RU2240838C1 - Method for preventing repeated myocardial infarction in patients with behavioral type a - Google Patents

Abstract

FIELD: medicine, inner diseases, neurology.

SUBSTANCE: patient's behavioral type should be corrected due to cognitive training and progressing nervous-muscular relaxation; also, it is necessary to perform physically passive nervous-muscular relaxation and respiratory-relaxation training. In case of progressing nervous-muscular relaxation one should start muscular relaxation from the lower third of patient's body by gradually coming to the group of muscles from the upper part, moreover, the pause after each exercise corresponds to 7-15 sec, and after relaxation of every muscular group - 15-30 sec. After performed seance of progressing nervous-muscular relaxation it is necessary to perform respiratory-relaxation training for 3-5 min dealing with maximum concentration of patient's attention at inhalation and expiration. One day after the seance of progressing nervous-muscular relaxation it is necessary to carry out physically passive nervous-muscular relaxation. Prophylactic course lasts for 10-12 wk. Seances of progressing nervous-muscular relaxation and respiratory-relaxation training should be performed once weekly for the period of the 1^st and 3d mo and - twice weekly during the second month, and physically passive nervous-muscular relaxation - 2-3 times weekly for the whole course.

EFFECT: decreased frequency of repeated myocardial infarction.

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Description

The invention relates to medicine, namely to internal medicine and neurology, and can be used to prevent repeated myocardial infarction in individuals with behavioral type A.

There is a known method of correction of behavioral type A, which consists in relaxation, introspection, training in conflict resolution skills in the family and at work, as well as various methods of group psychotherapy [1].

This type A behavior correction method was used to prevent recurrent myocardial infarction in patients with coronary artery disease. When applying this method, a distinct decrease in the severity of hostility was revealed, other structural components of type A behavior remained without significant changes.

A study of type A behavior correction issues has also been undertaken in a number of other studies. So, R. Swinn et al. [2, 3, 4] used Anxiety management training to correct type A behavior. The therapeutic effect was carried out in a group of 10 men who had myocardial infarction. The technique for reducing anxiety included deep muscle relaxation. The authors claimed that the use of this method led to a decrease in the severity of the emotional response in type A individuals and to a decrease in the content of cholesterol and triglycerides in blood serum, however, a decrease in the severity of hostility and other structural components of type A behavior was not observed.

The works of M. Jenni [5] noted positive results when using the method of cognitive training in combination with psychotherapeutic methods to reduce anxiety. This method made it possible to reduce the severity of type A manifestations, however, it did not lead to a significant decrease in blood pressure and serum cholesterol.

In his works, R. Thompson [6] used the method of progressive muscle relaxation and music therapy to correct type A behavior in patients after myocardial infarction. Of these, 42 patients underwent muscle relaxation technique, 20 - music therapy, and 20 people made up the control group. The severity of type A behavior was studied using a Jenkins questionnaire before and after treatment intervention. Studies using the method of progressive muscle relaxation and music therapy did not lead to a decrease in the severity of manifestations of type A behavior, as well as to a decrease in indicators on the anxiety and hostility scales.

The closest in technical essence as a prototype we have chosen a method for the prevention of repeated myocardial infarction in individuals with behavioral type A, which consists in correcting the behavioral type using methods of neuromuscular relaxation and cognitive therapy [7, 8].

The prevention program involved 1013 patients who had one or more myocardial infarction. The age of the examined patients was no more than 65 years. The severity of type A behavior was assessed using a structured interview, as well as a Jenkins questionnaire. All patients were divided into three groups: 1. Behavioral intervention group (patients who underwent type A behavior correction course); 2. Persons who regularly consulted with a cardiologist (comparison group); 3. A group of patients who refused any type of treatment (control group).

To correct type A behavior, behavioral intervention was carried out in classes in groups of 10 people. Classes were held during the first two months once a week, in the next two months once every two weeks and then once a month. Type A behavior correction technique was a combination of cognitive and relaxation group training. Patients attended lecture classes on risk factors for coronary heart disease and myocardial infarction, the pathogenesis of these diseases, and modern methods of treatment. The method of cognitive-behavioral training was to teach patients to identify type A behavior elements in their daily lives (tendency to argue on minor issues, frequent interruption of the interlocutor, etc.). At the same time, the notions of oneself and others were subjected to correction. The doctor suggested alternative behaviors (often simulating them himself) so that the participants would carry them out in a group. Homework was offered to learn the experience gained in the classroom. During the classes, patients were trained in methods of relaxation stress relief - mainly by the method of progressive neuromuscular relaxation. Each lesson began with relaxation exercises, which began with the upper muscle group. Patients then talked about their experiences identifying and stopping type A behavior elements. At the end of each year of the study, a second assessment of the severity of type A behavior was conducted using a structured interview and Jenkins questionnaire. A second study showed that during the first year of conduct of behavioral intervention, signs of severity of type A behavior decreased: patients felt a lack of time and hostility, as well as signs of specific behavior (interruption of the interlocutor, loud speech, brisk walking, jerky gestures, etc.) . In the comparison and control groups, there was a slight decrease in hostility and a feeling of lack of time. No signs of specific behavior were noted. Researchers noted that the most distinct reduction in type A behavior symptoms occurred at the end of the first year of behavioral intervention. Subsequently, this trend continued, but was not so pronounced.

The disadvantage of the prototype is not high enough efficiency. An analysis of data for three years of the study showed that the frequency of myocardial infarction in the behavioral intervention group was 7.2%.

The objective of the invention is to increase the efficiency of the method by reducing the frequency of repeated myocardial infarction.

The problem is solved in that patients with behavioral type A undergo a correction of the behavioral type using cognitive training and progressive neuromuscular relaxation, as well as physically passive neuromuscular relaxation and respiratory relaxation training, and during progressive neuromuscular relaxation, relaxation muscles begin from the lower part of the body, gradually moving to a group of muscles of the upper part, while the pause after each exercise is 7-15 seconds, and after relaxation each muscle group - 15-30 seconds. After a session of progressive neuromuscular relaxation, breathing and relaxation training is carried out for 3-5 minutes, which consists in maximizing the patient's attention on inhalation and exhalation, and a day after a session of progressive neuromuscular relaxation, physically passive neuromuscular relaxation is performed. A preventive course, including cognitive training, progressive neuromuscular relaxation, physically passive neuromuscular relaxation, and respiratory relaxation training is 10-12 weeks. Sessions of progressive neuromuscular relaxation and respiratory relaxation training are carried out 1 time per week during the first and third months and 2 times a week during the second month, and physically passive neuromuscular relaxation 2-3 times a week throughout course.

The method is as follows.

The method of cognitive-behavioral training consists in teaching patients to identify elements of type A behavior in their daily lives. At the same time, ideas about oneself and others are corrected. Alternative behaviors are offered, homework is given to assimilate lessons learned. During the classes, patients are also taught methods of relaxation stress relief, mainly by the method of progressive neuromuscular relaxation.

