RU2262953C2 - Method for treating boundary psychic disorders and states of addiction - Google Patents

Abstract

FIELD: medicine, psychotherapy.

SUBSTANCE: one should analyze anamnesis, perform rational psychotherapy and curative psychotherapeutic impact in patient's active state. Moreover, one should diagnose individual disadaptive cognitive-behavioral style of patient's psychological reactions to negative factors, with the help of which the patient process these negative factors, and, also, accompanying mimics and pantomimics. At the first stage of curative psychotherapeutic impact one should develop adaptive patient's integrative reactions to negative factors being contrast against disadaptive and being ahead by time of appearance with the help of a card, in the left side of which there is a text containing information on detected disadaptive cognitive-behavioral style, and in its right-hand part - text that contains opposite information about adaptive cognitive-behavioral style. Moreover, left-hand part should be deleted, patient should repeat it impressively, in one's mind, by imaging negative images along with mimics and pantomimics of disgust, and right-hand part should be spoken expressively loudly by strengthening it with positive images and combining it with adequate pronounced mimics and pantomimics. After learning the text one should cut the left-hand part of the card ff and throw and keep the right-hand part. At the second stage one should neutralize disadaptive cognitive-behavioral style with physical exercises, manipulations and pharmacological preparations that lead to negative feelings. At the third stage it is necessary to prepare a patient to apply developed adaptive integrative reactions under conditions of modeling the contact with negative factors with the help of successively performed visualization and role trainings. Therapy course consists of 7-10 seances of 1-2 h duration.

EFFECT: higher efficiency of therapy.

Description

The invention relates to medicine, namely to psychotherapy. Diseases of the 20th century migrated to the 21st century, not only without changing its composition and specific gravity among various types of centuries-old pathology of mankind, but also supplemented with new diseases. The competence and points of application of psychotherapy cover the entire spectrum of these noogenic disorders and can be directed both to their treatment and to prevention. However, the arsenal of such impacts is still insufficient and requires further strengthening and strengthening.

There is a method of treating neurosis-like and borderline conditions (RU 2089231, class IPC A 61 M 21/00, 1996), which includes conducting individual and / or group psychotherapeutic effects, at the preliminary stage of which history data are collected and evaluated, the dynamics of somatic suffering are studied, at the first stage of the session, taking into account the obtained diagnostic data and the etiology of the disorder, the method of rational psychotherapy provides a sedative and distracting effect, at the second stage an extensive psychotherapeutic the effect, first in the waking state, and then in the state of hypnotic trance, carry out motivated suggestion, including clarification and activating suggestion using unconditionally reflex reinforcement, create a psychotherapeutic depot at the third stage, and at the preliminary stage, the dominant hemisphere of the patient’s brain is additionally determined and at the stages treatment session in patients with left dominant hemisphere, rational psychotherapy, suggestion and suggestion is carried out using of the lolesynological aspect of communications, and in patients with the right dominant hemisphere, using perceptually-shaped representations, while at the final stage of the session in patients with the left dominant hemisphere, the main suggestion formulas are reflexively associated with a deep breath, and in patients with the right dominant hemisphere, with touch to the left shoulder and additionally, when a patient with the right dominant hemisphere is withdrawn from a state of hypnotic trance, they are shown a green screen using verbal th suggestion help to present on the screen image of the ring, after 5 minutes show a real image of the screen ring, wherein at each treatment session next ring diameter is reduced and at the last session demonstrate point. When conducting group psychotherapy, the group is formed in such a way that it includes patients with the identical dominant hemisphere.

The disadvantage of this method is the one-sided approach, based on the neurophysiological principles of interhemispheric asymmetry and the theory of conditioned reflexes, which are only one of the foundations of human behavior and play a role in organizing mainly simple behavioral acts. The method is not effective enough, since the occurrence of disorders for the treatment of which it is intended is associated with problems of a personal level, which are hardly corrected by the proposed techniques.

