RU2725339C1 - Andreev's method for psychotherapy of drug addictions - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention can be used for emotional stress psychotherapy of drug addiction. Anosognosia is removed to drug addiction. Dependence development diary is made. Adaptive potential of the circulatory system is determined according to R. M. Bayevsky. If adaptation capacity is 3.50 and less units, static physical exercises are performed within 10–15 days. If observing improvement of static exercise performance as compared to the background ones by 2–3 points according to the table contained in the description, group or individual emotional stress psychotherapy is performed. Psychotherapy consists of an introductory part, in which patients are exposed to social and personal problems of drug addiction, the main part - stress psychotherapy by A. R. Dovzhenko, during which positive emotional-behavioural motivation is reinforced to recovery and healthy lifestyle, and final, where patient is prescribed psychotherapeutic pledge on abstinence from drug use with bringing information on negative consequences in case of code violation.EFFECT: method enables detecting significant experiences, generating motivations for the effectiveness of treatment by individual static physical exercises and emotional stress psychotherapy of the drug-addicted patients.4 cl, 1 tbl, 3 ex

Description

The invention relates to medicine and can be used for the treatment and rehabilitation of patients with alcohol and drug dependence syndrome.

A known method of psychotherapeutic treatment of patients with alcohol dependence [Auth. testimonial. 1165392 A USSR. IPC A61H 39/04. Method A.P. Dovzhenko treatment of chronic alcoholism / Dovzhenko A.R .; Kharkov, scientific researcher Institute of Neurology and Psychiatry. V.P. Protopopova. Application No. 2969611 / 28-13, declared 08/01/1980; publ. 07/07/1985, Bull. 25. Dovzhenko A.R. Organization, stress therapy of patients with alcoholism on an outpatient basis (work experience): method, recommendations / resp. for issue. P.V. Voloshin; USSR Ministry of Health [et al.]. M., 1984. 12 pp.], However, with this method, patients do not keep diaries of the development of addiction and the formation of volitional qualities and motivation for treatment, and the deactivation of significant experiences and situations indicated in the diaries enhances the emotional and behavioral motivation for recovery and a healthy image of life.

A known method of body-oriented psychotherapy [Pat. 2016135882 RU. IPC A61H 1/00, A61M 21/00. The method of body-oriented psychotherapy / Filippov NB Application No. 2016135882/14, 09/05/2016. Publ. 05/21/2018, Bull. No. 15] in which patients undergo a combination of psychotherapeutic sessions with static psychophysical exercises aimed at overstraining the muscles, such as muscles of the lower extremities, muscles of the abdomen, buttocks and pelvic floor, muscles of the upper limbs and cervical-collar zone, after which there is a decrease in constant increased muscle tone under stress. After a series of static exercises, it is recommended to perform several relaxing breathing psychophysical exercises to relieve muscle tension.

There is also known a method of body-oriented psychotherapy [Pat. 2584088 RU. IPC A61H 1/00, A61M 21/02. A way to deal with stress / Boldyreva A.G. Application No. 2014135688/14, 09/03/2014. Publ. 05/20/2016, bull. No. 9], in which during phased psychophysical exercises to relieve stress, patients are advised to perform respiratory gymnastics and concentration training in calm deep breathing against the background of static exercises.

The closest analogue of the claimed invention is a method of rehabilitation of patients with a syndrome of dependence on psychoactive substances [Pat. 2203015 RU. IPC A61H 1/00, A61M 21/00, A23L 1/29. A method of antidepressant effects on the emotional and affective sphere of a person and a method of rehabilitation of patients with a syndrome of dependence on psychoactive substances and patients with emotionally affective disorders / Marshak Ya.I., Voronenko P.A. Application No. 2001108387/14, 03/29/2001, publ. 04/27/2003, Bull. No. 12], combining the use of psychotherapy, nutritional supplements, complexes of respiratory, dynamic and static physical exercises. Patients perform static exercises in the form of holding certain postures until overcoming uncomfortable sensations.

The closest analogues from the field of technology have not been identified.

Achievable when using the present invention, the technical result is the identification of significant experiences of patients, the formation of motivation for the effectiveness of treatment through individual static physical exercises and increasing the effectiveness of emotional stress psychotherapy for patients with drug addiction.

