RU2164806C2 - Method for adjusting psychophysiological condition of patients with tuberculosis diagnosis set for the first time - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves getting rid of mistaken judgements of patients having tuberculosis diagnosis set within the preceding 3 months and considering their own disease as incurable one. The patients are oriented on positive result. Training programs are applied at the stage of clinical transpersonal group psychotherapy including relaxation for 15 min, automassage during 10-15 min, plastic physical training exercises during 10-15 min under music, meditation autotraining during 10-15 min and natural breathing exercises composed of three breathing modes. The first mode involves breathing at a rate of 60 breathing movements per 1 min during 5 min. The second mode involves some kind of superficial frequent breathing without making pauses between in- and exhalation phases during 40 min. The third one is very light superficial breathing during 15 min. Emotions are evoked, body movements are done, patient attention is attracted to positive factors in achieving the aim with step-by-step escaping from the trance to the awakening state. Mobilizing psychotraining is carried out at the end of the treatment. EFFECT: enhanced effectiveness of treatment. 3 cl

Description

 The invention relates to medicine, namely to phthisiology and is intended for the complex treatment of newly diagnosed tuberculosis.

 Currently, a standard, biological, impersonal approach to the treatment of tuberculosis dominates in phthisiology, which is clearly manifested in standardized programs of short-term chemotherapy, especially outpatient chemotherapy for newly diagnosed tuberculosis patients, whose main goal is to eliminate the spread of infection by sputum negation with minimal material costs, which is justified with socio-economic positions, but not from the perspective of the patient as a person.

 Such an approach to the treatment of tuberculosis patients does not take into account the huge spectrum of mental reactions, their features, their impact on the course of tuberculosis, i.e. there is no holistic approach to the patient. Attention is mainly paid to the somatic side of the disease without taking into account changes in mental status that occur in 100% of patients that affect the physical capabilities of the body and the dynamics of the underlying disease (this remains outside the field of view of doctors). A particularly pathogenic psychogenic effect on the patient is the fact of a diagnosis of tuberculosis (its stressogenicity has been investigated), which is the source of the above polymorphism of neuropsychic changes, up to suicidal tendencies that impede the effective dynamics of the tuberculosis process, despite the use of antibacterial anti-tuberculosis therapy. Therefore, "where the basis for the response to diseases, psychotherapy is necessary" (Schlifer R. Ya., 1930), especially a personality-oriented one aimed at correcting the mental status of newly diagnosed patients with tuberculosis using the free breathing method, one of the main in a programme.

 A known method of correcting the psychophysiological state of a person by using modified holotropic breathing (forced breathing, accompanied by severe hyperventilation, proposed by S. Grof, 1992) in patients with non-psychotic depressions (Kanaeva LS "Clinical transpersonal psychotherapy of non-psychotic depressive disorders", Moscow, 1996 g.).

 The disadvantage of this method is that the main component for introducing patients into an altered state of consciousness is the suggestive method and preliminary cognitive work, as well as a short hyperventilation process interrupted by respiratory delays, and therefore the method cannot be used in tuberculous patients.

 The closest is a method of psychotherapeutic effect on a person by using rebirthing in combination with meditations (Kozlov V. "Free Breath", guidelines, ed. Transpersonal Center, Moscow, 1993) and "Rebirthing or How to Know and Use the Fullness of Life" (Jim Leonard, Phillaut, St. Petersburg, TF "IKAM", 1993).

 According to these sources, rebirthing is a simple self-improvement technique. The disadvantage of this method is that there is no sufficiently clear program, its complexity. In addition, it does not clearly trace the sequence of "steps" of execution (of the individualization of the sequence of "steps"), i.e. there are no indications of a specific technological chain, and this is insufficient for use in order to correct the mental state of tuberculosis patients.

 The task is to increase the effectiveness of psychotherapeutic correction of post-stress neuropsychiatric disorders caused by powerful stress - a diagnosis of tuberculosis.

