RU2110287C1 - Method for treating neurotic disorders as integral model of clinical psychiatry - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining symptomatic expression of the neurotic disorder. Psychotherapy is applied. Patient is set into hypnotic trance state and conditional adult patient personality division is prompted as reasonable, emotional and somatic parts. Therapeutic treatment is applied to each of the parts. In performing somatic part treatment, suggestion is prompted that process self-regulation takes place in the organism in case the entrance phase is equal to the pause following it. In performing emotional part treatment, suggestion of distant contact of adult patient with its reasonable part and close contact to its emotional part are prompted and comfortable states are marked. Reminiscence of discomfort experience is stimulated to induce comfortable self-sensation responses with respect to it by addressing the reasonable part. In performing reasonable part treatment, gestalt-therapy approach is applied to make suggestion of age regress and catharsis state occurrence is stimulated. In coming back into the actual age, adequate communication rules are taught. All parts integration is prompted in conclusion and the patient is got out of the trance state. EFFECT: enhanced effectiveness of treatment; accelerated treatment course. 8 clмi

Description

 The invention relates to medicine, namely to psychiatry. The proposed method can be used to treat patients with various borderline mental disorders and neurotic disorders in case of somatic diseases in combination with pharmacotherapy or independently in both inpatient and outpatient practice, in medical institutions of a wide profile (psychiatric hospitals, neuropsychiatric dispensaries, psychotherapeutic rooms of somatic hospitals and clinics).

 There is a known method of psychotherapy in the treatment of neurosises occurring with severe somatized disorders - the method of autogenic sensory regulation, which in a single combination uses the specialized orientation of autogenic training, relaxation techniques of concentration on the area of your body and targeted pass manipulations of "bioenergotherapy" (Ph.D. thesis - Mirzabekyan Rafael Zavenovich, Moscow 1993). Integrating the techniques of some psychotherapeutic methods and based on the body’s ability to restore psychophysiological self-regulation, autogenous training of the first stage is trained daily for five days with concentration on the limbs, causing sensations of heaviness and warmth in them. At the same time, targeted pass manipulations are performed over the patient's head. The next five days they carry out an autogenic training of the second stage, after preliminary dividing the patients into groups: breathing, heart, abdomen, head, and teach them to steadily concentrate on a painful area of their body. In the presence of a combined pathology, the patient undergoes five-day training in the next group. From the third lesson, patients independently conduct themselves "bioenergy therapy", holding their hands above their heads. Then they master self-action with their hands and over other painful parts of the body, combining this effect with a steady concentration of attention at the site of exposure. After this, some patients are referred for reconstructive pathogenetic psychotherapy, the minimum duration of which is 40 days.

 The disadvantage of this method is the focus of psychotherapy mainly on the biological link, without taking into account the combined biopsychosocial nature of neurotic disorders, which reduces the effectiveness of treatment; the impact only on sensory regulation, which leads to positive changes, characterized, however, only by the degree of symptomatic improvement, which reduces the percentage of outcome of recovery from therapy (16%); the need to increase the duration of treatment and exclude from treatment patients with complicated psychopathological symptoms in the picture of a neurotic disorder, as well as connecting after the end of the course of treatment with a pathogenetic-analogous psychotherapy, which increases the duration of treatment, and also requires additional costs for patients on outpatient treatment time; conducting psychotherapy in the internal picture of the disease using the directive didactic form of exposure, which forms a great dependence, the need for outside help, and, in accordance with internal motivation, the retention of psychopathological disorders, and, as a result, the decrease in the effectiveness of treatment.

 There is a method of treating neurotic disorders by conducting integrated psychotherapy using psycho-technologies of self-action to stimulate personal growth and expand internal resources (Jeoff Graham. How to become a parent to yourself. Happy neurotic, or How to use your biocomputer in your head in search of happiness. M: Class. 1993, pp. 10-11, 17-18, 33-35, 44-47, 62-65, 69-76, 88-91, 110-114, 159-171, 175-176, 190-195).

 The method consists in conducting psychotherapy with mental self-help techniques (psychotechnics), with the aim of restructuring the pathological behavioral reactions of the infantile personality, acquired, according to the author, as a result of traumatic experiences at birth - negative imprinting (trauma of the first kind), or in subsequent periods of life as a result of fixation traumatic relationships of the child with parents - negative imprinting and negative conditioning (injuries of the second and third kind). The method is as follows. According to the patient's complaints, the symptoms manifested, his life history and illness, the nature of the traumatic experience is determined. In case of injuries of the first kind, they are taught through self-hypnosis of pleasant memories and relaxation to enter an altered state of consciousness (trance), in which non-directive hypnosis is carried out with a history (therapeutic metaphor) about the victory in a marathon at birth. Then, psychotechnics of dissociation of consciousness into children's and adult parts is carried out, and the latter observes its own childbirth, as filmed on a film, and the adult part of consciousness changes the distortion of the way of thinking with the help of a therapist who tells what to say and what to do. The adult part of the consciousness promises the child to become his own parent and, unlike his real parents, who have deprived him of love and care, constantly love and protect him. In addition to visual psychotechnology, the repetition of birth (rebirthing) is carried out by the psychodramatic method, creating physical difficulties in releasing the patient from a cramped and dark space. Next, work is carried out with a specific injury of the second and third kind, using the psychotechnics of various psychotherapeutic methods. At the same time, the patient is explained the goals and specific tasks of psychotherapeutic methods to change those information processing processes that cause a person to act against his will, being stuck in habits. Correct distortions in the perception of sensations and thoughts, expand their positive choice. Restore the connection between parts of the body, such as the body and head; mind control, which exercises constant control. Resolution of the conflict between behavior, thoughts and feelings is achieved by repeated and constant repetition of psychotechnical exercises until the desired result is obtained. The change is helped by a story with a metaphor that includes the patient’s problem and its resolution, for example, acquiring a new suit and throwing away the old one is a metaphorical statement of the need to replace old reactions with new ones. The programming of pathological reactions to the past is also carried out by the anchoring psychotechnology, when non-verbal patterns are used to determine first a positive and then a negative experience, each of which is noted at the height of the experience by touching the therapist with different parts of the patient’s body, then, when repeating the negative experience, they simultaneously touch both areas that destroys both anchors - the psychotechnology of combining anchors.