There is also known a method of treating diseases caused by psychological dependence (application No. 97106416/14, class IPC A 61 M 21/00, A 61 H 39/08, 1997), including the formation of a patient's state of intense expectation, which is created using advertising conducting a treatment session, consisting of three parts, in the first part of which anosognosia is eliminated by the methods of rational psychotherapy, form the patient’s feeling of unacceptability of the state in which he is in, and explain the possibilities of overcoming this condition, in the second part of the session The patient’s patient is brought into a state of light trance and a therapeutic suggestive effect is performed, in the third part of the session, the required psycho-emotional state is formed by the method of acupuncture, against which, with the help of words, music and visual images, continuing the suggestive effect, inhibit the pathogenic psychological factor, switch the patient’s attention and increase the patient’s attention sensations that compensate for the missing components of the psycho-emotional sphere. The psychotherapeutic information of the first part of the session is included in a staged performance lasting at least 60 minutes, an obligatory element of which are two lines - a dark and a light line, a dark line contains information regarding all manifestations of the disease and painful behavior, and the light line interprets the necessary actions and recommendations for recovery , a dark storyline is realized against a background of red, and / or blue, and / or moonlight-like backlight and music of minor and / or frightening content with a low timbre, m with a reverb, speech effect is carried out in a low voice, in slow motion, with frightening intonation, and a bright storyline is realized against a background of white and / or pale pink backlight and / or sublime music, speech effect is carried out in an emotionally warm style, in the second part of the session, which lasts at least 15 minutes, the psychotherapeutic information of the first part of the session is presented in the form of imperative suggestion against the background of relaxing music, and the third part is carried out no later than 34 minutes after the end of the second part of the session of treatment, immediately after inserting the needles, the patient is put on headphones through which they are presented with all the audio information for at least 20 minutes concentrating the patient's attention on the sensations under the needles, suggesting that the greater the focus on these sensations, the stronger the therapeutic effect, while the verbal suggestion arrange musical compositions that were used in the first and second parts of the treatment session.

However, the method has a number of disadvantages limiting its use: it is characterized by the absence of therapeutic effects on the deep foundations of psychological dependence, laboriousness, and requires material equipment — a color-music setting and additional knowledge of acupuncture by a psychotherapist.

As the closest analogue, a method has been adopted for the treatment of borderline mental disorders and addiction states using conditioned reflex therapy (Fedorov A.P. Cognitive-behavioral psychotherapy. St. Petersburg: Peter, 2002, pp. 11-163), including self history analysis and rational psychotherapy. Its basis is the theory of the conditioned reflex of IP Pavlov, explaining behavior as a result of “learning and learning.” In accordance with this, they carry out the actual therapeutic effect by positively reinforcing appropriate, consistent with the goals of treatment behavior - adaptive or free from manifestations of addiction - with the help of "tokens" - pleasant effects for a person, praise, gifts, awards, etc. Due to the negative reinforcement with the help of unpleasant influences, playing the role of a disguised or explicit punishment, for example, with the help of criticism, ignoring, permissible discharges of electric current, etc., they stimulate the rejection of undesirable, inappropriate behavior - maladaptive or associated with one form or another of dependence.

The disadvantages of this method are: the mechanistic approach and effects, a simplified, one-sided understanding of the basics of human behavior as the sum of conditioned reflexes, a small representation of cognitive-rational influences. In this regard, the patient is not sufficiently aware of the causes and essence of his illness. The method has a long treatment time, does not allow to obtain a stable therapeutic effect.

The objective of the invention is to provide a highly effective method of treating borderline disorders and addiction, with wider functionality and versatility, which allows to obtain a more stable therapeutic effect in a short time.