 The task is achieved in that with a patient with tuberculosis with a period of detection of up to 3 months. correction is carried out in the form of a complex of actions, consisting of the stage of initial verbal easy correction, which consists in eliminating erroneous judgments of patients about their illness as an incurable disease, orienting the patient to a positive result, and the stage of group clinical transpersonal psychotherapy consisting of successively alternating trainings, and namely: a "circle of open interaction" for 15 minutes, then inductive self-massage for 10-15 minutes in accordance with the Tao system, then elastic gymnastics for 10-15 minutes with musical accompaniment to aggravate the state of relaxation with activation of subconscious functions, enhance positive emotions, after which meditative auto-training is carried out for 15-20 minutes and, at the end of the complex, the free-breathing stage (rebirthing), consisting of 3 types respiration, while the 1st type is full and deep breathing with maximum inhalation and exhalation (with a frequency of ≈ 60 respiratory movements in 1 min) for 5 min, which forms the patient’s introduction into a trance, type 2 is more superficial frequent breathing without pauses between inhalation and exhalation for 40 minutes, type 3, final - very light shallow breathing for 15 minutes with the active inclusion of emotions and bodily movements with fixation of positive factors for achieving the goal, with awareness of it through insight, followed by gradual waking up with a conclusion from a trance using mobilizing psycho-gymnastics, and the final stage of a comprehensive psychotherapeutic correction, a dynamic intra-group interaction is performed.

 The course of complex correction consists of 4 week cycles, the time of each lesson is 3-3.5 hours, while in the 1st week the classes are held daily, in the 2nd week the classes are held every other day, the 3rd week - after 2 days, 4 weeks - after 3 days.

Introduction to the process of free breathing is carried out with. a gradual temporary increase in load, namely during the first cycle (week) on the 1st day, the first type of breathing is not carried out, the second type is carried out for 20 minutes, the third type - 10 minutes, on the 2nd day - the 1st type of breathing - for 1 minute, type 2 - for 30 minutes, type 3 is carried out for 15 minutes, on day 3 - increase the duration of the 1st type of breathing to 2 minutes, type 2 - 30 minutes , 3rd type of breathing - for 15 minutes, on the 4th day - breathing with the 1st type is carried out 2 minutes, with the 2nd type - 30 minutes, with the 3rd type of breathing 15 minutes, on the 5th day increase in duration of the 1st type of breathing up to 3 min, 2 mt pom - up to 35 minutes, type 3 - 15 minutes, on day 6 - type 1 breathing - 3 minutes, type 2 - 35 minutes, type 3 - 15 minutes, during type 2 cycle (week) on the first day - the first type of breathing is carried out for 4 minutes, the second type is 40 minutes, the third type is 15 minutes, on the second day the 1st type of breathing is 4 minutes, the second type is 40 minutes, 3rd type - for 15 minutes,
on the third day - the 1st type of breathing - 5 minutes, the 2nd type - 45 minutes, the 3rd type of breathing - 15 minutes, during the 3rd cycle (week) - on the 1st day - the 1st type of breathing 5 minutes, the second type - 45 minutes, the 3rd -15 minutes, on the 2nd day - the 1st type of breathing - 5 minutes, the 2nd type - 45 minutes, the 3rd type - 15 minutes, during 4 cycle (weeks) - on the first day - the 1st type of breathing lasts 5 (10) min, the second type - 45 (40) min, the 3rd type of breathing 15 minutes, on the second day - the 1st type of breathing - 10 min, type 2 - 40 min, type 3 - 15 min.

 Depending on the individual condition of the patient, the complex correction of the psychophysiological state can be repeated as many times as necessary.

 A complex combination of inductive self-massage, plastic psycho-gymnastics with musical accompaniment, meditative autotraining provide the removal of neuromuscular tension (relaxation) and the patient’s consciousness is switched from the problem associated with the disease to the activation of internal self-regulation processes (inclusion of subconscious functions).

The new tactics of free breathing after the preparatory stages provides:
1. A marked improvement in mental state, the elimination of stress, anxiety, depression and other mental disorders.

 2. The tendency to normalize psycho-vegetative functions.

 3. Increasing levels of self-esteem.

 4. Improving self-confidence.

 5. Change in the "internal picture of the disease" in a positive way.

 6. Positive attitude towards oneself, towards the disease and towards the future.

 7. Positive clinical and radiological dynamics in patients of the main group, ahead of the corresponding in the control group.

