RU2244569C2 - Method for treating food addiction accompanied with obesity - Google Patents

Abstract

FIELD: medicine, psychiatry, psychotherapy.

SUBSTANCE: the present innovation deals with carrying out dietotherapy and psychotherapeutic impact in the course of group seances. Moreover, the main psychotherapeutic impact should be performed during two seances per 8 h each, each due to marathon technique under asthenization conditions, biorythmical misfunctioning and behavioral stereotypes. Motivation should be elaborated for patient's healthy nutrition along with self-confidence and belief into success. Program for losing body weight should be developed to visualize and concretize therapy. Diary for nutritive behavior should be written, psychological protection should be performed in case of affected dietary situation. After the main seances one should carry out psychotherapeutic impact during one seance of 3 h duration in 1 or 3 mo. During seances the results obtained should be fixed by discussing and excluding situations provoking obesity relapse. The method enables to prolong duration and stability of remission.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to the field of medicine, specifically psychiatry, and can be used for the treatment of food addiction, accompanied by obesity.

Known methods for the treatment of bulimia nervosa and overeating, leading to overweight (BMI), which are used in a complex combination, where dietotherapy and physiotherapy in combination with drug therapy are most important (E.A. Beyul, Yu.P. Popova, 1990). Many treatment regimens have been proposed based on different theoretical concepts. So, E.A. Markova et al. (1986) devote considerable attention to diet therapy and altering primarily disturbed eating behavior and offers the following principles for treating obesity: mandatory psychotherapeutic restructuring of eating behavior; regulation of the intake of energy substances in the body; increase in energy costs of the body (physiotherapy exercises, physical methods of exposure); the use of pharmacotherapeutic drugs; the use of pharmacotherapy and therapeutic fasting only in case of ineffective dietary treatment; surgical treatment of nutritional and constitutional obesity with the failure of conservative therapy; relapse prevention.

Many Russian and foreign authors adhere to this position (R.Kh. Kadyrova et al. 1986, 1987; E.A. Beyul et al. 1987; S.F. Konev, T.A. Zykova, 1988; V.A. Oleneva , Yu.P. Popova, 1992). A.A. Gadzhiev et al. (1996) suggests the use of reflexology.

A number of other authors (A.M. Vein et al. 1979; E.I. Marova et al., 1981; I.V. Tereshchenko, 1993; M.M. Ginzburg, G.S. Kozupitsa, 1996; and others. ) consider drug therapy as the main method of treatment of exogenous constitutional obesity.

Diet therapy. According to many authors, this type of therapy is leading (E.A. Markova et al., 1986; E.A. Beyul et al., 1986). The purpose of a reduced diet with a sufficient protein content and a limitation of animal fats and easily digestible carbohydrates is proposed. The diet should contain the necessary amount of vitamins and minerals. The Institute of Nutrition of the Academy of Medical Sciences of the USSR developed the basic principles for building a diet for obese. These include: 1) The purpose of a diet of reduced energy value (reduced), balanced for all irreplaceable nutritional factors and containing a sufficient amount of protein; 2) Compliance with the regime of 5-6 - single meals without increasing the overall energy value of food; 3) Systematic control over the amount of food eaten; 4) Complete abstinence from alcoholic beverages, which, in addition to a significant increase in the energy value of the diet, dramatically weaken the self-control of food intake; 5) The limited introduction of carbohydrates, especially mono- and oligosaccharides, which are the main suppliers of energy and are easily converted into fat in the body; 6) Limiting animal fats and increasing the consumption of vegetable oils (up to 50% of the total amount of fat); 7) Reducing salt intake to 5-6 g per day; 8) Control of fluid intake (not more than 1.5 liters).

Separately, we can distinguish therapeutic fasting. The fashion trend, an active supporter of which was the American scientist P. S. Bragg (1997), the author of the book “The Miracle of Starvation,” and which found support in the scientific community, has now practically lost its attractiveness for a number of objective reasons. With complete starvation, the body is forced, in addition to fat, to expend structural proteins of cells and tissues, primarily muscles. Especially high protein consumption during prolonged fasting (more than 15 days) according to E.A. Beyul et al. (1986). The authors believe that starvation becomes a serious stress, leading to a deepening of the already impaired metabolism in patients. During fasting, glycogen stores in the liver are consumed very quickly and, as a result, its depot function suffers. Fasting puts the body at a disadvantage even when increased demands are placed on immunity. Any commonplace infection can take a protracted course. With complete starvation, there is a certain risk of cardiovascular disorders (De Carvalho S. 1988).

According to Eriksson L.S. et al. (1988), Kral J.G., Heymsfield S. (1988), in patients with obesity in the treatment of fasting there is no recovery or radical improvement.

G.G. Zhdanov et al. (1994) propose a method of short-term (10-14 days) alimentary deprivation for the preoperative preparation of patients with obesity as a prophylaxis of surgical complications. Agree with this provision and T.G. Voznesenskaya et al. (1990), and I.V. Tereshchenko et al. (1994). Physiotherapy. There is an opinion that physical therapy has wide indications for use in obesity (E.A. Markova et al., 1986). Exercise includes all parts of the nervous system, from brain cells to peripheral receptors, as well as humoral and endocrine mechanisms; accelerate oxidative processes by enhancing gas exchange; improve the secretory function of various organs and promote the vigorous release of metabolic products, increase energy costs (E.A. Beyul et al., 1986, P.P. Kuziv, Yu.I. Slivka, 1998; and others).

