combination of neuro-corrective and personality-reconstructing influences, during which at the first stage they create neurophysiological foundations for voluntary control of psychoemotional reactions teach the patient psychosensory-mental self-regulation and consistent with self-monitoring, at the second stage, they conduct training on the correction of psychophysiological sensitivity with increasing the threshold of sensitivity to negative somatovegetative and psychosensory factors and thereby create the basis for a subsequent increase in psychological tolerance, at the third stage they begin to personality-oriented influences, update personal resources with testing and selection of psychological defenses, at the fourth stage carry out cognitive personality correction, adaptive sympathetic suggestion at the fifth stage to increase nonspecific tolerance to potentially psycho-traumatic factors, the patient discusses and trains models of behavior in situations of psychological loss, conducts training in visual-verbal self-programming and cognitive-sensory self-regulation at the sixth stage to increase nonspecific tolerance to potentially traumatic factors increase specific tolerance in relation to relevant traumatic factors for the patient with the help of cognitive-vector self regulation, at the seventh stage they verify the results of treatment in real conditions, dynamic monitoring and correction of long-term results, the course of treatment includes 7-10 sessions, therapeutic and corrective self-actions at the training stage are performed daily from 10 to 40 times a day, the acquired psychological skills tolerance and stress tolerance are further used to improve adaptation.

Using the invention allows to obtain the following technical result.

The method is highly effective. The achieved result is stable. The onset of a positive effect in the form of increasing psychological tolerance and stress resistance 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 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.

Another direction of using this method is the psychoprophylaxis of borderline mental disorders and dependence on psychoactive substances, the development of adaptive abilities in mentally healthy individuals, psychological tolerance and stress tolerance, the formation of the most beneficial positive behavioral strategies to overcome stresses and psycho-injuries that are inevitable in every person’s life. The skills acquired during the treatment are aimed at application in real conditions, 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 to the use of this method 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, practically does not require 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 increase psychological tolerance and stress resistance, encompassing both neurophysiological and personality levels. The neuro-correctional effect itself is complemented by a psychological one, profound positive changes affect both the neurophysiological and personality levels, forming a favorable basis for the assimilation of new adaptive behavioral strategies.

The proposed method includes highly effective psychocorrectional and psychotherapeutic technologies aimed at inducing the patient to change negative existence strategies, destabilizing rigid maladaptive behavioral stereotypes, neutralizing the overvalued attitude to psycho-traumatic influences or objects of dependence, and developing tolerance and stress resistance.

The method is as follows.

Initially, a deep empathic contact is established with the patient due to various manifestations of a humanistic interest in helping him, similar conceptual and sensory-specific statements about current issues and problems, demonstration and imitation of similar non-verbal manners, various manifestations of one's own competence and ability to provide full assistance. Here, criticism, confrontation and the creation of blocs with relatives in conflict with the patient are undesirable (this can be done in the future). Not only the success of the subsequent psychocorrectional and psychotherapeutic work, but also the likelihood of the fact of continuing contacts depends on the results of this stage.

Next, an analysis of the history and individual psychological characteristics of the patient is carried out. Psychological diagnosis includes a cognitive-analytical analysis of the personality structure and the identification of pathological maladaptive cognitive-behavioral strategies using adequate clinical and psychological methods. In difficult cases, hypnosis is used. Attention is paid to the study of such elements of a personal organization as the style of perceiving and processing impressions associated with contacts with the outside world or introspection, individual characteristics of situational and pre-situational thinking, a relationship system, a hierarchy of life values, concepts, ideas, etc. They are considered in terms of their influence on the development of the disease, on the one hand, and in terms of the availability of resources, the capabilities of this individual, capable of providing recovery, on the other. It is important to conduct an associative experiment aimed at the study of verbal and non-verbal (analog-shaped) patient associations associated with stimulus words that are thematically related to the structure of the disease. This experiment is repeated during the treatment to assess the dynamics of recovery. It is necessary to identify and register with the help of introspection of spontaneous and voluntary thoughts that arise in a patient with memories and reflections on problematic topics or when in traumatic situations. For these purposes, he is given instructions to write down (without any edition) his thoughts on problematic topics.

On this basis, rational psychotherapy and suggestive influence are carried out, clarifying, convincing and suggesting the concept of the leading role of intolerance to stress in the occurrence and preservation of pathological deviations. The patient is informed that the purpose of the method is to destabilize and eliminate negative cognitive-behavioral stereotypes that are an obstacle to a harmonious life, and the assimilation of a new positive, adaptive cognitive-behavioral style. An individual scheme for increasing psychological tolerance and stress resistance is being developed. From the treatment and correction arsenal, the techniques form a set of accessible, individually acceptable actions and operations that provide both neuro correction and personality-reconstructing action.

Then, in accordance with the developed scheme, a sequential stepwise cognitive and suggestive-behavioral effect is carried out, which is carried out mainly in the patient’s wakeful state, if necessary, use hypnotherapy to accelerate the assimilation of medical information.

The technique of increasing psychological tolerance and stress resistance includes seven stages, the implementation of which uses the following psychotherapeutic techniques:

psychosensory and mental self-regulation,

consistent systematic self-control,

psychophysiological sensitivity correction training,

updating resources

testing and selection of psychological defenses,

cognitive personality correction,

increase of nonspecific psychological tolerance and stress resistance,

verbal suggestive self-programming,

visual and verbal self-programming,

Thematic role-based training

cognitive-sensory self-regulation,

specific psychological tolerance training,

cognitive-vector self-regulation, dynamic observation and correction of long-term results.

