RU2218189C1 - Method for treating the cases of migraine in periods between attacks - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves concurrently administering kineso- and psychotherapy courses in individual schedule during 2-3 weeks each course being 8-10 trainings long in alternating the kineso- and psychotherapy treatments each other day. A kinesotherapy course is composed of physical training exercises for adjusting posture, training feeble muscles and expanding contracted muscles and dosed physical training exercises on bicycle ergometer. A psychotherapy course is composed of education and training by applying emotional and muscle relaxation and breathing exercises as well as psychological influence courses aimed at patient self-estimation by means of induced reproduction and following dynamic posture and verbal fixation of psychophysiological states of at least for types associated with satisfying of predominant types of biosocial needs like safety, freedom and independence in achieving aims and self-realization, in approval and acknowledging and love of people from close surrounding. The course also includes psychological treatment stimulating patient motivation to recovery and psychological treatment expanding skills of psychological self-regulation and helping in solving the most disturbing problems exciting the patient. EFFECT: enhanced effectiveness of treatment; accelerated treatment course. 5 cl

Description

 The present invention relates to medicine, namely to neurology, rehabilitation medicine and psychotherapy, and can be used to treat migraine patients in the interictal period of the disease.

 The urgency of the problem of improving approaches to the treatment of migraine is due to the high frequency of this pathology. While the relief of migraine attacks is carried out mainly by medications, in the treatment of migraine in the interictal period, more and more attention has been given to nonpharmacological effects. The high frequency of neurotic disorders in patients with migraine served as the basis for the inclusion of psychotherapy in their medical rehabilitation programs (B. Persson, 1997; E Van Hook, 1998). As a rule, it is recommended to conduct educational and informational courses, the use of auto- and heterosuggestion, autogenous training, respiratory relaxation training and other ways of emotional and muscle relaxation, as well as the use of “controlled imagination” and methods of psychophysiological self-regulation using biological feedback. It is indicated that the skills acquired in the process of psychotherapy allow patients to arbitrarily influence the intensity of pain perception, change non-adaptive beliefs and behavioral reactions associated with the disease, influence the triggering psychophysiological mechanisms of migraine (A.M. Wein et al., 1995; GE. Ilacqua, 1994; A.Mc. Grady et al., 1994; SF Dworkin, 1997; G. Peters et al., 2000).

 The relevance of the use of kinesitherapy in the prophylactic treatment of migraine is justified by the need to correct violations of the functional state of pericranial muscles and shoulder muscles, which are more common in these patients than in healthy individuals (R.F. Kidd, R. Nelson, 1993).

 However, in general, questions of the effectiveness of the use of therapeutic physical and psycho-correction methods in the medical rehabilitation of migraine patients are not well understood.

 Closest to the proposed method for the treatment of migraine is the method of D. A. Marcus et al. (1998), combining the use of individualized kinesitherapy and psychotherapy (Marcus DA, Scharff L., Mercer S., Turk DC Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback // Cephalalgia, 1998, Vol., 18 N 5. - P.266-272). This method is selected as a prototype.

 The authors used the sequential prescription of psychotherapy after kinesitherapy (19 people) and kinesitherapy after psychotherapy (11 people).

 Kinesitherapeutic effects were carried out by a group method and included physical exercises aimed at correcting posture, increasing the mobility of the cervical spine and stretching pathologically strained muscles of the trunk and extremities. Psychotherapy was carried out by a group method and included relaxation training (training to regulate muscle tone using conscious perception of the temperature of one’s own fingertips, that is, biological feedback) and breathing exercises. As a rule, a prolonged course of migraine is accompanied by the development of tension headaches that bother patients in the interictal period of the disease. In this regard, as a criterion for the effectiveness of migraine treatment, the authors used the degree of regression of concomitant migraine headaches stress (GBI). A significant treatment effect was determined with regression of HDN by more than 50% of the initial values; in other cases, the effect of treatment was considered insignificant. The course of both kinesitherapy and psychotherapy took 4 weeks each, and their alternate use, respectively, 8 weeks.

 Thus, in the prototype, courses of kinesitherapy and psychotherapy are carried out sequentially alternately (and not in parallel) and through classes in a group (and not individually) with a total duration of treatment of 8 weeks.

 After treatment, significant improvement was achieved in 9 out of 19 women who received consecutive courses of kinesitherapy and psychotherapy, and in 6 of 11 women who received consecutive courses of psychotherapy and kinesitherapy, that is, only 15 out of 30 people (50%), whose treatment included combined using these two methods.

The disadvantages of the prototype method include:
- longer duration (8 weeks);
- insufficient effectiveness: significant improvement is achieved only in 50% of patients immediately after treatment, and long-term results do not indicate a decrease in the average frequency of migraine attacks.

 The objective of the invention is to reduce treatment time and increase efficiency by increasing the number of patients with significant improvement, as well as by reducing the average frequency of migraine attacks and prolonging the duration of remission in the long term.

 The problem in the method of treatment of migraine in the interictal period of the disease, which consists in the combined use of kinesitherapy and psychotherapy courses with the inclusion of physical exercises in the kinesitherapy course for posture correction, sluggish and stretched muscle training, and in the psychotherapy course - training and training using various methods of emotionally -muscular relaxation and breathing exercises, is achieved by the fact that the courses of kinesitherapy and psychotherapy are carried out simultaneously and individually for 2-3 spruce, 8-10 lessons in each course, alternating every other day with kinesitherapy and psychotherapy, and in addition to the course of kinesitherapy include physically-focused physical exercises on a bicycle ergometer, and the course of psychotherapy also includes: psychological effects that purposefully increase the patient’s self-esteem using reproduction at least four types of psychophysiological conditions associated with the satisfaction of leading types of biosocial needs (safety; in freedom and independence; in achieving the goal and self-realization; in approval, in recognition and love of others) with subsequent cognitive-dynamic and verbal consolidation of the resulting psychophysiological conditions; psychological effects that increase the patient's motivation for recovery; psychological influences that expand the skills of psychophysiological self-regulation and help solve the most disturbing problems for the patient.

 The need to include physical training on a bicycle ergometer in the kinesitherapy program for migraine patients is determined by the following.