Before treatment, it is determined that the patient has contraindications for progressive neuromuscular relaxation associated with muscle or neuromuscular disorders (neurological diseases, muscle weakness or damage, bone pathology, etc.). Find out if the patient has experience using neuromuscular techniques. They determine what role - positive or negative - is played by this knowledge and experience of previous classes. The patient is given an idea of the use of progressive neuromuscular relaxation and the theoretical justification for its action, they describe the most rational conditions for conducting the lesson (a quiet, comfortable place to give you the opportunity to fully concentrate on your bodily sensations, loosen tight clothing, take off glasses and shoes) .

The following methodology for cognitive-behavioral training is proposed:

1. The study of patient complaints, analysis of the clinical picture of the disease, laboratory and instrumental examination data.

2. Diagnosis of behavioral type A using the Jenkins questionnaire recommended by WHO for these purposes and the psycho-diagnostic scale of behavior of type A.

3. Formation of a group for behavioral intervention.

During the first lesson, they conduct a general conversation with all patients. At the beginning of the treatment session, they talk about the main features of type A behavior (such people walk quickly, eat, gesticulate energetically, talk a lot and quickly, are constantly busy with something, practically do not rest. Type A behavior is characterized by constant mental activity and psychological tension, lack of periods of internal relaxation). They talk about the features of type A behavior so that patients recognize themselves in the examples given.

In the future, we discuss the relationship between type A behavior and the incidence of coronary heart disease. Indicate that in patients with IHD of behavioral type A, a more severe course of the disease occurs.

Research results are presented that show that patients with type A are more likely to develop IHD. They talk about data showing that people with type A behavior are 4–9 times more likely to suffer myocardial infarction, and they are 5 times more likely to die suddenly. It is shown that the degree of damage to the coronary vessels of the heart is significantly higher in patients with this risk factor.

During the conversation, circumstances are clarified under which type A behavior patterns are most often manifested. Patients are shown that excessive mental stress reduces work productivity, hinders the realization of creative opportunities, and leads to an increase in errors. They indicate that behavior correction will not lead to a decrease in productivity at work and a decrease in the vital activity of patients, and a change in the type of behavior will make it possible to work with even greater efficiency, but more psychologically economically and in accordance with its real capabilities, which will ensure the preservation of health. Indicate that over-voltage during work for people with type A behavior is unconscious and familiar. At the same time, they need to control themselves and maintain an optimal voltage level for work. If the level of stress is excessive, it must be reduced by switching to other activities or temporary relaxation.

Classes are held in free form with the participation of participants in the discussion. They create an atmosphere when each patient asks a question, expresses his opinion and discusses it with other participants. Everyone present speaks out, as it is proved that the more people discuss their problems, the more his erroneous attitudes change.

In conclusion, the classes analyze the main methods of changing type A behavior, which do not require a long time and organically fit into the usual daily routine of the patient. The optimal number of participants in the group is 8 people, the duration of the conversation is 90 minutes.

One of the important methods of conducting classes is a group discussion. At the same time, the role of the group is used to the maximum extent as a factor stimulating and supporting health care. The lesson is conducted in such a way that each participant is convinced of the possibility of changing the stereotypes of their behavior. To this end, in every possible way fix the attention of patients on the positive results of the fight against risk factors. All treatment is based on the formation and consolidation of positive motivation.

Group discussions are held for 60-90 minutes in the amount of 5-7 lessons 2-3 times a week. The purpose of group discussions is to create motivation for changing type A behavior in each group member. Patients are explained the relevance of behavior correction. On concrete examples show that a change in behavior will not entail a decrease in their social activity and productivity in the work.

Another major task of group discussions is to create an idea of a new lifestyle in the patient’s worldview system. To do this, each participant recalls situations in which he showed particular signs of type A behavior. These situations relate to at least two components of this behavioral type: aggressiveness and excessive emotional stress associated with work and especially during leisure hours. All manifestations of type A behavior are explained to patients, they are trained to find them in their daily lives, and then specific situations of behavior correction are analyzed. Discuss alternative methods of behavior in these situations. They teach the patient to recognize the negative features of their behavior and try to eliminate them. They advise you to change your daily routine to a calmer one, develop skills to walk at a slow pace, try to speak in a quiet voice, learn to respect any interlocutor. To do this, it is recommended to listen to at least two people daily, without interrupting them, to train to smile on the street, when talking with the interlocutor. It is necessary that patients try to avoid situations that annoy them, try not to notice people who bother them.

As an example, they are waiting for their turn. In such a situation, it is recommended not to think about when she will fit and how much the patient will lose time on this, but they are advised to study people and reflect on their plans, mentally solve their problems.

In the first lesson, situations from the life of patients in which type A behavior was revealed are revealed. Each participant analyzes his daily behavior and finds deviations from the norm in it. Involving all patients in such a discussion provides an additional incentive to change behavior. The doctor demonstrates possible behaviors in various conflict situations that cause the manifestation of type A behavior in group members. Such analyzes are carried out on the example of specific situations, focusing the attention of patients on the positive consequences of changing their behavior.

Subsequent classes focus on identifying factors that contribute to the formation of type A in each patient. When analyzing the causes, patients most often refer to a lack of time. The doctor convinces them that the main reason for this lies in the lack of ability to organize their activities. As a rule, most patients do not share this point of view, so they are led to it gradually. It is recommended to analyze with specific examples how to avoid an acute lack of time leading to disorganization of activities and deterioration of results. They convince the group that the most affordable way to deal with the feeling of running out of time is to follow a clear daily routine and draw up a daily work plan. In the daily routine, it is necessary to provide for a switch from one type of activity to another. If the patient is predominantly engaged in mental work, it is recommended to include physical exercises and relaxation training classes, which helps to reduce and prevent nervous tension. In one lesson, each participant is offered to draw up a work plan and daily routine, which would include not only work, but also the organization of rest.

The next lesson discusses the strengths and weaknesses of each patient’s plans. At the end of each lesson, they give homework to group members, which include recommendations aimed at recognizing the signs of type A behavior and correcting them in everyday life. At the beginning of the next lesson, they ask each patient about their success in correcting behavior, focus on existing success and use the influence of the group to consolidate changes in the stereotype of behavior.

The final lesson is devoted to discussing the results of the implementation of the developed plans in practice. Particular attention is paid to those situations in which it was possible to apply the acquired knowledge. They stimulate all patients who have achieved success, talk as much as possible about the positive aspects of the new lifestyle, and discuss the prospects that may open up for participants in the event of a change in behavior. Not all patients manage to achieve certain results in the correction of type A behavior, with such persons they analyze failures and adjust their plans. The whole group is attracted to such a discussion. During the discussion, they exchange experience between group members, highlight those who have already achieved success in changing their style of behavior.