 The restructuring of defense mechanisms is carried out by training to reduce the time of concentration on negative aspects, look at the problem from the outside, free oneself from the game “search for the guilty”, and restore faith in oneself. For this, the psychotechnology of changing the slide is used, when the patient, when visually dissociating, sees himself as changed, his body enters the screen, associating with the desired self. To release suppressed experiences, the patient is encouraged to express feelings in a safe atmosphere. In contact with part of the personality, ideomotor reactions are used, for example, raising the finger of one hand with the answer “yes” to the questions asked and the finger of the other hand with the answer “no”. The patient is encouraged by a more positive and desirable behavior for himself, encouraged to become mature and responsible for himself, help to gain greater freedom of choice, while using various psychotechnics that can replace an undesirable self-image or his own negative reactions with others that contribute to the reorganization of the state by a higher level of balance and the healing of the individual as such.

 The disadvantage of this method is the relatively low effectiveness of treatment, including limiting therapeutic possibilities, since treatment in the prototype method is carried out without a medical (clinical) approach that takes into account the pathogenesis and psychopathological structure of neurotic and personality disorder, and in addition, there is a predominant focus on the most mild neurotic disorders, presented in the form of reactions in individuals with psychasthenic or sensitive accentuations, for which chenie limited symptomatic psychotherapy and psychological correction is sufficient. In addition, the basis of the method is one general idea - "accept and love yourself," although the material presented in the book belongs to heteronomic nosological structures. With such an attitude, one can expect not only the preservation, but also the deepening of psychopathological symptoms in 2/3 of patients with neurotic disorders having hysteroid, schizoid, epileptoid, expansive, narcissistic and cycloid accentuations of personality deviations, which will definitely affect the decrease in the effectiveness of treatment. The next drawback is the long-term treatment, which includes several courses of therapy during the year, as well as the continued need for psychotherapy after completing the course of treatment with repeated psycho-traumatic influences, which pose an actual threat to the health of a patient in remission who has undergone a phase of neurotic disorder and has remained dependent on the therapist, which analyzes the content of each of its problems and corrects pathological manifestations of a neurotic personality.

 The purpose of the invention is to increase the effectiveness of treatment, while this implies the expansion of therapeutic opportunities by treating patients with a more complex and prolonged course of the disease, i.e. with more pronounced violations of the psychopathological structure of personality and neurotic disorders compared with the prototype, and an increase in the number of patients who recovered as a result of treatment, as well as a reduction in the duration of the course of therapy.

 The purpose of the invention is achieved by using the developed integrated model of clinical psychotherapy with a single dynamic design, created from a combination of specially selected and creatively transformed elements of neuro-linguistic programming, gestalt therapy, non-directive therapy with metaphors, transactional analysis, psychoanalytic introspection and psychodrama psychotherapeutically affecting the general development factors of these diseases, but according to clinical differences, psychopathological tions neurotic and personality disorders and allowing the patient master communication skills congruent with itself, including the restructuring of the pathological functioning of organs and body systems, and others, i.e. master the skills of positive metacommunication, to recreate the harmonious interaction of the individual in the biological, psychological and social spheres; using psychotechnologies of self-action to restore psychophysiological self-regulation and moving from the internal picture of the disease to the internal picture of health with a change in pathological perception, understanding and response at all levels: sensorimotor, effective and cognitive and the acquisition of psychological maturity with adequate adaptation in accordance with the nature of the innate personality temperament.

 The purpose of the invention is carried out by conducting, from the first lesson, non-directive psychotherapy of a pathogenetic orientation and working with a form of perception, and not with the specific content of the patient’s problems, for this use examples of typical models, therapeutic metaphors, which leads to the acceptance of responsibility for the reformation of their own pathological structures by the patient who masters self-help positions in the long-term stabilization of health, gaining independence from the therapist.

 The method of the invention has the following justification. Somatic personality parameters, genetically defined and ontogenetically acquired, should correlate with its mental parameters, defining some psychological characteristics of the personality - a functional trinity of sensory information, behavioral reactions and the most important connecting Even between them - intracerebral processes, with a perfect mechanism of homeostasis, providing adaptation of the nervous apparatus for maintaining mental stability in spite of external and internal influences. The preservation of externally balanced behavior occurs due to the large internal stress of dynamic processes and, in response to irritation from the body's vital products, manifests itself as a spontaneous internal response. The subjective reflection of internal changes in the body receives a mental interpretation, which forms motives already at the level of “arbitrary” actions. In the cells of the memory archive, the past perception, understanding and response of both an adaptive (positive) and maladaptive (negative) character is preserved. With distress and frustration at the level of consciousness, the past negative perception is unzipped and a maladaptive pathological response is triggered, disrupting the harmonious interaction of consciously and unconsciously controlled structures - cognitive, emotional and behavioral levels - in the biological, psychological and social spheres of the personality. If there is a neuropathic constitution in the previously formed personality pathology that contains a double pole unstable response model, a stable neurotic disorder with a phase course is fixed - the third response model is “going into a disease”, which forms a “vicious circle” of psychosomatic disorders. A rupture of the circle (or destruction of the old gestalt) creates the opportunity for the development of a healthy conditioned reflex (building a new gestalt), i.e. the fourth model of responsiveness of a dynamic design is access to the internal picture of health with congruent motivations of cortical-subcortical perception and adequate external and internal reactions, which is the main idea of the proposed method.