 Migraine patients are often afraid of physical exertion and limit it in everyday life, often because they know from their own experience about the adverse effect of physical effort on the severity of headaches during an attack. At the same time, significant differences in the psychophysiological state of patients with migraine during the attack and in the interictal period (A.M. Vein et al., 2000) suggest a different, more favorable reaction of patients to physical training. In previous studies, we found that exercise tolerance in migraine patients is lower than in healthy individuals of the same gender and age. This fact, as well as the negative correlation we have found between the level of physical endurance of migraine patients and the severity of their emotional stress, which negatively affects the course of this disease, led us to the need for physical training in the treatment of migraine patients.

 It is known that training physical activity is able to restore the natural structure of the flows of afferent ascending impulse, modulate the level of excitability of various parts of the brain, normalizing the state of the limbic-reticular complex and reducing the severity of emotional stress. Regular training reinforces the adaptive response skills, gradually transferring them to an automatic, unconscious and more economical level of energy.

 Physical exercises on a bicycle ergometer are accepted in medical rehabilitation of cardiological patients (L.F. Nikolaeva, D.M. Aronov, 1988) in comparison with other methods of training physical fitness, the following advantages: they allow you to strictly dose the load, maintain it within the aerobic regimen ensure its training character and prevent unwanted overloads.

 We used the generally accepted regimen for patients with cardiovascular diseases training on a bicycle ergometer with a dosing load that did not exceed 70-75% of aerobic power, determined by the results of a bicycle ergometer test. In this case, we proceeded from the ideas (L.F. Nikolaeva, D.M. Aronov, 1988), according to which it is the level of the threshold heart rate (HR), determined by VEM, that is the main criterion for dosing the load when training patients with vascular pathology. In order to avoid overloads and at the same time provide a training effect, it is necessary to focus on the level of heart rate equal to 70-90% of the individual threshold frequency. In this case, only certain episodes are permissible, “peaks” of increasing heart rate up to 90% of the level, while the main training session is conducted at a heart rate of approximately 70% level (the so-called “plateau of loading”).

 In general, the program of differentiated kinesitherapy for migraine patients was aimed at correcting violations of the statocomotor stereotype revealed in patients, increasing exercise tolerance, and improving the functional state of the respiratory and cardiovascular systems. The treatment complex included physical exercises to relax pathologically strained and strengthen the weakened muscles of the trunk and limbs, exercises to improve coordination and balance, a system of breathing exercises, training on simulators, bicycle training to increase the aerobic capacity of the body. Training on a bicycle ergometer was carried out using a dosed load not exceeding 60-75% of aerobic power, determined by the results of a VEM test. The training time gradually increased from 8-10 minutes in the first lesson to 24-26 minutes to the ninth to tenth lesson (on average, the duration of the cycling training in each lesson increased by 2 minutes, the total duration of the lesson increased gradually, starting from 30-40 minutes a day beginning of treatment and up to 50-60 minutes by the end of a three-week course of therapy.). Kinesitherapy was carried out by an individual or small-group method.

 The need for targeted use in the treatment of migraine patients with psychological influences aimed at increasing the patient’s self-esteem is determined by the close relationship between emotional stress, which negatively affects the course of this disease, and a decrease in the person’s self-esteem. For patients with migraine, a high frequency of stress and low self-esteem, the so-called "trained helplessness / hopelessness" (G.M. Aronoff, J. B. Feldman, 2000), are very characteristic. The mechanism of the relationship between emotional stress and low self-esteem can be explained as follows. Low self-esteem by a person of his own abilities to achieve a certain goal (to satisfy his specific biosocial need) is associated with the prediction of failure, which, in turn, leads to a conscious or unconscious refusal of active activity aimed at achieving this goal. The larger the areas of life related to a decrease in self-esteem, the more passive a person is in life. Behavioral passivity leads to detraining, the loss of existing skills and to failures with a new attempt to solve the corresponding problem. Thus, the vicious circle "low self-esteem-hopelessness-refusal of activity, passivity-failure during activity-low self-esteem" closes. There are scientific studies supporting this assumption. So, in the work of Ben-Zur H. et al. (2000) revealed a relationship between the level of stress, a person's choice of ways to respond to a problem situation, and the prediction of one or another outcome of this situation. Pessimism (the usual expectation of the adverse effects of any encounters with life difficulties) negatively correlates with problem-oriented, effective strategies for coping with stress. According to the authors, maladaptive anti-stress strategies and pessimism contribute to the growth of mental stress, which, in turn, predisposes to the choice of passive behavioral maladaptive strategies.

 Emotional stress is largely generated by the violation of the satisfaction of actual needs. To meet their leading needs and reduce the state of stress, it is important for a person to change or expand his inherent repertoire of methods of targeted cognitive and behavioral response, which is possible only with an increase in his self-esteem.

 In order to help a person increase his self-esteem, we suggest inducing his memories of situations in which, after a period of his active work, he met any of the leading needs. During such a memory, a comfortable psychophysiological state corresponding to this need is reproduced. Its repeated reproduction in combination with an adequate phrase and gesture leads to the formation of a conditioned reflex. The repetition of these phrases and gestures later on in itself helps to reproduce the indicated comfortable state and increase the person’s confidence that he can achieve such a state, that is, his self-esteem. At the same time, the patient is taught to notice the slightest signs of the appearance of a corresponding comfortable state in everyday life when solving any seemingly everyday tasks, which reinforces the high level of his self-esteem based on the acquisition of already new experience.

 Depending on the semantic orientation, four types of leading biosocial needs can be conditionally distinguished: 1 - the need for security, isolation from a disturbing object, realized by suppressing one's own aggression and one's imperceptible withdrawal or flight from the enemy; 2 - the need for freedom and independence from people, realized through the active / aggressive pushing of the enemy and the release of their own personal space; 3 - the need for self-fulfillment and achievement of the goal, realized by one’s own approach to the object and its active / aggressive modification; 4 - the need for approval, recognition and self-love on the part of others, realized by suppressing aggression, expressing one's own goodwill and getting closer to the social environment. Four types of personality are distinguished, depending on which person’s need is leading and what methods of emotional-cognitive-behavioral response prevail in him (L.N. Sobchik, 1991).

 Satisfaction of various biosocial needs is accompanied by the emergence of various psychophysiological conditions that differ in their own characteristics of vegetative-visceral, neurohumoral, neuromuscular regulation. With this in mind, in order to increase self-esteem, we proposed using reproduction of at least four types of psychophysiological conditions associated with the satisfaction of the four main types of biosocial needs. The patient is stimulated by memories of situations in which he experienced feelings of his own attractiveness, success, independence, security. Cognitively dynamic (with the help of poses and gestures) and verbal (with the help of phrases) conditioned reflex fixing of these states, in our opinion, helps to stabilize positive self-esteem, that is, assessing one's own abilities to successfully interact with the outside world, while satisfying the corresponding need.