In conclusion, a course of cognitive-behavioral training conducts a repeated examination of the severity of behavioral characteristics of type A.

Progressive neuromuscular relaxation is the process of a patient performing a series of exercises that relieve striated muscle tension and help reduce anxiety and reduce the pathogenic effects of emotional stress.

Each lesson begins with a set of exercises aimed at primary tension with subsequent relaxation of certain muscles and muscle groups in order to achieve a state of deep relaxation. The main action of progressive neuromuscular relaxation is aimed at learning to know the state of tension and relaxation. This method is based on the expansion of the patient's creation of proprioceptive neuromuscular impulses that occur at the level of peripheral muscles and increase as the striated muscles increase with tension. Afferent proprioceptive impulses largely determine the level of chronic diffuse anxiety and general sympathetic arousal. After learning to appropriately perceive neuromuscular sensations, patients effectively reduce excessive muscle tension by consciously and gradually reducing tension in selected muscles.

Patients in a certain sequence selectively weaken neuromuscular activity in a particular muscle or muscle group, and also strain and relax individual muscles of the body so that the whole process progresses from relaxation of the main muscle groups to relaxation of the whole body. With constant daily exercises, the patient develops a progressive tendency to develop a "habit of resting" - a psychological attitude characterized by less excitability and susceptibility to stress.

After teaching patients an adequate perception of neuromuscular sensations, they learn to effectively reduce excessive muscle tension through conscious and gradual “release” or reduction of tension in selected muscles.

When performing exercises, the patient's body should have maximum support (with the exception of the neck and head, if the patient involuntarily falls asleep). The patient is taught the correct way of breathing. During muscle tension, breathing does not hold. Inhalation is carried out during exertion, and exhalation during relaxation. The patient is instructed on the differences between the desired muscle tension and undesired muscle contracture (the tension is characterized by a slightly unpleasant feeling of compression in the tensed muscle, and with contractures there is pain in the muscles, joints and ligaments, as well as involuntary muscle tremors). Contracture is in fact excessive muscle tension.

Before the start of the lesson, the patient is shown all the exercises that will be used for treatment. They explain how the doctor will give instructions. For example: “For each muscle group that we will focus on, I will always first describe in detail the relaxation exercise for you. Therefore, do not start doing the exercise I describe until I say:“ Ready? Started. "

The treatment begins with relaxation of the muscles of the lower body and ends with relaxation of the muscles of the face. This is done so that after tension and relaxation of the muscles to prevent their re-tension.

The following sequence of therapeutic effects is recommended: explain to the patient which muscle and how it will strain: “You will now strain the calf muscle. To begin with, lift both heels up, the socks remain on the floor.” You need to start the exercise by a certain command: "Ready? Started." It is recommended to maintain voltage for 5-7 seconds. At this time, the patient makes an even greater effort: "Raise the socks higher ..., higher ..., even higher." After this, a command is issued to relax the muscle: "Now, relax."

The patient is helped to feel what is happening in the newly relaxed muscle, encouraging the patient to search for a feeling of relaxation: “Now feel the back of the legs. Do you feel warmth, tingling or heaviness in them? Follow these feelings.”

Further cause deeper relaxation: "Now let the muscles relax even more. The muscles become heavier, harder and harder." After each exercise, it is necessary to hold a pause for 7-15 seconds in order to give the patient a feeling of relaxation. After relaxing each muscle group, pause for 15-30 seconds. In the future, go directly to the opposite muscle group.

Before a session of progressive neuromuscular relaxation, the patient is given basic instructions.

As an example, they propose the following option: "Now you are ready for a sequential relaxation of the main muscle groups of your body to achieve a state of complete relaxation. Please, sit back and sit comfortably. You need to remove the constraining details of your clothes. Sit down as convenient as possible. Close, please , eyes. Please concentrate your attention on breathing. Please feel how the air enters through the nose and enters your lungs, how your chest and stomach expand as you inhale, and how they fall out. Okay, please focus on your breath (pause for 30 seconds).

The following exercise options are recommended for each muscle group:

1) The muscles of the legs and feet. Place both feet flat on the floor. Please leave your socks on the floor and at the same time raise both heels as high as possible. Ready? We started. Lift both heels very high ... very high ... Hold it and relax. Let them gently fall to the floor. You should feel tension in the back of the calf muscles. Repeat this exercise. Ready? We started. Lift your heels very high ..., very high ..., higher than the first time. More higher. Hold it and relax .... When you relax, you will feel tingling, warm. You will feel warm while your muscles become soft and relaxed. To work out the opposite muscle group, please lift both socks very high, leaving your heels on the floor. Lift them upright. Let's do it now. Ready? We started. Raise your socks higher, higher .... Hold it and relax. Let's repeat this exercise. Ready? We started. Raise your socks high, higher than the first time. As high as possible, hold it and relax. You should feel tingling or heaviness in the lower parts of your legs. For some time, try to feel these tingling sensations, warmth, or possibly heaviness. Let the muscles become more relaxed (pause 30 seconds).

2) The muscles of the hips and abdomen. Please extend your legs in front of you as straight as possible (if this exercise is inconvenient for the patient, he can do it with each leg individually). Remember to keep your calf muscles free. Let's do this exercise now. Ready? We started. Straighten both legs in front of you. Very straight forward. Even straighter. Hold it and relax. Allow your feet to gently fall to the floor. Repeat this exercise. Ready? We started. Straighten your legs. Very straight forward. More directly than the first time. As straight as possible. Hold it and relax.

To work out the opposite muscle group, please imagine that you are on the beach and burying your feet in the sand. Ready? We started. Bury your feet in the sand. With great effort. Even stronger, stronger ..., stronger. And ... relax ... relax. Now repeat this exercise. Ready? We started. Bury the heels in the sand with great effort. With even more effort. Stronger ..., stronger ..., even stronger ..., ... and ... relax. You feel relaxed in your upper legs. Let them become more and more relaxed. Even more ... and ... more relaxed. Focus on this feeling (pause 30 seconds).

3) The muscles of the chest. Please take a deep breath. Try to breathe in all the air around you. We are doing it now. Ready? We started. Take a deep breath ..., a very deep breath ..., deeper ..., deeper ..., even deeper ..., breath holding ... and ... relax ... Exhale all the air from the lungs and resume ordinary breathing. You should notice tension in the chest as you inhale and relaxation as you exhale. Keep this in mind when we repeat the exercise. Ready? We started. Breathe in very, very ... deep ..., even deeper ..., even deeper ..., as deep as possible ... Hold your breath ... and ... relax. Exhale and resume normal breathing. This time you felt tension and relaxation. Try to focus on this difference when we perform the exercise for all muscle groups (pause 7-10 seconds).