 The method of course treatment of neurotic disorders, transformed into an integral model of clinical psychotherapy, is aimed at treating general - cognitive, affective and sensorimotor levels - disorders caused by common factors of the development of these diseases and in accordance with the clinical differences in the psychopathological manifestations of neurotic and personality disorders. The method is based on the use of communication methods with the patient, taking into account strategies of cortical and subcortical perception, hemispheric differences in the processing of information and stereotyped psychopathological response. To change the neurotic (infantile) needs and transform the pathological reactions of the personality into healthy ones, clinical psychotherapy relies on the neuropathic constitution, which includes two pole models of the pathological response of the personality and its internal picture of the disease, and reveals properties characteristic of the innate temperament. Next, a conditional division of the adult body into three parts is carried out: rational, emotional and bodily, and therapy is carried out with each of them individually. When working with the body part under the guidance of a psychotherapist of psychotechnology, self-actions are applied to the body's ability to self-regulate by acting on sensory analyzers. Since the speech (verbal) effect mainly affects the left hemisphere cortical-subcortical formations, they transmit rational information that is perceived, understood and fixed by a reasonable part in the patients' memory. Connecting imaginary visual videos and audio messages made up of the most contradictory, controversial or highly uncertain information about intentions, actions and situations allows you to influence the right hemisphere cortical-subcortical formations - the emotional part, which helps patients to independently draw conclusions, make predictions and accept solutions. Working with the emotional part, the prenatal and intranatal periods are repeated with an audible impact with visually presented illustrations, and then its internally free maturation is observed by the bodily and intelligent parts, the latter easily moving in place and time. With age-related regression, an unzipped cell is found in past experience and creates the possibility of emotional response and rethinking of the old perception, separate the past from the present, restructure infantile defense mechanisms and form new options for the creative response of an adult mature person. As a result of therapy, the rational part is rejuvenated, gaining flexibility; bodily - self-regulates, restoring the harmonious interaction of body systems; and emotional matures. The patient integrates synchronously developed parts, associates at a new mature level and, overcoming the neuropathic constitution, enters the internal picture of health, completing the formation of an adult personality that is able to adequately harmoniously externally and internally respond: actively defend, fulfill their needs, achieve desired goals, develop creatively and solve any problems.

 The method is as follows. In the first lesson in an individual conversation, they stimulate the patient to express their complaints and problems, their life history and illnesses. Not verbally - by facial expressions, gestures, sounds and verbally - short questions what ?, how?, How? - clarify the answers, encourage the patient to include free associations, while recording events to which he attaches particular importance. The incongruence of cognitive and affective perception, stereotypes of pathological response manifested in situations reported by the patient and in this conversation both in a free presentation and when answering sudden questions are previously identified, using neuro-linguistic programming psychotechnologies and monitoring changes in intonation, tempo, timbre of speech, loudness of voice, liveliness of facial expressions, gestures, looks, breathing rhythm, coloring of the skin, muscle tension in certain parts of the body. The psychopathological symptom complex of neurotic disorder, the nature of personality pathology and the dynamics of their formation are determined. Next, rational psychotherapy is carried out with an explanation of the essence of the disease and the therapy used, while at the same time they stimulate the patient to an active position in the treatment and cooperation with the therapist. Rational presentation is illustrated with therapeutic metaphors containing identical stories and alternative options for adequate perception and response. Using the psychotechnology of neurolinguistic programming and therapeutic metaphors, they simultaneously and sequentially act on the cognitive, affective and sensory-motor structures of the personality, with clinical and characterological manifestations of borderline mental and psychosomatic pathology.

 In subsequent sessions, individual and group psychotherapy is carried out. The second session begins with psychoanalytic introspection (Karen Horney. Introspection. -M .: Progress Universe, 1993, p. 320-326); stimulate the patient to recognize personality reactions characteristic of his genetically constitutional temperament, and to form flexible cognitive attitudes that ensure adequate perception and response. Encourage dialogs and spontaneous emotional reactions. Then, rational psychotherapy is carried out: the psychology of an abnormal and healthy personality is laid out, therapeutic metaphors are used in parallel with examples of identical states of typical cases from medical practice. Further, with the help of controlled auto-action (Karvasarsky B.D. Psychotherapy.-M .: Medicine, 1985, p. 109-111; Volpert I. E. Psychotherapy. -L.: Medicine, 1972, p.164) enter the patient into a state trance, a first-person singular conditional division of the adult patient’s personality into rational, emotional and bodily parts corresponding to the intellectual-mnestic, emotional-motivational and motor-kinesthetic systems is called by their own name: their first name, patronymic, diminutive and affectionate and complete by name adult patient, and conduct sequentially and parallel therapy with each of them. Further, the sensation of the distant contact of an adult patient with a really existing body with a reasonable part (Leslie Cameron Bandler. Since then they have been happy. - Voronezh: NPO Modek, 1993, p. 163-167) and direct contact with the emotional part is promulgated. located inside his body. The patient is indirectly taught that the emotional part, which has a younger, even childhood, should be introduced to the most positive memories: mentally tell about the best moments of your life, accompanying with the major sound and showing the film on an imaginary screen, or an album with color photographs that may come to life. Then they stimulate the emotional part to consistently recall the comfortable states of positive episodes of past experience - at least three. Induce the patient to coordinate emotional experience at the height of affect with bodily sensations: smile with an external and / or internal smile, and / or straighten your shoulders, and / or freely raise your head, and / or take a confident pose or other identical movements to establish self-identification of a resource-friendly comfort state. Then the sensation of distant contact with the emotional part is souffled, which is stimulated to recall and show on the imaginary screen uncomfortable experiences of the past. The patient and his rational part induce to remotely perceive everything that the emotional part will show, to realize from a radically positive position and to understand how in the future to promote the emotional part in the same situations to react without uncomfortable feelings. After that, the patient is induced to disconnect the emotions arising from the various behavioral reactions of the object and the emotions experienced directly to him, and express them verbally and non-verbally. In this case, the verbal construction of the psychotherapeutic text is carried out in such a way that the insufficiently psychologically mature emotional part can perceive the content of the transmitted material without distortion and feel the benevolent and sincere participation of the adult, who is encouraged to accept and feel it when combined - merging mental and physical comfort. In the treatment of the body part, they singularly non-directive from the first person singular text, and the patient is induced to synchronously transmit messages of his body part with an internal speech at the optimum pace for his temperament and, if necessary, adjust the content, exercising self-influence on the restoration of psychophysiological self-regulation. To do this, focus the patient’s attention on the respiratory cycle, induce him to choose the optimal expiratory rhythm and the equivalent pause after it - 2, 3, 5, or 8 s according to the comfortable sensations (Fibonacci numbers - the Golden Section series - stable equilibrium: 2, 3, 5, 8, 13 ...), to equalize the exhalation phase and the pause following it, and not indirectly suggest that it is with this ratio that the temperament is reconciled with the biorhythm and the impaired self-regulation of biological processes in the body is restored. The body part is induced to direct the process of self-regulation to an arbitrary program, and the rational part is to observe from the side, notice the still remaining muscle clamps and note the duration of the phases of the respiratory cycle. At the end of the lesson, they stimulate the patient to focus on inhaling, exhaling residues of weakness, drowsiness, lethargy, and feel - on the 3rd, 5th, 8th or 13th breath - pleasant strength in the muscles, vitality and comfort in the body, lightness and freshness in the head, inhale deeply and forcefully and exhale sharply with the sound “Ha!”, at the same time shake oneself, open one's eyes and get out of a trance state.