At the first stage, psychic self-regulation is taught to accelerate the formation of the ability to voluntarily control the psycho-emotional state and increase the psychological tolerance and stress resistance of the patient.

Initially, all involved develop the ability to psychosensory and mental self-regulation. This has both neurophysiological meaning - in the form of a real increase in the ability to voluntarily control the psychosensory and mental spheres, and hidden, suggestive, representing a metaphor for controlling the psycho-emotional state and the first stage of this ability. Human experiences are sensory-dependent, on the one hand, and cognitively mediated, mental, on the other. Exercising ability to regulate within different mental levels is an important element in increasing stress tolerance.

To do this, within each sensory system, exercises are carried out to weaken the parameters of sensory-specific representations, both positive, pleasant, and negative, unpleasant. All this allows us to simultaneously reduce the psycho-emotional effects of perception.

For the visual system use: the representation of bright, large, close, contrasting, color images with a decrease in their brightness, size, distance to them, the degree of contrast and color saturation, as well as “peering” through objects and people (representing the transparency of objects or people).

For the auditory system: reproducing loud, fast, distinct sounds with a decrease in their volume, sound speed and clarity.

For the kinesthetic system: regulation of muscle tone in the range from the stress of certain muscle groups to relaxation.

In the tactile-tactile system: variations of touch, fixation, point effects from maximum in intensity to minimum.

In olfactory and taste systems, appropriate representations are used with their change from the most reproducible to the elimination of memory.

At the level of mentality, they teach to lower the degree of distinctiveness of awareness of thoughts - they displace, “quench”, “cloud” the thoughts that arise in the consciousness and train the ability not to linger on any of them, instantly switch to another in the form of a “stream of consciousness”, a free, unfixed flow thoughts.

All these exercises are carried out up to 30-40 times a day.

Next, the patient masters the method of consistent systematic self-control. Its basis is the psychophysiological (functional-dynamic) model of the organization of behavior. The development of the self-control skill begins with the assimilation of the trigger for optimal behavior - a word, phrase, visualized image, gesture, etc., which the patient arbitrarily “turns on” at the right time.

The practitioner sequentially asks and instructs himself:

1. “What is happening to me now?”;

2. “What do I really want now?”;

3. “What did I do before to achieve what I really want now?”;

4. “What do external conditions and my resources allow me now?”;

5. “How does experience relate to reality?”;

6. “My choice, my plan is ... Forecast -...”;

7. “I allow myself ...”;

8. “I act and completely control my thoughts, words, intonations, body condition, breathing, facial expressions, muscle tone, movements”;

9. “I completely control the process of achieving the goal and regulate my condition”;

10. “Result - ... Assessment - ... Conclusion - ... Decision to terminate or resume activities to achieve the goal -...”;

11. “Information in the memory archive -...”.

At each stage of consistent systematic self-control, it is important to be aware of your emotional state. Mastering the method begins with the most simple, non-problematic behavioral acts, such as satisfying hunger, brushing your teeth, choosing clothes according to the situation and weather conditions, etc.

Further, the development of stress tolerance includes the correction of various levels of sensitivity - psychophysiological and psychological, since their severity is inversely proportional to the degree of tolerance to negative psychological effects.

At the second stage, adaptive abilities are enhanced through training in the correction of psychophysiological sensitivity. This refers to an increase in the threshold of sensitivity in relation to somatovegetative factors, harmless to health states of physiological discomfort, which the patient is gradually learning to tolerate. Training has both an obvious, training somatovegetative tolerance meaning, and hidden, being a metaphor and a previous step in increasing psychological tolerance.

Exercises include adaptation to various negative psychophysiological conditions, such as:

deficiency of night sleep - reducing the duration of night sleep to harmless limits in limited periods of time, up to episodes of complete refusal of sleep;

forced uncomfortable postures - holding any physiologically safe options for uncomfortable postures of the body, trunk and limbs (asanas from the system of yogis or their modifications) lasting from several minutes to the maximum possible time;

cold and thermal quenching procedures (taking into account the principle of gradualness) - general and local baths, rubbing, wrapping, contact with snow, ice or with hot water and hot objects;

refusal of favorite types of food for a certain time;

hunger - an increase in the intervals in food intake to the maximum possible, and in the presence of qualified medical supervision and the absence of contraindications - therapeutic fasting of optimal duration;

acceptable options for adapting to pain are exercises with acupressure that increases in duration using sensitive points: He-Gu, tragus auricles, ulnar condyles (“Ankylosing spondylitis”), etc .;

vascular reactions - adaptation to changes in vascular tone by taking nicotinic acid or xanthinol nicotinate tablets in increasing doses (nicotinic acid, vitamin PP - 0.05 g tablets in single doses for children - up to 0.025-0.05 g, for adults up to 0 , 15-0.5 g, daily doses for children - up to 0.15 g, for adults - up to 1 g; xanthinol nicotinate - 0.15 g tablets in single doses for children - 0.03-0.05 g, for adults - up to 0.15 g, daily doses for children - up to 0.15 g, for adults - up to 0.9 g), tablets are given with 200 ml of water;

negative taste sensations - tolerance is trained by taking bitterness or xanthinol nicotinate, the latter is taken in doses from 1/3 to 1 table. 0.15 for resorption in the oral cavity;

negative olfactory sensations - the smell of ammonia or other subjectively unpleasant odors.