4) Hands. Now let's get to the hands. Please, squeeze both hands at the same time very tightly into fists, as tightly as possible. Ready? We started. Clench your fists very tightly. Very tight ..., tighter ..., tighter ... Hold that and ... relax. Now repeat the exercise. Ready? We started. Clench both fists very tightly ... very tightly ... as tightly as possible ... Hold that and ... relax. To work out the opposite muscles, spread your fingers as wide as possible. Ready? We started. Spread your fingers very wide ..., wider ..., even wider .... Hold it and ... relax. Now repeat this exercise. Ready? We started. Spread your fingers wide ..., wider ..., wider ... as wide as possible. Hold it and ... relax. Focus on the sensation of warmth or tingling in the hands and forearms (pause 20 seconds).

5) The muscles of the shoulder girdle. Now let's work with shoulders. This exercise consists of lifting the shoulders vertically up towards the ears. Imagine that you are trying to touch the tops of the shoulders of the earlobes. Ready? We started. Pull your shoulders up. Very high ..., even higher ..., even higher .... Hold it and relax. Now repeat. Ready? We started. Pull your shoulders up. Higher ..., higher ..., even higher ..., as high as possible ... Hold it and ... relax. Repeat this exercise again. Ready? We started. Pull your shoulders as high as possible ..., higher ..., even higher .... Hold that and ... relax. Very well. Now focus on the feeling of heaviness in the shoulders. Lower your shoulders, let them relax completely - stronger ..., stronger (pause 20 seconds).

6) The face. Now let's move on to the front area. Let's start from the mouth. Please smile as wide as you can first. Ready? We started. Very wide smile. Very wide. Very wide. Wider ..., even wider .... Hold it and ... relax. Now repeat this exercise. Ready? We started. Smile very wide. Broad smile. Wider ..., Wider .... Hold it and ... relax. The opposite muscle group will be activated if you put your lips together, as if trying to kiss someone. Ready? We started. Bring your lips together. Squeeze them very tight ..., even tighter ..., even tighter .... Hold that and ... relax. Now repeat this exercise. Ready? We started. Tighten your lips together. Tighter ..., tighter .... Hold it and ... relax. Let your mouth relax. Release your muscles, let them relax, more and more. Now let's move on to the eyes. Keep your eyes closed, but close them even tighter. Imagine that you are trying to prevent splashes of water from getting into your eyes. Ready? We started. Close your eyes very tightly ... very tightly ... very tightly ... even tighter .. ,, tighter. And ... relax. Let's repeat this exercise. Ready? We started. Close your eyes tighter ..., tighter ..., tighter ... Hold that and ... relax.

The last exercise is simply to raise your eyebrows as high as possible. Your eyes remain closed, and you raise your eyebrows as high as possible. Ready? We started. Raise your eyebrows high ..., even higher ..., much higher ..., much higher ... Hold that and ... relax. Now let's repeat this exercise. Ready? We started. Raise your eyebrows higher ..., even higher ..., as high as possible .... Hold that and ... relax. Take a short pause to allow yourself to feel relaxed face (pause 10 seconds).

7) The final part. You have relaxed most of the main muscles of your body (in order to make sure that they are relaxed, the doctor lists the muscles that previously activated and relaxed). You will feel how relaxation descends in a warm wave all over your body. Feel the relaxation of the forehead muscles: it goes down to the eyes, cheeks. You will feel how the heaviness during relaxation descends to the jaws, neck, descends over the shoulders, to the chest and arms, to the stomach, in the hands. Relaxation descends to the legs, hips, calves and lower, to the feet. Your body is very heavy right now. Very relaxed. This is a pleasant feeling. For some time, enjoy this feeling of relaxation (pause 5 minutes).

8) The transition to wakefulness. Please focus on yourself and the world around you. (The doctor counts from 1 to 20). With each count, you will feel how your mind is more and more awakening, and your body is becoming more and more fresh and active. When I count to 20, you will open your eyes and feel better than you have ever been today. You will feel cheerfulness, a state of refreshment and a charge of energy, a readiness to resume daily activities. Let's get started: 1-4 - you begin to feel more energetic, 5-8 - you wake up more and more, 9-12 - now stretch your hands and feet, 13-16 - stretch your arms and legs, 17-20 - now open your eyes . You feel awake. Your mind is clear and your body is fresh.

When conducting sessions of progressive neuromuscular relaxation, pay attention to the following points:

1. After the muscle group has relaxed, the doctor should go back and give the patient the opportunity to achieve deeper relaxation with the help of the “final part”. The doctor goes back and lists the main groups of already relaxed muscles, instructs the patient to remove any residual stress.

2. In the case of complete bodily relaxation, this condition lasts from several minutes to one hour. This is recommended if relaxation is used to speed up falling asleep or as a sedative. However, it is advisable for patients who should return to work within a short time after relaxation to show how to “wake up” or “recharge their batteries”.

3. Inform the patient that relaxation is necessary both at home and at work. Tell him that it is advisable to practice regularly twice a day under the supervision of a doctor. The best time to engage in progressive neuromuscular relaxation before lunch, dinner or going to bed.

4. It must be pointed out that the method is a skill that can only be developed through constant practice.

Immediately after conducting progressive neuromuscular relaxation, breathing and relaxation training is carried out for 3-5 minutes.

The use of this method is aimed at reducing stress reactivity. Respiratory and relaxation training is based on concentrating on one’s own breath. You need to passively focus on inhaling and exhaling. Previously, the patient is indicated on the importance of concentrating on his breathing.

First of all, they provide a calm and comfortable environment. The patient sits in a comfortable, relaxed position. Feet are on the floor, legs are not crossed, hands are on hips, palms are half open, fingers are not linked. Sitting completely still should not be, as this may impede relaxation.

The order of the exercises is as follows: inhaling through the nose, think: “Inhale”, exhaling through the mouth: “Exhale”. Focus on your breath. Think: "Breathe. You-s-doh." Inhale through your nose and let the air out through your mouth without any effort. Open your mouth and let the air out. Do not hold the exhale. You are absorbed in the breathing process. Inhale ... You-doh. Now every time you take a breath, you feel the fresh, cool air you breathe in, and when you exhale, you feel how warm and humid it is. With each breath, your body is increasingly filled with pleasant lightness. With each exhalation, anxieties and troubles go further and further.

A day after a session of progressive neuromuscular relaxation, physically passive neuromuscular relaxation is performed

This method consists in focusing on sensory signals coming from certain groups of striated muscles, and their subsequent relaxation in the process of direct concentration on these muscle groups. During relaxation, muscle contraction at the beginning of the relaxation cycle is practically absent. The method of physically passive neuromuscular relaxation has several positive and negative points. Her advantage is that she has no restrictions related to possible physical disorders. The patient can engage in passive relaxation without creating obstacles to others and without attracting attention. The process takes much less time than progressive neuromuscular relaxation. The main disadvantage of the method is that it, like other forms of mental imagination, can contribute to the emergence of distracting thoughts.