 The third lesson begins with psychoanalytic introspection, then conduct rational psychotherapy outlining the fundamentals of the psychology of interpersonal relationships and, in parallel, metaphor therapy; direct attention to the awareness of attitudes (beliefs that limit the free choice of response). The practical part of the lesson includes analogues of gestalt therapy techniques - working using the two-chair technique or working with an empty chair (R. Bendler. Use gour brain - to change. Future Pace, Inc. San Rafael, California, 1985. - 14 p.; Kjell Rudestam Group psychotherapy. - M .: Progress, 1990, p. 158). The patient is induced to communicate with a reasonable part by using two empty chairs, which are installed in front of him. The text is first-personized with the suggestion of a reasonable part to sit on one of the empty chairs, then they distance themselves from it by placing a part in the other chair that contains patterns of attitudes, perceptions and behavior. Encourage the adult associated with the physical and emotional parts to communicate with the mental and template components of the rational part. At the same time, it is non-directive that the mental component maintains a constant image, which is addressed by the patient’s name and patronymic, and the template component sequentially accepts the prototypes of the parents and / or caregivers, from whom the patient perceived rigid beliefs, models of neurotic emotional perception and the corresponding response. At the same time, it is explained to the patient that the parents and / or carers only symbolize the templates stored in the memory archives, which are often a source of conflicting motivations; they do not indirectly inspire age-related regression, stimulate the onset of catharsis with the response of past repressed emotions and suppressed actions, and return to the present age. Further, they encourage the patient to verbalize the emotions of the past affective experience and to reform those structures of the template part “that trigger neurotic behavior with stereotypes of externally manifested and internally perceived pathological responses. They stimulate to leave negative patterns in an empty chair and return the positive ones to a sensible part, after which cross an imaginary psychological the umbilical cord between two empty seats. At the same time, the patient is taught adequate communication reality using ver point messages congruently perceived by the mental and emotional structures of the brain: they use words without a bit of “not”, the questions “why?” and “why?” are replaced by the questions “what? "and" how? ", from the psychological vocabulary exclude the words" try, try, should, must, must, "but keep them at the social level - professional-role interaction, enter the words" feel, "" I want, "" will do, “I know”, “I can”; they build their requests and suggestions in a positive way (D. Jampolsky. How to find inner balance and improve your relations with others. - M .: Education. - 1990, p. 18). Teach the patient in case of conflict situations to move (distance) in the third position - the position of a psychologist and a sage giving himself, at least 3 tips; encourage people to abandon edification, present demands, dictates and ultimatums to others, and to communicate their feelings, desires, preferences and requests. They complete the lesson by venturing out a text about the conclusion of a permanent agreement on cooperation and mutual assistance between an intelligent and bodily structures of an adult, carry out the integration of parts and out of trance.

 The fourth lesson can be individual or group. Rational psychotherapy is carried out with an explanation of the need to distinguish and separate the past perception of the internal reactions of the body, adaptive in previous situations, from their maladaptive nature when repeated in the present, in another reality. Inducing entry into a trance state and distant contact with the rational and emotional parts. The text is indirectly souped, which allows us to visualize a comfortable intrauterine stay, then the process of our own birth, accompanied by painful sensations and experiences. Before the birth of a newborn, an intelligent part is induced to enter the imaginary screen of memories so that it carries out the correction of false conclusions and distorted judgments. A text explaining that the experiences then experienced was physiological only in that situation, and their use at the present time causes pathological disturbances, is used to correct the perception of these reactions as the only ones necessary for the body to survive in a frustration situation. They complete the lesson by integrating the parts, souffle the text of the adult's appeal to the emotional part with the promise to take care of her, fulfill her needs, protect and help in her maturation.