 Improving the motivation for recovery is of particular importance in the treatment of migraine patients who usually do not believe in recovery and therefore do not wait for it and do not make active efforts to achieve it. In addition to disbelief in one's strengths, the patient’s passivity is also often facilitated by the unconscious conditional desirability of the disease. It occurs when a disease allows a person to satisfy those important needs for him that he could not satisfy before the disease (GL Engel made this assumption for patients with chronic pain in 1959, creating his concept of a “patient prone to pain "). In our opinion, it is possible to increase the motivation for recovery by associating in the patient’s consciousness and subconscious mind feelings, emotions and thoughts related to a state of health, with other feelings, emotions, images and thoughts related to satisfying any of his urgent needs, that is to achieve a very important task for him. Such a connection can be made through suggestion or outreach. Previously, it is necessary to help the patient to form an idea of his state of health, that is, to feel and realize those feelings, emotions, thoughts with which he defines him.

 The targeted training of migraine patients, not only the traditionally recommended methods of emotional and muscle relaxation and relaxing breathing, but also the methods of correcting cognitive and behavioral responses is dictated by the fact that all these skills help to reduce the severity of emotional stress. All these methods in a broad sense are the skills of psychophysiological self-regulation.

 Especially important is the training of patients in self-observation skills. Improving the skill of self-observation and observation of the surrounding world (Sandomirsky M., 1995) helps to increase the adequacy of responses, and teaching a person how to perceive not only negative, but also positive signals from the external and internal environment of the body can increase the "specific gravity" of positive emotions in him psychological state, reducing the proportion of negative.

 In order to correct the cognitive response style, positive thinking can be taught (L. Jannoun et al., 1982; S. Devaney, 1997.) Replacing negative thoughts and beliefs with positive ones also leads to a decrease in the severity of negative emotions and a decrease in the severity of emotional stress. Another well-known technique that has not been used in migraine patients is goal setting (W.T. McWhirter, 1999; T.R. Lasane, 1999). It allows a person to increase their ability to realize the desired goal of activity and diversify the ways to achieve it. This skill allows you to increase the effectiveness of solving many life problems and thereby reduce the level of mental stress. Another technique that contributes to changing and expanding the repertoire of habitual beliefs and judgments is the technique of rethinking the events of one’s past (P. Goldberg, 2000). Its use allows you to reduce the adverse effects of psychological trauma experienced earlier on the usual emotional, cognitive and behavioral response of a person. Along with those described, there are a huge number of other methods of cognitive-behavioral therapy that help reduce the level of emotional stress. Their use helps to reduce the severity of emotional stress caused by disturbing patient problems. In addition, the use of these skills allows you to change your attitude to the disease and accelerate recovery (in particular, due to the transition to a healthier lifestyle).

 The proposed method is as follows.

 A patient with a migraine undergoes a course of psychotherapeutic and kinesitherapy sessions lasting 45-60 minutes each. Psychotherapeutic and knesotherapeutic exercises alternate with each other. Each of them is carried out every other day. The entire course of treatment consists of 8-10 psychotherapeutic and 8-10 kinesiotherapy classes and takes 2.5-3 weeks. These terms correspond to medical standards adopted for the treatment of patients with migraine.

 After each lesson, the patient is given a task for independent training and the corresponding methodological literature is provided.

 Psychotherapeutic and kinesiotherapy classes are carried out in the following sequence.

 At the first psychotherapeutic lesson, a conversation is held with the patient, during which information is provided on the negative impact of chronic emotional stress on the development and course of migraine. During the conversation, the patient is helped to partially realize the main sources of his mental stress and the relationship between his mental state and manifestations of the disease. At the same time, the patient’s motivation to master the methods of psychophysiological self-regulation increases. They provide training in one or two methods of emotional-muscle relaxation. It is taken into account that most migraine patients have previously tried to engage in autogenic training and most often failed to master this rather laborious technique. Therefore, the simplest techniques of emotional-muscle relaxation are used (such as body awareness, relaxing breathing, etc.). Quickly achieved success increases patients' self-confidence and helps to increase their motivation for further studies.

 At the first kinesiotherapy session, the functional state of the muscles of the trunk and limbs is tested. After this, the patient learns two or three exercises to stretch the pathologically strained and training weakened muscle groups. Then, 2-3 respiratory relaxing exercises (diaphragmatic breathing, slow breathing with extended expiration, techniques of sound gymnastics, etc.) are learned with the patient. The lesson is completed by talking about the benefits of aerobic exercise to improve the general physical condition, expand the reserves of the cardiovascular and respiratory systems of the body.

 At the second psychotherapeutic lesson, the patient continues to be taught some methods of emotional-muscular relaxation: relaxation by remembering the muscular-articular sensations from those who relaxed after muscle contraction, relaxation using "controlled imagination". The patient also learns how to use “controlled imagination” to reduce the severity of pain.

 In the second kinesitherapy lesson, two or three new exercises are trained to stretch pathologically tense and train weakened muscle groups. The first cycle training lasts 8-10 minutes. After that, the patient performs 2-3 breathing relaxation exercises already known to him. This sequence provides a quick normalization of heart rate after training and convincingly demonstrates the effectiveness of breathing exercises.

 At the third and fourth psychotherapeutic classes, the patient is trained in the cognitive-dynamic and verbal expression of certain positive psychophysiological conditions. For this person they are asked to recall a specific situation during which he felt a sense of pride, joy, confidence after achieving success in any difficult business, to present his visual, auditory, tactile, muscular-articular and internal (protopathic) sensations at that moment , and then express your condition arising from this with a specific movement of the hands, head, shoulder girdle, as well as a short statement that reinforces positive self-esteem. The patient himself invents the movement and statement, the doctor only gives a small clue. Very often, the movement includes a sharp extension of the arms in the elbow joints with their simultaneous rise in abduction and flexion in the shoulder joints. Positive self-affirmation often has a formula such as “I can win,” “I can succeed,” etc. The specified memory, accompanied by appropriate movement and phrases, is recommended to be repeated daily 2-3 times a day.