P.Ya. Grigoriev et al. (1989) argues that the role of exercise in the pathogenesis of obesity is greatly exaggerated, especially for the prevention and treatment of obesity. I.V. Tereshchenko (1993) believes that an increase in physical activity should be included in the complex treatment of obesity, but it should be borne in mind that an inadequate increase in physical activity in an obese patient creates a stressful situation, i.e. tension in the hypothalamus – pituitary – adrenal cortex system and hyperproduction of adrenocorticotropic hormone, cortisol.

Pharmacotherapy. At present, a lot of drug methods for the treatment of obesity have been developed, but there are no specific generally accepted methods and regimens. The drugs used to treat exogenously constitutional obesity can be divided into drugs that reduce the need for food intake, and dosage forms that help normalize the functional state of the body, accelerate weight loss processes, evacuate adipose tissue from adipocytes, etc.

Means that reduce the feeling of hunger can be divided:

1 on pharmaceuticals acting on their own weight;

2 drugs that have a direct effect on the excitability of the food center.

It is known that a certain degree of filling the stomach with food leads to reflex inhibition of the food center. The use of drugs of the 1st group, acting on their own weight, is based on this principle. These include various kinds of ballast substances, the most pronounced effect of which has methyl cellulose.

For more than 40 years, pharmacological drugs that reduce hunger, such as ampepramone, fepranone, desopimon, and others have been known. But due to the mandatory side effects of existing drugs (agitation, insomnia, palpitations, increased blood pressure, development of drug dependence), the search for new anorexigenic drugs .

I.V. Tereshchenko (1993) believes that anorexigenic drugs, no matter which group they belong to, do not significantly affect the outcome of obesity treatment, since they are only a symptomatic type of therapy.

From the point of view of this author, therapeutic measures that increase thermogenesis are pathogenetic.

Since eating disorders are often accompanied by psychopathological disorders (depression, anxiety), antidepressants can be used to treat these conditions. For this purpose, selective serotonin reuptake inhibitors (fluoxitin-prozac, sertraline-zoloft) are used, which reduce appetite (Smulevich AB, 1997). E.A. Markova et al. (1986) claims that drug treatment of obesity is an indispensable means of etiotropic and pathogenetic effects on the body. At the same time, these same authors notice a number of serious side effects of pharmacotherapy.

To treat patients with BMI, the acupuncture technique according to V.G. Vogralik et al. (1985), based on exposure to biologically active points located on the auricles and other parts of the body. To suppress hunger, thirst and normalize appetite, the inhibitory effect on auricular hunger points is 18, thirst 17, stomach 87, mouth 84, hypothalamus 26, pancreas 96. To stimulate fluid excretion and restore water-salt metabolism tonic effect on ear points 95, 26 and corporal 9 IM, 67 V, 7R, 6R, 25-27 V. is used

E.A.Beyul et al (1986) consider that drug therapy plays a secondary role. The authors propose differentiating patients with obesity and distinguish: 1) - persons with “normal” energy expenditures that can reduce the energy value of food without the help of drugs; 2) - persons with “normal” energy expenditures who are not able to reduce food intake without the help of anorectic drugs; 3) persons with “normal” energy expenditures who cannot refrain from excessive food, even with medication; 4) - persons with reduced energy consumption, in need of their increase.

Thus, a number of Russian and foreign authors consider drug therapy symptomatic that does not affect the fixation and maintenance of normal body weight achieved as a result of treatment (E.A. Beyul et al., 1986, 1990; I.A. Koreshkin, 1998; JE Mitchell et all, 1993). At the same time, it is difficult to make a choice in determining the tactics of treatment between the effectiveness of a drug and its side effects.

Psychotherapy. Hyperalimentation. layering on a constitutional predisposition to the development of obesity, subsequently leads to metabolic dysfunctions, which, in turn, leads to secondary somatic disorders (diseases of the musculoskeletal system, cardiovascular system, etc.). Based on this provision, the etiotropic treatment of exogenously constitutional obesity should, first of all, be aimed at eliminating the causes of eating disorders. These reasons may be intrapersonal and social conflicts. Psycho-traumatic factors related to the social sphere, according to many authors, are quite subjective. Therefore, the main emphasis in the treatment of an overweight patient should be placed on the normalization of intrapersonal well-being and the ability to optimally and adequately respond to exogenous psycho-emotional stress.

Psychotherapeutic treatment aimed at changing eating behavior with exogenously constitutional obesity is used, as a rule, as a supplement to the other types of therapy for this disease (M. Grabovska, V.A. Oleneva, 1968; E.S. Kreslavsky, V. I.Loyko, 1984; I.V. Tereshchenko, 1993; E.A. Markova et al; 1986 and others).

E.A.Beyul (1986) attaches great importance to suggestive psychotherapy, considering hypnosis not only a symptomatic measure, but also a pathogenetically directed method of treatment, since with the help of hypnosis it is possible to restructure the psyche of an obese patient and eliminate bad eating habits, which, according to essentially, the underlying cause of the disease is related.