 The fifth lesson is individual. Rational psychotherapy is carried out with an explanation of the essence of the methodology for reforming pathological reactions, both external and internal, into adequate healthy ones. They induce a light trance, ventilate the distant disconnection of the rational and emotional parts and induce, with a mental gaze and hearing, to look through and listen to everything that the emotional part presents from the memory archives, which pops up in the memories from birth to the present. At the same time, episodes of joyful memories are induced to accompany a smile and independently establish a marking of a comfortable state, while sad, gray and minor memories are viewed and listened in an emotionally sounding tone until the situation is completed and the first color frame is stopped. They induce a reasonable part to enter this frame and comment on what has happened from a new positive perspective, then rejuvenate to the age of a movie hero and, merging with it together, convey comfortable self-awareness from the colorful perception of the surroundings to an adult sitting in an armchair. They stimulate: quickly, in color, reverse look at the beginning of the episode, erasing the old record from the video cassette, then creating in your imagination a color and sound film with a new emotional and cognitive perception and internally free reaction in the same situations of the past. They induce positive corrections in a similar way to all negative experiences that occur on an imaginary screen to the patient's current age. After that, a mature emotional part is induced and the rational one becomes flexible, integrating with the body structure of an adult and interacting at a new level of understanding, with congruent motivations and reactions.

 In the sixth lesson, as in the previous ones, psychoanalytic introspection is carried out, then metaphor therapy and, in parallel, rational psychotherapy explaining the basics of metacommunication. When a symptom persists, a trance state is induced and a search for the source of a similar manifestation in the past, and then the perception of the accompanying circumstances from another perspective and the implementation of an adequate response. Indirectly, they suggest that they send to the memory archive a connected complex of the past - infantile perception - a pathological reaction, and the weed torn out from the root disappears. They then induce the adult patient to turn to reasonable and emotional parts so that they create at least three different behaviors for the near future - for 1, 2 or 3 months or years, at the choice of the adult, with adapted somatic and mental reactions and in accordance with moral ethical and ethnic social norms. An adult patient is stimulated to choose or recreate at least three possible variants of a positive reaction for the body. They consistently communicate with an actual significant person - in an individual lesson they work with an empty chair, and with group psychotherapy they play psychodrama. Check the patient's readiness for a constructive resolution of psychological and social problems, the harmony of the three-level interaction. In conclusion, they integrate the integration of the emotional, rational and bodily parts, positively adjusted by the adults themselves, who have assumed responsibility for the realization of the healthy needs of a psychologically mature personality, while simultaneously removing the patient from a trance state.

 The course of treatment includes 6 sessions lasting 1.0 to 1.5 hours, conducted 1 time per week for 1.5 months.

 The treatment by the proposed method, an integral model of clinical psychotherapy was carried out for 135 patients (39 men and 96 women) aged 18 to 60 years, the average age was 38.9 ± 8.7 years, on an outpatient basis, while maintaining the patients' usual social status . The duration of the disease ranged from 1 month to 13 years, the average duration was 5.2 years, a significant proportion of patients were repeatedly treated by specialists of various fields both on an outpatient basis and in hospitals for several years. In a significant part of patients (90 people), psychotherapy with this method was carried out as an independent and only type of treatment, which is more convenient for outpatient practice. In 45 cases, patients were prescribed psychotherapy in combination with pharmacotherapy. The appointment and correction of pharmacotherapy was carried out depending on the clinical assessment of the patient's condition at the time of each of the weekly examinations. In most cases, tranquilizers of various chemical series in relatively low daily dosages, tricyclic antidepressants and antipsychotics with weak psychotropic activity were prescribed.

 Example 1. B-naya P., 39 years old, skilled pyrometry worker, with secondary technical education, divorced, lives with a 19-year-old daughter. The patient feels about 25 years old. The present deterioration is 4 months after the violation of relations with a partner. She was treated by various specialists, took homeopathic and psychotropic drugs, but without effect. She began outpatient treatment for protracted hystero-hypochondriacal reactions with a predominance of hystergic and conversion disorders within the framework of a hysterical type of psychopathy. Complained of a feeling of heaviness (like a cobblestone) and tingling with small needles in the region of the heart, a feeling that the heart was “trembling”, interruptions in the heart, pains and numbness of the left arm, headaches, fainting, periodic shortness of breath, stumbling when walking, trembling hands , irritability, tearfulness, fears that something might happen to the heart, weakness, low mood, inability to work. The treatment course of the proposed method began with group psychotherapy - classes N 2. The second meeting was held 4 days later, an individual lesson N 1 and group psychotherapy were held. Since the patient had a sick leave and free time for treatment, on the third day the 3rd meeting took place - psychotherapy in the group. Next, the sessions were held weekly according to the described method and were individual. During treatment, an unstable improvement was noted: emotional lability persisted, after conflicts with her daughter and at work, headaches and heartaches resumed, and mood decreased. However, disability was restored, and further treatment was carried out after work. At the end of therapy, the feeling of internal tension, cardialgia, autonomic and conversion disorders, anxious fears for one’s health disappeared, the mood was leveled, self-confidence, vigor, activity in achieving the set goals appeared. In the follow-up, a stable high effect was noted after a year.

 Example 2. B-naya X., 22 years old, a 4th year student of the Economics Institute, evening department, works as an accountant in a bank, is not married, lives with her mother. She received psychotherapy for protracted neurotic depression, which debuted after a mental trauma (the death of his father 2 years ago). The disease proceeded with symptoms of unstable hypotension, irritability and subsequent cardialgia (punctures, compression), intensifying during inhalation and exhalation, accompanied by heart palpitations, increased fatigue. 6 individual lessons were conducted in this way, 2 of them were combined with group psychotherapy. In the course of treatment, a significant improvement occurred, manifested in an improvement in mood and a significant reduction in somatoform disorders. However, in conflicts with the mother and the boss, pains in the heart region resumed. At the end of the course, a complete reduction of somatoform disorders was noted. In follow-up - persistently pronounced high effect.

