RU2252038C1 - Method for interactive treatment of addictive behavior - Google Patents

Abstract

FIELD: medicine, psychiatry, narcology, telemedicine.

SUBSTANCE: one should perform suggestive impact upon a patient to form negative emotions at different addictions. One should project a video-sequence of negative picture on the screen. Positive emotions should be developed by demonstrating positive pictures. Moreover, one should conduct psychotherapeutic impact through the canals of audiovisual devices along with distance control for patient's state. Moreover, it is necessary to register fluctuations of omega-potential, anxiety level, initial psychophysiological characteristics. At the background of positive emotions one should form a dominant for healthy life and the program to avoid addiction. Then comes correction of behavioral stereotypes. Patient should choose motivating video-image by activating the dominant and program to avoid the addiction available. Verbal impact occurs under stereophonic conditions with binaural sound fluctuations. The method enables to prevent relapses of addictive behavior at the stage of pre-clinical manifestations of the above-mentioned disease.

EFFECT: higher efficiency of therapy.

1 cl, 3 ex, 4 tbl

Description

The invention relates to medicine, namely to psychiatry, and can be used in psychotherapy.

Most effectively, the invention can be used in narcology for the treatment of dependent conditions.

In addition, the invention can be used in the practice of family doctors and telemedicine.

The relevance of developing new methods of treating various forms of addictive behavior is determined by the constant and significant growth, both in developed and developing countries of the world, of the number of people, including young people, who are addicted to drugs, alcohol addiction, overweight, etc. item, as well as the lack of effectiveness of existing methods of drug and non-drug therapy.

Currently, a number of methods for interactive treatment of addictive behavior are known.

A known method of interactive treatment of addictive behavior, including conducting three stages of hypnosis and indirect suggestive exposure by demonstrating static and dynamic pictures containing verbal information in the 25th frame with a ban on alcohol, drugs and tobacco (RF Patent No. 2162349 of 03/29/99 )

The disadvantage of this method is the use of only an indirect suggestive effect, which does not always have the necessary therapeutic effect on patients with addicted behavior, especially in visually impaired people, which can lead to a decrease in the effectiveness of treatment, a decrease in the duration of remission and the possibility of relapse of the disease.

In addition, the treatment is not accompanied by constant remote monitoring by the doctor of the patient’s psychoemotional state and the level of his attitude towards dependent behavior through feedback through wired and wireless channels of audiovisual devices, which does not provide the opportunity to identify signs of dependent behavior at the preclinical stage, to remotely monitor the remission of dependent behavior and prevent relapse.

There is another way of interactive treatment of addictive behavior, including exposure to the patient for 40 minutes by pulsed current from electrodes located in the forehead, light pulses, sound signals, suggestive action against the background of a relaxing melody and setting the refusal of alcohol and narcotic substances that cause mental dependence (RF Patent No. 2205665 dated 12/26/2001).

The disadvantage of this method is that when it is used, patients are exposed to pulsed current, light and sound stimuli, which in people with increased excitability and traumatic brain injuries can cause undesirable side reactions, for example, seizures, which can lead to a decrease in efficiency and the safety of treatment.

Another disadvantage of this method is that its implementation is not combined with the constant recording of objective information about the patient's condition and its analysis, which does not allow to reveal signs of addictive behavior and prevent relapse at the stage of preclinical manifestations of the disease.

There is another way of interactive treatment of addictive behavior, including preliminary training sessions of biological feedback on the alpha rhythm and theta rhythm of the electroencephalogram (EEG) and hypnosis in the treatment of drug addiction (RF Patent No. 2217177 of 05/06/2002).

The disadvantage of this method is that treatment is possible only in a limited number of patients, since 10-15% of people have no alpha EEG rhythm, and registration of one EEG is insufficient for an objective assessment of the patient's psychophysiological state, which ultimately can lead to a decrease the effectiveness and safety of treatment, reducing the duration of remission and a possible relapse of the disease.

A known method of interactive treatment of addictive behavior, including suggestive action on obese patients, mechanical irritation of exit points of one of the branches of the trigeminal nerve with sharp violent tilts of the patient’s head back and forth, accompanied by verbal commands (RF Patent No. 2034575 from 11/18/93).

The disadvantage of this method is that mechanical irritation of the exit points of the trigeminal nerve branches and sharp violent tilts of the patient's head can cause damage to the cervical vertebrae, which reduces the safety of treatment.

In addition, the disadvantage of this method is that the treatment in a known manner is carried out only in a hospital and direct contact with the patient, which does not allow for effective treatment in the remote dialogue mode between the doctor and the patient and remote monitoring of remission of dependent behavior.

Closest to the proposed technical solution is a method of interactive treatment of addictive behavior, including the treatment of alcohol, nicotine, narcotic and food addiction by showing a video sequence of negative pictures on the screen of a video monitor with the patient focusing on unpleasantly grotesquely emphasized moments, while on the background of psychoemotional overstrain they perform a suggestive exposure through audiovisual devices and verbally form an attitude to abandon abuse with osleduyuschim creating positive emotions by projecting onto the screen in the form of meaningful visuals positive picture of the formation of ideal images of the person, free from various addictions, with an additional olfactory and tactile exposure to light and sound-proofed room (RF patent number 2,193,900 on 01.10.2000).

The disadvantage of this method is that its application does not provide for the use of feedback through wired and wireless channels of audiovisual devices, which makes it difficult to conduct treatment in the mode of remote dialogue between a doctor and a patient and remote monitoring of remission of dependent behavior.