Kreslavsky E.S. and Loyko V.I. (1984) proposed a rehabilitation program for obese patients (partnership, diversity of efforts, unity of psychosocial and biological methods of exposure), a significant part of which is accompanied by psychotherapeutic methods such as hypnosis, rational psychotherapy. Later, Kreslavsky E.S. (1985) reports on the need for a combination of psychotherapeutic methods with medical treatment aimed at correcting emotional disorders, such as anxiety, low mood, irritability.

According to Donelly J., Duncan David F., Procaccino Anthony T. (1993) in patients undergoing group treatment for overweight, there is a decrease in both reactive and personal anxiety when filling out the Spilberger personal and reactive anxiety questionnaire.

There is evidence of a behavioral approach to reducing excess body weight in obese patients accompanied by coronary heart disease (Khramelashvili V.V., 1990). A significant role is given to the group method of psychotherapeutic influence (B.D. Karvasarsky, 1985).

In general, scientific research on the psychotherapeutic method of treatment is fragmented and controversial. Data on the dynamics of the psychosocial status of patients who reduce weight, and its correlation with the achieved effect in the treatment are not fully developed for practical use. The role of psychotherapeutic intervention and strategic treatment techniques in specific patients have not been finally determined. Recently, more and more authors are inclined to dispensary correction of overweight, as more beneficial follow-up. Outpatient treatment is often associated with the development of the right dietary habits not only in the patient, but also in his family, which plays a significant role in achieving lasting treatment results (R. Kadyrova et al., 1986; E.A. Markova et al. 1986 ; Zamotaev I.P. et al., 1988).

The increasing severity of the problem requires an active continuation of the search for the most effective directions and methods for reducing body weight in obese people and fixing the result.

The objective of the invention is to increase the effectiveness of the treatment of food addiction, accompanied by obesity, and increase the resistance and duration of remission.

The problem is solved by applying psychotherapeutic effects and diet therapy, and the main psychotherapeutic effect is intensively carried out for two sessions of 8 hours each, then a supportive psychotherapeutic effect is carried out in one session lasting 3 hours one and three months after the main psychotherapeutic effect.

The method is as follows:

The main methods of psychotherapy used in the treatment of obesity are:

1) Rational psychotherapy

2) Hypnosuggestive methods (directive hypnosis, Erickson hypnosis)

3) Self-regulation and auto-suggestion

4) Emotional stress therapy

5) Neuro-linguistic programming

6) Positive psychotherapy

7) Music Therapy

8) Behavioral therapy

Mandatory conditions that take into account and change the psychology of eating behavior in the process of psychotherapeutic exposure are the following:

1) Development of motivation for a healthy diet.

2) A clear statement and the formation of a weight loss program - for how long and for how many kilograms you need to lose weight.

3) Visualization and specification of the goal, compilation of a plan.

4) Keeping a food diary.

5) Rapid or gradual change in eating habits.

6) The attitude to believe in success and the development of self-confidence.

7) Psychological protection in the event of a situation of a possible violation of the diet (situations of temptation or emotional stress).

Stages of treatment

The technique of providing psychotherapeutic assistance to overweight patients involves a certain phasing. Each stage provides its own tasks, and the psychotherapeutic effect varies in form, focus and content.

The first stage (preparatory) is characterized by the use of indirect (indirect) suggestion. It turns out to be advertising and information activities, advisory work of psychotherapists, other patients who have undergone treatment (live advertising), somatic doctors who issued a referral for treatment, familiarizing patients with the treatment results presented in the album with photographs and videos. Before starting treatment, a psychological and psychophysiological examination of the patients is carried out.

The second stage (medical) includes a collective group session for 4 meetings. Two meetings of 8 hours in a row by the marathon method (it is better, but not necessary, when one of the two meetings is held at night) and two control-supporting sessions of three hours a month and three months after the main exposure. The marathon method has the following specific mechanisms and advantages:

1) the intensity and concentration of the psychotherapeutic effect exceeds the intensity of the similar total effect of the “classical” (90 minutes) classes due to the saving of time for “warming up” and structuring the group;

2) increasing asthenization and failure of biorhythms, behavioral stereotypes of patients reduces resistance, facilitates the occurrence of altered states of consciousness, the development of a new experience;

3) the continuity of group experience contributes to the inclusion of a variety of exercises and experiences in a single group process.

The number of group members is usually not more than 12-15 people. An increase in their number is impractical, since this makes it difficult for the doctor to contact patients, control over them, deprives him of the opportunity to introduce elements of individual suggestion, keep all patients in sight during the class, and maintain their attention. Individual treatment would be less effective, since the joint activity of patients in the group actively involves patients in the treatment process, develops communication skills, facilitates the exchange of impressions of treatment and individual experience, and helps to overcome unconstructive fixation on disbelief in achieving the goal.

After the formation of the group, the acquaintance of its members with each other and with psychotherapists, rational psychotherapy is carried out. During the conversation, the therapist repeatedly emphasizes that the most effective way to lose weight and maintain optimal weight is to change eating habits, reduce the frequency and number of meals in accordance with the needs of an individual weight normalization program, and reorganize a person’s psychological motivation in relation to food and their own physical activity. At the same stage, indicators of normal body weight for each member of the group are discussed. It can be calculated using formulas or tables.