 Then, in a similar way, a person is asked to recall a specific situation during which he experienced a sense of his own attractiveness, to reproduce the visual, auditory, olfactory, tactile, muscular-articular and protopathic feelings experienced at that moment. The condition that occurs in this case is asked to be indicated with a short self-affirming phrase and the movement of the head and neck. The patient himself invents the movement and the phrase, the doctor only gives a hint. Very often, the movement consists in a smooth turn and easy extension of the head and neck, alternately from left to right. This movement and phrase along with the corresponding memory is also recommended to be reproduced daily 2-3 times a day.

 In a similar way, a person is asked to recall situations when he experienced a sense of his own security, and he is taught his postural-dynamic and verbal expression of the corresponding positive psychophysiological state.

 Finally, the patient is induced to recall a specific situation during which he felt a sense of his own independence, and he is trained in the cognitive-dynamic and verbal expression of the corresponding positive psychophysiological state.

 The playback order of these states may vary. It is better to start with the memory that is given to the person more easily due to the fact that such situations were often encountered in his life.

 At the end of classes 3 and 4, the patient is advised in ordinary everyday life to fix his attention on those episodes when he experiences a sense of his success, or attractiveness, or security, or independence, accompanying each of them with an appropriate phrase and / or movement.

 In the third and fourth kinesitherapy classes, the patient performs already known exercises for relaxing tense and strengthening weakened muscles of the trunk and limbs. Also continue cycling, the duration of which gradually increases by the fourth lesson to 14-16 minutes. The patient is introduced to the criteria for termination of the load. Along with this, a general tonic complex is being studied with the patient, including dynamic exercises involving the middle and large muscle groups of the upper and lower extremities, exercises with static tension of the muscles of the cervical-collar zone, coordination and balance exercises, as well as exercises on muscle trainers.

 At the fifth and sixth psychotherapeutic classes, the patient is taught the methodology for setting and achieving goals, and provides information about non-adaptive thinking styles. The patient is helped to analyze the features of his thinking and is taught some techniques for replacing negative thoughts and beliefs with positive ones.

 At the fifth and sixth kinesitherapy sessions, they continue to use special exercises aimed at correcting the functional state of pathological tense or weakened muscle groups, using a general tonic set of exercises and training on a bicycle ergometer. The duration of cycling increases to 18-20 minutes to the sixth lesson. In addition, the patient learns two or three exercises to correct scoliotic posture.

 At the seventh psychotherapeutic lesson, psychological effects are used that increase the patient's motivation to recover from the underlying disease. For this patient, they are asked to present themselves as healthy, creating in their imagination an appropriate visual, auditory, kinesthetic image. After this, the patient is explained and / or inspired by the relationship between his state of health and the achievement of his most significant goals in life, the existence of which the doctor knows from previous conversations with the patient. Then they assist in introducing and mentally rehearsing possible ways to cure the disease.

 At the eighth to tenth psychotherapeutic sessions, the patient is taught the use of new self-regulation skills to solve his most worrying problems, including overcoming the disease.

 At the seventh-ninth kinesiotherapy classes, classes continue using the above-described therapeutic physical exercises and training on a bicycle ergometer, the duration of which gradually increases to 24-26 minutes. The correctness of the exercises is checked and possible errors are sorted out. A set of exercises for homework for the next 1-2 months is being selected.

A brief description of the results of the application of the method
A three-week course of kinesitherapy (8–9 lessons) and psychotherapy (8–9 lessons) was carried out according to the described methodology for 23 women with migraines. A positive effect in the form of a decrease in the intensity of concomitant tension headaches by more than 50% of the initial values was achieved in 15 of them (65.2%). The long-term (estimated two months after the end of the course) effect was to reduce the average frequency of migraine attacks. Compared with the prototype, there was a higher treatment efficiency, as well as a reduction in its duration to 3 weeks (in the prototype - 8 weeks).

A detailed description of the results of the application of the method
In the neurological hospital of the Nizhny Novgorod Regional Clinical Hospital. ON THE. Semashko observed 23 patients suffering from migraine. The diagnosis of migraine was made according to the International Statistical Classification of Diseases of the tenth revision, taking into account the diagnostic criteria of the International Headache Society. Along with the clinical and neurological and standard laboratory and instrumental diagnostic examination, a psychodiagnostic, vertebral neurological examination was also carried out; manual diagnosis of the functional state of the muscles of the trunk and extremities, an assessment of the frequency and duration of migraine attacks, a measurement of the intensity of the accompanying migraine headaches of tension (GBN) on a visual-analogue scale (YOUR). A pulsometric study was performed, which is a type of cardiointervalography, including registration of heart rhythm (PC) with subsequent mathematical analysis of data using a special program developed by the Nizhny Novgorod Institute of Applied Physics of the Russian Academy of Sciences. A statistical analysis of the temporal parameters of the PC was carried out with the determination of the parameters of the entire set of cardio intervals, as well as a spectral analysis of the PC with the determination of the power of the main frequency components of the heart rhythm spectrum. The indicators of the temporal analysis of PC, reflecting the features of the autonomic regulation of cardiac activity, were mode (Mo), mode amplitude (AMo), variational range (BP), standard deviation of the dynamic range of cardio intervals (RMS), coefficient of variation (KB) and their derivatives indices - vegetative rhythm index (VLR), the index of regulatory system tension (IN) and the vegetative equilibrium index (IVR). The absolute and relative (%) power of respiratory waves (DW), the relative power of slow waves of the first order (MV1), the relative power of slow waves of the second order (MV2), as well as the centralization index (PM) (PM Baevsky and et al., 1984).

 Physical performance was determined on a Kettler Ergometer TXI 7987-900 bicycle ergometer designed for therapeutic purposes with recording of heart rate on an ASTA Plus ESAOTE, BOIMEDICA monitor. Bicycle ergometry (VEM) test included the use of continuous physical activity, stepwise increasing to achieve 75% of individual aerobic power, corresponding to an increase in the heart rate of the subject to submaximal age values. The duration of each step was three minutes. The initial power of the presented load was equal to 50 W, at each subsequent stage it increased by 25 W. The level of tolerance to physical activity (W) was determined by the value of the maximum achieved load, performed within three minutes without the appearance of generally accepted criteria for the termination of a bicycle ergometric test (G.G. Efremushkin, E.I. Busina, 1995; D.M. Aronov, 1995).

 In order to study the psychological characteristics of patients, the Abbreviated Multifactor Questionnaire for Personality Research (SMOL) in the adaptation of V.P. Zaitsev and the eight-color Lusher test were used. The specified examination was carried out before and after a three-week course of treatment.