The following sequence of physically passive neuromuscular relaxation is recommended. Start the lesson with an introductory word. They explain to the patient that muscle tension can lead to stress and anxiety, therefore, if you can learn to relieve excessive muscle tension, you will reduce the manifestations of stress and anxiety. The exercises that we recommend are aimed at relaxing the main muscle groups of your body. You can do this by focusing on each muscle group that I will name. Studies have shown that patience and practice will help you learn how to achieve a state of deep relaxation of the whole body only by focusing on relaxation of each of the various muscle groups in your body.

Physically passive neuromuscular relaxation is carried out according to the following procedure.

Close your eyes and sit as comfortable as possible. Lean on a chair or bed with your whole body. You should focus on letting your muscles relax.

Take a deep breath. Ready? Started (pause 5 seconds). As you exhale, feel the tension leave your chest and stomach. Repeat again. Ready? Started (pause 5 seconds). Relax and exhale - the tension goes away, the chest and stomach relax. Next, focus on the muscles of the head. Begin to feel the muscles relax as a warm wave of relaxation begins to descend from the parietal part of the head. Focus on the forehead muscles. Allow these muscles to become heavy and relaxed. Focus on how the forehead becomes heavy and relaxed (pause 15 seconds). Concentrate on the muscles of the eyes and cheeks, let them become heavy and relaxed. Focus on how the eyes and cheeks become heavy and relaxed (pause 15 seconds). Pay attention to the muscles of the mouth and jaws. Allow these muscles to become heavy and relaxed. Focus on how the mouth and jaw become heavy and relaxed (pause 15 seconds). Begin to feel the warm wave of relaxation sink to the muscles of the neck. While you turn your attention to the muscles of the neck, the head remains relaxed. Allow the neck muscles to become heavy and relaxed. Focus on how the neck becomes heavy and relaxed. Begin to feel the warm wave of relaxation descend to the muscles of the shoulder girdle. While you shift your attention to the muscles of the shoulder girdle, the muscles of the head and neck remain relaxed. Allow the muscles of the shoulder girdle to become heavy and relaxed. Focus on how your shoulders become heavy and relaxed (pause 15 seconds).

Start to feel the warm wave of relaxation descend to your hands. While you shift your attention to both hands, the head, neck and shoulders remain relaxed. Allow both hands to become heavy and relaxed. Focus on how your hands become heavy and relaxed (pause 15 seconds).

Begin to feel the warm wave of relaxation descend to the hands. While you pay attention to the muscles of both hands, the head, neck, shoulders and arms remain relaxed. Let your hands become heavy and relaxed. Focus on how the hands become heavy and relaxed (pause 15 seconds).

Begin to feel the warm wave of relaxation sink to your hips. While you are focusing on your thigh muscles, your head, neck, shoulders, arms and hands remain relaxed. Let the hips become heavy and relaxed. Focus on how the hips become heavy and relaxed (pause 15 seconds).

Begin to feel the warm wave of relaxation descend to the calf muscles. While you pay attention to both calf muscles, the head, neck, shoulders, arms, hands and hips remain relaxed. Focus on how the calves become heavy and relaxed (pause 15 seconds).

Begin to feel the warm wave of relaxation descend to the feet. While you pay attention to the muscles of both feet, the remaining muscles of the body remain relaxed. Allow both feet to become heavy and relaxed. Focus on how the feet become heavy and relaxed (pause 15 seconds).

Final part. All the major muscles of your body are now relaxed. To remain relaxed, repeat to yourself as you exhale: "I am relaxed." For 5-7 minutes, continue to relax, repeating to yourself: "I am relaxed ...", "I am relaxed ...", "I am relaxed ..." (pause 5-7 minutes).

In the final part, attention is returned back to the world around the patient. “I will count from 1 to 20. With each count, you will feel how your mind becomes more and more awake, and your body more and more obedient and rested. When I get to 20, you will open your eyes and you will feel better than ever before. You feel energetic and ready to resume your usual activities. Let's start: 1-4 - you become more alert; 5-8 - you are more and more awakening; 9-12 - pull with your hands and feet; 13-16 - stretch your arms and legs; 17-20 - open your eyes. You feel lively and alert oh, your mind has become clear and your body is fresh. "

After the first session of physically passive neuromuscular relaxation, inform the patient that he can use this method to achieve relaxation 1-2 times a day - before lunch and dinner or going to bed.

Distinctive essential features of the proposed method are:

1. During progressive neuromuscular relaxation, muscle relaxation begins from the lower body, gradually moving to the upper muscle group.

2. Additional respiratory and relaxation training for 3-5 minutes after a session of progressive neuromuscular relaxation.

3. The additional conduct of physically passive neuromuscular relaxation a day after a session of progressive neuromuscular relaxation.

4. The pause after each exercise is 7-15 seconds, and after the relaxation of each muscle group - 15-30 seconds.

5. A preventive course, including cognitive training, progressive neuromuscular relaxation, physically passive neuromuscular relaxation, and respiratory relaxation training is 10-12 weeks. Sessions of progressive neuromuscular relaxation and respiratory relaxation training are carried out 1 time per week during the first and third months and 2 times a week during the second month, and physically passive neuromuscular relaxation - 2-3 times a week throughout the course .

A causal relationship between the hallmarks and the result:

1. Progressing neuromuscular relaxation should begin with relaxation of the muscles of the lower body and end with relaxation of the muscles of the face. This is done because after tension and muscle relaxation, you need to try not to allow them to re-tension, since the muscles of the face are most susceptible to re-tension, therefore, in order to exclude this possibility, it is necessary to relax them last.

2. Respiratory and relaxation training is carried out by maximizing the patient's attention on their own breath (inhale and exhale). The technique develops the skill of deep relaxation, restores the tone of internal organs, regulates blood circulation, improves the activity of the endocrine glands, strengthens the human will and causes positive emotions. Respiratory and relaxation training is carried out after progressive neuromuscular relaxation, so that after relaxation there is a feeling of peace, concentration, well-being, mood. During relaxation, blood pressure decreases, the heart rate decreases, breathing becomes rarer and superficial, the motility of the gastrointestinal tract slows down, the processes of excitation and inhibition are balanced, which leads to the removal of emotional excitability. Our chosen time interval of 3-5 minutes is sufficient to completely restore the tone of the internal organs and relaxed muscles.

3. The additional conduct of physically passive neuromuscular relaxation a day after a session of progressive neuromuscular relaxation is necessary so that, while relaxing the muscles, the patient reflexively changes the tone of the central nervous system, thus training not only the muscles, but also the central nervous system. Changing muscle tone, the patient changes his emotional state. This is achieved, firstly, by shifting attention from a specific situation to the external manifestations of an emotional reaction; secondly, by reducing the tension of muscle groups. In this regard, we offer a series of exercises aimed at focusing on sensory signals coming from certain groups of striated muscles, and their subsequent relaxation in the process of direct concentration on these muscle groups. The advantage of physically passive neuromuscular relaxation is that it has no restrictions associated with possible physical disorders.