Another disadvantage of the known method is that the verbal formation of the installation for refusing abuse is not supported by binaural sound vibrations (the influence of the sound signal on both ears simultaneously with the frequency difference between the right and left channels) in stereo mode with EEG rhythm frequencies that allow modulating the state of cortical activity and subcortical structures of the brain, which makes it impossible to enhance, at a subconscious level, the patient’s perception of verbal settings for care is dependent ty.

Another disadvantage of this method is that during a suggestive exposure there is no constant multichannel remote monitoring of the current psychophysiological state of the patient, which enables online monitoring and objective analysis of his personal qualities, timely and dynamic correction of the intensity of impact on the psyche, which reduces the effectiveness of the treatment, it does not reveal signs of addictive behavior and prevent its relapse at the preclinical stage occurrences.

In addition, the disadvantage of this method is that the olfactory and tactile effects on the skin and mucous membranes of the patient are carried out by air and water flows, which can cause irritation and damage to the respiratory system, body surface, which reduces the safety of treatment.

The technical result of the invention is expressed:

- the possibility of increasing the effectiveness and safety of treatment;

- the possibility of enhancing, at a subconscious level, the patient’s perception of verbal settings for avoiding addiction;

- the possibility of identifying signs of addictive behavior and preventing relapse at the stage of preclinical manifestations of the disease;

- the possibility of treatment in the mode of remote dialogue between a doctor and a patient and remote monitoring of remission of dependent behavior.

The basis of the invention is the task of developing an effective remote method for interactive treatment of addictive behavior, convenient and safe for the patient and the doctor and able to stop the development of alcoholism, drug addiction and other forms of addictive behavior.

The problem is achieved in that the method of interactive treatment of dependent behavior includes suggestive action on the patient, sound accompaniment, installation on the formation of negative emotions with the patient focusing on the unpleasant grotesquely emphasized moments of abuse by projecting on-screen audiovisual devices semantic footage of negative pictures with the subsequent formation of positive emotions in the form of showing positive pictures, a reference social environment, ideal the basics of personality development, free from various dependencies, and according to the invention, suggestive action is carried out through feedback through wired and wireless channels of audiovisual devices under constant multichannel remote monitoring by a doctor of the patient’s psycho-emotional state and level of its installation on dependent behavior, and initial psychophysiological characteristics, fluctuations are first recorded omega potential, level of anxiety, emotional reactions to relevant questions at rest and not the background of negative emotions, then create individual samples of the patient’s responses and the variability of the level of his negative attitude towards dependent behavior, while the patient’s dominant form of a healthy lifestyle against the background of positive emotions, after which, with the maximum improvement in the psycho-emotional state, controlled by the stability of psychophysiological reactions and minimum level of anxiety, conduct interactive correction of behavioral stereotypes with the development of an adaptive strategy of self-realization and then the patient himself chooses a motivating video image in the form of a constant splash screen, which is stored in the memory of the audiovisual device and activates the previously formed dominant with the addiction avoidance program, the verbal impact of which is carried out in stereo mode with binaural sound vibrations in the voice range and adjustable frequency difference on the right and to the left channels from 30 to 3 Hz, in the future, the doctor periodically checks the effectiveness of the program of interactive correction for avoiding dependence and antisocial behavioral stereotypes and control of the formed dominant.

Thus, the invention proposed a new set of essential features. All the proposed features are significant because they affect the technical result achieved, i.e. are in a causal relationship with the specified result.

So, for example, in the preferred embodiment of the method of interactive treatment of addictive behavior, suggestive action is carried out by feedback through wired and wireless channels of audiovisual devices under constant multichannel remote monitoring by the doctor of the patient's psycho-emotional state and the level of its installation on the dependent behavior.

In this regard, it became possible to conduct treatment in the mode of remote dialogue between a doctor and a patient and conduct remote monitoring of remission of dependent behavior, since during a suggestive exposure through communication channels, for example, via the Internet, a cellular GPRS channel of a smartphone, mobile phone, etc. , the doctor has such contact with the patient, in which he constantly receives information on his condition with the help of audiovisual devices, so he can adjust the intensity of the exposure, being at a distant distance ns from the patient, due to the in-phase combination of psychotherapeutic procedures with multi-channel on-line monitoring of actual psycho-physiological condition of the patient, enabling timely and dynamic adjustment of the intensity of the impact on the patient's psyche, which ensures the adequacy of the treatment, its maximum efficiency and safety.

It is reasonable that the initial psychophysiological characteristics, omega-potential fluctuations, anxiety levels, emotional reactions to relevant questions at rest and against a background of negative emotions are recorded first, then individual samples of patient responses and variability of the level of his negative attitude towards dependent behavior are created, while in the patient, against the background of positive emotions, they form the dominant for a healthy lifestyle, after which, with the maximum improvement in the psychoemotional state, it is controlled In terms of the stability of psychophysiological reactions and the minimum level of anxiety, they conduct an interactive correction of behavioral stereotypes with the development of an adaptive strategy of self-realization, which allows you to obtain objective data on the patient's psychophysiological state during treatment by analyzing information about the limits of fluctuations of psychophysiological indicators acceptable for a given person, the severity of a pathological attraction or the presence of psychopathological preferences through a combination of multi-channel register walkie-talkies of psychophysiological indicators and psychological testing with simultaneous automated processing of the results by means of mathematical statistics, which allows to identify signs of the disease, including psychological personality traits of the patient, predisposing to the development of pathological attraction, before the onset of manifestation of its clinical symptoms and syndromes, which made it possible to identify signs of dependent behavior and to prevent its recurrence at the stage of preclinical manifestations.