The technical result is achieved by the fact that the method of emotional stress psychotherapy for drug addiction includes the removal of anosognosia for drug addiction, the compilation of a developmental diary for identifying significant experiences and situations that contribute to drug use, and assessing the background indicators of the adaptive capacity of the circulatory system according to P.M. Bayevsky, after which, based on their state of health and age, they are prescribed an individually selected set of static physical exercises for 10-15 days and a group (individual) emotional stress psychotherapy consisting of an introductory part, in which patients are exposed to the social and personal problems of drug addiction, the main part - stress psychotherapy according to A.R. Dovzhenko, during which they reinforce a positive emotional and behavioral motivation for recovery and a healthy lifestyle, and the final one, where the patient is given a psychotherapeutic vow to abstain from taking drugs with information about the negative consequences of code violation. This allows you to increase the effectiveness of psychotherapeutic treatment of patients with drug addiction.

After performing a set of dynamic physical exercises, muscle relaxation is not carried out, and the development of endurance and tension in the muscles is identified with the formation of motivation for refusing to take drugs. Tension in the muscles creates a certain discomfort (unexpressed stress state) against which the suggestive effect on the emotional and behavioral motivation for recovery and a healthy lifestyle improves during a session of emotional stress psychotherapy.

The dominant is created for patients - the formation of the best results on the proposed static physical exercises as a guarantee of getting rid of drug addiction, which, among other things, provides an increase in the period of abstinence from taking drugs before a psychotherapy session and, on the whole, increases the effectiveness of psychotherapeutic treatment.

Indication for a session of emotional stress psychotherapy is to improve the performance of static physical exercises compared to the background by 2-3 points calculated by the method of variation statistics. Due to significant differences between patients by age, period of drug use, functional reserves of the body, and other data, the median, upper and lower quartiles of absolute exercise performance in seconds, which were converted into points, were calculated by the method of nonparametric statistics. 1 point indicates poor results (less than the lower quartile), 2 points - the range is greater than the lower quartile, less than the upper quartile, 3 points - more than the upper quartile. Thus, the increase in the results of the exercises probabilistically testified to the patients' desire to get rid of drugs and strengthened the positive emotional and behavioral motivation for recovery.

Identified significant experiences and situations that contribute to the use of drugs, which patients point to in diaries, are deactivated during a psychotherapeutic session, which enhances the emotional and behavioral motivation for recovery and a healthy lifestyle.

Thus, the distinctive features of the present invention is an individual selection of static physical exercises, after which relaxation is not carried out, the development of endurance of tense muscles is identified with the formation of motivation for the success of psychotherapeutic treatment, the creation of a certain muscle discomfort increases the suggestive effect on the emotional and behavioral motivation during the session emotionally -stress psychotherapy, and deactivation of significant experiences and situations that patients note in diaries improves the effectiveness of treatment.

The proposed method is implemented as follows.

At the first visit to patients, a medical history is collected, the level of anosognosia to drug dependence is assessed. According to the developed scheme, the task is given to fill out a diary on the development of addiction to identify significant experiences and situations associated with the negative impact of drug use on life.

The background assessment of the psychophysiological reserves of the body was calculated by the adaptive potential of the circulatory system according to R.M. Bayevsky [Zhizhenina L.M., Klokova TB Methodical development of a research lesson to determine the adaptive potential of the circulatory system in the school course of biology of grade 8 // Young scientist. 2016. No. 12. S. 863-865. URL https://moluch.ru/archive/116/31401/]:

AP = 0.0011 ⋅ PP + 0.014 ⋅ GARDEN + 0.008 ⋅ DAD + (0.009 ⋅ MT) -0.009 ⋅ P + 0.014 ⋅ B-0.27,

where AP is the adaptive potential of the circulatory system (score),

PE - pulse rate (bpm);

GARDEN and DBP - systolic and diastolic blood pressure (mmHg);

P - growing t (cm);

MT - body weight (kg);

In - age (years).

The average group assessment of adaptive capacity according to R.M. Bayevsky was (1.65 ± 0.06) units. With indicators of adaptive potential of more than 3.50 units. no physical exercises were prescribed.

Depending on the age and functional reserves of the body, static exercises were used for the formation of volitional qualities and emotional and behavioral motivation for getting rid of drugs, for which high physical fitness was not required. It was believed that through the development of volitional qualities to achieve a result in an activity, emotional-behavioral motivation for getting rid of drugs and a healthy lifestyle is formed against the background of brightly colored emotions. Patients were told that the formation of the best results on the proposed static physical exercises is the key to getting rid of drug addiction.