Carrying out physically passive neuromuscular relaxation a day after a session of progressive neuromuscular relaxation is due to the fact that a day later the “neuromuscular homeostasis” is restored and there is a readiness for further therapeutic effects.

4. After each exercise, the pause is 7-15 seconds, and after the relaxation of each muscle group - 15-30 seconds, in order to give the patient the opportunity to feel relaxation and restore the normal breathing rhythm. This time is necessary so that the muscles become more relaxed, more and more heavy, there is a feeling of warmth or tingling in them.

The course of treatment is 10-12 weeks and sessions of progressive neuromuscular relaxation and respiratory relaxation training are carried out 1 time per week during the first and third months and 2 times a week during the second month, and physically passive neuromuscular relaxation - 2- 3 times a week throughout the course. The number of sessions and the time interval between them are selected to maximize the therapeutic effect, taking into account the time required for changes in psychoemotional and internal homeostasis.

The set of distinctive essential features is new and allows to increase the effectiveness of the method by reducing the frequency of repeated myocardial infarction.

Example 1. Medical record No. 836. Patient G., 49 years old, on 09/01/1991, was hospitalized with complaints of compressive chest pain without irradiation, shortness of breath when walking fast, general weakness.

From the anamnesis of the disease: for 10 years suffering from coronary heart disease. For the first time, angina attacks occurred against the background of excessive physical exertion. I did not seek medical help, I did not take any medications. In 1987 he suffered an acute myocardial infarction. In the future, almost daily, angina pains began to disturb without characteristic irradiation. Most often, angina attacks occurred against the background of a peak in psychoemotional stress and negative emotions of the stenic type (anger, rage). Pain was stopped by taking nitro drugs (nitroglycerin).

Hospitalized in the clinic due to an increase in the frequency and intensity of pain.

From the anamnesis of life: secondary education. Disability pensioner. Drinks alcohol on holidays. Smokes 15-20 cigarettes per day. Heredity is not burdened. The presence of allergic reactions or diseases, traumatic brain injury denies.

An objective study of the patient's condition. Proper physique, excess nutrition. The skin and visible mucous membranes of normal color.

Pulse - 82 beats per 1 minute, satisfactory voltage and filling. The expansion of the boundaries of relative cardiac dullness to the left. With auscultation of the heart and large vessels - emphasis II tone above the aorta and systolic murmur over all auscultatory points. AD-160/100 mm Hg

Respiratory rate - 18 in 1 minute. Auscultatory vesicular respiration above the surface of the lungs, no wheezing.

The abdominal wall is involved in breathing. The abdomen is soft, painless on palpation. Liver at the edge of the costal arch.

Physiological administration is normal.

Data of laboratory and instrumental studies:

- general clinical blood test, general urinalysis - without deviations from the norm;

- biochemical blood test: AsAT - 0.8 μmol / (h ml); AlAt - 0.9 μmol / (h ml); bilirubin - 8.5 μmol / l; alkaline phosphatase - 52 ME; glucose - 199 mg /%; potassium - 4.9 mmol / l; sodium - 142 mmol / l; triglycerides - 1.8 mmol / l; total cholesterol - 9.9 mmol / l; beta-lipoproteins - 607 mmol / l; fibrinogen - 3.75 g / l; prothrombin - 112%; LDH - 4.86 μmol / (h ml); CPK - 118 nmol / (s l).

ECG: sinus rhythm, heart rate 80 in 1 minute. Signs of left ventricular myocardial hypertrophy. Single ventricular extrasystoles. Moderate ischemia of the anterior septal region of the left ventricle. Cicatricial changes in the posterior wall of the left ventricle.

Coronarography: Atherosclerosis of the coronary arteries. The left main trunk is the norm. The anterior descending artery is an indirect sign of atherosclerosis. Envelope artery - indirect signs of atherosclerosis. Right coronary artery - stenosis of about 30% in the middle third.

The level of personal anxiety is 55 points.

The final diagnosis: ischemic heart disease. Stable angina pectoris II-III functional class. Atherosclerosis of the aorta and coronary arteries. Atherosclerotic and post-infarction (acute myocardial infarction in 1987) cardiosclerosis. Circulatory failure stage II. Hypertension - stage III. Diabetes mellitus, moderate, type II.

Treatment: regimen, diet, polarizing mixture, nitro drugs (nitrosorbide, sustac-forte), beta-blockers (betalok), calcium ion antagonists (verapamil), aspirin, manninil.

Type A behavior correction was carried out once a week during the first month, and once every two weeks in the next six weeks. Type A behavior correction technique was a combination of cognitive-behavioral training, progressive neuromuscular relaxation, respiratory relaxation training, and physically passive neuromuscular relaxation. During progressive neuromuscular relaxation, muscle relaxation began from the lower body, gradually moving to the upper muscle group, with a pause after each exercise of 7 seconds, and after relaxation of each muscle group - 15 seconds. After a session of progressive neuromuscular relaxation, respiratory relaxation training was carried out for 3 minutes, which consisted in the maximum concentration of the patient's attention on inhalation and exhalation. Physically passive neuromuscular relaxation was carried out 2 times a week throughout the course.

Assessment of the severity of type A behavior and indicators of the state of lipid metabolism in patient G. before and after behavioral treatment are presented in Tables 1 and 2.

A second study showed that after conducting a behavioral intervention, the severity of type A behavior clearly decreased: impatience, hostility, certain signs of specific behavior (interruption of the interlocutor, loud speech), restraint of emotions, involvement in work decreased (Table 1). The patient gave up smoking. There was no increase in blood pressure. Angina pains did not recur.

ECG: sinus rhythm, heart rate 76 in 1 minute. Signs of left ventricular myocardial hypertrophy. Cicatricial changes in the posterior wall of the left ventricle.

The level of personal anxiety is 42 points.

After the treatment, an improvement in lipid metabolism (a decrease in total cholesterol and beta-lipoproteins) was determined (Table 2). For 5 years, i.e. until 1996, the patient did not have recurrent myocardial infarction.

Example 2. Medical record No. 1271. Patient S., 65 years old, on 05/06/1991, was hospitalized with complaints of pain in the heart region of a pressing nature with radiation to the left arm, interscapular region, fear of death, shortness of breath and palpitations when walking.

Anamnesis morbi. For over 15 years, he suffers from coronary heart disease. For the first time, angina attacks arose against a background of chronic psychoemotional (after their completion, amid relaxation) stresses and negative emotions of the stenic type in the sphere of production relations in the team and with the bosses. I did not seek medical help, I did not take any medications. In 1981, he suffered the first myocardial infarction, in 1983 and 1989. - repeated myocardial infarction. On an outpatient basis, he regularly took nitrosorbide, sustac forte, anaprilin, aspirin, corinfarum.

Over the past 10 days, an increase in the frequency and intensity of anginal pains was noted, shortness of breath with minimal physical activity appeared, which was an indication for inpatient treatment.