It is advisable that the patient himself chooses a motivating video image in the form of a constant screen saver, which is stored in the memory of the audiovisual device and activates the previously formed dominant with the addiction avoidance program, the verbal (verbal) effect of which is carried out in stereo mode with binaural sound vibrations in the voice range and adjustable difference frequencies on the right and left channels from 30 to 3 Hz, in the future, the doctor periodically checks the effectiveness of the interactive correction program for move on dependence and antisocial behavioral stereotypes and control of the formed dominant.

This made it possible to increase the effectiveness of treatment, to achieve stable and stable remission, to prevent relapse of dependent behavior and to improve the safety of treatment, since the doctor at all stages of treatment first has the opportunity to objectively assess the patient’s condition, to increase the patient’s perception of verbal settings by care for addiction and its motivation, since the doctor can directionally adjust the degree of psychotherapeutic influence adequately the patient’s condition, provide psychosupport, including long-term, as well as periodic monitoring of the patient’s psychoemotional status regardless of geographic distance from the doctor using remote methods of interactive therapy and duplex transmission of information via wired and / or wireless and communication channels. The choice of the frequency range (30-3 Hz) is due to the possibility of directional modulation of brain activity in the frequency range of the main EEG rhythms.

The method is as follows

As audiovisual devices (AVU), a personal computer with a microphone and a video camera, a laptop, a smartphone, a mobile phone with a built-in video camera, an MPEG player, stereo and polyphonic sound reproduction, etc., and a multi-channel analyzer of psychophysiological indicators, for example, can be used , “Mingograph-34” (Germany) or “DELTA” (Russia) with cutaneous electrodes and respiratory sensors.

The omega potential is recorded in the lead of the vortex tenar of the right and / or left hand.

As the psychophysiological characteristics of the proposed method, an electrocardiogram (ECG), respiratory rate (BH), galvanic skin response (RAG), the sound spectrum of the carrier frequencies of the patient’s voice are recorded, facial expressions are recorded. If necessary, other psychophysiological characteristics can be used.

An assessment of the level of anxiety is carried out according to the Spielberger test (Spielberger Ch. Theory and research on anxiety / In: Anxiety and behavior / Ed. Ch. D. Spielberger. New York; London, 1966), and / or on sample questions from the Taylor questionnaire ( Taylor JA A personality scale of manifest anxiety. J. Abnormal and Social Psychol., 1953, v. 48, p. 285-290) and Cattell's random 16-factor test (Cattell RB, Scheier JH The meaning and measurement of neuroticism and anxiety (New York. The Ronald Press company, 1961).

As relevant questions for assessing the severity of addictive behavior, test questionnaires are used, for example, a test to identify motivation for alcohol consumption - MAL (Zavyalov V.Yu. Psychological aspects of the formation of alcohol dependence, Novosibirsk, Nauka, 1988, 195 pp.), Screening- test to determine the attitude to alcoholization and narcotization - STAN (Grebenyuk A.A. Psychological dependence on narcotics, Simferopol, 1999, 212 pp.), upper level scales (mental imbalance, asociality and introversion) psychodiagnosis test - PDT (Melnikov V.M., Yampolsky L.T. Introduction to Experimental Psychology of Personality: Textbook for teachers and teachers of pedagogical disciplines of university and pedagogical institutes, Moscow: Education, 1985, 319 C.), excessive food intake, etc., which alternate with indifferent and control questions.

Before the start of a suggestive exposure, the audiovisual devices of the doctor (AVU _B ) and the patient (AVU _P ) are connected via wired and / or wireless communication channels, for example, through a wired communication channel of the Internet via the basic TCP / IP (Transmission Control Protocol / Internet Protocol).

Interactive treatment of dependent behavior is carried out in the remote dialogue mode between the doctor and the patient, regardless of their geographical remoteness, in conditions of silence and with a minimum of factors distracting the patient.

At the first stage of treatment, the doctor through the AVU _V and AVU _P assesses the condition of the patient in appearance, gives him an indication of the connection of electrodes and sensors of the AVU _P to the areas of the body from which the initial psychophysiological parameters are recorded, conducts a conversation, during which the patient receives instructions regarding their actions during the treatment session, gets acquainted with the questions that will be presented. Then the doctor begins the survey and suggestive impact by demonstrating a meaningful video sequence of negative pictures with focus on the unpleasant grotesquely emphasized moments of abuse that cause dependence, for example, the steady degradation of a person who abuse alcohol. During a suggestive intervention, the doctor fixes the patient’s attention on the factors and developmental mechanisms, dramatic consequences and complications of a particular deviation. At the same time, he carries out remote monitoring of the patient’s psychoemotional state and level of attitude toward dependent behavior by continuously recording psychophysiological characteristics: ECG, BH, RGR, sound frequency spectrum voice and video recording of facial expressions, as well as fluctuations in omega potential, level of anxiety and emotional reactions to ind fferentnye and related issues in peace and against the background of negative emotions when writing responses to questionnaires, tests in a constant dialogue with the patient.