At the third stage, to increase the potential for stress resistance, they switch to personality-oriented influences. Initially, a method of updating resources is used, aimed at using the patient's natural and existing capabilities and reserves. Each psychological quality, especially the accented one, can bring both benefit and harm to a person, his environment or both sides. For example, fearfulness can relieve injuries or situations of violence and at the same time be the basis of a phobia. Self-esteem can help a person survive one group of problems, but, being disadvantaged, serves as the basis for others. Pedantry in some cases is necessary, for example, in pharmacy, in others it is harmful, etc.

When resources are updated, at the first stage, resources are diagnosed — they find the “strengths of the personality”. They can be both positive and negative, including socially unapproved (e.g. greed) properties. The qualities of other people or the heroes of films and books can also be attractive resources. They make up a kind of “resource bank”.

Next, they carry out “targeted attachment” of one or a set of resources to the subject of the problem state, the specifics of mental injuries. Thus, the actualization of feelings of shame can help to overcome increased irritability in instilling shame on the patient for such negative emotional outbursts. Updating hypochondria may be useful in imposing restrictions on behavior if it is stipulated that “going beyond” can lead to “negative consequences for the body.”

When using several resources, their balance, ratio, and features of synergistic or antagonistic interaction are taken into account.

Resources are updated by understanding their role, as suggested by the psychotherapist (this suggestion may have the tinge of exaggeration hidden from the patient), and by repeating, in the right situation, autosuggestive texts compiled for the patient.

To simulate the desired adaptive behavior, trainings are conducted with the exploitation of the resource during visualization - associated (the patient “sees” the situation in the same way he is used to perceiving it in real life) or dissociated (here they present their copy of a double in a problem situation). The use of resources is facilitated by the standardization of training procedures with the simultaneous connection and fixing at the height of experiences of subjectively acceptable verbal, auditory, motor or other stereotypes, which further play the role of conditioned reflex cogenerators of positive behavior.

Next, use the method of testing and selection of psychological defenses. It includes role-based training, during which the patient, acquainted with the features of various options for psychological defense, tries to “get used” to each of them, one by one and adapt accordingly to the problems that are relevant to them. Testing is accompanied by selection - the selection, under the supervision of a psychotherapist, of the most acceptable options for psychological protection.

The psychological “fitting” is: repression, suppression, transference, rationalization, irony, projection, identification, denial, regression, isolation, compensation, hypercompensation and, with a well-designed technique, conversion (its imitation). The result, as a rule, is desensitization in relation to psycho-traumatic influences and expansion of abilities and tactics of overcoming a problem state.

The content of the fourth stage is cognitive correction of personality, aimed at forming the patient's motivation for personal growth and the development of traits of a harmonious personality. To do this, using an aversion and sympathetic suggestion, he is informed about the manifestations of psychological disharmony and harmony within the framework of the cognitive-analytical concept of personality. The main point of this concept is the concept of the cognitive type (cognitive type) of a person. The cognitive type is mainly of psychogenic, sociogenic origin, and it is he who determines the degree of tolerance and stress tolerance, the characteristics of the individual’s adaptation and the risk of developing borderline mental disorders.

Initially, they give a clinical and psychological description of the maladaptive cognitive types of the person so that the patient recognizes himself in one of them. This information is presented in the form of an aversion suggestion for patient reorientation, rejection of maladaptive attitudes and adoption of positive behavioral patterns characteristic of adaptive cognitive types. Maladaptive cognitive types tend to accompany certain accentuations or personality abnormalities. They, in comparison with adaptive ones, are distinguished by the presence of rigid disadaptive cognitive-emotional stereotypes and a tendency to the development of psychogenic disorders even when they exist in objectively relatively favorable conditions. The following options are observed here:

1. A hyper-actualizing cognitive type is manifested in an overvalued attitude to one or another side of the internal and / or external world, disadaptive maximalist attitudes, a disposition towards the obligatory fulfillment of one’s needs, and ideal fulfillment by the surrounding of established rules. At the same time, one may observe a hypertrophied sense of duty, attitude to the complexities of life and failures as universal catastrophes (“catastrophization” according to A. Beck), and to minor offenses of others as crimes. Monotemic or polytematic hyperactualization is possible here. This cognitive type is the most universal, often combined with others, can occur in almost all types of personality, and is characteristic of neurotic disorders.

2. The idealistic cognitive is based on the primacy of vulnerable values, such as “eternal” well-being and stability, health and appearance, gratitude of children, friendship, love, marital fidelity, location of bosses and staff, etc. Here there is a dominance of everything that inevitably changes over time, mainly for the worse, up to the “saddest end”. Adaptation to imperfect reality, the “truth of life” while preserving rigid, naive-idealistic concepts is possible only by including such protective psychological resources as repression, denial, repression or isolation reactions. Deficiency of the latter in the collision of rigid infantile-idealistic concepts with the negative dynamics of the state of society, microsocium or their own psychophysical health leads to maladaptation. This cognitive type, like the previous one, hyperactualizing, is universal.