 8. A reliable connection between the improvement of mental and somatic conditions.

 9. Stability of results in follow-up study.

 The regimen for changing the types of breathing (per minute) is selected with the aim of gradually introducing patients into the process of free breathing and their adaptation.

 Conducting a comprehensive exposure for 4 weeks and with a certain regimen every day is caused by the severity of stress and the volume of damage to the lungs and pleura.

 A session duration of 3-3.5 hours is caused by a high degree of neuromuscular tension and a high level of prior stress and depressive disorders.

 The introduction of free breathing according to the proposed growing scheme is caused by the need to adapt a patient who has specific changes in the lungs and pleura that limit the process of breathing.

 The repeatability of the cycle provides for certain patients the opportunity to consolidate and stabilize the skills acquired in the 1st year and the ability to develop ways to resolve other problems at the request of the patient.

 The essence of the method is as follows: for patients with newly diagnosed tuberculosis, perceiving the recognition of tuberculosis as psychotrauma (as stress), accompanied by severe polymorphic psychosomatic reactions, along with antibacterial anti-tuberculosis therapy, psychotherapeutic correction is carried out according to a specially developed program.

 To do this, form groups of 5-9 people of both sexes with a permanent composition for the entire cycle of work - 1 month.

The term for detecting tuberculosis is up to 3 months. The mental status is “without features” (i.e., mentally healthy individuals). They find out anamnestic data, especially the response of patients to the fact of tuberculosis (as a trauma), their attitude to the disease and, in this regard, to everything around them ("internal" and "external" conflict). To assess the clinical and mental status, clinical and psychological testing is carried out. It is important to clarify the need for psychotherapeutic correction, the patient’s desire to help himself, the patient’s ability and willingness to reveal his inner world. At the same time, at this stage, a verbal "soft correction" is carried out:
erroneous opinions of the patient about his illness as an "incurable"disease;
orientation of the patient to the desired result (positive result) both in relation to himself and to all spheres of life.

 This is the basic stage of the whole work of the groups, as in it, the beginning of a change in the patient’s attitude to a traumatic situation (accepting it as a “given”, as a “reality”), to oneself, to the healing process (reassessment of values), the formation of a positive attitude towards the correction process for “here and now” and the future.

2. Stage of group clinical transpersonal psychotherapy
The duration of the groups is 3-3.5 hours per day. The work includes theoretical, practical aspects and dynamic intra-group interaction.

Classes are built from sequential trainings:
forming a "circle of open interaction";
inductive self-massage;
body-oriented psycho-gymnastics (dance);
meditative auto-training combined with music therapy;
work using the free breathing technique (Rebirthing);
dynamic interaction.

 The transition from one training to another occurs after assessing the condition of patients, discussing the previous training, correcting and clarifying the implementation of the next.

The sequence of the session:
2.1. The beginning of the lesson is the “circle of open interaction”

 The group is seated in a circle, the members of the group get to know each other, call themselves (this is only in the 1st lesson), inform the members of the group and the facilitator about the problems and determine for themselves the desired result. The host gives information material in the form of a conversation about the principle and methods of working in a group, characterizes the methods of therapy used. And after that, the group begins to implement a practical program.

 To reach the initial stage of relaxation and establish a calm, even emotional background, an “open interaction circle” is used, for which participants “palm in palm” hold hands, eyes are closed. Self-hypnosis formulas are pronounced to the presenter, for example: “We relaxed, calmed down, closed our eyes and imagine that we open our heart and direct a bright, warm flow of energy into our right shoulder and right hand and transfer it to the left hand of the seated person, with the left hand we accept the flow and distribute it in a circle ... "and so on. As a result, all members of the group achieve a state of muscle relaxation and calm -15 min.

2.2. Inductive self-massage
(within 10-15 minutes) - in accordance with the eastern system of "Tao".

 The goal of self-massage exercises is to activate bioactive points, meridians and energy centers to streamline the energy supply of organs and systems, to relieve excessive neuromuscular tension, anxiety, enhance the initial level of relaxation and easy self-immersion, achieved during the first exercise in the circle. Exercises are performed while sitting, lying and standing using classical massage techniques, but - light rubbing, light touch, pressure, striking, stroking.