The recorded data is transmitted to the AVU _B , where it is processed by mathematical statistics (Computer Software / Institute of Mathematics, Academy of Sciences of the BSSR. Minsk, 1983, issue 44, 163 pp.) And create individual samples of patient responses and variability of the level of his negative setting dependent on the behavior of which is stored in memory _in ACD. In this case, a multiple correlation analysis of the relationship between the variability of the level of the patient’s negative attitude toward dependent behavior with ECG, BH, RAG, amplitude-frequency characteristics of the sound spectrum of the voice, omega-potential and level of anxiety is carried out, individual facial expressions typical for different levels of anxiety are recorded automatically output coefficients and regression equation, and then the calculation results are entered into the memory AVU _in. In addition, an analysis of the individual informativeness of the patient’s recorded indicators is carried out and the minimum number of variables that form the target and prognostic signs, sufficient for a reliable assessment of the state, for example, 1-8, 12, 28, 32 questions of the magnetic resonance, the dispersion of the omega potential and the 3rd harmonic amplitude, is determined the sound spectrum of the voice, from which an individual indicator of the variability of the level of the patient’s negative attitude towards dependent behavior is formed.

At the second stage of treatment, the patient, under the influence of his chosen melodic soundtrack, evokes positive emotions in the form of showing positive pictures, a reference social environment, ideal images of personality development, free from various addictions, for example, the image of a healthy and successful person in a circle of loving wife and children, and during the ongoing remote dialogue with the doctor, they form the dominant for a healthy lifestyle, after which, against the background of the maximum improvement in the psychoemotional state, roliruemogo Stability psychophysiological reactions and the minimum level of anxiety by comparing current performance with individual samples created previously, conduct interactive correction of behavioral patterns with the development program of self-adaptive strategy, which includes a sequence understandable to the patient actions and efforts to gradually overcome the psychological dependence.

At the third stage of treatment, the patient himself chooses a motivating video image in the form of a permanent screensaver, for example, photographs of family members, a loved one, a pleasant landscape, etc., which are recorded in the memory of AVU _P. Further, the doctor with the help of AVU _{In the} means of remote suggestive therapy activates the previously formed dominant with the program of interactive correction of care for addiction and asocial behavioral stereotypes and checks its effectiveness.

At all stages of treatment, the doctor, verbally influencing the addiction withdrawal program, directionally switches the AVU _P to stereo mode with binaural sound vibrations in the voice range and adjustable frequency difference along the right and left channels from 30 to 3 Hz, enhancing the patient’s verbal perception attitudes to addiction.

Binaural sound vibrations are generated using a typical frequency converter-multiplier with four fixed ranges of 3, 5, 10, and 30 Hz (Shkritek P. Reference Guide to Sound Circuitry. - M.: Mir, 1991, 446 p .; Anthony A. Digital Filters :. analysis and design - M .: Radio and communication, 1983. - 320 pp .; R. Blahut Fast algorithms for digital signal processing - M .: Mir, 1989. - 448) connected to an audio AVC _B...

The duration of all stages of treatment is 2-3 weeks for patients suffering from alcoholism or addiction to drugs, and 3-4 months for patients with obesity.

The control of the formed dominant is carried out once a month or at least once every six months, depending on the typological characteristics and lifestyle of the patient.

The proposed method of treatment was used at the Department of Psychiatry of the Northern State Medical University (SSMU, Arkhangelsk) together with the O-05 department of the State Scientific Center of the Russian Federation - Institute of Biomedical Problems of the Russian Academy of Sciences (SSC RF IMBP RAS, Moscow).

Example No. 1 from a medical record.

Patient A., 42 years old, lives in Arkhangelsk, married, has one child, daughter 12 years old. He entered the clinical department of the Department of Psychiatry of SSMU for treatment of alcohol dependence at the insistence of his wife.

Diagnosis at admission: chronic alcoholism of the 2-3rd stage.

Anamnesis data: heredity is burdened (father drank), the patient has been drinking alcohol since 16 years old, high tolerance to alcohol, withdrawal symptoms from 35 years old, the maximum duration of remissions is 6-8 months.

On admission: no complaints, considers himself a healthy person who uses alcohol “like everyone else”, the skin is clean, pale, the lower edge of the liver protrudes 1.5 cm from the edge of the costal arch, other internal organs without pathology, HELL 135/85 mm Hg, heart rate - 89 bpm, severe anxiety, weak desire to be treated.

After a preliminary conversation with the patient’s wife and himself, explaining the features of the proposed therapy, an interactive method of treatment was chosen, for the implementation of which the necessary equipment and equipment was delivered to the patient’s apartment (AVU _P ). Another part of the equipment (AVU _V ) was located at the department of SSMU.

Two notebooks “ASUS A-1300” (Taiwan) with a microphone and a video camera UW10TNC-1250VUE (Taiwan), which were connected via a wired communication channel of the Internet via the basic TCP / IP protocol provided by MTU, were used as AVU _V and AVU _P -Intel (Russia), and the multichannel analyzer of psychophysiological indicators “Mingograph-34” (Germany) with cutaneous electrodes and a respiratory sensor.

During treatment, the patient recorded omega potential (abduction of the vortextenar of the right and left hand), ECG (in the sky), BH, RAG (according to Tarkhanov), the sound spectrum of the carrier frequencies of the voice, individual facial expressions that are characteristic for different levels of anxiety.

An assessment of the level of anxiety was carried out according to the Spielberger test, to assess the severity of the dependent behavior, we used the MAL, STAN, questionnaire questionnaires, upper-level scales (mental imbalance, antisociality and introversion), which alternated with indifferent and control questions.