 Example 3. B-naya S., 38 years old, has three sons, secondary pedagogical education, works as a manager in a company, lives with his whole family in one room of a communal apartment. She received psychotherapy for somatoform disorder in the form of cardialgia and tachycardia in combination with anxious fears, cardiophobia, shortness of breath, headaches, sleep disturbance, fatigue and increased irritability. The disease proceeded within the framework of protracted neurotic reactions according to the type of development (duration 5 years), with an exacerbation of the last 4 months in a person with schizoid features. Six one and a half hour individual sessions were conducted, one of which (2) began with group psychotherapy. In the process of psychotherapy, a significant improvement occurred, manifested in the reduction of somatoform disorders: headaches, tachycardia and cardialgia. At the end of the course, a high treatment efficiency was noted: a complete reduction of both somatoform disorders and phobias, including the fear of death. In the follow-up history, a persistently pronounced effect is preserved after a year.

 Example 4. B-Noi Ch., 55 years old, a metalworker, lives together with his wife. He received psychotherapy for schizotypal neurosis with the phenomena of alexithymia, cardioneurosis in the form of arrhythmias and cardialgia, not accompanied by phobias. The disease arose in connection with a massive psychological trauma (the death of his son 6 years ago) and was protracted. 5 individual lessons were held, one of which (1) was prolonged by group and 2 classes by group psychotherapy. During the treatment, mood improved and algiums and cardiophobic disorders were reduced. Upon completion of psychotherapy, there was a significant improvement, accompanied by both an improvement in general condition and a rise in mood, as well as a decrease in bodily sensations, only temporary arrhythmias persisted. In the follow-up, a month later, a persistently pronounced high effect was noted, arrhythmias were reduced. Follow-up after 9 months - a stable high effect was noted.

 Example 5. B-naya K., 36 years old, teacher, higher education, lives with her husband and son in a new three-room apartment. She received psychotherapy for a somatoform disorder, occurring with anxiety-phobic manifestations, mainly cardiophobia, panic attacks and senestoform disorders in the form of cardialgia, chest pressure, lack of air, which was accompanied by tachycardia, depression and weakness in the morning. Sick for more than a year, was treated by specialists in various fields, took psychotropic drugs, was forced to leave work. The phenomena of hypotension were accompanied by diurnal fluctuations. 5 classes of individual psychotherapy were conducted, 3 of which were transferred to group sessions and one lesson (1) was conducted in the group. During therapy, there was an improvement in terms of overall well-being and mood, accompanied by a decrease in bodily sensations. The first disappeared phobic syndrome, then algia and tachycardia. The mood was leveled, became vigorous and active, including finding interesting and profitable work. Upon completion of the course of psychotherapy, a complete recovery was noted, which was confirmed follow-up after 2 years.

 Example 6. B-naya A., 2 years old, a 5th year student at the Institute of Chemical Technology, single, living with her parents. Over the past month, after suffering bronchitis, there were pains in the heart area of a constricting nature, palpitations after physical exertion, difficulty breathing, anxiety for one’s heart, life, fear of death from suffocation or from heart disease. Concerning cardioneurosis, determined by somatoform disorders - cardialgia, feelings of constriction of the heart, tachycardia, accompanied by anxiety-phobic disorders in the form of anxious fears, the hysterical person received combined treatment - pharmacotherapy and psychotherapy. I took nitrazepam 5 mg at night, equanil 250 mg 3 times a day. The first session of psychotherapy was individual. From the first days, pains in the heart area ceased to bother, became much calmer, but experienced increased drowsiness, which made learning difficult. During this period, she passed exams at the institute and did not engage in psychotherapy for two weeks. Before the first exam, vomiting was noted at night, and in the morning when traveling on the subway I felt a fainting state. Before the second exam at night I could not fall asleep. Pharmacotherapy was slightly changed: I took 100 mg of equanil 3 times a day. The 2nd session of psychotherapy consisted of a double individual (2 and 3 sessions according to the above description) and group sessions. In the future, she remained well, she passed all exams by 5 points. She noted that she had changed her attitude towards herself in a positive direction: "Before, I looked at myself as if from the outside and criticized, but now I began to relate to myself warmly and feel more confident." 3 session was combined: an individual session consisted of 4 classes and was prolonged by group psychotherapy. 4 lesson was individual and final, 5 and 6 lessons of the proposed method were conducted simultaneously. The conclusion of the expert commission: "Recovery". Pharmacotherapy was canceled, treatment ended. In the follow-up after a year - healthy.

 Example 7. B-naya L., 51, a higher education, does not work, lives with her husband and two adult sons. She received combined treatment - pharmacotherapy and psychotherapy for a psychogenic provoked aggravation of the dynamics of psychopathy in an anxious-schizoid personality in the form of cardialgia, dyspnoea, anxiety states and fears. Sick 9 months. Valium was prescribed 5 mg in the morning and evening, but due to increased drowsiness, the doses were reduced: 1.25 mg in the morning and afternoon and 5 mg at night. 1 session of psychotherapy was a group, 2 - an individual (according to the described method, 2 was first conducted, then 1 lesson). I came to class 3 with a temperature of 37.3, I felt weak, unwell. Group psychotherapy was carried out, showed interest in the subject under discussion on metacommunication and psychology of interpersonal relationships, participated in role-playing in the conflict psychodrama. At the 4th lesson, she reported that the cold had passed very quickly. However, in the last 2 days, diarrhea bothered me, despite which I did a lot of washing at home these days and noted pain in the heart area, shortness of breath with excitement and physical exertion, and the rest of the time I felt increased drowsiness and lethargy. But at the same time she did not feel anxiety for her heart, and her mood kept an even background. Pharmacotherapy has been changed: atarax 12.5-12.5-25 mg, Valium - 5 mg at night. When psychotherapy was carried out (as part of gestalt therapy), work with an empty chair, communication with a significant person - stepmother. At the same time, she realized and reacted to previously repressed feelings. In the future, it became calmer and more productive to resolve their problems associated with the family. Shortness of breath reduced, sleep recovered. Pain in the heart occasionally resumed, but were less pronounced. Pharmacotherapy has been changed: atarax 25 mg in the morning and afternoon, lysanxia - 20 mg at night. In the 5th lesson, in the framework of gestalt therapy, communication was conducted with the mother, whom she lost at 3 years old, then with the father, who died when the girl was 10 years old. Survived the catharsis, positively changed its perception of the past. The 6th lesson was a group, the psychotechnology of rebirth was conducted. 7 lesson was individual and contained 5 and 6 lessons of the proposed method. The expert commission’s conclusion: “Improvement with an almost complete reduction of general anxiety and psychosomatic disorders. There are not pronounced residual manifestations of arrhythmia with a neutral attitude towards them. The effect of therapy is high. It is recommended to continue pharmacotherapy: phenazepam 0.5 mg at night. - a state of persistent remission.In spite of the traumatic situation - the theft of a new car 2 months ago, the condition remained stable, did not resort to taking medications.