Anamnesis vitae. Higher education, Ph.D. Disability pensioner. Drinks alcohol on holidays. Smokes 10-12 cigarettes per day. Heredity burdened by coronary heart disease. The presence of allergic reactions or diseases, traumatic brain injury denies.

Status praesens. Hypersthenic physique, excess nutrition. The skin and visible mucous membranes of normal color. Slight cyanosis of the lips, pastes of the legs.

Pulse - 92 beats per 1 minute, arrhythmic, satisfactory voltage and filling. The expansion of the boundaries of relative cardiac dullness to the left. With auscultation of the heart and large vessels - emphasis II tone above the aorta and systolic murmur over all auscultatory points. HELL - 160/90 mm Hg The respiratory rate is 19 in 1 minute. Auscultation above the surface of the lungs breathing with a harsh tinge, single rales in the lower parts of the lungs.

The abdominal wall is involved in breathing. The abdomen is soft, painless on palpation. The liver protrudes from the edge of the costal arch by 1 cm. Dimensions according to Kurlov: 11 × 9 × 8 cm. Physiological administration is normal.

Data of laboratory and instrumental studies:

- general clinical blood test, general urinalysis - a normal option;

- biochemical blood test: AsAT - 0.34 μmol / (h ml); AlAt - 0.34 μmol / (h ml); bilirubin - 8.0 μmol / l; alkaline phosphatase - 78 ME; glucose - 162 mg /%; potassium - 4.8 mmol / l; sodium - 139 mmol / l; triglycerides - 1.8 mmol / l; total cholesterol - 10.1 mmol / l; beta lipoproteins - 670 mmol / l; fibrinogen - 3.5 g / l; prothrombin - 100%; LDH - 3.8 μmol / (h ml); CPK - 148 nmol / (s l).

ECG: sinus rhythm, heart rate 90 in 1 minute. Signs of left ventricular myocardial hypertrophy and left atrium. Signs of systolic overload of the left ventricle. Coronary insufficiency in the anterolateral region of the left ventricle. Cicatricial changes in the left ventricle.

Coronarography: Atherosclerosis of the coronary arteries. The left main trunk - signs of atherosclerosis. The anterior descending artery is occlusion, stenosis at the mouth of the diagonal branch. Envelope artery - indirect signs of atherosclerosis. Right coronary artery - subocclusion at the mouth.

The level of personal anxiety is 54 points.

The final diagnosis: ischemic heart disease. Stable angina pectoris III functional class. Atherosclerosis of the aorta and coronary arteries. Atherosclerotic and post-infarction (acute myocardial infarction in 1981, 1983, 1989) cardiosclerosis. Circulatory failure II-b stage. Hypertension - stage III. Diabetes mellitus, moderate, I-type.

Treatment: regimen, diet, polarizing mixture, nitro drugs (nitrosorbide, sustac-forte), diuretics (lasix), potassium preparations (panangin), beta-blockers (metoprolol), aspirin, insulin.

Type A behavior correction was carried out once a week during the first month, and once every two weeks in the next eight weeks. Type A behavior correction technique was a combination of cognitive-behavioral training, progressive neuromuscular relaxation, respiratory relaxation training, and physically passive neuromuscular relaxation. During progressive neuromuscular relaxation, muscle relaxation began from the lower body, gradually moving to the upper muscle group, with a pause after each exercise of 10 seconds, and after relaxation of each muscle group - 20 seconds. After a session of progressive neuromuscular relaxation, respiratory relaxation training was carried out for 4 minutes, which consisted in the maximum concentration of the patient's attention on inhalation and exhalation. Physically passive neuromuscular relaxation was carried out 2 times a week throughout the course.

Assessment of the severity of type A behavior and indicators of the state of lipid metabolism in patient C. before and after behavioral treatment are presented in Tables 3 and 4.

A second study showed that after conducting behavioral treatment, the severity of type A behavior decreased: impatience, hostility, individual signs of specific behavior, restraint of emotions, involvement in work decreased (Table 3). The patient gave up smoking. There was no increase in blood pressure. Angina attacks did not recur.

ECG: sinus rhythm, heart rate 80 in 1 minute. Signs of left ventricular myocardial hypertrophy and left atrium. Cicatricial changes in the myocardium of the left ventricle.

The level of personal anxiety is 40 points.

After the treatment, an improvement in lipid metabolism (a decrease in total cholesterol and beta-lipoproteins) was determined (Table 4). For 5 years, i.e. until 1996, the patient did not have recurrent myocardial infarction.

Example 3. Medical record No. 2079. Patient J., 50 years old, September 19, 1991 hospitalized with complaints of compressive chest pains radiating to the left arm, interscapular region, lower jaw, shortness of breath at rest, general weakness.

From the anamnesis of the disease: for 5 years suffering from coronary heart disease. The first attack of angina pectoris appeared against the backdrop of a peak in chronic psycho-emotional stress and negative emotions of the asthenic type (fear, fright) in the sphere of industrial relations with superiors. On the recommendation of a doctor, he took nitrosorbide and tranquilizers. In 1984 he suffered an acute small focal anterior septal myocardial infarction. In the future, angina pains radiating to the left arm were almost daily disturbed. Most often, angina attacks occurred against the background of a peak in psychoemotional stress and negative emotions of the stenic type (anger, rage). Pain was stopped by taking nitro drugs (nitroglycerin).

From the anamnesis of life: higher education. Serviceman. Alcohol does not consume. Smokes more than 20 cigarettes per day. Heredity burdened by coronary heart disease. The presence of allergic reactions or diseases, traumatic brain injury denies.

An objective study of the patient's condition. Hypersthenic physique, excess nutrition. The skin and visible mucous membranes of normal color.

Pulse - 88 beats per 1 minute, arrhythmic, satisfactory voltage and filling. The expansion of the boundaries of relative cardiac dullness to the left. With auscultation of the heart and large vessels - emphasis II tone above the aorta and systolic murmur above the apex of the heart. HELL - 160/100 mm RT. Art.

Respiratory rate - 18 in 1 minute. Auscultatory vesicular respiration above the surface of the lungs, no wheezing.

The abdominal wall is involved in breathing. The abdomen is soft, painless on palpation. Liver at the edge of the costal arch. Physiological administration is normal.

Data of laboratory and instrumental studies:

- general clinical blood test, general urinalysis - a normal option;

- biochemical blood test: AsAT-0.60 μmol / (h ml); AlAt - 0.60 μmol / (h ml); bilirubin - 20.5 μmol / l; glucose - 5.2 mmol / l; potassium - 4.5 mmol / l; sodium - 146 mmol / l; triglycerides - 1.8 mmol / l; total cholesterol - 9.8 mmol / l; beta-lipoproteins - 609 mmol / l; fibrinogen - 6.25 g / l; prothrombin - 92%; LDH - 3.8 μmol / (h ml); CPK - 112 nmol / (s l).