The essence of the invention lies in the fact that in a method of treating borderline mental disorders and addiction conditions, including anamnesis analysis, rational psychotherapy and therapeutic psychotherapeutic effects in the patient’s wakeful state, an individual maladaptive cognitive-behavioral style of the patient’s psychological reactions to negative factors is diagnosed, revealing features formulations by the patient of his problem, its interpretation, concept, associations, terms and images with which he processes and submits these negative factors, as well as the facial expressions and pantomime associated with them, at the first stage of the therapeutic psychotherapeutic intervention, the patient forms adaptive integrative reactions to negative factors that are contrasting to maladaptive and are ahead of their time of occurrence using a card, on the left side which contains a text containing information about the identified maladaptive cognitive-behavioral style, in the form of a formulation of the problem, its concept, terms, associations, and times, and on the right side text containing opposite information about adaptive cognitive-behavioral style, with the left side crossed out, thus giving the dominant character of the information located on the right side of the card, sequentially work with the text of the left and right parts, while the left part the patient speaks impressively, to himself, presenting negative images, accompanying them with facial expressions and pantomimes of disgust, and the right part speaks expressively out loud, reinforcing with positive images and combination with adequate expressive facial expressions and pantomime, after memorizing the text, the left part of the card is cut off and discarded, symbolically demonstrating the rejection of the maladaptive style, and the right part is retained and carried with it, at the second stage they completely neutralize the maladaptive cognitive-behavioral style, carrying out its negative reinforcement by physical exercises , manipulations and pharmacological drugs that cause negative sensations, at the third stage prepare the patient for the use of the formed adapt integrative reactions in conditions of modeling contact with negative factors using sequential visualization and role-based trainings, at the fourth stage, the effect is fixed by dynamic observation and the necessary correction of deviations from adaptive cognitive-behavioral style, the treatment course includes 7-10 sessions, lasting 1-2 hours.

Using the invention allows to obtain the following technical result.

The method is highly effective. The achieved result is stable. The onset of a positive effect in the form of a reduction in the manifestations of borderline mental disorders and dependence is observed in all patients already at the first session, in the future it is steadily increasing and supplemented by positive changes in their lives. A pronounced and stable therapeutic effect is achieved in a short time - in 7-10 days.

The method has a wide range of indications, including neurotic disorders, personality and behavior disorders, affective disorders, psychosomatic disorders, addictive states (anorexia nervosa and bulimia nervosa), substance dependence (alcoholism, drug addiction, substance abuse, tobacco addiction), psychological dependence in relation to individuals, as well as bad habits and any other disorders associated with psychogenic factors.

Another direction of using this method is the psychoprophylaxis of borderline mental disorders and addiction states, the development of adaptive abilities in mentally healthy individuals, and immunity to traumatic effects that are inevitable in the life of every person.

The skills acquired during the treatment are aimed at application in real conditions, including imperceptibly to others, without stopping the main activity or communication, especially in situations of direct exposure to negative factors that trigger abnormal behavior.

Contraindications to the use of this method are only acute psychotic conditions and dementia.

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

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

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

The technical result is achieved by combining cognitive psychotherapeutic influences on the deep conceptual foundations of personality behavior with a wide parallel coverage of the verbal-logical and psychosensory spheres with the involvement of somatopsychic (bodily-psychic) interaction mechanisms. During treatment, due to training and positive reinforcement, the patient achieves fixation of psychological reactions in the patient, integrating adaptive leading reactions at all levels of the mental organization when faced with psycho-traumatic factors and other influences that provoke the manifestations of the disease. While manifestations of a maladaptive cognitive-behavioral style, which is the basis of borderline mental disorders and addiction states, are reinforced negatively, achieving their neutralization. This allows you to achieve sustainable adjustment and replacement of negative behaviors with positive, adaptive, excluding the development of this pathology.

The method is as follows.

After establishing adequate psychological contact with the patient, an anamnesis and personality characteristics are analyzed, an individual maladaptive cognitive-behavioral style of the patient’s psychological reactions to negative factors, as well as facial expressions and pantomimics, are diagnosed. The cognitive element of this style is a specific way of understanding, interpreting, presenting actual problems, psycho-traumatic and other factors important for the development of a disease, characteristic of a given patient, as well as the concepts underlying this understanding. The behavioral element includes attitudes arising from these cognitive prerequisites (models, stereotypes, habitual behaviors, psycho-emotional responses). Normally, a person uses an adaptive cognitive-behavioral style that helps to overcome stress, borderline mental pathology and the phenomena of dependence arise when using maladaptive styles.