 Analysis of the clinical effectiveness of therapy showed that the best results are achieved in the treatment of the proposed method of neurotic disorders with algias and bodily sensations in patients oriented to "complicity" in the treatment process (a high effect was observed in 87% of cases). In cases with anxiety-phobic, conversion and affective manifestations in persistent neurotic and psychopathic disorders in patients with traits of dependence, infantility, and demonstrativeness, prone to a paternalistic model of treatment and orientation to the authority of a doctor, this method can be the treatment of choice (improvement was achieved in 60% of patients ) A differentiated analysis of the effectiveness of the therapy revealed that the outcome of the therapy in the anxiety-schizoid and hyperthymic group is significantly more favorable than in the group of hysteroids and hysteroepileptoids. These patients need longer therapy, since their initial motivation is aimed at demanding changes in the behavior of significant personalities. It is necessary to influence an additional factor, including time, and / or conduct special psychotechnologies to awaken their readiness for their own changes and active work during psychotherapy. This is achieved by combining individual and group psychotherapy in combination with pharmacotherapy during the first three to four weeks, which increases the percentage of effectiveness (80%). The study suggests that the application of the proposed method may be one of the ways to optimize the treatment of neurotic disorders. The implementation of the proposed method will allow specialists to successfully simulate the psychotherapeutic process at the very beginning of the treatment of patients and timely make the necessary adjustments to it.

 In FIG. Figures 1-4 show graphs reflecting the frequency distribution of the psychopathological symptoms of neurotic disorders before treatment (row 1) and at the end of therapy (row 2).

 The proposed method for the treatment of neurotic disorders significantly increases the effectiveness of treatment, since, firstly, the positive effect is directed to all components of the neurotic and personality disorder, which is achieved by a fundamentally different constructive approach to therapy, which consists in conducting dissociation psychotechnology with the conditional separation of personality structures and work in the required directions with each of them separately; secondly, reprogramming of pathological reactions into those adequate for a mentally and somatically healthy person is carried out, which is carried out using the clinical psychotherapy model developed by the author, aimed at moving the personality rod from the internal picture of the disease, that is, a neurotic disorder, into the internal picture of health, bypassing the horizontal level of pathological personal deviations; thirdly, they support the patient’s active position in achieving psychological maturity and social adaptation, sharing with him the responsibility for the result of therapy, which leads to the full acceptance of responsibility for an adequate response at the end of the course of treatment.

 The proposed method significantly reduces the duration of the course of treatment while reducing the number of sessions, since, firstly, the patient is taught indirectly the psychotechnics of self-regulation / secondly, information is fed simultaneously to both levels of consciousness; thirdly, in rational psychotherapy and metaphor therapy they use the concepts of a typical general model, i.e. abstracted from the patient, which facilitates the easier adoption of new knowledge; fourthly, the work is carried out in such a way that the patient exercises self-influence, taking responsibility on himself, and no longer needs psychotherapy and a psychotherapist.

 Using the proposed method for the treatment of neurotic disorders has the following advantages compared to the prototype.

1. The fastest and most stable clinical effect, which is achieved by applying a medical (clinical) approach that takes into account the pathogenesis and psychopathological structure of neurotic and personality disorder, and an integrated model of clinical psychotherapy, with a single dynamic design that allows expanding the therapeutic possibilities of treating patients with more expressed complex violations and with a longer course of the disease compared with the prototype and increase the number of patients, recovered as a result of treatment, reforming the strategies of pathological perception, comprehension and behavior at all levels: sensory-motor, affective and cognitive due to: a) conditional isolation of the personality’s body structures and separate work with each of them individually; b) non-directive training in harmonious communication in the biological, psychological and social fields;
2. A significant reduction in the duration of the course of treatment with a decrease in the number of sessions that is due to the work in this method with the form of perception of the problem, and not with its content, which is carried out: a) using in the examples and metaphors a general, as if dimensionless model, allowing the patient to increase abstract space and process the material presented freely, expanding the possibilities of perception from various perspectives and, therefore, possible options for a positive response; b) the supply of information simultaneously to both levels of consciousness, contributing to the congruence of perception and, consequently, response;
3. Identification of the properties characteristic of the innate temperament and the transformation of neurotic needs (infantile attitudes) and pathological reactions of the person into healthy ones, exercising a psychotherapeutic effect on the general factors of the development of psychopathological structures of neurotic and personality disorder in accordance with the clinical differences in their manifestations, which is achieved a) using psychotechnologies self-interaction, allowing the patient to master the skills of congruent communication with himself, including structuring of the pathological functioning of organs and systems of the body when moving into the internal picture of health with adequate adaptation and personality reactions corresponding to the nature of the innate temperament; b) the use of Fibonacci numbers, contributing to the creation of stable harmony in the somatic and mental structures of the body (by analogy with architectural and technical structures);
4. The absence of the need for psychotherapy after completing a course of treatment for a patient who is mastering positive metacommunication acquires independence in decision-making and independence from a psychotherapist, which is achieved as a result of: a) maintaining an active position of the patient in the psychotherapeutic process, with the formation of responsibility for the result of treatment at the patient the patient; b) self-help psychotechnology training in long-term stabilization of health.