 When assessing the immediate results of treatment, the dynamics of concomitant GBI migraine and exercise tolerance, changes in the parameters of the mathematical analysis of the pulsogram and the results of psychodiagnostic testing were taken into account.

 Changes in the average intensity of HDN and the indicator of physical tolerance after a course of treatment in a hospital were determined in percentage terms relative to the corresponding initial values and were evaluated on a two-point scale as significant (1 point) or insignificant (0 points). Significant were considered to be a decrease in GBN intensity by more than 50% with respect to the initial (reference) and increase in physical tolerance by more than 20% with respect to the original.

 The degree of normalization of the ratios between ergotropic and trophotropic autonomic influences was determined on the basis of an integrated assessment of the dynamics of indicators of temporal and spectral mathematical analysis of the heart rhythm and was assessed as significant (1 point) or as insignificant (0 points). Changes in the psychological state of the patient were evaluated as a significant improvement (1 point) or a slight improvement (0 points) based on the results of clinical observation of the patient, as well as a comparative analysis of the parameters of the SMOL test and the Luscher test before and after the course of treatment.

 A general assessment of the effectiveness of treatment by the time the patient was discharged from the hospital was carried out taking into account the number of those parameters that underwent significant improvement, and was carried out on a 5-point scale (0 points — no improvement, 4 points — significant improvement).

 2 months after discharge from the hospital by correspondence questioning, the intensity of HDN by YOUR and the frequency of migraine attacks in patients were re-evaluated.

 In assessing the differences in the indicators, the Student t test for connected and unrelated samples was used, as well as the nonparametric U-Wilcoxon-Mann-Whitney criterion. The significance of the differences in the fractions (percent) was calculated by the method of the angular Fisher transform. To study the relationship between random variables, the Brave-Pearson correlation coefficient was determined.

 After the course of treatment, the proportion of individuals in whom GBN significantly decreased by more than half relative to the initial values was 65.2%.

 Post-treatment patient tolerance to physical activity increased on average by 20.8 + 2.4% with respect to baseline values. Favorable changes in the parameters of the mathematical analysis of the cardiointervalogram were revealed, which testify to the equalization of the balance between ergotropic and trophotropic, sympathetic and parasympathetic autonomic influences (see the table at the end of the description).

 When analyzing the dynamics of the parameters of the SMOL test in patients, a significant decrease in the values of the first, second, third, sixth and seventh base scales after treatment was found. By reducing the “neurotic tilt” and decreasing the relative rise in the sixth and seventh level, the general configuration of the average personality profile was smoothed, which reflected a tendency to decrease the level of emotional stress, increase overall behavioral activity and increase the level of mental adaptation of patients of the first group. According to the integrated assessment of the results of all used psychodiagnostic techniques, a significant improvement in the psychological state after the course of treatment was noted in 87% of patients.

 Two months after discharge from the hospital, the frequency of migraine seizures in patients significantly decreased from 1.9 ± 0.5 to 1.0 ± 0.1 per month, p <0.05.

 The results obtained indicate that patients after the therapeutic course showed a significant decrease in HDN, increased physical endurance, improved functional status of the suprasegmental departments of the autonomic system and a decrease in the level of emotional stress, which indicates the effectiveness of treatment.

 One of the possible mechanisms of the therapeutic effect may be the optimization of the functional state of the regulatory systems of the brain caused by the combined use of kinesitherapy and psychotherapy. These data are consistent with the notion that therapeutic physical activity can modulate the level of excitability of various parts of the brain, change the nature of neuroendocrine, vegetovisceral and neuromuscular reactions, while destabilizing pathological hyperactive neuronal systems responsible for chronic pain (Kryzhanovsky GN, 1996; Bykov Yu.N., 2001). In our opinion, special attention was paid to the restoration of the natural structure of afferent flows and the normalization of the functional state of the brain, which was devoted to improving the ability of patients to recognize their bodily sensations and feelings. As a rule, migraine patients are characterized by increased sensitivity to negative (nociceptive) physiological and negative mental stimuli. It is possible that attracting patients' attention to positive incentives helped to balance the balance of ergo- and trophotropic systems at the physiological level and improve their emotional mood background at the psychological level.

 To increase the effectiveness of the treatment of migraine as a stress-dependent pathology, in our opinion, the increase in stress resistance and adaptability of patients was also important, achieved by expanding the range of their inherent methods of mental, physical and psychophysiological response. Improving the awareness of their bodily sensations, partially serving as biological feedback signals from the internal and external environment, was also related to increasing the ability to regulate the accuracy, proportionality and adequacy of physical and mental responses, that is, to increasing the adaptive capabilities and stress resistance of patients. Regular physical and psychological training reinforced the new skills of such a response and gradually transferred them to an automatic, unconscious and more economical level of energy. Thus, it is known that a decrease in the conscious perception of one's own physical and mental efforts and a weakening of voluntary control over one's motor and behavioral activity leads to an improvement in well-being of asthenized individuals by saving cerebral energy resources (S. K. Blackwood et al., 1998). The special use of psychological influences aimed at increasing self-esteem, changing attitudes towards the disease and increasing overall activity could also contribute to increasing the effectiveness of treatment of patients. The inclusion in the psychocorrectional program of a number of psychodynamic influences aimed at helping the patient in his awareness of his personality problems contributed, in our opinion, to the achievement of deeper adaptive personality changes in the process of psychotherapy.

 Some evidence of this is the fact that in patients the decrease in the average personality profile of SMOL after treatment was also accompanied by the alignment of this profile with the disappearance of the initially expressed “failure” on the fourth scale, reflecting the level of spontaneity and activity. The results are consistent with the literature data that the use of psychotherapy can lead to a decrease in depression in migraine patients, increase their self-confidence, rejection of the "trained helplessness" typical of these patients, an increase in behavioral activity, and a transition to a healthier image life, as well as to increase the ability to maintain a productive level of life activity even in conditions of partial preservation of pain (G. Sartory et al., 1998; F. Hoodin et al., 2000).

 Thus, the results obtained indicate that the combined use of kinesitherapy and psychotherapy in the treatment of migraine patients leads to a decrease in the frequency of migraine attacks and the intensity of tension headaches that accompany them, a decrease in the severity of mental maladaptation, normalization of autonomic regulatory influences and an increase in physical endurance of patients.

A clinical example of a specific use of the method
Patient D-va E. B., 40 years old, resident of the city, chief specialist of the Institute for the Development of Education.