Self-massage includes:
1. Information (explanatory) - rational psychotherapy.

 1. Exercises of "general action" - "Salutation of the sun", "Bow to the sun".

 2. Activation of the anteromedian and posteromedian meridians (VC, VG).

 3. Activation of hand meridians (C, P, MS, Gl, IG, TR).

 4. Activation of the head meridians (E, V, PC-5, 6, VB, TR, BAP of the auricles).

 5. Activation of the foot meridians (V, VB, E, F, RP).

 6. "Full massage of the abdomen" (RP, R, VC, VB, E).

 7. "Thanksgiving of the Universe."

 2.3. Plastic psycho-gymnastics (10-15 min) with the selection of musical accompaniment, at the same time, the state of relaxation is aggravated with the activation of subconscious functions, the strengthening of positive emotions, the conditions are created for learning methods of self-regulation, as well as (further) the emergence of a therapeutic suggestive effect. The patient learns to feel his body, pay attention to any sensations, movements and follows these movements to the music in the process of a kind of spontaneous dance. Attention is drawn to the presence of muscle blocks, clamps, and body movements leading to the elimination of these conditions.

 2.4. Meditative auto-training using models of psychosynthesis, neuro-linguistic programming (NLP) in the following sequence - patients occupy a horizontal position, attention is focused on the appearance of relaxation sensations combined with a feeling of heaviness and warmth in the hands (especially in the hands). Particular importance is given to the appearance of heat in the solar plexus. To enhance the effect, patients can position, attention is focused on the appearance of relaxation sensations in combination with a feeling of heaviness and warmth in the hands (especially in the hands). Particular importance is given to the appearance of heat in the solar plexus. To enhance the effect, patients can visualize various representations that help to achieve the indicated sensations (for example: present a flow of energy of golden color, etc.), or visualize the proposed model - training in psychosynthesis (training "Fire" - "Imagine a burning fire. Look at its dancing volatile outlines Look at his movement, try to feel its fiery quality. Continuing to imagine the fire, think about it and its manifestations in the mental life: warmth, passionate love, fiery fun, Lamen enthusiasm.

 Finally, holding the image of fire in front of your gaze, slowly imagine that this fire endows you with life, that you become this fire. Be aware of this for a while, and then let the image fade away ").

In this case, as a rule, modifications of the classical I. Schulz method were used, where the sequence of formation of a comfortable mental state includes 6 stages:
1. Heaviness in arms and legs.

 2. Heat in the arms and legs.

 3. Heat, heaviness, relaxation throughout the body.

 4. Heat in the solar plexus.

 5. A uniform combination of relaxation and abdominal breathing.

 6. Heat, relaxation throughout the body and coolness in the forehead.

 Autotraining lasts for 15-20 minutes.

2.5. Actually, Rebirthing is a complex process that includes the following components:
2.5.1. Rational - includes the theoretical aspects of free breathing (history, the elements of "fragmentation" of consciousness and their consequences, integrative mechanisms, physiological aspects of free breathing, its elements, etc.), discussion of the selected model, ways to build it depending on the goal and objectives, identifying the patient own goals (their formulation), the combination of goals (model and patient) at this stage, i.e. the formation of the desired positive result (the process of recognizing the problem, accepting it, transforming, restructuring, "unblocking" it, integrating it and reaching a positive solution "for now" with a change in attitude towards the future). The breathing process is carried out in a horizontal position in a state of muscle relaxation and takes 1 hour.

 2.5.2. Rebirthing is a process of connected breathing ("circular" breathing) - without pauses between inspiration and expiration. The structure of respiration is determined by 3 main parameters - the depth of respiration, frequency, and the ratio between inspiration and expiration.

 Respiratory rate - sets the speed of the process, the speed of the transformed situation that the person is working on (negative situation - a problem, transforms into a positive one - into the desired result).

 The depth of breathing sets the intensity of the experienced situation, the degree of emotional involvement in it and the level of physical sensations.