Brock's Advanced Formula:

M = P-100-10% of the difference obtained,

where M is the normal body weight, kg, P is the growth in cm.

Breitman score:

M = P * 0.7-50

In the English language literature, the Body Mass Index (BMI) is widely used.

BMI = M / P ² (m)

Body weight in kilograms is divided by the height in meters squared. An indicator of no more than 25 indicates normal body weight, BMI in the range of 25-27 corresponds to overweight, more than 27 indicates obesity.

Violation of the regulation of food intake is one of the significant reasons for the development of excess adipose tissue. For most people with normal body weight, usually no special involvement of consciousness is required in determining the volume and quality of food. In a significant part of overweight people, achieving the energy balance of energy input and expenditure requires constant conscious control.

For a correct understanding of human nutritional behavior, it is necessary to touch upon such concepts as “hunger”, “appetite”, and “satiety”.

Hunger is a combination of unpleasant sensations in the form of emptiness and spasms of the stomach, an instinctive sensation of the need for food. It occurs when the nutritional reserves of the body have dropped below the level necessary for energy balance.

Appetite (from lat. - desire, desire) - a general feeling of pleasant emotional sensations that are associated with a person’s desire to eat certain foods. It is based on the desire to get the pleasant sensations that accompany the intake of a particular food. In contrast to hunger, appetite occurs with sufficient nutritional reserves of the body.

Satiety - lack of desire to eat, caused by eating. It is the opposite of starvation, being the back of one coin.

During the conversation, the therapist emphasizes the need to listen to changes in the sensations that usually occur during and after treatment (for example, increased satiety, decreased appetite, changed taste, indifference or aversion to previously beloved high-calorie, sweet or fatty foods, etc.) and gives the task not to eat without a feeling of hunger, which often do many obese people. But, if you still wanted to eat, then you need to eat correctly, abandoning the "empty calories", correctly compiling your diet using the proposed dietary recommendations.

1) Reduce caloric intake due to the restriction of carbohydrates, which are especially easily digestible (sugar, chocolate, sweets, pastries, pasta, white bread, cakes, cakes, etc.). From carbohydrates, you can leave cereals that are boiled in water (rice, buckwheat, oatmeal, barley), not more than 100 g of coarse bread (bran, black, rye), which contains fiber, more protein and B vitamins and is less caloric. Having excluded honey, jam and sugar from your diet, you can add sweetener (“Milford”, “Zucly”, etc.) to tea and coffee.

2) Exclude animal fats from the diet (lard, butter, fatty meat, cream, fatty cheeses). In a small amount (1-2 tablespoons) you need to leave vegetable oil in the diet for dressing vegetable salads.

3) Follow the correct methods of cooking food (boiling, stewing in water, steaming, etc.).

4) Mandatory inclusion of proteins in the diet. The mistake of many people who want to lose weight is to neglect protein foods. But proteins, breaking down to amino acids, are the “building material” for the cells of the body, they are low-calorie and give a feeling of satiety in the food field. Therefore, be sure to include in your diet animals (lean meat, poultry, low-fat varieties of fish, boiled eggs - no more than 1-2 per day) and vegetable (peas, beans, beans, mushrooms, soy products) proteins.

5) Dairy products (skim milk, cottage cheese, yogurt, kefir, yogurt, sour cream 2-3 tablespoons for salads) can be used as a source of protein and calcium.

6) Fruits and berries are all but bananas. They are a source of vitamins, trace elements, fiber, but they need to be eaten only before the “main” meal or in a separate meal. In winter and spring, include in the diet dried fruits (dried apricots, raisins, prunes), which are a source of potassium and stimulate the intestines.

7) Vegetables (raw, boiled, stewed) without restriction, except for potato, which is high in calories due to the high starch content, but after soaking peeled potatoes in cold water for 10-12 hours, its calorie content can be reduced.

8) Exclude beer and other alcoholic beverages.

9) Limit the consumption of salted products (salted and smoked fish, corned beef, salted sauces and seasonings), since salt retains fluid in the body, contributes to the formation of edema, thereby slowing down the process of splitting of adipose tissue.

10) Properly organize a drinking regime, drinking without limitation only filtered or mineral water. Listening to your own feelings, drink only if you want, without overloading the body with excess fluid.

11) Eliminate from the diet spices and seasonings that can stimulate appetite.

To lose weight, you must use the following rules and recommendations.

1) Keep a weight loss diary in which every day to note the amount of food eaten in kilocalories.

2) Using a diary to learn how to regulate the energy balance of the body. Any type of obesity is ultimately ensured by an excess of energy intake from food over energy costs. In a person with normal body weight, the amount of kilocalories consumed with food approximately corresponds to the amount consumed in the course of life. The body adjusts this balance automatically. To a complete person whose processes of regulation of energy metabolism are disturbed, in order to lose weight, it is necessary to strictly regulate the intake and expenditure of energy. Therefore, counting your energy balance in the diary using the proposed calorie tables and energy expenditure tables for various types of activities, you can achieve the necessary energy supply deficit. In order for the effective process of losing weight to begin, the energy deficit should be about 500-1500 kcal per day.

3) On the day to receive with food no more than 600 kcal.