 Received in the neurological department of the Nizhny Novgorod regional clinical hospital. ON THE. Semashko with complaints of headaches of a pulsating nature in the right temporal region, less often in the left temporal region, accompanied by nausea, photophobia, aggravated by physical exertion, lasting about 24 hours. A decrease in headache occurred after sleep and sometimes after taking sedalgin.

 Attacks were noted 1-2 times a week. In the interictal period, the feeling of heaviness and compression of the head, like a "semi-hoop," was almost constantly worrying.

 Attacks of headaches first appeared at the age of 15 for no apparent reason. At first, they rarely occurred - 2-3 times a year, then became more frequent. In recent years, along with bouts of headaches, there has been a constant feeling of heaviness in the head and a feeling of squeezing it. For many years, she was treated with a diagnosis of Autonomic Dystonia (taking vasoactive drugs), without improvement. Two years ago, the diagnosis of Migraine without aura was established, treatment with anaprilin and kordafen was recommended for prophylactic purposes. I took these drugs irregularly, not believing that treatment could help. In the last 3-4 months, against the background of psychoemotional overloads, headache attacks became more frequent up to 2-3 times a week.

Of other diseases, it suffers from endometriosis. Recently, the symptoms of this disease began to increase, in connection with which E.B. suggested surgical treatment
Anamnesis of life
Born in a complete family, had no brothers and sisters. Mother worked as a teacher at school, was a strict woman, she loved order and constantly controlled her daughter's life. Father was a factory worker. He often abused alcohol, but by nature he was a gentle, flexible man, he did not offend his wife and daughter.

 E.B. studied at school for 4-5, graduated from college, then pedagogical institute. She worked as a school teacher, then as a specialist at the Institute for the Development of Education. A month ago, at work in connection with the planned layoffs, the question arose of her dismissal.

 She married in love at the age of 20, has one son. Relations with her husband have worsened in recent years. E.B. worried about the fact that he became inattentive, indifferent to her. His son has his own family, he lives separately and less and less visits his mother.

 By nature, E. B. has always been distinguished by responsibility and diligence. She remembered how at the age of 11 she was put by a physical education teacher for some minor misconduct in a corner and forgotten by everyone, she stood there for several hours until her mother came to school for her. He loves everything in order. The house contains almost perfect cleanliness. In everyday life and at work, he performs many tasks and assignments, often not only for himself, but also for others, not knowing how to refuse others in requests. It is characterized by softness and pliability. These qualities, as well as outward charity, have always attracted many friends and acquaintances. I got used to restrain my negative emotions, I was afraid to offend another person. Tried to never lie. Although she had several fans in her life, she never allowed herself to cheat on her husband. Since childhood, it is also distinguished by increased anxiety, a tendency to anxiety for any reason. Recently, she began to get very tired, she noted an increase in irritability, anxiety, tearfulness, and a deterioration in mood. Against this background, migraine attacks became more frequent. The feeling of squeezing the head in the interictal period has become constant.

On examination:
In neurological status, there is a slight tremor of the fingers of extended arms and slight instability in the Romberg position, a uniform revival of tendon reflexes from the arms and legs without their asymmetry. There were no motor, sensory or cranial nerve disorders.

 Scoliotic posture (the right shoulder above the left, asymmetry of the waist triangles, iliac crests), increased chest kyphosis, pathological tension of the upper portions of the trapezius muscle and pectoralis major muscles, tenderness of the points of the coracoid processes of the scapula, supraerbic points and points of vertebral arteries from two sides were revealed.

 Changes in the general analysis of blood and urine, indicators of carbohydrate, lipid and protein metabolism were not found.

 According to ultrasound dopplerography of extra- and intracranial vessels, an increase in vascular reactivity, instability of vascular tone, spasm in the vessels of the neck are more on the right with a slight decrease in blood flow in the right middle cerebral artery. Increased blood flow in the left vertebral artery. Turns of the head reduce blood flow in the vessels of the vertebro-basilar basin more to the right.

 A temporary analysis of the pulsogram revealed an increase in comparison with the average normal values of the following indicators: mode amplitude (56%; autonomic equilibrium index (430.8 units); autonomic rhythm index (VLR) - up to 11.4 units, voltage index (IN) - up to 319 units At the same time, a decrease was found in such indicators as the standard deviation of the dynamic range of cardio intervals (RMS) - up to 0.03 s; the variational range (BP) of the pulsogram - up to 0.1 s; the coefficient of variation (CV) - up to 4%. background a activation of suprasegmental mechanisms of regulation of the heart rhythm, increased tone of the sympathetic division of the ANS and slight activation of the parasympathetic division of the ANS. A spectral analysis of the heart rhythm revealed a low level of the relative value of the power of the respiratory waves (DW) (8%) and increased levels of the relative values of the power of the slow waves of the first (MV1 ) and the second (MV2) order, amounting to 13 and 10%, respectively.The data of spectral analysis of the pulsogram indicated hyperactivity of the sympathetic and ergotropic systems absence of conjugate activation of the parasympathetic division of the ANS.

 In a psychodiagnostic study, the color range of preferences according to the Luscher test was as follows: brown, gray, green, purple, red, blue, black, yellow. The “anxiety” indicator turned out to be equal to 9 points (with an average normal indicator of 0-3 points). The level of depression on the Tsung scale was 55 points, indicating a mild depression of situational or neurotic origin. According to the Spibebleger-Khanin test, a moderate increase in reactive anxiety (35 points) and a high degree of personal anxiety (65 points) were revealed.

 The personal profile of the SMOL test had a “border-like peak” character, located between 55 and 75 T-points, with peaks on the second and seventh scales, which indicated a state of moderate mental stress with a predominance of anxiety-depressive personality traits.

 The started course of treatment along with the use of aspirin at a dose of 0.1 mg per day and the parenteral administration of a 5% solution of ascorbic acid at a dose of 2 ml per day included the differentiated use of kinesitherapy and psychotherapy according to the proposed method.

At the first psychotherapeutic lesson after an introductory conversation with the patient, the essence of chronic emotional stress, its negative physiological consequences and the adverse effect on the course of migraine was told. Together with the patient, the most obvious causes of her chronic mental stress and her most worrying problems were analyzed. The patient realized that, along with the inhibitory effect of the headaches themselves and the restrictions they cause in daily activity, other factors also have a stressful effect. E.B. I realized that she was very worried about the upcoming surgery for endometriosis. She herself does not want to be operated on, but doctors insist. He believes that this operation will make her a "defective" woman. At one time at the same age, her mother underwent a similar operation, after which her relationship with her husband, father E. B., worsened. Now E. B. she is afraid that she will face the same fate, especially since she already feels the cooling of her husband, who has become less attentive and caring. In addition, constant overwork at work and at home caused by the desire of E.B. do everything yourself and in the best way. Of particular concern are thoughts of impending dismissal.
The exercise "Body Recognition" was conducted, aimed at increasing the ability to perceive temperature, tactile, muscular-articular sensations from healthy parts of the body and contributing to the achievement of muscle relaxation. The patient is also trained in the technique of diaphragmatic breathing.