3. The monocentered cognitive type, with its main difference, has a stable one-sided conceptual and value orientation that is not able to change in accordance with the changing living conditions or mental and physical condition of the individual. The possibility of a problem-free existence in this case either entirely depends on the environment and state of health, or on how autonomously and comfortably (subjective adaptation) a person with such a cognitive type can exist. This is possible for autistic schizoid or fanatical individuals who are closed-uncritically embraced by any idea. If the possibility of painless autonomization, isolation from society is excluded, then such subjects inevitably come into conflict with changing living conditions. Psychological crises can be prevented here only if stability is maintained in the above areas, which is rarely possible. A similar feature can also be observed with spiritual and intellectual limitations, dependent personality disorder, and with addiction to psychoactive substances.

4. The contrasting cognitive type is distinguished by the absence of highlighting intermediate variations and shades in relation to oneself, other people, and life phenomena - on the principle of “either black or white”, “either friend or enemy”, etc. (A. Beck's dichotomous thinking ) Varieties of it are rigid-contrast (with stable polarization) and labile-contrast (with ease of transitions from one extreme to another). This cognitive type is found mainly in epileptoid, paranoid, emotionally unstable and hysterical personality disorders.

5. Low-differentiated antagonistic cognitive type. The poorly differentiated cognitive type as a whole is characterized by weak differentiation, fuzzy differences between subjective concepts, especially their value qualities. The maladaptive version of a poorly differentiated cognitive type is manifested in doubts, hesitations, struggle of motives, difficulties of choice, which arise in connection with the “fuzziness” of subjective concepts. There may be stability in the competition of certain concepts and needs or instability in which one or the other enters into antagonistic relations. This is observed mainly with the psychasthenic and anancaste psychotype.

6. A negatively interpreting cognitive is characterized by inadequate negative retrospection, a negative assessment of the present, or negative prediction. Such interpretations can be extrapunitive (negative assessment of the environment) or impusive (negative assessment of oneself). A totally negative interpretation is also possible. This cognitive type occurs mainly in anxious personality types, psychasthenia, hypochondriacal and depressive states.

7. The maladaptive integrated cognitive type combines various combinations of the maladaptive cognitive types discussed above.

Next, the patient is revealed the clinical and psychological characteristics of adaptive cognitive types. This is carried out in the form of sympathetic suggestion, the patient is tuned to accept, internalize the conceptual-behavioral algorithm of an adaptive personality, adaptive thinking style. He is told that everyone will benefit from this - both he and those around him. The presence of an adaptive cognition completely or almost completely eliminates the possibility of significant intrapersonal or interpersonal conflicts. This is characteristic of the mental norm and favorable variants of character accentuation. Adaptive cognitive types allow a person to adapt to any social and microsocial conditions.

1. Adaptively plastic cognitive type is the most perfect in terms of adaptation and personality maturity. It is characterized by the plasticity of subjective concepts with the leading significance of psychological harmony, spirituality (in the broad or narrow religious sense), humanism and the development of this personality. Such a person is able to positively interpret any internal and external conflicts and is ready for any loss. This cognitive type also includes positive forecasting and self-programming - the ability to tune oneself to the best with any outcome of expected events. In addition, the characteristic features are positive detachment (lack of involvement in the bustle, tension and scandalousness of the world) and adequate minimalism (willingness to be content with little). If an alternative arises between preserving certain subjective concepts and the danger of significant psychological or physical harm to oneself or others, an individual with an adaptive-plastic cognitive chooses a concept correction. Such persons perceive material damage as less significant in comparison with spiritual.

2. Low-differentiated conformal cognitive type. The poorly differentiated cognitive type as a whole is characterized by weak differentiation, fuzzy differences between subjective concepts, especially their value qualities. The adaptive group includes its conformal version, which has the main features of the ease of restructuring personal cognitive systems and adjusting them to any socio-psychological conditions. This is typical mainly for infantile and suggestible persons. Persons with an adaptive-plastic cognitive type differ from them in the level of personal maturity, spiritual harmony and integrity.

3. Adaptively integrated cognitive type integrates various combinations of adaptive cognitive types.

At the fifth stage, attention is directed to increasing nonspecific psychological tolerance and stress resistance. Here they discuss and train optimal behaviors in situations that carry the risk of psychological breakdown. Usually the core of such situations is the experience of a particular loss. This does not include psychologically traumatic (“specific”) events that are relevant to the patient, which are worked out in the next step. The following situations are most typical:

impaired pride,

self-esteem crisis

the mismatch between the desired and the actual,

material collapse

problems with loved ones

health problems,

problems with appearance

conflict with superiors (teachers, parents),

conflict with employees (classmates),

loneliness,

lack of demand, etc.

They consider all angles and aspects of these stressful situations. The patient receives suggestive texts regarding each non-specific type of psychological trauma and memorizes them. Next, visual-verbal self-programming of behavior is carried out - a multiple visual representation of possible stresses and options for a positive response to them against the background of pronouncing memorized autosuggestive texts and performing psycho-regulatory exercises of a sedative nature. The quality of assimilation of information is checked during repeated sessions.

In addition, they conduct thematic role-based trainings, while playing out various situations that have psycho-traumatic potential, during which the patient implements previously developed models of adaptive behavior. The topics of these trainings correspond to the above list of stressful situations.

After that, work is carried out to form, consolidate and automate the skills of cognitive-sensory regulation of the emotional state in relation to individual stressful factors. It includes the following psychological operations:

1. Awareness and / or visualization of the scale of life values with the presentation on the top of this scale of the value of psychological harmony with an understanding of the comprehensive benefits of this type of personal organization.