 Inhalation should occur actively, on muscle effort, exhalation - passively, with muscle relaxation. (almost like normal breathing). The inhale-exhale cycle occurs either through the nose or through the mouth. Better through the mouth, which allows more intensive breathing.

The therapist teaches every type of breathing. We used 3 types (classes) of respiration, which differ in t ratio of frequency and depth of respiration:
1st type (class) of breathing - frequent and deep breathing with emphasis on inspiration (max inspiration and max exhalation) ≈ 60 resp. movements in 1 min
- is used for the purpose of forming a trance (introducing oneself into an altered state of consciousness - ASC or a state of expanded awareness.

 2nd type of breathing - more superficial, but more frequent (quick) breathing (the name of this type of breathing as “dog breathing” is common among free breathing instructors in our country) - without pauses between inspiration and exhalation, inspiration is active, exhalation is passive. This is a "working breath" during which the formation of an "image of achievements" occurs using a given model, i.e. sensory representation of the result and its achievement.

 For example: (a task is set - a model with which the patient works in the process of breathing). The model is a fairy tale: "Imagine yourself on the shore of a lake, river, by a waterfall (etc. - the patient chooses himself), where there is" living "and" dead "water on a sunny day. There is silence, trees, grass, flowers and etc. And, you, with your inner gaze, examine every internal organ of your body (lungs, heart, stomach, etc.). "

 And the patient, being in a trance state, identifies himself with the fairy tale character and mentally, visualizing the picture, fills (washes) “dead” and “living” water with every organ of his body, feeling at the same time everything that happens in the body (heat, coolness, lightness, etc.) and so on. and thus, a stable positive and emotional state is achieved against the background of relaxation. The patient presents himself as being healed of diseases. This result is fixed by maintaining the image of a healthy self with appropriate sensations (lightness, comfort, surge of strength) and positive emotions (joy, good mood).

 The psychotherapist transfers patients to the 3rd stage of breathing - very light and shallow breathing (resembling the breathing of a newborn); this type of breathing is carried out at the final stage of the breathing process, while there is an active inclusion of emotions (laughter, singing, etc.) and bodily functions (hand movements, dance movements, etc.), fixing of positive factors for achieving the goal with awareness through insight - instant understanding essence of the problem and exit from it.

 2.5.3. Waking up with a complete and gradual withdrawal from trance using mobilizing psycho-gymnastics, i.e. within 1-2 minutes, patients are transferred to the usual type of breathing (at the "command" of a psychotherapist), making light movements with limbs and body, they become aware of themselves "here and now" and open their eyes and become awake.

 2.5.4. Dynamic intra-group interaction ("patient-patient", "patient-therapist") - is a complete free kind of "self-report" of the patient about all the details of the session with an emphasis on individual well-being and positive emotions. The therapist maintains and stimulates a high level of frankness, positively reinforces with the words, touch and other incentives (click of the fingers, clap in the palm) the patient’s statements characterizing his achievement of a positive result.

 During group management, the therapist actively directs the work of group members to avoid or interrupt evaluative statements, i.e. attempts to say that “this is good” or “bad”, “right” or “wrong”, etc., replacing them with “I like”, “I am pleased”, “I am interested”, “I want”, “ I can".

 2.5.5. The end of each session is a “homework”, including the breathing process (without type I, type II — 20 min, type III — 10 min), “refinement” of the desired state with control of its fixation, i.e. individual repetition of the past session at home with a subsequent “report” in the form of a “Rebirthing Diary” and, if necessary, in the form of statements on the group.

 The psychotherapist directly “conducts” the breathing process, setting the “reference” rhythm throughout the entire hour of breathing, while simultaneously adjusting the breathing process of each patient in accordance with his (the patient's) actual functional capabilities (ie, “puts” the rhythm, depth, frequency into physiological framework) with the gradual withdrawal of breathing to "automatic mode".

 In addition, the psychotherapist helps to adapt and navigate in a variety of visual, emotional, autonomic and bodily plans, both throughout the session and after the clinical transpersonal psychotherapy session.