In the process of diagnostic work, they strive to detect the most profound (“deep”, “nuclear”) concepts underlying the cognitive-behavioral style, less conscious, but at the same time having a decisive influence on human behavior, on which superficial, dependent concepts are based realized to a greater extent.

They study individual terminology regarding the specifics of the words and formulations used, related to the subjective name of the problem and the description of its content.

Identify verbal and figurative associations associated with words related to the problems of the patient. They cover as much verbal-semantic material as possible and for each stimulus word they get several words and images associated with it.

They specify which images and from which sensory systems the patient uses when thinking about psychotraumatic factors and his disease.

Non-verbal - mimic and pantomimic manifestations characteristic of the patient's experiences are evaluated.

Based on the history and clinical and psychological diagnosis in the process of rational psychotherapy, the patient is explained the mechanisms of development of his disease and the features of the proposed method of treatment.

Then conduct a sequential therapeutic psychotherapeutic effect in the waking state of the patient.

At the first stage, in order to ensure the timely inclusion of all elements of the adaptive cognitive-behavioral style in the future encounter with negative factors provoking unwanted behavior, the patient forms adaptive integrative reactions to them, contrasting with the initial, maladaptive and ahead of them in time of occurrence. The trained, timely inclusion of such an adaptive attitude creates the basis for successful control of emotions and behavior, displaces previous pathological behavioral stereotypes characteristic of maladaptive style.

Leading integrative adaptive reactions are a complex (integration) that combines cognitive-verbal (mental-verbal, verbal-logical) and non-verbal (psychosensory, sensory-figurative, visual-figurative, visual-effective, facial-pantomime) levels of organization of behavior. Both levels undergo correction, maladaptive stereotype is replaced by adaptive.

Correction of the cognitive-verbal part includes the training of cognitive oppositions. With its help, interpretations, concepts, problematic terminology and associations that are opposite, contrasting, polar, positive with respect to the initial negative ones identified earlier are recorded in the patient’s memory.

The sequence from interpretations to associations is chosen to form the patient’s belief in the validity and acceptability of new, contrasting concepts and formulations, and then associations, which in this case are learned more effectively.

Contrasting interpretations - this is a new, adaptive, eliminating the occurrence of abnormal reactions, a look at problems relevant to the patient, the opposite of the original, disadaptive look. It represents a more adequate interpretation of traumatic events, for the adoption of which the patient is individually individually required number of sessions of rational psychotherapy and suggestion.

At the same time, they explain and inspire that the psychological reactions of a person to external influences entirely depend on how he interprets, presents these influences to himself, based on his own concepts (beliefs) and life experience: a negative interpretation entails negative reactions, positive - positive.

The patient is also explained and encouraged that the beliefs and interpretations of a person have their own terminology characteristic of a given individual — names and formulations relating to the verbalization of the content of various topics, including problem ones, which also have significant psychological effects. In order to change the psychological reaction to any effect, it is necessary to change the subject's interpretation of this effect, its foundations (concepts, attitudes) and related terminology.

For example, negative interpretative terminological material:

“This is so humiliating, so terrible that they insulted me” is replaced by a contrasting statement: “Let it exalt me. It’s good that they insulted me - I got to know this person more deeply and got an incentive to become more perfect, to master the techniques of influencing myself and others. ” Or instead of “It’s intolerable that my husband left me” they accept “It’s a relief, it’s happiness that the husband has left - certainty has appeared. Living in a suspended "state", without firm support, humiliated by deception and neglect is much harder. Now I can straighten my shoulders more freely and create a full-fledged family. If I want. "

For the most effective impact, the identified “deep”, “nuclear” concepts underlying the inadequate, maladaptive interpretations are contrasted with others that are contrasting to them. It should also be significant, deep, fundamental concepts that allow us to form a number of appropriate, adaptive interpretations coming from them.