2. Awareness and / or visualization of the minimum sufficient amount of vital goods (“positive-value minimum minimorum”). In accordance with the previously discussed positions, the patient again allocates and accepts a minimum that would be sufficient to maintain the subjective state of psychological comfort, "even if the rest of the world collapsed."

3. A positive interpretation of the traumatic factor and positive forecasting.

4. Reduction to the maximum possible level of negative impact value (“stress devaluation”) - awareness and / or visualization of this.

5. Conducting sedative exercises in parallel (one or another variant of mental self-regulation) and psychosensory manipulations with weakening the parameters of the images presented.

At the sixth stage, the patient develops a specific psychological tolerance with respect to the individual spectrum of psycho-traumatic situations that is characteristic of a given personality. At the same time, cognitive influences and self-actions are used, among which the cognitive-vector method is of primary importance. It is performed by performing special mental operations according to the following cognitive-vector scheme:

Negative emotions → Negative thoughts → Negative concepts and values →

Vector of choice. Question: “What do I really want?” Play a positive trigger →

Positive concepts and values → Positive thoughts →

Positive emotions and actions.

As a positive trigger, any significant stimulus can be selected that sets the patient to adaptive behavior - any image, word or phrase, options for facial expressions and gestures, etc. Important is the preliminary study of the patient's problematic topics according to the vector scheme with the correction of negative trends and the compilation of self-suggestive texts, which are algorithms for cognitive regulation of behavior.

In addition, at this stage they also use thematic role-based trainings and cognitive-sensory regulation, discussed above, focused here on the individual problems of the patient. If necessary, they are supported by any other methods of mental self-regulation.

At the seventh, final stage, they check the results of treatment in real psycho-traumatic conditions in compliance with the principle of gradualness and preliminary preparedness. Real contact with negative factors is carried out according to a hierarchical scheme from the minimum “volume” of interaction to the maximum. Before this, and in parallel with the development of the situation, the patient performs the exercises learned earlier.

The methodology of increasing psychological tolerance and stress resistance is carried out in the form of a psychotherapeutic marathon or individual sessions, individually, in a group or with the involvement of the family. The duration and number of sessions is not limited, they should be as many as needed, on average, from 7 to 10 psychotherapeutic meetings are required.

To increase the degree of sustainability of success achieved during psychotherapy and psychocorrection, dynamic observation is carried out, supporting sessions and correction of long-term results, taking into account individual need.

Example: Patient A., 27 years old, housewife. Diagnosis: neurotic depression in an accentuated anxious-suspicious personality, a complex of one's own inferiority. Complaints: low mood, unwillingness to live, fear of communication with others.

Anamnesis. She was born from a casual connection with her mother, from late pregnancy, her father refused to marry, was not further interested in the child, did not help financially. She was brought up by a mother, a selfish and rude man. From early childhood, A. lived in an atmosphere of emotional deprivation. Mother clearly emphasized her uselessness and burdensomeness, was excessively demanding, often subjected the girl to humiliation, physically punished for the slightest offenses, called ugly, moronic, nasty, etc. The child grew up timid, shy, uncommunicative and anxious. School performance was uneven, very worried before class, panicky afraid to answer before class. After graduating from high school, A. unsuccessfully tried to enter the institute and technical school, but at the exams she could not cope with the excitement, although she knew the material to a sufficient degree. I got a job as a dispatcher in the DEZ.

At 24, she was left alone, her mother died, her death suffered calmly. Left work, lives on dividends from renting an apartment. He leads a secluded lifestyle, there are practically no friends, he avoids dating with men. His appearance - hair, eye color, face and body is considered ugly. He wears a wig, wears blue decorative contact lenses, uses a lot of makeup, puts on clothes that hide the figure. Believes that he has a primitive mind. Without unnecessary necessity, he does not leave the house.

In the past 9-10 years, the above complaints gradually increase, I did not dare to share my feelings with anyone, I did not contact doctors and psychologists.

Initially, deep empathic contact was established with A.

For this, a humanistic interest in helping her was demonstrated in various ways, similar conceptual statements were made that it is very difficult for a person with an ugly appearance to calmly communicate with others. Among sensory-specific statements, mainly visually oriented ones were used (“look”, “look”, “see prospects”, “watch success”, etc.), because the patient was clearly visually accented. At a non-verbal level, similar behaviors were imitated. In addition, their own competence and ability to provide full assistance was demonstrated directly and indirectly in various ways. Criticism was not used at this stage. The patient tuned in to continued contact.

The analysis of the anamnesis showed a noticeable negative influence of the mother on the psychological development of A., who blindly adopted maternal suggestions about her own inferiority, external and internal, reaching the degree of “ugliness and dementia”. In the course of psychological diagnostics, which included a cognitive-analytical analysis of the personality structure and the identification of pathological maladaptive cognitive-behavioral strategies, super-valuable ideas were revealed about one's own ugliness and inferiority, on the one hand, and the obligatoriness of a “normal” appearance and mind in order to be accepted in society, on the other. The “normal” appearance and mind, understood by A. exaggeratedly, as well as the increased attention of others to these human “parameters”, occupied a leading place in her hierarchy of life values. Inconsistency with these standards led to the only possible style of behavior for her in the form of a maximum disguise of her appearance, rejection of reality and withdrawal into her autistic world. The style of perception and processing of impressions associated with contacts with the outside world and introspection, individual features of situational and pre-situational thinking, a system of relationships - all this turned out to be focused on the idea of one’s own inferiority and fear of communication. In the very depths of the personality, in the “basements of the subconscious,” were the scourging statements of the mother, which became the basis of the patient’s “I” structure.