4) Create a better diet yourself. Using the above dietary recommendations, individual characteristics of his own body, tastes and habits, each patient can create for himself the most effective and optimal diet.

5) Regularly monitor your weight on the same scales at the same time, as well as monitor changes in volumes of different areas of the body. Most often, the weight is reduced not smoothly, but stepwise, so you need to be prepared for the fact that the process of losing weight will be accompanied by periods of “stop” weight loss. The main thing is not the speed of losing weight, but a change in habitual harmful stereotypes of nutrition, a change in the quantity and quality of food.

6) Eat slowly, chewing thoroughly. Usually a feeling of fullness comes 15-20 minutes after the start of a meal, so this is the minimum time that you need to spend on food. If you eat quickly, then before the onset of satiety, a person eats more than necessary to satisfy hunger.

7) Apply fasting days 1 time per week. For instance:

A. Milk-kefir diet: 1 liter of milk or kefir

B. Fruit and vegetable diet: 1 kg of apples or tomatoes or cabbage and carrot salad.

B. Complete abstinence from food: use only 1.5 liters of mineral water or herbal tea.

8) There are only small spoons from small plates, which subjectively increases saturation.

9) When there is a desire to eat, in order to limit hunger from appetite, try to distract for 10-15 minutes, if you still have a desire, you can go to the kitchen. But you should always start the process of eating with liquid (a glass of water, tea or juice in small sips) or low-calorie dishes (fruits, vegetable salads), carefully listening to the sensations in the body.

10) Stop eating by the clock, under the TV, eat up at home.

11) To increase the motivation to lose weight, you can buy an expensive dress or suit of the size that the patient seeks and, hanging it in a prominent place, present your “slim image” in this outfit.

12) Use a steam room or sauna to cleanse the skin, remove toxic products from the body, get rid of excess fluid, speed up the process of splitting of adipose tissue.

13) The use of methods of self-regulation and self-hypnosis at home.

During treatment, patients learn the basics of autogenic training and self-hypnosis in order to independently influence their own feelings at home, reducing appetite, increasing satiety, strengthening willpower, etc. The activity of auto-training confronts some of the negative aspects of hypnotherapy in its classical model - the patient’s passive attitude to the treatment process, and dependence on the doctor. The main elements of the technique are muscle relaxation training, self-hypnosis and self-education. The therapeutic effect of autotraining, along with the development of a trophotropic reaction as a result of relaxation, which is characterized by an increase in the tone of the parasympathetic department of the autonomic nervous system and helps to neutralize the stress state, is based on a weakening of the activity of the limbic and hypothalamic regions, which is accompanied by a decrease in general anxiety and the development of anti-stress tendencies. In recent years, more and more works have appeared in physiology, which show that the saturation signal triggers complex reactions of the hypothalamic-pituitary and limbic systems, some of which are associated with positive emotions. With emotional stress amid increasing anxiety, a feeling of fullness and the emotional reactions associated with it may possibly act as a compensatory mechanism. According to psychiatrists, emotionally immature individuals experience a hyperphagic reaction to stress, which is a maladaptive, but not socially reprehensible form of protection for any emotional and psychological discomfort (I.S.Korosteleva, 1994). A number of authors note that bulimia may be a sign of latent depression. The presence of such indicators as anxiety and depression is characteristic of patients suffering from obesity as a symptom of mental distress (V.I. Krylov, 1994). Therefore, it is advisable to teach patients who are overweight, the elements of auto-training: 1) the lowest level - relaxation training using exercises aimed at evoking a feeling of heaviness, warmth, and mastering the rhythm of cardiac activity and breathing; 2) the highest level - the creation of trance states of various levels. The lower stage consists of six standard exercises that are performed by patients in one of three poses (sitting in the “coachman” position, lying or reclining). Exercises are carried out by mentally repeating 5-6 times the self-hypnosis formulas that are prompted by a psychotherapist and aimed at causing a feeling of heaviness in the arms and legs, a feeling of warmth in the arms and legs, regulation of the heart rate, normalization and regulation of the respiratory rhythm, inducing sensations of heat in the abdominal area cavity, sensations of coolness in the forehead in order to prevent and weaken headaches of vascular origin. An indicator of the assimilation of the next exercise is a generalization of sensations. The second stage uses the exercises of plot imagination and self-assertion developed by domestic authors (Panov A.G., Belyaev G.S., Lobzin B.C., Kopylova I.A., 1980), which are based on techniques of intentional regulation of emotions. The purpose of the exercises is an independent conscious modeling of a given emotional state, and the essence is to reproduce emotionally colored representations, images and dynamic situations. Self-affirmation exercises consist in a mental rehearsal of an exciting, meaningful situation in the light that the patient wants to see. These exercises are best done in the morning, not yet awaking completely, i.e. being in a natural autogenic immersion. Self-suggestion or autosuggestion is a process of suggestion addressed to oneself. It allows the patient to evoke one or another sensation, perception, control the processes of attention, emotional and somatic reactions. The essence of auto-suggestion according to Pavlov I.P. consists in concentrated irritation of a certain area of the cerebral cortex, which is accompanied by inhibition of the remaining parts of the cortex, representing the interests of the whole organism, its integrity and existence. Self-hypnosis does not require special training. It is enough twice a day after waking up and before going to bed 3-4 times to yourself to repeat the formula of self-hypnosis. It is compiled arbitrarily, consists of several short phrases. As an example, we give one of the possible options:

1) I have a good mood and well-being.