ECG: sinus rhythm, heart rate 90 in 1 minute. Left ventricular myocardial hypertrophy. Single ventricular extrasystoles. Ischemia of the lateral wall of the left ventricle. Cicatricial changes in the anterior septal and apical region.

Coronarography: Atherosclerosis of the coronary arteries. The left main trunk is without features. The anterior descending artery - stenosis in the 1st third of more than 60%. Envelope artery - signs of atherosclerosis. Right coronary artery - signs of atherosclerosis.

The level of personal anxiety is 51 points.

The final diagnosis: ischemic heart disease. Stable angina pectoris II-III functional class. Atherosclerosis of the aorta and coronary arteries. Atherosclerotic and post-infarction (acute myocardial infarction in 1984) cardiosclerosis. Circulatory failure stage I.

Treatment: regimen, diet, polarizing mixture, nitrosorbide, aspirin, tenormine, nifedipine.

Type A behavior correction was carried out once a week during the first month, and once every two weeks in the next seven weeks. Type A behavior correction technique was a combination of cognitive-behavioral training, progressive neuromuscular relaxation, respiratory relaxation training, and physically passive neuromuscular relaxation. During progressive neuromuscular relaxation, muscle relaxation began from the lower body, gradually moving to the upper muscle group, with a pause after each exercise of 15 seconds, and after relaxation of each muscle group - 30 seconds. After a session of progressive neuromuscular relaxation, respiratory relaxation training was carried out for 5 minutes, which consisted in the maximum concentration of the patient's attention on inhalation and exhalation. Physically passive neuromuscular relaxation was carried out 3 times a week throughout the course.

Assessment of the severity of type A behavior and indicators of the state of lipid metabolism in patient J. before and after behavioral treatment are presented in Tables 5 and 6.

A second study showed that after treatment, the severity of type A behavior clearly decreased: ambitiousness, impatience, hostility, competition, certain signs of specific behavior (interruption of the interlocutor, loud speech, etc.), restraint of emotions, involvement in work decreased (Table 5 )

The patient quit smoking. An increase in blood pressure is not registered.

ECG: sinus rhythm, heart rate 82 in 1 minute. Left ventricular myocardial hypertrophy. Cicatricial changes in the anterior septal and apical region.

The level of personal anxiety is 43 points.

After the treatment, an improvement in lipid metabolism (a decrease in total cholesterol and beta-lipoproteins) was determined (Table 6).

For 5 years, i.e. Until 1997, the patient did not have recurrent myocardial infarction.

We examined 88 men with behavioral type A who had myocardial infarction (age of patients from 32 to 67 years).

Methods of psychoemotional research included assessing the severity of type A behavior using a Jenkins questionnaire and a type A psychodiagnostic scale of behavior, the C.D. Spilberger – Yu.L. Khanin personal and reactive anxiety scale. The study determined the level of total cholesterol, beta-lipoproteins and triglycerides. The examination was carried out on 3-5 days from the moment of admission to the clinic and after a behavioral intervention carried out for 3 months. All patients were divided into two groups: group I - patients who underwent a course of correction of type A behavior (intervention group - 56 people); II - persons who refused behavioral intervention (comparison group - 32 people). Randomization of patients into groups was carried out by random sampling. According to the initial clinical and functional characteristics, the groups of patients were statistically comparable. Type A behavior correction was performed in classes of 8 people during the first month once a week, in the next month once every two weeks, then once a month. Type A behavior correction technique was a combination of cognitive-behavioral training, progressive neuromuscular relaxation, respiratory relaxation training, and physically passive neuromuscular relaxation.

The results of the observation showed that the behavioral treatment group was characterized by a more favorable course of the disease, greater positive dynamics of psychological status and correction of behavioral risk factors.

At the end of the course of treatment, a second assessment of the severity of type A behavior and the state of lipid metabolism was carried out. The results of the study showed that after behavioral treatment, patients showed signs of severity of type A behavior: a feeling of lack of time, impatience, hostility, ambitiousness, restraint of emotions, individual signs of specific behavior (p <0.001). Accordingly, the average score on the psychodiagnostic scale of type A behavior after the intervention was 155.0 ± 1.80, while before treatment it was 203.5 ± 4.50 points (p <0.001). In the comparison group, only a slight decrease in the indicators of hostility was noted (Table 7). The level of personal anxiety in the first group was significantly lower after the intervention than before treatment, 50.2 ± 1.78 and 36.2 ± 1.35 points, respectively (p <0.001). Among patients in the intervention group, 96.4% followed the diet at the time of the repeated examination, in the comparison group only 18.8% of patients (p <0.001). A periodic increase in blood pressure figures was observed in 14.3% of the treated patients and 81.3% of the comparison group patients; 42.3 and 3.1% of patients, respectively, gave up smoking (p <0.001).

It was found that only in patients who underwent a course of behavioral therapy (group I), an improvement in lipid metabolism was determined. The average level of total cholesterol in this group was significantly lower after the intervention than before treatment, 5.45 ± 0.231 and 9.98 ± 0.252 mmol / L, respectively (p <0.001). The state of lipid metabolism in patients who did not undergo behavioral treatment did not significantly change (Table 8).

An analysis of data for five years of observation of patients showed that the frequency of recurrent myocardial infarction in the behavioral intervention group was 3.4%, and in the comparison group - 15.9%.

An analysis of the data for three years of the study by the authors of the prototype method showed that the frequency of repeated myocardial infarction in the behavioral intervention group was 7.2%, which is almost 2 times higher compared to our results.

Thus, the inventive method for the prevention of myocardial infarction in people with behavioral type A is more effective than the prototype by reducing the frequency of myocardial reinfarction by almost 2 times.

Literature

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Claims (1)

A method for the prevention of recurrent myocardial infarction in individuals with behavioral type A by correcting the behavioral type using cognitive training and progressive neuromuscular relaxation, characterized in that they additionally carry out physically passive neuromuscular relaxation and respiratory relaxation training, and when carrying out progressive neuromuscular muscle relaxation muscle relaxation begins from the lower body, gradually moving to a group of upper muscle, with a pause after each exercise was it is 7-15 s, and after relaxation of each muscle group 15-30 s, after a session of progressive neuromuscular relaxation, breathing and relaxation training is carried out for 3-5 minutes, which consists in the maximum concentration of the patient's attention on inhalation and exhalation, every other day after a session of progressive neuromuscular relaxation, physically passive neuromuscular relaxation is carried out, a preventive course including cognitive training, progressive neuromuscular relaxation, physically passive neuromuscular relaxation july and respiratory relaxation training is 10-12 weeks, and sessions of progressive neuromuscular relaxation and respiratory relaxation training are carried out 1 time per week during the first and third months and 2 times a week during the second month, and physically passive neuro-relaxation muscle relaxation - 2-3 times a week throughout the course.