At the same time, the A.’s resources capable of ensuring recovery were highlighted by the will, which manifested itself more than once in the limitations and self-restraint in which it was so successful, preserved intelligence, good artistic and graphic abilities, and attractive appearance, which she mistakenly estimated as inferiority and ugliness.

In the course of an associative experiment, in order to study the verbal and non-verbal (analog-shaped) associations of the patient associated with the stimulus words “beauty”, “appearance”, “mind”, “success”, “inferiority”, etc., which had a thematic relationship to structure of the disease, the corresponding unflattering and unpromising associations that the patient reproduced were identified. This experiment was repeated in the course of treatment to assess the dynamics of recovery (in the course of treatment, associations were replaced by more positive ones).

In addition, identification and registration was carried out with the help of introspection of spontaneous and voluntary thoughts that arise in the patient with memories and thoughts about her problems or when in traumatic situations. For these purposes, she was instructed to write down (without any edition) her thoughts on a topic that traumatizes her. An analysis of these notes demonstrated the prevailing nature of inadequate, self-derogatory thoughts that concerned literally A.'s entire existence.

On this basis, rational psychotherapy and suggestive influence were carried out, during which the absurdity and painful nature of the attitude to oneself and the views of others on it was explained and instilled. The final “points” of each such thought chain were examined with the help of the questions: “Who said that specifically?”, “How did you guess that they think of you that way?”, “So what?”, “How will this interfere with you?” , “How can it affect your life?”, Etc. As a result, the patient received the first positive ideas regarding her appearance, intellect, relationships of others and the source of her self-depreciating position. It turned out that no one except the mother spoke negatively about her, and she did not know specific examples of a bad attitude towards her or the consequences of a bad attitude of others in relation to anyone else (except for the criminal cases described in the press, from which she was far from )

In addition to this, A. considered the concept of the leading role of intolerance to stress in the occurrence and preservation of pathological abnormalities. She was informed that the purpose of the method is the destabilization and elimination of negative cognitive-behavioral stereotypes that are an obstacle to a harmonious life, and the assimilation of a new positive, adaptive cognitive-behavioral style. An individual scheme was developed to increase psychological tolerance and stress resistance. From the treatment-corrective arsenal of the technique, a set of accessible, individually acceptable actions and operations that have both neuro-corrective and personality-reconstructing effects was formed.

Then, in accordance with the developed scheme, a sequential phased cognitive and suggestive-behavioral effect was carried out, which was carried out in the patient's wakeful state.

At the first stage, in order to accelerate the formation of the ability for voluntary control over the psychoemotional state and increase psychological tolerance and stress resistance, A. self-regulation was trained. Its main content was exercises to weaken and “neutralize” stimuli that have an external or internal origin.

Initially, psychosensory and mental self-regulation abilities developed.

For the visual system was used: the representation of bright, large, close, contrasting, color images with a decrease in their brightness, size, distance to them, the degree of contrast and color saturation, as well as “peering” through objects and people (representing the transparency of objects or people).

For the auditory system: reproducing loud, fast, distinct sounds with a decrease in their volume, sound speed and clarity.

For the kinesthetic system: regulation of muscle tone in the range from the stress of certain muscle groups to relaxation.

In the tactile-tactile system: variations of touch, fixation, point effects from maximum in intensity to minimum.

In the olfactory and taste systems, representations of pleasant and unpleasant odors and tastes were used with their change from the most reproducible to the elimination of memories.

At the level of mentality, training was conducted to lower the degree of distinctiveness of awareness of thoughts — crowding out, “extinguishing”, “blurring” the thoughts arising in the consciousness, and training was held not to linger on any of them, to instantly switch to another in the form of a “stream of consciousness”, a free, unfixed flow thoughts.

All these exercises were carried out up to 30-40 times a day.

Then the patient mastered the method of consistent systematic self-control. The development of this skill was begun with the assimilation of a trigger for optimal behavior, for which the word “freedom” and a facial expression of joy were chosen. This trigger A. “turned on” at the right time, and then sequentially asked and instructed herself:

1. “What is happening to me now?”;

2. “What do I really want now?”;

3. “What did I do before to achieve what I really want now?”;

4. “What do external conditions and my resources allow me now?”;

5. “How does experience relate to reality?”;

6. "My choice, my plan is ... Forecast ... ...";

7. “I allow myself ...”;

8. “I act and completely control my thoughts, words, intonations, body condition, breathing, facial expressions, muscle tone, movements”;

9. “I completely control the process of achieving the goal and regulate my condition”;

10. “Result - ... Assessment - ... Conclusion - ... Decision to terminate or resume activities to achieve the goal -...”;

11. “Information in the memory archive -...”.

At each stage of consistent systematic self-control, the patient learned to be aware of her emotional state. Initially, mastery of the management of the simplest, non-problematic behavioral acts, such as satisfying hunger, cooking, brushing teeth, cleaning an apartment, etc., was trained.