The results of the examination at the beginning of treatment showed a pronounced degree of alcohol dependence, confirmed by tests of MPA (68 points) and STAN (9 arbitrary units) with a high degree of sincerity in the responses (low value of the STAN lie scale and slight shifts in BH and RGR during an interactive survey), high the level of anxiety according to Spielberger, indicators of the PDT scales - mental imbalance, asociality and introversion, indicating the phenomena of psychotism, neurotization and pronounced asocial behavior, accompanied by high pulse rate (89 beats / min), significant fluctuations in the dispersion of RAG and omega potential with a sharply negative value of the latter (-54 mV), both at rest and against the background of negative emotions.

The processing of the recorded indicators revealed the greatest informativeness for assessing the condition of this patient on the 1-16th, 23rd and 38th questions of the PDT, as well as the spectral characteristics of voice recording.

Within 2 weeks, the patient underwent a 3-stage remote interactive treatment of alcohol dependence with suggestive therapy sessions with the formation of a dominant healthy lifestyle and behavioral stereotype correction programs with the development of an adaptive strategy of self-realization. At the same time, as a motivating video image in the form of a constant splash screen, we chose a photograph of my daughter, who was periodically shown to the patient during sound therapy sessions and the implementation of the addiction care program, against the background of sound accompaniment, the verbal effect of which was accompanied by binaural sound vibrations with a frequency difference between the right and left channels 5 Hz, reinforcing, on a subconscious level, the attitude toward quitting alcohol abuse. During treatment and between sessions of suggestive therapy, the level of the patient’s negative attitude toward addictive behavior was assessed by presenting informative questions to him with simultaneous recording and voice analysis.

As a result of treatment, a high level of motivation for abandoning addiction, a decrease in the level of anxiety, normalization of heart rate (68 beats / min), minimization of variance of RAG and omega potential with a decrease in its values (-22 mV), the absence of signs of psychotization, neuroticism, decrease were noted introversion and an increase in the social orientation of behavior, which led to the onset of a state of remission and a complete abandonment of alcohol consumption.

After 2 months after the end of treatment, during the next control of the level of negative attitude and dominant, an increase in anxiety, mental imbalance and introversion was observed, accompanied by a low amplitude and a large dispersion of omega potential, as well as an increase in high-frequency harmonics in the frequency spectrum of the voice, which was qualified as a preclinical stage relapse of alcohol dependence, which was prevented by interactive correction of the program of suggestive therapy.

After the correction, the patient is in a state of persistent remission for 28 months under control with a frequency of 1 time in 3 months of the formed dominant by presenting informative questions of PDT and simultaneous analysis of the voice spectrum.

Example No. 2 from a medical record.

Patient K., 15 years old, lives in Moscow. Parents appeal to the clinical department of the SSC RF IMBP RAS about changes in the lifestyle and behavior of the son.

Diagnosis at admission: suspected drug addiction.

History: heredity is not burdened, alcohol is not consumed, does not smoke, isolated cases of drug use (“ecstasy”) among peers.

At admission: no complaints, the skin is clean, internal organs without features, blood pressure 120/80 mm Hg, heart rate - 78 beats / min, during the examination he came into contact reluctantly, is laconic, systematic drug use is denied, answered in a monosyllabic , moderately expressed state of anxiety, does not consider himself sick.

Employees of the department of the SSC IMBP of the Russian Federation held a consultation with the clinical department of the Department of Psychiatry of the SSMU, after which an interactive treatment method was chosen, for which the necessary equipment and equipment (AVU _P ) was delivered to the apartment of the patient's parents. Another part of the equipment (AVU _V ) was located at the Department of SSMU in Arkhangelsk.

As AVU _V and AVU _P , we used ASUS A-1300 laptops (Taiwan) with a microphone and a UW10TNC-1250VUE video camera (Taiwan), and Delta multichannel analyzer of psychophysiological indicators (Russia) with cutaneous electrodes and a respiratory sensor, and the last stage as an AVU _P is a Motorola Timeport T722i cell phone complete with a camera. During the treatment, AVUs were connected via a wireless Internet communication channel via TCP / IP and GPRS 1 Up / 4 Down WAP 2.0 microbrowser, including M services (WML 1.3, WAP Push, HTTP) provided by MTU-Intel (Russia )

During treatment, the patient recorded omega potential (abduction of the vortextenar of the right hand), ECG (in the sky), BH, RAG (according to Tarkhanov), the sound spectrum of the carrier frequencies of the voice, individual facial expressions that are characteristic for different levels of anxiety.

An assessment of the level of anxiety was carried out according to the Spielberger test, to assess the severity of dependent behavior, we used the STAN test questionnaire, upper-level scales (mental imbalance, antisociality and introversion) of the PDT, which were alternated with indifferent and control questions.

The results of the examination at the beginning of treatment showed a weak degree of drug addiction, confirmed by the STAN test (5 arbitrary units) with a low degree of sincerity in the answers (high value of the STAN lie scale during an interactive survey), high level of anxiety according to Spielberger, indicators of PDT scales - mental imbalance and introversion, indicating moderately pronounced phenomena of psychotism and neurotization with normal indicators of the antisocial scale, accompanied by a high dispersion of omega-potency ial, by negation of its amplitude (-43 mV) with a significant increase in the amplitude of the main tone of the voice, both at rest and against the background of negative emotions.