2) I like the process of losing weight.

3) Every day, the more I try to lose weight, the less my appetite.

4) The longer I keep a diary, the more harmonious and easier my body becomes.

5) I am indifferent to sweet, fatty and floury foods.

6) The faster the saturation increases, the faster the fat tissue breaks down.

7) Reducing weight and volume enhances health and improves well-being.

Much attention in psychotherapy of overweight is given to trance methods - psychotherapeutic methods using altered (split) states of consciousness for therapeutic or prophylactic purposes. In our work, we use the techniques of not only classical hypnosis, but also Erickson's, which, having absorbed all the positive experience of classical hypnosis, differs from it by the following criteria:

1) The patient’s sanogenic resources are used.

2) All patients are considered hypnotic.

3) The therapeutic formulations are vague (generalized), with a high resolution ability to connect the subjective reality of the patient.

Examples of psychotherapeutic texts are given below (O.V. Krasnoperov, 1996).

Text No. 1.

Before you enter a trance state, I will ask you to get comfortable. And you can note that as soon as you relax, this condition arises inside you, a state of trance. And you can note that you hear my voice well, hear the music well, feel like you are sitting in a chair, and you can feel your hands touching your legs, relaxing. And you can feel the temperature of your hands, the weight of your hands and, while continuing to listen to my voice and music, you can continue to relax, plunging further and deeper into this state. And feeling your legs touching the floor and your back touching the back of the chair, you can feel calm and safe, and continuing to relax, plunging deeper and deeper into this state, you can allow yourself to learn more about this condition. Listening to my voice will help everyone to improve their health, get rid of bad habits, and solve many psychological problems. And your consciousness can be far from here, in some places that are pleasant for you, where you can relax and rest, and these memories or ideas activate your subconscious in a certain direction, which in turn makes the changes that you need with the body. You absolutely do not have to believe in them or not to believe. Just listening to my voice and my words, you will immediately or gradually begin to find in your body those or other changes that are useful to you. It is absolutely not necessary to understand the meaning of all the proposals; your well-being will improve without it. Maybe sometimes listening to these phrases, you will catch yourself thinking that you think about something of your own or don’t think about anything at all and don’t understand their meaning. And this is good ... And if you want, you can listen further and listening to my voice will relieve fatigue, improve your mood, increase vigor, activity and working capacity. Since each of us, to varying degrees, is tired: someone is constant, the other is at the end of each working day, and the third is only occasionally after hard work. Our mood is also subject to fluctuations. Sometimes you after troubles can be depressed for a long time, but sometimes you can experience an increase in vitality and an increase in mood, without knowing why. It all depends on the work of your subconscious.

And each of you now can recall one or several cases from your life (maybe from childhood or adolescence or from the recent past), when even, it would seem, after hard work, you still remained active, cheerful and efficient and could “collapse mountains ”... And I don’t know at what moment this feeling of vivacity and good mood from your past can return to you. Everyone needs their own time for this (for someone - minutes, for someone - hours). But I know that your subconscious is capable of much better than yourself to look at your past and find in it exactly those resources, the energy that you need.

I wonder how you will learn about these useful changes. Maybe you will feel the lightness and elasticity of the muscles or physically feel that you can walk, climb stairs or work without fatigue much longer than before, or maybe you will hear from others that you look good, or you will see your joyful smiling face in the mirror.

And the more often you smile, the more you will be surprised that your mood has really improved and your working capacity has improved.

Text No. 2.

This treatment session will help everyone to get rid of excess weight, and, regardless of how many extra pounds you have: sixty or two. But if someone thinks that all the extra pounds of weight will disappear by the end of the session, then he is mistaken. Weight reduction will occur gradually. Someone will need several weeks for this, someone some months depending on your initial weight. And your consciousness may doubt it, while your subconscious mind is already beginning to explore your inner mysterious world and begins to determine ways and methods of normalizing weight. And maybe some of you, listening to my words, will take a deeper breath, while others will begin to plunge into some state or even go into a trance, while others, on the contrary, will feel most alert and activate their consciousness even more.

In general, trance is not such a special phenomenon, it is a frequently encountered, widely distributed condition. Each person has been in this state many times in his life. And you, too, several times during the day enter this state and exit it. Since trance means standing in line, listening to a lecture, driving a car, and all other conditions when you are immersed in yourself, in your thoughts, in your sensations. And, listening to me, some of you can already plunge into a state of trance of the depth that you need here and now. And it is interesting that each person, as if intuitively, knows what depth and duration of the trance he needs at one or another moment in time, in one or another state.