At the second stage, adaptive abilities were enhanced with the help of psychophysiological sensitivity correction training. This concerned an increase in the threshold of sensitivity in relation to somatovegetative factors, physiological discomfort harmless to health, which the patient was gradually learning to tolerate. Exercises included adaptation to various negative psychophysiological conditions, such as:

deficiency of night sleep - reducing the duration of night sleep to harmless limits in limited periods of time, up to episodes of complete refusal of sleep;

forced uncomfortable postures - holding any physiologically safe options for uncomfortable postures of the body, trunk and limbs (asanas from the yoga system) lasting from several minutes to the maximum possible time;

cold and thermal quenching procedures (taking into account the principle of gradualness) - general and local baths, grinding, wrapping, contact with snow, ice and hot water;

refusal of favorite types of food for a certain time;

hunger - an increase in gaps in food intake to the maximum possible;

acceptable options for adapting to pain are exercises with acupressure that increases in duration using sensitive points: He-Gu and tragus auricles;

vascular reactions - adaptation to changes in vascular tone by taking nicotinic acid tablets from 0.1 to 0.5 g per dose, 1 time per day with 200 ml of water (performed 7 times);

negative taste sensations - tolerance was trained by absorbing lemon slices in the oral cavity;

negative olfactory sensations - the smell of ammonia was used.

At the third stage, to increase the potential for stress resistance, personality-oriented effects were used. Initially, a method of updating resources was used, aimed at using the patient's natural and existing capabilities and reserves. A “resource bank” was compiled, which included the aforementioned will, intellect, artistic and graphic abilities, and good external patient data. All of them were in a synergistic ratio.

Then, “address attachment” of one or a set of resources to the subject of a problem state was carried out. The psychopathological point of accession of these resources was the idea of their own inferiority and ugliness.

Resources were updated by repeatedly realizing their role as suggested by the psychotherapist (this suggestion had the tinge of exaggeration hidden from the patient) and by repeating the psychotherapist's words in situations of psychological discomfort and in the right situation.

To simulate the desired adaptive behavior, trainings were conducted with the exploitation of the resource during visualization. Initially, its dissociated version was used - the patient repeatedly presented her copy, a double, who is in a problematic communication situation, but free from an inferiority complex. In parallel, self-hypnosis of self-confidence was conducted. After reaching a calm state, associated representations were trained in these representations - multiple representations of communication situations “from the inside”, as in life, until a calm attitude to this appeared. The use of resources reached a level of success due to standardization of training procedures with simultaneous connection and consolidation at the height of the experiences of the trigger “freedom” with a facial expression of joy, which then played the role of a conditioned reflex cogenerator of positive behavior.

Next, the method of testing and selection of psychological defenses was used. It included role-based training, during which the patient, acquainted with the features of various options for psychological defense, tried to “get used” to each of them, one by one and adapt accordingly to the problems that are relevant to them. Testing was accompanied by selection - the selection, under the supervision of a psychotherapist, of the most acceptable options for psychological protection.

The psychological “fitting” was: repression, suppression, rationalization, irony, denial, regression, compensation and hypercompensation. The transfer, identification, isolation, and projection for A. were already the “passed stage” of inappropriate behavior. As a result, the process of desensitization in relation to traumatic effects began. The patient's arsenal of abilities and tactics for overcoming a problem state has expanded. Compensation included drawing and painting classes at home and in the studio. For hypercompensation, a ballroom dance school was chosen, but the patient did not advance beyond visualizing dance classes that gave a good emotional charge.

The content of the fourth stage was a cognitive correction of the personality, aimed at forming the patient's motivation for personal growth and the development of traits of a harmonious personality. To do this, using aversion and sympathetic suggestion, she was informed about the manifestations of psychological disharmony and harmony in the framework of the cognitive-analytical concept of personality.

Initially, the clinical and psychological characteristics of maladaptive cognitive types of the personality were given so that the patient would recognize herself in one of them. This information was presented in the form of an aversion suggestion to reorient the patient, prompting her to abandon the maladaptive installations. A. possessed a maladaptive integrated cognitive type - combined the cognitive elements of several maladaptive cognitive types: hyperactualizing, monocentric, contrasting and negatively interpreting.

Further, the patient was described the clinical and psychological characteristics of adaptive cognitive types. This was carried out in the form of a sympathetic suggestion, tuning in to accepting, internalizing the conceptual-behavioral algorithm of an adaptive personality, an adaptive thinking style. She was impressed that she would greatly benefit from this in everything, because the presence of an adaptive cognition completely or almost completely eliminates the possibility of significant intrapersonal or interpersonal conflicts. Adaptive cognitive types allow a person to adapt to any social and microsocial conditions.

At the fifth stage, attention was focused on increasing nonspecific psychological tolerance and stress resistance. Here, optimal models of behavior were discussed and trained in situations bearing the risk of psychological breakdown. The core of such situations is the experience of a particular loss. This did not include the psycho-traumatic problems of self-esteem and contact with others that were relevant to the patient. The following situations were worked out:

material collapse

health problems,

conflict with future possible bosses,

conflict with employees of a possible future team.

All angles and aspects of these stressful situations were considered. The patient received suggestive texts regarding each non-specific type of psychological trauma and memorized them. Further, visual-verbal self-programming of behavior was carried out - multiple visual representation of possible stresses and options for a positive response to them. This was carried out against the background of pronouncing memorized autosuggestive texts and performing previously mastered psycho-regulatory exercises - psychosensory and mental self-regulation and arbitrary systematic self-control, which had a corresponding problem orientation here. The quality of assimilation of information was checked during repeated sessions.