The processing of the recorded indicators revealed the most informativeness for assessing the condition of this patient with questions of PDT, dispersion of omega potential, as well as analysis of voice recording and facial expressions.

Over the course of 3 weeks, the patient underwent a 3-stage remote interactive treatment of drug addiction with suggestive therapy sessions with the formation of a dominant healthy lifestyle and behavioral stereotype correction programs with the development of an adaptive strategy of self-realization. At the same time, a photo of parents was chosen as a motivating video image in the form of a constant splash screen, which was periodically presented to the patient against the background of sound accompaniment during therapy and an addiction care program, the verbal effect of which was accompanied by binaural sound vibrations with a frequency difference between the right and left channels 5 Hz, reinforcing, on a subconscious level, the attitude toward refusing to use drugs. During treatment and between sessions of suggestive therapy, the level of negative attitude of the patient to addictive behavior was assessed by presenting informative questions of STAN and PDT with simultaneous recording of omega potential, recording and analysis of facial expressions and voice spectrum.

As a result of treatment, a complete rejection of the use of narcotic drugs was achieved, which was confirmed by a high level of motivation for abandoning addiction, a decrease in anxiety levels, normalization of omega potential indicators, the absence of signs of psychotization, neuroticism and a decrease in introversion.

After the correction, the patient is in a state of stable remission for 32 months under control with a frequency of 1 time in 6 months of the formed dominant by presenting informative questions of the PDT and simultaneously registering the omega potential, analyzing the voice spectrum and facial expressions.

Example No. 3 from a medical record.

Patient G., 34 years old, lives in Arkhangelsk, is married, has one child. I entered the clinical department of the Department of Psychiatry of SSMU for the treatment of obesity.

Diagnosis at admission: nutritional obesity of the 2nd degree.

Anamnesis data: heredity is burdened (father and mother were obese, died early from coronary heart disease caused by the progression of coronary artery atherosclerosis), alcohol is consumed in small quantities (dry and dessert wine) no more than 2 times a month, suffers from overeating from 18 years (the beginning during pregnancy and the postpartum period), loves sweet and floury (according to the patient, she can “persuade” a whole cake weighing 1 kg during evening tea alone), has repeatedly tried to reduce the number of calories consumed, including nd 1-1.5-month course of starvation and varied diet, which resulted in reduced weight 3-5 kg, maximum duration of remission 2-3 months, after which the former gaining weight again.

On admission: complaints of a rash on the face, excessive sweating, overweight, skin on the face were characterized by acne with single papular formations, the skin of the body is clean, high humidity, the thickness of the skin fold between the shoulder blades is 42 mm, height 166 cm, weight 87 kg, body mass index - 31.5, blood pressure 130/85 mm Hg, heart rate - 86 beats / min, high degree of anxiety, expressed desire to be treated. Data from a biochemical blood test: blood cholesterol - 7.9 mmol / L, low density lipoproteins - 5.88 mmol / L, triglycerides - 1.95 mmol / L, other indicators are normal.

After a preliminary conversation with the patient and clarification of the features of the proposed therapy, an interactive treatment method was chosen for which the necessary equipment and equipment (AVU _P ) was delivered to the patient’s apartment. Another part of the equipment (AVU _V ) was located at the department of SSMU.

Two notebooks “ASUS A-1300” (Taiwan) with a microphone and a video camera UW10TNC-1250VUE (Taiwan), which were connected via a wired communication channel of the Internet via the basic TCP / IP protocol provided by MTU, were used as AVU _V and AVU _P -Intel (Russia), and the multichannel analyzer of psychophysiological indicators “Mingograph-34” (Germany) with cutaneous electrodes and a respiratory sensor.

During treatment, the patient recorded omega potential (lead of the vortex tenar of the right and left hands), ECG (in the II standard lead), BH, RAG (according to Tarkhanov), the sound spectrum of the carrier frequencies of the voice, individual facial expressions characteristic of different levels of anxiety.

An assessment of the level of anxiety was carried out according to the Taylor scale, to assess the severity of the dependent behavior, questions of the upper level scales (mental imbalance, asociality and introversion) of the PDT were used, which were alternated with indifferent and control questions.

The results of the examination at the beginning of treatment showed a pronounced degree of food dependence, confirmed by answers to questions about the nature of nutrition and food preferences with a high degree of sincerity in the answers (high value of the frankness scale of the Taylor questionnaire and slight changes in BH and RGR during an interactive survey), a high level of anxiety by Taylor’s scale, indicators of the PDT scales - mental imbalance and introversion, indicating the phenomena of psychotism, neurotization, and normal indicators of scales asociality, accompanied by a high frequency pulse (86 u. / min) considerable fluctuations dispersion RAG and omega-capacity at moderate amplitude negativization last (-38 mV), in conditions of rest, and on the background of negative emotions.

The processing of the recorded indicators revealed the most informativeness for assessing the condition of this patient with questions of the PDT, the Taylor questionnaire, the variance of the RAG and the omega potential.

Over the course of 3 months, the patient underwent a 3-stage remote interactive treatment of dependent behavior with suggestive therapy sessions with the formation of a dominant healthy lifestyle and behavioral stereotype correction programs with the development of an adaptive strategy of self-realization. At the same time, a photograph of the patient before pregnancy was selected as a motivating video image in the form of a permanent splash screen, which was periodically presented to the patient during the sessions of therapy and the implementation of the addiction care program against the background of sound accompaniment, the verbal effect of which was accompanied by binaural sound vibrations with a frequency difference between left and right channels of 5 and 10 Hz, reinforcing, at a subconscious level, the attitude toward refusing to abuse overeating. During treatment and between sessions of suggestive therapy, the level of the patient’s negative attitude toward addictive behavior was assessed by presenting informative questions to her with the TTC and Taylor questionnaire with simultaneous registration of RAG and omega potential.