 At the end of the lesson, the patient was given the task of analyzing whether there was a connection in her life between severe prolonged stress and periods of increased migraine attacks. It is proposed to train independently in performing relaxing exercises.

 At the first kinesitherapy lesson, muscle testing was performed with the identification of shortened and weakened muscle groups, as well as changes in posture. According to the test results, the patient was asked to master 3 special exercises (2 for stretching the trapezius muscles and 1 for stretching the pectoralis major muscles). Training was conducted on the technique of “relaxing breathing with an extended expiration” and such methods of breathing exercises as the “purifying exhalation pf” and “closed groan mm”. At the end of the lesson, a discussion was held about the importance of aerobic exercise to improve the physical condition as a whole.

 The second psychotherapeutic lesson discusses the successes and problems that arose during the independent performance of the exercises presented in the first lesson.

 The exercise "breathing against pain", carried out using the technique of "controlled imagination." E.B. I imagined her interictal headache in the form of a hoop. It was a hoop of gray color, about 4 cm wide and about 0.5 cm thick, made of rough leather and having a rough surface. The brighter the representation of E.B. this image, the more she felt the pain squeezing her head. During the exercise, E. she imagined how the air exhaled by it during each respiratory cycle passes through this hoop, gradually eroding it and turning it into a light airy silver rim around the head. During this exercise, the pain gradually disappeared. At the end of the lesson E.B. given the task of self-training at home.

 In the second kinesiotherapeutic lesson, a bicycle ergometer was trained with a load of 60 W for 10 minutes (the initial pulse was 72 beats / min, the maximum pulse was 126 beats / min). After cycling, already known patient breathing techniques were used. Following this, the exercises were repeated to stretch the strained trapezius and pectoralis major muscles, and then three new exercises were learned to strengthen the weakened muscles of the lower fixators of the scapula and abdominal muscles. The total duration of the lesson was 40 minutes. The patient is recommended to perform these exercises and breathing exercises on their own 2-3 times a day.

 At the third and fourth psychotherapeutic classes, training was given in the cognitive-dynamic and verbal expression of comfortable psychophysiological conditions corresponding to the satisfaction of various biosocial needs.

 In response to a request to recall a specific situation from the recent past, during which she felt that a certain person liked her, E. B. she began to cry, noting that she forbade herself to remember such moments. As it turned out, the appearance of E.B., until then, of an unrecognized self-prohibition, was served by her idea of the loss of her attractiveness caused by illnesses in the present period of time and the conviction that in the future she “will never be able to please either men, friends or friends. " During the conversation, E.B. I partially realized that the most significant needs for her were the need to please others and the need for security. Violation of this need was one of the important causes of severe emotional stress in recent years. A corrective conversation and indirect suggestion were held regarding the possibility of a person retaining his attractiveness under any circumstances. After that, E.B. quite easily recalled the corresponding situation and the visual, tactile, temperature, muscle-joint sensations experienced at that moment; at the same time, she experienced an internal feeling of easy pleasant bursting in the upper parts of the anterior surface of the chest. At the moment of experiencing the corresponding comfortable psychophysiological state, E. B. imagined herself in the form of a gray fluffy cat with blue eyes and depicted how she moves her head and neck. In the same state, E.B. formulated a positive self-affirmation "I can like others." Recollection of a situation in which E.B. achieved success after a period of hard work, it was not given to her right away. After such a memory was evoked (victory in the competition of creative projects), E.B. and the protopathic bodily sensation (feeling of pleasant warmth in the throat) that arose with this with the movement of the hands and the positive self-esteem phrase “I can win” reinforced it.

 When asked to recall the situation in which she experienced a sense of satisfaction after having defended her independence and freedom of action, E. B. I realized that in most cases in such situations she did not get true satisfaction, because she immediately began to regret that she had offended another person. A conversation was held on situations requiring a choice between upholding one’s own interests and satisfying the interests of another person, and about the possibilities of compromise solutions. It is proposed to practice such compromises in everyday life, to remember the comfortable bodily sensations arising at the same time, and to express the corresponding psychophysiological state in the most appropriate movements and words.

 The memory of a situation in which she experienced a sense of security after getting rid of danger was associated with E.B. with a feeling of lightness in the occipital region. E. B., who emerged from this comfortable psychophysiological state, designated a certain movement of the shoulder girdle and the phrase "I can get rid of danger."

 It was proposed to reproduce all comfortable memories, the corresponding internal bodily sensations, movements and self-esteem phrases daily two to three times a day. In addition, it is recommended to record new situations that arise in everyday life, during which she experiences comfortable feelings of her own attractiveness, success, independence and security, reinforcing them with elaborated movements and mental self-affirmations.

 In the third and fourth kinesitherapy sessions, the cycling time was gradually increased (up to 14 minutes in the fourth session, with a maximum heart rate of 132 beats / min). In addition to the previously mastered breathing exercises and exercises for training weakened and stretched spasmodic muscles of the trunk, the patient learned the general tonic set of exercises, including dynamic exercises in the initial position, standing for large and medium muscle groups of the upper and lower extremities, coordination and balance exercises, exercises with static muscle tension of the cervical-collar zone. To strengthen local effects on weakened muscle groups and disperse the load, training included the Kettler and Tunturi simulators (10 minutes). On their own in their free time it is proposed to perform 5-6 exercises from this complex.

 In the fifth lesson, E. B was introduced to the methodology for setting and achieving goals. Information is provided on the importance of recognizing personal near and distant plans in various areas of life and determining their priorities. Recommendations are given on the technique for setting realistic, developmental and measurable goals, ways to effectively solve the problem are described, the advisability of using feedback for successes and failures is indicated, the reasons for possible failures along this path are explained. It is proposed to identify their life goals and establish their priorities, as well as celebrate daily successes in mastering this technique. In the same lesson, issues related to the importance of expanding one's own style of cognitive-behavioral response in everyday life were discussed. The pros and cons of distinguishing E.B. hyperresponsibility and diligence. These features, on the one hand, contributed to gaining approval, love and attention from others, but, on the other hand, led to “self-immolation” and chronic fatigue due to ignoring the basic needs for relaxation. Talked about different ways of flexible behavior, adequate to the situation and allowing to take into account both their own and others' interests.