In addition, thematic role-based trainings were conducted, and various situations from the above list that had psycho-traumatic potential were played out, during which the patient realized previously developed models of adaptive behavior.

After that, work was carried out to form, consolidate and automate the skills of cognitive-sensory regulation of the emotional state in relation to the identified stress factors. It included the following psychological operations:

1. Awareness and visualization of the scale of life values with the presentation on the top of this scale of the values of psychological harmony with an understanding of the comprehensive benefits of this type of personal organization.

2. Awareness and visualization of the minimum sufficient amount of vital goods (“positive-value minimum minimorum”). In accordance with the previously discussed positions, the patient isolated and accepted a minimum that would be sufficient to maintain the subjective state of psychological comfort, "even if the rest of the world collapsed." She chose here the opportunity to draw, dream of a “better life” and recall her favorite films and books she had read.

3. A positive interpretation of the traumatic factor and positive forecasting. In a positive interpretation, logic, humor, grotesque were used, comparisons with those whose affairs are even worse. Negatively adjusting phrases: “How terrible that ...”, “How bad that ...” were replaced by positively adjusting phrases: “Thank God that ...”, “How good that ...”.

4. Lowering the negative impact value (“stress devaluation”) to the maximum possible level - awareness and visualization of this.

5. Conducting sedative exercises in parallel - relaxation and psychosensory manipulations with weakening the parameters of the images presented.

At the sixth stage, the patient developed a specific psychological tolerance with respect to the individual, relevant, characteristic of her traumatic problems. In this case, cognitive influences and self-actions were used, among which the cognitive-vector method was of leading importance. It was performed by performing special mental operations according to the following cognitive-vector scheme:

Negative emotions → Negative thoughts → Negative concepts and values →

Vector of choice. Question: “What do I really want?” Play a positive trigger →

Positive concepts and values → Positive thoughts →

Positive emotions and actions.

The word “freedom” was again chosen as a positive trigger, tuning A. to adaptive behavior with reinforcement of his facial expressions of joy. The patient’s problematic topics were preliminarily worked out according to a vectorial scheme with correction of negative trends and compilation of autosuggestive texts aimed at changing the ideas of inferiority and fear of communication and representing algorithms for cognitive regulation of behavior.

In addition, at this stage, thematic role-based trainings and cognitive-sensory regulation, as discussed above, were used, the skill of which the patient had previously mastered. Here they were focused on the individual problems of communication, self-presentation and self-esteem A. With a positive interpretation and self-programming, the former life was presented as “a valuable experience that has training, tempering value and correctly orientates in life in the sense that it is already a completed stage to which there is no point in returning. ” Mother was rated as “a suffering person, a weak person, dead alone, deserving of sympathy and forgiveness.” The patient from the position of her current, more mature and strong I symbolically extended her helping hand. It was also suggested that “the past suffering carries the potential of compassion and kindness to other people who have similar problems, who can be helped by having their own experience in overcoming them. The future will surely become different, because the present is already different - increasingly brighter, more joyful and free. Will be able to cope with any problems. ”

At the seventh, final stage, the treatment results were checked in real psycho-traumatic conditions, observing the principle of gradualness and preliminary preparedness. Real communication with other people was carried out according to a hierarchical scheme from the minimum “volume” of interaction to the maximum. Before this and in parallel with the development of the communication situation, the patient performed previously mastered exercises. A. was gradually freed from masking attributes - excess cosmetics, a wig, lenses and expanded the scope of communication.

The treatment was carried out in the form of sessions, individually. Their duration averaged 1.5 hours. It took 9 psychotherapeutic meetings.

To increase the degree of stability achieved during psychotherapy and psychocorrection of success, dynamic observation was carried out during the year, 4 supportive sessions were conducted. Long-term results of treatment are characterized as stable and satisfactory. A. communicates more freely, stopped wearing wigs and contact lenses and disguises, estimates herself as an attractive and reasonably smart woman, got a job as a secretary in a public utility organization, thinks about options for creating a family.

Claims (1)

A way to increase psychological tolerance and stress resistance, including anamnesis analysis, rational psychotherapy and suggestive impact, characterized in that when analyzing the anamnesis the patient identifies individually specific maladaptive cognitive-behavioral strategies, using rational and suggestive psychotherapy, clarifies and instills the concept of leadership role stresses in the occurrence and preservation of pathological abnormalities, then in a state of wakefulness and hypnotic trance they take into account the revealed maladaptive stereotypes and fix the optimal adaptive strategies of thinking and behavior, at the first stage they teach the patient psychosensory-mental self-regulation and consistent systematic self-control, at the second stage they conduct psychophysiological sensitivity training with an increase in the threshold of sensitivity to negative somatovegetative and psychosensory factors, update the resources at the third stage individuals with testing and selection of psychological defenses, at the fourth stage, cognitive personality correction, sympathetic suggestion of an adaptive-plastic cognitive personality type and aversive suggestion of a maladaptive cognitive type, at the fifth stage discuss and train models of behavior in situations of psychological loss, conduct visual-verbal self-programming training and cognitive-sensory self-regulation, and increase the specific tolerance at the sixth stage to traumatic factors relevant for the patient using cognitive vector self-regulation, at the seventh stage, ku treatment results in real conditions and dynamic monitoring, treatment includes 7-10 sessions.