So, the “nuclear” sociophobic concept: “Life is scary, people are dangerous, I am weak and inferior” is replaced by a contrasting contrast: “Life is not so scary, people are not so dangerous, and I am not so weak and inferior to hide from everything. With my over-caution, I can avoid any trouble, but to be honest, there were no special troubles before. I, like everyone else, do not have to be an ideal. Why scare yourself with something that has not happened and may never happen? So you can get to the point of absurdity. I still have to communicate. I will derive from this useful and pleasant. ”

Or as a contrast to the “deep” hysterical: “I am so good that everyone should notice it and love me”, they contrast it with “I, like everyone else, is not perfect, the love of others for me is proportional to what I do for others, and then, normal human nature does not oblige even in this case these others to love me. True good is that which is not done for the sake of retribution. ”

Positive interpretations and concepts are combined with a new, identical re-formulation of the name and content of the problem, which is polar, contrasting with the initial, traumatic terminological options. The adoption of a new formulation of the name, the name of one’s problem, situation, oneself or other people, in accordance with their new, positive meaning, causes contrasting reactions, instead of negative ones - positive ones. For example, the self-name “abandoned” is reformulated as “free”, “dropped the chains of family slavery”, “divorce” is replaced by “release” or “reorganization”, etc. After the change of formulations, the former no longer use.

Given individual acceptability, paradoxical interpretations and terminologies are used regarding traumatic factors. So, one of the patients with anxious psychogenic depression and panic attacks, who suffered rape in the elevator instead of the previous negative interpretations and terminology of this trauma, which caused the corresponding complex of negative emotional reactions, used a positive, paradoxical option that had a good desensitizing, emotionally positive effect: “ Not so long ago, an uncle made love in an elevator with me, and I, silly, was scared, although I could have fun. ”

A contrasting reformulation of the problem name or alias can also be paradoxical. For example, one of the patients with claustrophobia in the form of an obsessive fear of elevators successfully used the name "elevator" instead of an elevator. In other cases, “heart attack”, “cystitis” and “urethritis” successfully changed heart attack cystitis and urethritis, on which anxiety-hypochondriacal fixation was formed in different patients, and the formidable rowdy husband and alcoholic Vasily, receiving the pseudonym “Boar Vasyutka”, began to cause less anxiety and longing for his tormented wife, which allowed her to more effectively influence his behavior.

The associative part of the training of contrasting contrasts is carried out on the basis of associations identified earlier at the diagnostic stage that arise when words from the field of pathogenic topics are presented. For this, associative counter-complexes are built - sets of words that are opposite in meaning to stimulus words from a number of pathogenic ones.

To increase the effectiveness of contrasting associations and expand the scope of the healing associative influence, they are additionally reinforced by secondary association with additional words, concepts and images that carry the desired emotional effect. This is carried out according to the following scheme: pathogenic associative stimulus - primary contrasting association - secondary association (or sequence of associations).

After this preliminary work on the definition and adoption of new, contrasting interpretations, concepts, reformulations and associations, they proceed to their fixation, memorization.

For the successful fixation of cognitive oppositions use the use of compact cards, divided into 2 halves. There may be one or more of these cards, depending on the number of problematic topics. Using the appropriate terminology, the left side of the card is used to write down the initial, maladaptive variants of contrasts; on the right side, to demonstrate dominance, contrasting with them, adaptive (for left-handed people use the opposite ratio).

The text of each option has the following structure: The patient's formulation of his problem - Interpretation - Concept - Terms - Associations - Images - Facial expressions and pantomime.

The initial options are thought through or read impressively, to oneself, the contrasting versions are verbalized, pronounced aloud, expressively, in order to fix them more clearly, while changing the sound and speech characteristics accordingly - they use those intonations and the degree of volume that most adequately reflect the contrast sound oppositions. The card (s) are constantly carried with them to memorize medical material and train to use it when faced with traumatic situations or when thinking about them.