As a result of treatment, weight normalization, a switch to a balanced diet was observed, which was accompanied by a high level of motivation for abandoning addiction, a decrease in anxiety level, normalization of heart rate (58 beats / min), minimization of the variance of RAG and omega potential with a decrease in its amplitude to - 18 mV, lack of signs of psychotization and neuroticism.

After the correction, the body mass index is 24, the patient is in a state of stable remission for 34 months under the control with a frequency of 1 time in 6 months of the formed dominant by presenting informative questions of the PDT with the simultaneous analysis of RAG and omega potential. According to the biochemical analysis of blood in the clinic at the place of residence: the level of cholesterol in the blood is 5.2 mmol / L, low density lipoproteins - 3.4 mmol / L, triglycerides - 1.12 mmol / L - all indicators of lipid metabolism are normal.

Thus, the proposed method was used to treat 34 people, of whom 20 suffered from alcoholism, 6 from drug dependence and 8 from being overweight. According to the results of treatment, a statistical processing of the results is carried out, presented in tables 1-3.

Table 1
Indicators of the effectiveness of treatment of patients with alcohol dependence (average data for the sample, M ± m, n = 20) Indicator, units At the beginning of treatment After treatment M m M m Duration of remission, months 5 2,5 32 * 1,5 RAG variance, conventional units 7 0.3 3 * 0.2 Dispersion of omega potential, conventional units 8 0.5 2 * 0.3 ECG recording heart rate, bpm 88 3.8 68 * 2,3 Anxiety (according to the Spielberger test), conventional units 8 1 3 * 0.5 Anxiety (on the Taylor scale), conventional units: 1. Neurotic anxiety 6 0.5 3 * 0.3 2. Somatic anxiety 7 0.5 4 1,0 3. Social anxiety 8 0.4 3 * 0.3 4. Frankness 3 0.4 7 * 0.4 Psychodiagnostic test, conventional units: 1. Mental imbalance nine 0.6 3 * 0.3 2. Asociality 6 0.4 3 * 0.3 3. Introversion 7 0.6 3 * 0.3 MPA, points 64 8 17 * 3 Alcoholization scale (STAN), conventional units nine 1,5 3 * 0.5 Scale of lies (STAN), conventional units 2 0.3 1 0.5 Duration of treatment, weeks - - 2.6 0.5 Note: * - the differences compared with the period “At the beginning of treatment” according to the non-parametric Kolmogorov-Smirnov criterion are significant (p <0.05).

As can be seen from Table 1, after a course of treatment for alcoholism, the duration of remissions significantly increased in patients, which was accompanied by a decrease in the total values of the estimates according to the alcoholization scales of the STAN and MPA tests. At the same time, there was a significant decrease in the dispersion of RAG and omega potential, a normalization of the pulse rate and a significant decrease in the levels of anxiety and asociality compared to the period before treatment.

table 2
Indicators of the effectiveness of treatment of patients with drug addiction (average data for the sample, M ± m, n = 6) Indicator, units At the beginning of treatment After treatment M m M m Duration of remission, months 6 2,5 34 * 1,5 RAG variance, conventional units 8 0.3 3 * 0.2 Dispersion of omega potential, conventional units 8 0.5 2 * 0.3 ECG recording heart rate, bpm 86 3.8 64 * 2,3 Anxiety (according to the Spielberger test), conventional units nine 1 3 * 0.5 Anxiety (on the Taylor scale), conventional units: 1. Neurotic anxiety 7 0.5 3 * 0.3 2. Somatic anxiety 5 0.5 4 1,0 3. Social anxiety 7 0.4 3 * 0.3 4. Frankness 2 0.4 7 * 0.4 Psychodiagnostic test, conventional units: 1. Mental imbalance nine 0.6 4* 0.3 2. Asociality 8 0.4 3 * 0.3 3. Introversion 7 0.6 3 * 0.3 Anesthesia scale (STAN), conventional units 8 1 4* 0.5 Scale of lies (STAN), conventional units 2 0.3 1 0.5 Duration of treatment, weeks - - 2,8 0.4 Note: * - the differences compared with the period “At the beginning of treatment” according to the non-parametric Kolmogorov-Smirnov criterion are significant (p <0.05).

In patients with drug addiction (Table 2), after a course of treatment with an average duration of 2.8 weeks, the duration of remissions also significantly increased, which was accompanied by a decrease in the total values of the estimates on the anesthesia scale of the STAN test. Moreover, they noted a significant improvement in the psychoemotional state compared with the period before treatment, confirmed by a decrease in the dispersion of RAG and omega potential, normalization of the pulse rate and a significant decrease in ratings on anxiety and asociality scales.