Exercises were recommended to be performed 2-3 times a day for 10-15 days, after which relaxation is not carried out, and the development of endurance of tense muscles is identified with the formation of motivation for the success of psychotherapeutic treatment. Assessment of exercise performance is measured in seconds. After completing each exercise, it was necessary to slowly take a shallow breath, switch to voluntary breathing and return to the starting position (I.P.).

1. The Genche test. I.P. sitting on a chair, feet shoulder-width apart, lower legs perpendicular to the floor, chin raised, shoulders deployed, straight back, bending at the lower back, a vertical line dropped from the center of the head runs in the middle between the ischial tubercles, shoulder and hip joints. Pa against the background of voluntary breathing after inhaling, pinch your nose and make a maximum exhale. Keep a maximum pause, do not breathe.

2. The Planck. I.P. lying on the floor face down, palms under your shoulders, feet together socks on yourself. Keeping your head, body and legs in one straight line, push yourself off the floor and freeze for maximum time, do not breathe.

3. "Angle 90 °" I.P. lying on his back arms along the body, legs together. At the same time, lift the body and legs, keeping a 90 ° angle between them, exhale completely, do not breathe.

4. "Pose of the horseman" I.P. standing, the center of the head on the vertical, passing between parallel feet at shoulder width, the chin is raised, the shoulders are deployed, the back is straight, arching in the lower back, the shoulder and hip joints are on the same vertical. Slowly and smoothly sit on an imaginary chair - thighs parallel to the floor, try to keep the shins perpendicular to the floor, exhale completely, do not breathe.

5. A modified test of Romberg - "Pose tree." I.P. standing, the center of the head on the vertical, passing between parallel feet at shoulder width, the chin is raised, the shoulders are deployed, the back is straight, arching in the lower back, the shoulder and hip joints are on the same vertical, hands are down. Slowly smoothly at the same time we raise the driven leg to a height of 25-30 cm from the floor and arms, both to grasp the trunk of the palm tree at the level of the belt, exhale completely, do not breathe.

The resulting difference in the group background and generated exercise data by the method of variation statistics allowed us to formulate the translation of absolute indicators into points (Table). The improvement of individual results of static physical exercises in a patient by 2-3 points was a condition for conducting emotional stress psychotherapy.

Sessions of emotional stress psychotherapy were carried out in groups or individually [Andreev V.A. The student’s word about the Teacher - Alexander Romanovich Dovzhenko. Bulletin of psychotherapy. 2017. No. 64 (69). S. 25-48]. The duration of the session averaged 3-4 hours and provided for the stages:

in the first part, an introductory conversation was held with an indirect (indirect) suggestion about the biological, social and personal harm of the use of psychoactive substances;

in the second part, the psychotherapy session itself was carried out, in which rational psychotherapy came to the fore, the main provisions of which (culminating moments) ended with emotional-volitional imperative suggestions with elements of dramatization and ritual actions. In a state of mild hypnosis, the dominant form of exclusion of the use of psychoactive substances was formed. Introduced the semantic concept of "code". The suggestion formula used keywords that had a psychotherapeutic effect on the patient - “code”, “coding”, “decoding”, “stress in case of code violation”, etc. A program of a new lifestyle for the patient’s behavior after coding, emotional and behavioral motivation for healthy lifestyle. During the session, significant experiences and situations in patients revealed during filling out the diary were deactivated, attention was paid to the allegation of the undesirability of repeated treatment, and at the same time, the patient was given the right to choose for how long it would be encoded. They emphasized the need for complete abstinence from taking narcotic drugs and the inevitability of “punishment” in case of violation of this condition;

The third part was a materialization of suggestions - carrying out in a separate room individually with each patient a psychotherapeutic ritual of direct “coding”. After a receipt that the patient was warned of a possible deterioration in health or even death when taking drugs, the patient selected the period of psychotherapeutic vow from taking drugs. Preference was given to vow - for life. Against the background of visual deprivation by simultaneous forced closing of the eyes with the palm of a doctor and exposure to the vestibular apparatus as a result of a sharp throwing of the head back, a final imperative suggestion was carried out. Then, short-term and energetic (pain) stimulation of the trigeminal nerve was performed at the exit points (Vallee zone).