The left side is crossed out, thus giving the dominant character of the information located on the right side of the card, they successively work with the text of the left and right parts of the card, while the patient speaks the left side impressively, imagining negative images, accompanying them with facial expressions and pantomime of disgust , and the right part is pronounced expressively aloud, reinforced by positive images and combined with adequate expressive facial expressions and pantomime.

After the stage of memorizing the text, the patient periodically (from 10 to 20 times a day, depending on the depth of the disease) at the set time or unexpectedly presents pathogenic stimuli: they call words, ask questions, discuss topics related to his problems. Based on the answers that arise, they evaluate the stability of fixing contrasting associations, interpretations and reformulations, achieve a good effect of reproducing contrasting contrasts. These presentations during the sessions are carried out by the therapist, and at home - the patient's relatives who have received appropriate instructions or the patient himself.

As the quality of reproduction of positive cognitive oppositions improves, psychosensory contrasts are added to them. They are oppositions within one or another sensory system, which are more developed in the patient and / or are more involved in negative experiences.

Visual contrasts are a series of successive changes in the image reflecting the disease, contrasting with it, showing a non-pathological model of behavior. Initially, at the stage of mastering technology, they are presented separately from cognitive oppositions. Then, when both contrasting variants will be reproduced successfully, the negative image is presented together with negative cognitive material, and the positive, respectively, with the positive.

If the images relate to the correction of the “pattern” of one’s own reactions, then they use a remote version of visualization with the presentation of their copy or part of themselves (for example, a hand reaching for a glass of alcohol, a cigarette or a sweet one and approaching further to one’s own face). This allows you to alienate, distance the given behavior pattern from the subjective "I" of the patient from the very beginning. For opposite purposes, associated visualization is used - a “as in life” vision, which allows you to integrate a person with more appropriate behavior.

If the patient has developed reactions of disgust, nausea or vomiting with his consent, use an aversion reinforcement of the visual images of the disease. So, with alcoholism, aversive reactions are instilled with the visual representation of the unsightly sides of alcoholic excesses and degradation patterns, with hysteria or explosiveness - against the background of the corresponding hysterical or aggressive attacks.

Contrast images represent in series, the required number of times, the criterion of success is the patient’s emotional state - the appearance of reactions that contribute to getting rid of the disease. Image changes are made at different speeds, but it’s more efficient not to linger on the behavior pattern being eliminated for a long time, while the image selected for fixation is kept for longer, which allows a more positive image to be acquired.

For the same purpose, the images of eliminated behaviors are presented with weakening of parameters (brightness, color, size, distance to them, etc.), and images of preference, on the contrary, with an increase in these parameters. Paradoxical additions and modifications of the negative image are also effective. So, a negatively acting person can be represented in a diving suit, a ballerina’s robe, or with some physiognomic additions. In an appropriate paradoxical way, you can imagine your copy in a traumatic situation in contact with negative objects. For example, with a phobia of the subway, the patient can visualize himself there, in felt boots and with balloons.

According to a similar scheme, therapeutic effects are carried out within the auditory system, but auditory ones are used instead of visual images. Negative, pathogenic images are replaced by contrasting positive images in relation to them, weakening their effect. Both those and other images can be both memories and new designs. In addition to content, contrasting changes in auditory images can affect the volume, the rate of introduction of paradoxical elements, the peculiar "arrangement" of negative verbalism (psycho-traumatic statements): layering the musical background, turning speech into singing, listening to negative statements backwards. All this is reproduced both impressively, inwardly and expressively, aloud. Arias, mini-operas and mini-operets can be written in which, with the participation of other persons, they play a traumatic plot that loses its negative charge due to such a contrast-paradoxical contrast. The effects of the same level include the appointment for some time or within any situations of the silence mode.