Table 3
The treatment efficacy indicators for obese patients (averaged sample data, M ± m, n = 8) Indicator, units At the beginning of treatment After treatment M m M m Duration of remission, months 6 2,5 36 * 1,5 Body mass index, points 36 4 25 * 2 RAG variance, conventional units 8 0.3 3 * 0.2 Dispersion of omega potential, conventional units 7 0.5 2 * 0.3 ECG recording heart rate, bpm 82 6 64 * 2 Anxiety (according to the Spielberger test), conventional units nine 1 4* 0.5 Anxiety (on the Taylor scale), conventional units: 1. Neurotic anxiety 7 0.5 3 * 0.3 2. Somatic anxiety 7 0.5 3 * 1,0 3. Social anxiety 8 0.4 3 * 0.3 4. Frankness 3 0.4 7 * 0.4 Psychodiagnostic test, conventional units: 1. Mental imbalance nine 0.6 3 * 0.3 2. Asociality 3 0.4 3 0.3 3. Introversion 7 0.6 3 * 0.3 Duration of treatment, weeks - - 12.3 2,5 Note: * - the differences compared with the period “At the beginning of treatment” according to the non-parametric Kolmogorov-Smirnov criterion are significant (p <0.05).

As can be seen from Table 3, in obese patients after a course of treatment with an average duration of 12.3 weeks, there were significant signs of withdrawal from addictive behavior, a decrease and normalization of body weight, which was accompanied by an improvement in the psychoemotional state.

It should be noted that the presented results allow us to conclude that in all categories of patients with addictive behavior, who underwent treatment with the proposed method, a state of persistent remission.

Table 4
Comparative characteristics of the effectiveness of treatment of patients with dependent behavior (averaged data for the entire sample, M ± m, n = 36) Indicator, units Prototype Proposed method The effectiveness of treatment,% 57 ± 4 88 ± 1 * Duration of remission, months 8 ± 3 34 ± 2 * Safety of treatment (presence of complications),% 13 ± 2 0 * Identification of signs of addictive behavior at the stage of clinical manifestations,% - 14 ± 2 * The number of relapses,% 43 ± 8 12 ± 1 * # Note: * - differences compared with the prototype according to the non-parametric Kolmogorov-Smirnov criterion are significant (p <0.05); # - relapses that were identified at the preclinical stage.

As can be seen from table 4, the treatment of addictive behavior by the proposed method significantly increased its effectiveness compared to the prototype by 1.5 times, reduce the number of relapses, increase the safety of treatment, identify signs of addictive behavior at the stage of preclinical manifestations in 14% of patients, increase the duration remissions compared to the prototype from 8 to 34 months.

Thus, the proposed technical solution allows to increase the effectiveness and safety of treatment due to the in-phase combination of psychotherapeutic procedures with multichannel online monitoring of the current psychophysiological state of patients, which enables timely and dynamic correction of the intensity of impact on the patient's psyche.

In addition, it became possible to enhance verbal attitudes at the subconscious level of patient’s withdrawal from dependence as a result of the fact that therapeutic verbal treatment is performed in stereo mode with binaural sound vibrations in the voice range and adjustable frequency difference along the right and left channels from 30 to 3 Hz , which allows you to enhance the therapeutic effect, increase the duration of remissions and reduce the risk of relapse.

Thanks to the multichannel registration of psychophysiological indicators and psychological testing with the simultaneous automated processing of the results by means of mathematical statistics, it became possible to detect signs of addictive behavior and prevent relapses at the stage of preclinical manifestations of the disease.

Given the fact that it was possible to ensure the use of duplex information transfer via wireless and / or wire communication channels that is easily implemented and accessible for the patient and the doctor, it became possible to treat addictive behavior in the remote dialogue mode between the doctor and patient and to conduct remote monitoring of the remission period.

The method of interactive treatment of addictive behavior, according to the invention, may find application:

- in narcology for the treatment of dependent conditions, including for group psychotherapy of alcoholism, drug addiction and substance abuse of various origins;

- in psychiatry for the treatment of patients with mental disorders and borderline conditions;

- in the practice of family doctors for the prevention of addictive conditions in children and adults, for the effective treatment of tobacco smoking, obesity and neurosis, including in regions far removed from the centers of specialized care and treatment;

- in telemedicine for carrying out preventive and therapeutic measures relating to psychosocial issues of preventing the spread of drug addiction and rehabilitation of patients.

Claims (2)

1. A method of interactive treatment of addictive behavior, including psychotherapeutic, suggestive effect on the patient, sound effect, installation on the formation of negative emotions with the patient focusing on unpleasantly grotesquely emphasized moments of abuse by projecting on the screen of audiovisual devices a video sequence of negative pictures with the formation of positive emotions in the patient when showing positive pictures, characterized in that the psychotherapeutic, suggestive effect is through the channels of audiovisual devices under constant remote monitoring by a doctor, the patient’s psycho-emotional state and level of his attitude toward dependent behavior, for which initial psychophysiological characteristics, omega potential fluctuations, anxiety level, emotional reactions to relevant questions at rest and against negative emotions are recorded first, and against the background of positive emotions, the patient forms the dominant for a healthy lifestyle and a program for avoiding addiction, while improving the psychoemotional In this state, which is controlled by the stability of psychophysiological reactions and the reduction of anxiety level, behavioral stereotypes are corrected with the development of an adaptive strategy of self-realization, then the patient chooses a motivating video image in the form of a constant splash screen of an audiovisual device, activating a previously formed dominant and a program for avoiding addiction, with verbal impact carried out in stereo mode with binaural sound vibrations in the voice range and adjustable times frequency spine on the right and the left channels 30 and 3 Hz. 2. The method according to claim 1, characterized in that in the future periodically conduct monitoring and verification of the effectiveness of the formed dominant and the program of care from dependence.