 Features of working with this group of patients are the maximum individualization in combination with general group principles.

A specific correction course consists of the following cycles (4 weeks):
1 week - daily 3-3.5 hours
2 weeks - every other day
3 weeks in 2 days
4 weeks - in 3 days
In days free from group activities, patients perform their "homework" on their own.

 In the future, patients "breathe diabetes" on their own if they wish outside the group, at a convenient time for themselves.

 Within 1 week - the introduction into the breathing process is gradual, with an increase in the temporary load (taking into account the pathology of the bronchopulmonary system).

I week (cycle)
1 day: I type of breathing is not carried out.

 II type "----" 20 min.

 III type "----" 10 min.

 2 day: I type of respiration 1 min.

 II type "----" 30 min.

 III type "----" 15 min.

 3 day: I type of respiration 2 min.

 II type "----" 30 min.

 III type "----" 15 min.

 Day 4: I type of respiration 2 min.

 II type "----" 30 min.

 III type "----" 15 min.

 5 day: I type of breathing 3 min.

 II type "----" 35 min.

 III type "----" 15 min.

 6 day: I type of respiration 3 min.

 II type "----" 35 min.

 III type "----" 15 min.

II week
1 day: I type of respiration 4 min.

 II type "----" 40 min.

 III type "----" 15 min.

2 day:
I type of respiration 4 min.

 II type "----" 40 min.

 III type "----" 15 min.

 3 day: I type of breathing 5 min.

 Type II breathing 45 min.

 III type "----" 15 min.

III week:
I day: I type of breathing 5 min.

 II type "----" 45 min.

 III type "----" 15 min.

 II day: type I breathing 5 minutes

 II type "----" 45 min.

 III type "----" 15 min.

IV week:
1 day: I type of respiration 5 min (up to 10 min).

 Type II "----" 45 (40 min).

 III type "----" 15 min.

 2 day: I type of respiration 10 min.

 II type "----" 40 min.

 III type "----" 15 min.

 Depending on the patient’s state of health, these cycles can be carried out daily (10 days, 1 month, etc.), repeat this program through individually defined periods, or repeat it several times during the treatment period.

 This program can be recommended for wider use.

Claims (3)

 1. A method for correcting the psychophysiological state of a patient with newly diagnosed tuberculosis, including free breathing (rebirthing) in combination with meditation, characterized in that patients with tuberculosis with a detection period of up to 3 months, the correction is carried out in the form of a complex of actions, consisting of the initial stage verbal correction, which consists in eliminating erroneous judgments of patients about their illness as an incurable disease, orienting the patient to a positive result and the group wedge stage transpersonal psychotherapy consisting of successively alternating trainings, namely the relaxation stage and the establishment of a calm, even emotional background for 15 minutes, then self-massage for 10-15 minutes, then plastic gymnastics is performed for 10-15 minutes in musical accompaniment to deepen the state of relaxation with activation of subconscious functions, after which meditative auto-training is carried out for 15 - 20 minutes, and at the end of the complex - free breathing (rebirthing), consisting of 3 types of breathing, with 1 t Ip is a quick and deep breathing with maximum inhalation and exhalation with a frequency of 60 respiratory movements per minute, for 5 minutes, which forms the patient’s introduction into a trance, type 2 - more shallow surface breathing without pauses between inhalation and exhalation for 40 minutes , 3 - type of breathing - final - very light and shallow breathing for 15 minutes with the active inclusion of emotions and bodily movements, with the fixation of positive factors for achieving the goal, followed by a gradual exit to wakefulness, withdrawal from trance using aniem light movement of the limbs and body, and the final stage of a comprehensive psychotherapeutic correction is carried out "self-report" patients about their condition.  2. The method according to p. 1, characterized in that the course of complex correction consists of 4-week cycles, the time of each lesson is 3 - 3.5 hours, while in the 1st week the lessons are held daily, in the 2nd week of the lesson carried out every other day, the 3rd week - after 2 days, the 4th week - after 3 days.  3. The method according to claims 1 and 2, characterized in that, depending on the individual condition of the patient, the complex correction of the psychophysiological state can be repeated as many times as necessary.