And you can change quickly or slowly. In the same way, immediately or gradually you will begin to appear the necessary therapeutic effects. Someone today, tomorrow or in the coming days will notice that the appetite is reduced or completely disappears. Another will noticeably accelerate satiety after eating: to completely saturate and overfill the stomach, two or three tablespoons of food will be enough, or even any piece of food will cause expansion and bloating in the stomach. At the third, taste sensations will change at first - previously favorite food will become less tasty or even indifferent. For someone, all these sensations will appear simultaneously, for the other they will appear one after another - sequentially or intermittently. And the more your mind resists now, the faster you will lose weight. And I don’t know how you listen to me carefully or superficially, seriously or with a grin, but I know that after a while everyone who needs it will find that his weight has decreased, although maybe he didn’t pay attention, that appetite decreased, satiety accelerated, and the tastes and smells of food were perverted. This is because it is difficult for you to notice that the metabolism of your body has increased and the breakdown of adipose tissue has accelerated, and this happens for everyone who inhales and exhales while sitting in this room. And before you agree with what will be said further, I would like to recommend that you always pay attention to your feelings before eating and don’t eat at all if you don’t want to. And if you really want to lose weight, then sitting down at the table and starting eating, you will remember this state of trance and you will be surprised to feel that you are already full, or note that the food today is not so tasty and even reminds you in your mouth, mixing with saliva, something unpleasant.

Text No. 3.

I know that some of you have been embarrassed for a long time to go to the beach and bathe in reeds or do not bathe at all; others hate mirrored bathrooms; still others dream of wearing the clothes they want (shorts, short skirts, etc.), and not the clothes the figure makes them wear; fourth are tired of the diseases that are always associated with overweight: headaches, shortness of breath, pain in the joints and spine, hypertension, stones in the gall bladder and kidneys and many others. But I know that whoever really wants to can become slim, beautiful, healthy, and therefore happy.

And the more carefully you listen to my words, the further and further the process of your healing will go. And before you again feel a noticeable weight loss, you will remember our treatment two, three or even four times a day. And, smiling, you can recall that the process of weight loss is preceded by a decrease and loss of appetite, as fast as possible satiety, increased metabolism and others, personally your individual feelings.

Our existence is a chain of continuous change. The universe itself is constantly changing. Seasons change, the ebb and flow ebb, the leaves on the trees crumble and bloom again. Even in our body there is a constant process of cell death and the emergence of new ones. Even mighty rocks collapse and decrease over time. Therefore, the expectation of changes in ourselves is so natural. And the more you concentrate on this thought and realize that the achievement of these changes is within your capabilities, the more successes you will achieve in life. From the very beginning, set yourself up for the fact that you will certainly make the desired changes with the help of these texts ...

And you can imagine a warm winter day. You can remember yourself in childhood in winter ... or your children, or grandchildren ... or just children playing outside in the winter. And you can imagine, easily or with difficulty, how you or they build snowmen from wet snow. A small ball of snow is taken and rolled on the lying snow. And soft, friable, white snow begins to stick to a small lump. And the lump is increasing, becoming more and more. And now the first ball is ready. Then the second and third roll out. Set one on top of the other, you can attach your hands, stick a carrot instead of a nose, and the snowman is ready. And all winter this big, white, heavy snowman stands invariably. But spring comes, the sun warms, and it suddenly begins to melt, diminishes before our eyes. Every day it’s getting smaller and smaller, thinner and thinner, lighter and lighter. And there is only one carrot left. And I do not know when spring will come in your life. It can come even in winter and, of course, in spring, or maybe by the summer all your white loose “snow” will already melt, or maybe before that you will introduce healthy carrots into your diet or come up with something else more effective. But every day: in the winter, in the spring, in the summer or in the autumn, remembering our treatment, you will be surprised to find in your body all new and new useful things that will help you get rid of complexes, strengthen your health and completely cope with excess weight.

At the end of treatment, at the final stage, the program and the time of control and support meetings are discussed, which are necessary to consolidate the effect of treatment, as well as to answer questions that may arise in patients in the process of further independent weight loss. The doctor insists on the need to be especially careful when successfully completing treatment. After treatment, many patients are very happy with their appearance and well-being, forgetting about the possibility of recurrence of the disease if the diet and exercise regimen are not followed. Therefore, situations that can provoke a relapse of obesity are discussed: nervous tension, stress, temptation situations, which helps to avoid mistakes.

To identify the effectiveness of treatment used 4 groups of patients:

1. Diet therapy (without psychotherapy) - 15 people

2. Psychotherapy in separate sessions for two weeks (without dietetics) -12 people

3. Psychotherapy in separate sessions for two weeks in combination with dietetics with follow-up meetings after one and three months - 18 people

4. Psychotherapeutic marathon in combination with dietetics followed by maintenance sessions after one and three months - 80 people (the proposed method).

The following indicators were measured in all groups of patients: body weight before treatment, body weight 1 and 3 months after treatment, and results of the SAN test (subjective assessment of well-being, activity, and mood according to a ten-point system), respectively. Patients of all groups were tested according to the method of multilateral personality research: no significant differences between groups in terms of all scales of this method were found. Patients of all groups are women (mean age 34 years).