In the presence of “interest” in the disease process and good psychotherapeutic capabilities, the olfactory system uses contrast reproduction of the corresponding odors. More often they perform a load of adequate support, a positive or negative background for manipulations within other systems and levels.

The auditory and olfactory contrasting contrasts as they are mastered, followed by the visual contrasts are gradually attached to cognitive contrasts.

Further, to this complex (integration) of cognitive and psychosensory oppositions for the formation of a stereotype of integrative leading adaptive reactions that occur earlier (ahead of) than maladaptive reactions and have a multilateral psychotherapeutic effect, contrasting positive and negative body-fixed - mimic and pantomimic - components are added. They are also fixed on the card for more accurate memorization and reproduction. At the same time, negative variants of cognitive and psychosensory constructions are accompanied by a non-verbal expression of reactions of disgust and rejection in order to increase the tendency to refuse a pathological form of behavior, and the opposite positive variants of oppositions are combined with a non-verbal expression of positive emotions to fix a form of behavior that corresponds to the norm.

From the moment when the whole stereotype of integrative anticipatory adaptive reactions, contrasting positive contrasts is clearly reproduced, the left, negative part of the card is cut off and thrown away - this indirectly inspires, symbolically demonstrates complete liberation, a final rejection of a maladaptive style of behavior.

The right, positive part is preserved and carried for an indefinite period of time, demonstrating the adoption of an adaptive cognitive-behavioral style.

At the second stage, which they begin after mastering the manipulations of the first stage, they completely neutralize the maladaptive cognitive-behavioral style, carrying out its negative reinforcement by physical exercises, manipulations and pharmacological drugs that cause negative feelings. These effects are imitational in the form of pseudo-effects, placebo. Thus, they strengthen the body-fixed level of psychotherapeutic assistance.

The true goal of these physical exercises, pseudo-acupressure (placebospressure) and placebo-pharmacotherapy is the formation of a conditioned reflex that suppresses abnormal, negative behavior, hidden coercion to refuse it, the creation of conditions that burden the disease, depriving it of profitability. The patient subconsciously prefers to abandon the retention of symptoms in order to avoid these "medical prescriptions." It is important that he does not know their true nature.

The patient is prescribed to take individually accessible uncomfortable postures - asanas from the yoga system, exercises with holding general or local muscle tension for a certain time, “stretching”, various options for “twine”, bringing your hands into a “lock” behind your back, holding heavy objects, dumbbells in hands, etc. After fixing them for as long as possible, they take the most comfortable posture and realize the pleasant sensations in contrast. This allows a deeper understanding of the burden of such activities.

In addition, they give instructions to perform acupressure, while choosing points of pain sensitivity, for example, He-Gu, tragus auricles. Relatives of the patient are also attracted to the “massage” with the coverage of these sensitive points, especially when working with children.

Additionally, the patient is prescribed nicotinic acid (tablets of 0.05 g in single doses for children - up to 0.025-0.05 g, for adults up to 0.15-0.5 g, daily doses for children - up to 0.15 g ., for adults - up to 1 g) or xanthinol nicotinate for resorption in the oral cavity (0.15 g tablets in single doses for children - 0.03-0.05 g, for adults - up to 0.15 g. daily doses for children - up to 0.15 g, for adults - up to 0.9 g) with an individual frequency (from one to several times a day) in dosages that create unpleasant sensations.

Taking into account the patient’s preferences, spot rubbing of Finalgon ointment containing nicotinic acid and pepper extract can be used in areas not in contact with the mucous membranes. The ointment is applied pointwise on “interested” parts of the body - for example, on the hands or fingers, if it is necessary to block manual stereotypes with tics or pathological dependence, on the forehead, if it is desirable for the patient to “think more”, etc. Similarly, a solution of ammonia is used to smell or rub the forehead, temples and individual sections of the hands.