The proposed method is illustrated by examples.

Example 1

Patient K., age 30, has been using opioid drugs since 22 years. Diagnosis: Mental and behavioral disorders caused by the use of opioids (F11 ICD-10). In connection with serious problems in life, he revealed a confident desire to be treated. Repeatedly treated with traditional methods. The adaptive potential of the circulatory system according to Baevsky is 1.59 units. According to the patient, he regularly performed static physical exercises for 14 days. The improvement in the background indicators of all recommended exercises, with the exception of the modified Romberg test (1 point), was rated at 3 points. During a session of emotional stress psychotherapy, the patient vowed not to use drugs throughout his life. He sends acquaintances for the treatment of addictions to the psychotherapist; according to their reviews, he does not use drugs.

Example 2

Patient I., age 23 years, length of use of drugs 4 years. Diagnosis: Mental and behavioral disorders caused by the simultaneous use of several drugs and the use of other psychoactive substances (F19 according to ICD-10). He was unsuccessfully treated in neuropsychiatric hospitals and private clinics. He decided to seek psychotherapeutic help in connection with the deterioration of relations in the family and with law enforcement agencies. The adaptive potential of the circulatory system according to Baevsky 2.39 units. The prescribed static exercises were performed irregularly and reluctantly. Changes in the background indicators of exercises practically did not happen. Assessment “Genche Test”, “Planck”, “Modified Romberg Test” 1 point, “Angle” and “Horseman's Pose” - 2 points. During a session of emotional stress psychotherapy, the patient took a vow for 3 years. After 1 year, he broke the vow, began to use drugs, and came to the psychotherapist to remove the psychotherapeutic vow. His further fate is unknown.

Example 3

Patient K., age 25 years, drug use experience 8 years. Diagnosis: Mental and behavioral disorders caused by the simultaneous use of several drugs and the use of other psychoactive substances (F19 according to ICD-10). Tolerance to drugs is high. In connection with drug use, he lost his family, work, hundreds of thousands of rubles. Because of the expressed “withdrawal,” he once asked me to rivet myself to the battery when I stole money from my grandmother. The father locked the chain nuts, but the patient was able to unscrew them with his fingers, jump from the 4th floor to the roof of the garage, get a dose and prick. When visiting a doctor, he expressed a sincere desire to be treated. The adaptive potential of the circulatory system according to Baevsky 1.62 units. Assigned static exercises performed willingly. Change the background indicators of exercises by 2-3 points. During a session of emotional stress psychotherapy, the patient took a vow for 10 years. After 11 years, he resumed drug use, after which he underwent a second course of psychotherapeutic treatment with a vow for 10 years. Currently, she does not use drugs; in crisis situations she communicates with a psychotherapist over the phone.

Claims (4)

1. The method of emotional stress psychotherapy for drug addiction, including the removal of anosognosia for drug addiction, the compilation of a diary of the development of addiction to identify significant experiences and situations that contribute to the use of drugs, further determine the adaptive potential of the circulatory system according to R.M. Baevsky, with indicators of adaptive potential of 3.50 or less units. carry out static physical exercises for 10-15 days, while improving the performance of static physical exercises compared with the background by 2-3 points according to the table contained in the description, conduct group or individual emotional stress psychotherapy consisting of an introductory part in which patients reveal the social and personal problems of drug addiction, the main part - stress psychotherapy according to A.R. Dovzhenko, during which they reinforce positive emotional and behavioral motivation for recovery and a healthy lifestyle, and the final, where the patient is given a psychotherapeutic vow to refrain from taking drugs with information about the negative consequences of a code violation. 2. The method according to p. 1, characterized in that after performing a set of static physical exercises muscle relaxation is not carried out, and the development of endurance and tension in the muscles is identified with the formation of motivation for the success of psychotherapeutic treatment. 3. The method according to PP. 1, 2, characterized in that the dominant is created for the patients - the formation of the best results on the proposed static physical exercises as a guarantee of getting rid of drug addiction during a subsequent session of psychotherapy. 4. The method according to PP. 1-3, characterized in that the identified significant experiences and situations that contribute to the use of drugs, which patients indicate in the diaries, are deactivated during a psychotherapeutic session, which enhances the emotional-behavioral motivation for recovery and a healthy lifestyle.