The results are presented in the table. Analysis of these data shows that the best result was obtained using a psychotherapeutic marathon in combination with dietetics (4th group of patients): in the first month they lost an average of 9.68 ± 0.2 kg. (11.4% of the initial weight), and 3 months after treatment, the average weight loss was 17.4 ± 0.2 kg, which amounted to 20.2% of the initial weight. Group No. 3 turned out to be in second place in terms of the effectiveness of weight loss, when the classic version of psychotherapy was used - in separate sessions of 1-1.5 hours a day for 2 weeks in combination with diet therapy: weight loss in 1 and 3 months after treatment amounted to 7.4 ± 0.35 kg and 11.0 ± 0.3 kg (8.6% and 12.8% of the initial), respectively. Patients of group No. 2 even lower their body weight (when the classic version of psychotherapy was used for 2 weeks without diet therapy), who lost 5.8 ± 0.4 kg and 7.6 ± 0.4 in 1 and 3 months kg (7.0% and 9.2%), respectively. The worst result was obtained in patients of the 1st group who received only diet therapy: a month after treatment, their body weight decreased by only 3.9 ± 0.3 kg (4.8% of the initial) and after 3 months practically remained on this the same level - 4.3 ± 0.4 (5.3%). The obtained differences in the rate of weight loss between all groups are statistically significant (P <0.05). Moreover, in patients of the 4th group this speed is maintained 3 months after treatment, while in patients of the 3rd and 2nd groups it significantly decreases, and in the 1st one it practically stops.

Analysis of the SAN test indicators revealed a stable increase in the level of well-being, activity and mood from the start of treatment and 3 months after treatment only in the 4th group of patients who underwent a psychotherapeutic marathon in combination with diet therapy. Subjectively, they noted a decrease in appetite, an acceleration of the satiety process and painlessness (without great effort) of weight loss. While in patients of other groups, only in the first month there was an increase in the level of well-being, activity and mood (but to a much lesser extent than in patients of the 4th group), and 3 months after treatment, these indicators began to decline. In patients of the 1st group who underwent only diet therapy without psychotherapy immediately after treatment, a significant decrease in mood began, which they explained by restraining the amount and calorie intake of food due to only willpower, while appetite, on the contrary, increased.

Based on the foregoing, we can conclude that the proposed method for the treatment of food addiction allows to increase the effectiveness of treatment and stabilize the results through the integrated use of psychotherapeutic techniques in the form of a psychotherapeutic marathon, helping to change the nutritional strategies and psychological motivations of patients in combination with diet therapy, which allows optimizing the diet.

Thus, the proposed method for the treatment of patients with food addiction, accompanied by obesity, allows you to:

1. To increase the effectiveness of the treatment of patients with food addiction, accompanied by obesity due to the integrated use of psychotherapeutic techniques in the form of a psychotherapeutic marathon, changing their attitude to food (reducing appetite, accelerating the saturation process, etc.) and improving the subjective psychological background - well-being, activity mood.

2. To stabilize the results and increase the duration of remission through the use of methods of self-regulation and self-hypnosis in combination with diet therapy.

3. Optimize the psychotherapeutic process - work in a short time (2 eight-hour psychotherapeutic marathons), without drug exposure.

Table The dynamics of body weight and the level of SAN in patients with food addiction, accompanied by obesity Before treatment 1 month after treatment 3 months after treatment Body weight FROM
point BUT
point N
point Body weight reduction FROM
point BUT
point N
point Body weight reduction FROM
point BUT
point N
point abs.kg rel.% abs.kg Rel.% Diet therapy 80.7 4.8 3.9 6.3 3.9 4.8 5.3 4.0 5.2 4.3 5.3 5.2 4.2 4.9 ± 2.9 ± 0.25 ± 0.25 ± 0.3 ± 0.3 ± 0.4 ± 0.23 ± 0.25 ± 0.2 ± 0.4 ± 0.5 ± 0.22 ± 0.23 ± 0.2 Psychotherapy 82,4 4.6 3.8 5.9 5.8 7.0 5.5 5,4 6.5 7.6 9.2 5.5 5.7 6.2 ± 3.1 ± 0.3 ± 0.3 ± 0.35 ± 0.4 ± 0.4 ± 0.28 ± 0.24 ± 0.3 ± 0.4 ± 0.42 ± 0.3 ± 0.25 ± 0.3 Psychotherapy and 86.3 5,0 4.2 5.9 7.4 8.6 5,4 5.5 6.7 11.0 12.8 5,6 5,4 6.2 diet therapy ± 2,3 ± 0.25 ± 0.25 ± 0.25 ± 0.35 ± 0.35 ± 0.3 ± 0.25 ± 0.23 ± 0.3 ± 0.3 ± 0.26 ± 0.25 ± 0.25 Psychotherapist. 84.76 5.1 4.0 5.7 9.68 11,4 6.5 6.8 7.4 17.16 20,2 7.1 7.5 8.2 Marathon ± 1.75 ± 0.1 ± 0.1 ± 0.15 ± 0.2 ± 0.2 ± 0.1 ± 0.15 ± 0.2 ± 0.21 ± 0.23 ± 0.15 ± 0.2 ± 0.23

Claims (1)

A method of treating food addiction, accompanied by obesity, including diet therapy and psychotherapeutic effect during collective-group sessions, characterized in that the main psychotherapeutic effect is carried out for two sessions of eight hours each by the method of marathon under conditions of asthenization, failure of biorhythms and behavioral stereotypes, while develop motivation for a healthy diet, self-confidence and faith in success, form a weight loss program, visualize and concretize treatment, conduct Evnika eating behavior, psychological protection is performed when a situation diet disorders, major sessions performed after psychotherapeutic effects during one session lasting three hours later one and three months, aimed at consolidating the results, and debate exception situations triggering relapse obesity.