All these exercises, pharmacological agents, influences and tasks are used at a low rate of recovery, and are used for each relapse of the symptoms of the disease. They are presented to the patient as "neurophysiological", "somatopsychic", "pharmacological (" biogenic stimulants "," amino acids "," nootropics ") or acupressure agents that stimulate biological defense and self-regulation systems that save the nervous system from the damaging effects of stress." They explain to children that these are medicines, points and exercises that “scare away” sadness, fear, training character, etc.

For the same purposes, at this stage, the patient himself or his relatives carry out verification, "weighing the symptoms" or "test to identify the truth." Initially, they perform suggestive training - they propose to compare the truth and depth of unpleasant experiences and sensations typical of a given patient with other, mainly physical experiences and sensations. As such, the “acupressure” effects described above or intense compression of the skin fold, for example, in the dorsal region of the forearm, are used. They explain to the patient that for a deeper understanding of the degree of symptoms that concern him, it is necessary to conduct a similar “test” each time they occur, independently or with the help of relatives. The result, as a rule, is the gradual extinction of the initial symptoms, which are neutralized by such a "weighting of symptoms."

At the third stage, with the help of visualization and role-based trainings, they prepare the patient to use the acquired skills in the context of modeling contact with negative factors that provoke a stereotype of maladaptive behavior. To do this, two types of trainings are carried out sequentially and achieve the timeliness of the inclusion of integrated leading adaptive reactions.

At the first, visualization training, they improve the application of acquired skills to create an adaptive reaction with the visual presentation of the negative factors characteristic of a given patient’s disease.

At the second, role-based training, to which they pass after the successful completion of the first, modeling is carried out closer to life, playing out problem situations, during which they learn the exercises. Role-based training involves staff, other patients or relatives of the patient.

The criterion for the success of both trainings is the degree of confident removal of negative emotions. If there are positive results, the acquired skills are used further in conditions of real contact with traumatic factors.

At the fourth stage, the effect is fixed by dynamic observation and the necessary correction of deviations from adaptive cognitive-behavioral style. To increase the degree of sustainability of the successes achieved during treatment, taking into account individual needs, supportive sessions are carried out.

A method of treating borderline mental disorders and pathological dependence is carried out in the form of daily sessions or at intervals of 2-3 days, individually, in a group or with the involvement of the family. The duration and number of sessions are individual, on average, from 7 to 10 psychotherapeutic sessions lasting 1-2 hours are required.

Claims (1)

A method of treating borderline mental disorders and addiction conditions, including an anamnesis analysis, rational psychotherapy and therapeutic psychotherapeutic effects in the patient’s wakeful state, characterized in that they diagnose an individual maladaptive cognitive-behavioral style of the patient’s psychological reactions to negative factors, while revealing the peculiarities of the patient’s formulation of his problem , its interpretation, concept, associations, terms and images with the help of which it processes these bliss At the first stage of the therapeutic psychotherapeutic influence, the patient factors, as well as the facial expressions and pantomimics that form them, form adaptive integrative reactions to negative factors that are contrasting to maladaptive and are ahead of their time of occurrence using a card, in the left part of which is placed a text containing information on the identified maladaptive cognitive-behavioral style, in the form of a problem statement, its concept, terms, associations and images, and on the right side is a text containing information about the adaptive cognitive-behavioral style, sequentially work with the text of the left and right parts, while the left side is crossed out, the patient pronounces it impressively, imagining negative images, accompanying them with facial expressions and pantomime of disgust, and the right part is pronounced expressively out loud, reinforcing with positive images and combining with expressive facial expressions and pantomimony adequate to them, after memorizing the text, the left part of the card is cut off and discarded, and the right part is stored and carried with you, the second stage completely neutralizes the maladaptive cognitive-behavioral style, carrying out its negative reinforcement by physical exercises, manipulations and pharmacological drugs that cause negative feelings, at the third stage prepare the patient to use the formed adaptive integrative reactions in the context of modeling contact with negative factors using sequential visualization and role-based training, the course of treatment includes 7-10 sessions, long Stu 1-2 hours, to secure the effect obtained is carried out dynamic monitoring and taking into account the individual need performed supporting sessions.