 In the fifth kinesitherapy lesson, the cycle time is increased to 16 minutes. After that, breathing exercises and the previously described complex of general health exercises and exercises for stretching pathologically strained and strengthening weakened muscles of the trunk were performed. At the end of the lesson, the patient learned two new exercises for correcting scoliotic posture, performed in the supine position. The duration of the entire lesson was 45 minutes.

 In the sixth lesson, E. B. was introduced to ideas about non-adaptive thinking styles (catastrophic future, black-and-white and must-have thinking, negative thinking, labeling, etc.). On the example of his own statements E.B. The features of her thinking were analyzed and the possibility of their correction was demonstrated. The task of training the replacement of negative beliefs with positive ones is given.

 At the sixth kinesiotherapy session, the duration of the cycling exercise was 18 minutes, and the maximum pulse reached 138 beats / min. Continued classes in breathing exercises, previously learned exercises and training on muscle simulators.

 In the seventh lesson, E.B. in creating a self-image - healthy, with the reproduction of the corresponding desired visual, auditory, muscular-articular and internal sensations. During the lesson, an explanation and indirect suggestion of the importance that health has for solving significant for E.B. problems associated with the normalization of relations with her husband and with employment.

 Assistance was provided in planning and programming recovery paths.

 The eighth and ninth classes were devoted to the help of E.B. in solving her most worrying problems related to her relationship with her husband and the threat of losing her job. Various ways to solve these problems were discussed, and the possibility of using new self-regulation skills for this purpose was shown.

 At the seventh-ninth kinesitherapy sessions, the duration of the bike training was gradually increased to 24 minutes, the maximum pulse did not exceed 144 beats / min. The use of the above therapeutic physical exercises was continued.

 The patient was actively engaged, she mastered the proposed complex well and learned to get the joy of owning her own body. Recommendations on self-training at home are given.

 By the end of the three-week course of treatment, migraine headache attacks were not noted. According to YOUR data, the intensity of chronic daily pain pains decreased from 22 to 5 mm, exercise tolerance increased from 75 to 100 watts.

 The analysis of the dynamics of the CIG indicators revealed a decrease compared to the initial level of the amplitude of the mode (Amo) - 47%, the vegetative equilibrium index (IIR) - 188.0, the vegetative rhythm indicator (VLR) - 7.0, the stress index (IN) - 163 and at the same time an increase in the standard deviation of the dynamic range of cardio intervals (RMS) - 0.04 s, variational range (BP) - 0.2 s, coefficient of variation (KB) - 7%, which indicates a decrease in the initial excess sympathetic and an increase in the initial insufficient parasympathetic activity, as well as with lowering the degree of centralization of heart rhythm control. The heart rate spectrum was characterized by a compensatory increase in the contribution of the relative power value of the DV - 11% and the absence of changes in the relative power values of MB1 - 12% and MV2 - 10%. The dynamics of the value of the centralization index (IC) before and after treatment was not observed (308.07 before treatment, 308.68 after treatment).

 A repeated psychodiagnostic examination after the end of the course of treatment revealed a decrease in the initially elevated personality profile of SMOL on the F scale and on all basic scales by an average of 5-10 T points. The profile obtained during repeated testing ranged from 45-60 T points and was characterized by less than in the initial study, the severity of the peaks on the second and seventh scales. The results indicated a decrease in the severity of emotional stress and an improvement in the psychological adaptation of the patient.

 After 2 months, the frequency of migraine paroxysms was 1 time per month, the intensity of the headache during an attack according to YOUR data decreased from 85 to 55 mm, the intensity of daily chronic tension headaches became slightly higher (12 mm) compared with the intensity of HDN after the course of treatment (5 mm), however, was significantly lower than before treatment (22 mm).

Claims (5)

1. A method for the treatment of migraine in the interictal period of the disease, combining the use of kinesitherapy and psychotherapy courses and including physical exercises in the kinesitherapy course for posture correction, sluggish and stretched muscle training, and training and training using various methods of emotional-muscular relaxation in the course of psychotherapy and breathing exercises, characterized in that the courses of kinesitherapy and psychotherapy are carried out simultaneously and individually, for 2-3 weeks, for 8-10 lessons in each course, going through kinesitherapy and psychotherapy every other day, and in addition to this, the course of kinesitherapy includes therapeutic physical dosage training on a bicycle ergometer, in the regimen used for patients with cardiovascular pathology, and the course of psychotherapy also includes: psychological effects that purposefully increase the patient’s self-esteem using reproducing at least four types of psychophysiological conditions associated with the satisfaction of leading types of biosocial security needs; in freedom and independence; in achieving the goal and self-realization; in approval, in recognition and love of others with subsequent cognitive-dynamic and verbal consolidation of the resulting psychophysiological conditions; psychological effects that increase the patient's motivation for recovery; psychological influences that expand the skills of psychophysiological self-regulation and help solve the most disturbing problems for the patient. 2. The method according to claim 1, characterized in that the training on the bicycle ergometer is carried out using a load of not more than 70-75% of aerobic power and the training time is gradually increased from 8-10 minutes in the first lesson to 24-26 minutes to the ninth the tenth lesson, and the total duration of kinesitherapy classes is gradually increased from 30-40 minutes per day at the beginning of treatment to 50-60 minutes by the end of the course of kinesitherapy. 3. The method according to claim 1, characterized in that the psychological effects that purposefully increase self-esteem are carried out by inducing the patient's memories of situations in which he experienced feelings of his own security, independence, success, attractiveness, and teaching him postural-dynamic and verbal consolidation of the resulting psychophysiological conditions with subsequent consolidation through the reproduction of the reproduction of these conditions daily 2-3 times a day. 4. The method according to claim 1, characterized in that the psychological effects that increase the patient’s motivation for recovery are carried out using the help of the patient in linking in his mind images, emotions and thoughts regarding his health, with images, emotions and thoughts regarding achievement other vital goals for him. 5. The method according to claim 1, characterized in that the psychological effects that expand the skills of self-regulation and help solve the most disturbing patient problems are carried out using generally accepted techniques of self-observation and psychotherapeutic methods of positive thinking, setting and achieving goals.

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