 The treatment method is very versatile and can be successfully applied both in a hospital in combination with or without pharmacotherapy, as well as in outpatient practice, allowing a patient who is in his usual social status to test, adjust and fix in practice new constructive reactions for him . An important advantage of such therapy in outpatient practice when it is necessary to connect psychotropic drugs is the use of small doses of tranquilizers, antidepressants and antipsychotics, and there is also no need to prescribe maintenance therapy. In addition, when applying the proposed method in comparison with the prototype, high efficiency is noted with fewer ongoing sessions and a more pronounced psychopathology of neurotic and personality disorders. The proposed method as an independent method of therapy has several advantages over the prototype method: information is supplied simultaneously to all sensory channels and levels of perception, which allows more efficient unlocking of pathological foci; when working on an emotional level, most of the information is transferred to consciousness; the cognitive level is also reconstructed, freed from neurotic attitudes and needs, including the prohibitions of awareness and the prescription of self-destructive actions. The advantages of the method include the fact that the patient masters the skills of conflict-free communication both with himself and with others and acquires various variants of creative behavioral reactions with their internal freedom of choice in any circumstances. In other words, the patient masters the skills of a psychotherapist and psychologist for himself and no longer needs professional psychotherapy. Thus, the proposed method can make a significant contribution to the treatment of patients with neurotic disorders, improve their biological, psychological and social adaptation and, therefore, reduce their number.

Claims (8)

 1. A method of treating neurotic disorders, including individual and group psychotherapy sessions, simultaneous and sequential effects on the cognitive, affective and sensory-motor structures of the personality, with clinical and characterological manifestations of borderline mental and psychosomatic pathology, using psychotechnologies of neurolinguistic programming and therapeutic metaphors, characterized in that the incongruence of cognitive and affective Acceptance, stereotypes of pathological response, determine the psychopathological symptom complex of neurotic disorder, the nature of personality pathology and the dynamics of their formation; conduct rational psychotherapy with an explanation of the essence of the disease and the therapy used, at the same time stimulate the patient to an active position in treatment; then, using controlled self-action, the patient is brought into a trance state, the first person singular is vented to conditionally divide the adult patient’s personality into rational, emotional and bodily parts and conduct therapy with each of them; during therapy of the body part, the patient's attention is accentuated on the respiratory cycle, it is induced to level the expiration phase and the next pause after it, and it is indirectly suggested that it is with this ratio that the temperament is reconciled with the biorhythm and the impaired self-regulation of biological processes in the body is restored; during therapy of the emotional part, the sensation of distant contact of an adult patient with a really existing body with a reasonable part and direct contact with the emotional part, which is stimulated by successive recall of the positive state of positive episodes of the past experience, is pre-vented, inducing the patient to coordinate the emotional experience with a smile and / or other identical bodily sensations and establish self-labeling of the resource state, then the distant sensation is souffled contact with the emotional part, which uncomfortable experiences stimulate to recall, is induced to remotely perceive them, realize them from radical positive positions and promote the emotional part in the same situations to react without uncomfortable feelings, while treating the rational part, the part that contains patterns of attitudes, perceptions and behaviors, prompt the adult associated with the physical and emotional parts to communicate with the mental and template component those who are of a reasonable part, indirectly inspire the patient with age-related regression, stimulate the onset of catharsis and return to the present age; induce the patient to reform those structures of the template part that trigger neurotic behavior, at the same time teach adequate communication; in conclusion, the integration of the emotional, rational and bodily parts positively adjusted by the adults themselves is promoted, while the patient is taken out of a trance state.  2. The method according to claim 1, characterized in that when identifying incongruent cognitive and affective perceptions, stereotypes of pathological responses and in determining the psychopathological symptom complex of neurotic personality disorder personality pathology and the dynamics of their formation, methods of clinical psychiatry and psychotechnology of neurolinguistic programming are used.  3. The method according to PP. 1 and 2, characterized in that when conditionally dividing the adult’s personality into rational, emotional and bodily parts, each is called by its own name: first name, patronymic, diminutive and full name of the adult patient, and the therapy is carried out sequentially and simultaneously with each of them.  4. The method according to claims 1 to 3, characterized in that when focusing the patient on the respiratory cycle, they induce him to choose the optimal exhalation rhythm and an equivalent pause after it for 2.3.5.8 s according to the comfortable sensations.  5. The method according to claims 1 to 4, characterized in that during therapy of the emotional part, the verbal construction of the psychotherapeutic text is carried out in such a way that the insufficiently psychologically mature emotional part can perceive the content of the transmitted material without distortion and feel the friendly and sincere participation of the adult.  6. The method according to claims 1 to 5, characterized in that, with positive memories, self-marking of a comfortable state is established: the patient is induced to smile with an external and / or internal smile, and / or straighten his shoulders, and / or freely raise his head, and / or take confident pose.  7. The method according to claims 1 to 6, characterized in that when reforming structures that trigger neurotic behavior with stereotypes of a pathological response, and when teaching adequate communication, they use verbal messages congruent to mental and emotional brain structures; use words without the particle "not", the questions "why?" and “why?” is replaced by “what?” and “how?”, the words “try, try, should, must, must ...” are deleted from the vocabulary, they enter - “I want, I will, I feel, I can ...”, requests and suggestions are built in a positive way.  8. The method according to PP. 1 to 7, characterized in that the course of treatment includes 6 sessions lasting 1.0 to 1.5 hours, conducted 1 time per week for 1.5 months.

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