RU2231292C1 - Method for relaxation-type psychophysical regulation in children with thermal trauma - Google Patents

Abstract

FIELD: medicine, psychotherapy.

SUBSTANCE: one should perform by stage muscular relaxation by applying imagination and respiration. At the first stage of relaxation it is necessary to detect the purpose of psychological regulation. Patient should be informed on positive achievement of desired relaxation. Individualized image should be found out at the background of musical accompaniment by adding the formulas of auto-suggestion. Possibility is available for both verbal and nonverbal expression of feelings appeared. At the second stage it is necessary to perform relaxation by the first stage and add rhythmic steady breathing by pronouncing one of the vowels at deep expiration. At the third stage one should conduct relaxation by the first and second types: at first, it is necessary to perform the tension of in the groups of body muscles from the top downwards at expiration till feeling relaxation, calmness, hardness, warmness and lightness by adding verbal curative auto-suggestion. At the fourth stage relaxation should be carried out by stages by the first, second and third stages at finishing the seance and making the command for healing and confidence.

EFFECT: higher efficiency of therapy.

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Description

The present invention relates to medicine, psychotherapy, correctional and medical psychology and can be used in a neurological clinic in the treatment of neurosis, psychosomatic diseases, post-traumatic stress disorders.

The known method N.P. Zakharova corrected psychoemotional and psychosomatic conditions, including analyzing the anamnesis, formulating the goal of self-hypnosis, using a mantel-like sound combination selected by the patient from the proposed list endowed with hypnotic and suggestive power “key to health”, communicating information about the human brain like a biocomputer and formulating four programs, while the first program includes self-hypnosis formulas containing affirmative information that the desired state will be achieved as a result of a self-hypnosis session, the second - self-hypnosis formulas, which verbally connect the onset of a hypnotic state with the repetition of mantel-like sound combinations and relaxation, the third - self-hypnosis self-hypnosis formulas, the fourth - post-hypnotic self-hypnosis formulas containing affirmative information about the achieved desired state, and self-hypnosis formulas according to the programs (US Pat. No. 2155076, A 61 M 21/00, 2000)

However, the known method provides the possibility of psychocorrection only in the adult patient population, the proposed tasks and formulas are difficult for children's perception.

As a prototype, a method of relaxation psychophysical regulation of a person was selected, including mental training, elements of autogenous training, which consistently perform the steps of muscle relaxation by tensioning and relaxing and focusing on the difference in sensations, focusing attention on individual parts of the body and presenting energy flows in the form a light cloud, complementing the previous actions with breathing exercises, visualizing images of golden energy using the “mental screen”, visual zatsiyu first warm pink, then a bright orange color with "mental screen", creating a positive emotional background by presenting in the chest and closes blossoming bud of a flower known and at the last stage - self-hypnosis relief from problems. After each stage, the pulse rate is monitored (US Pat. No. 2155075, A 61 M 21/00, 2000).

However, the known method is used only in the treatment of an adult population, does not take into account children's perception, anatomical, physiological and psychophysical characteristics of a developing child. In addition, the multi-stage method, involving complex tasks due to the inclusion of four presented images in the session. Self-hypnosis of rest and confidence is pronounced only at the last stage of a relaxation session. The presentation of bright orange in the fifth stage is not applicable for patients with thermal trauma, since for them red and orange colors are associated with fire, fire and resemble a traumatic situation, deepen feelings of grief, increase tension and anxiety.

Performing alternate relaxation and tension of all muscles at the 1st stage is difficult for patients affected by thermal or mechanical trauma, of different ages, especially children, due to their isolation, numbness, detachment, fencing, desire for solitude and the need for an introductory stage for establishing contact for the session and increasing motivation and interest. In addition, in the acute period of a burn disease, patients are in a forced position of the body and need long-term infusion-transfusion therapy.

Pulse control after each stage of relaxation is not possible in severe patients with burns, because any touch of “alien hands” causes the appearance of reactions of protest, moodiness, aggression, and refusal to cooperate.

The known method, therefore, cannot be used for relaxation in children with burns. The range of application of the method is limited in clinical practice by age and medical factors. Acute traumatic experiences, separation from parents, staying within the walls of the hospital, pain in the wounds and during medical manipulations, decreased memory and concentration of attention, and regression in behavior complicate the process of muscle relaxation, immersion in a trance state and therapeutic self-hypnosis.

The objective of the invention is to simplify the method by reducing phasing, reducing the number of images presented and gradually assimilating tasks by gradually moving to the next stage until the body is completely relaxed, taking into account children's perception and the severity of burn injury.

The problem is solved due to the fact that in the method that includes phased muscle relaxation using a figurative presentation and involving the breath, the goal of psychological regulation is identified at the first stage of relaxation, the patient is informed about the affirmative achievement of the desired relaxation, and an individualized image with the inclusion of formulas is selected against the background of musical accompaniment self-hypnosis, provide the opportunity for verbal and non-verbal expression of the sensations that have arisen, at the second stage they relax the first stage and involve rhythmic calm breathing with the pronunciation of one of the vowels in slow exhalation, in the third stage they relax in the first and second stages and first perform tension of the muscle groups of the body from top to bottom during inhalation, and then relax the muscles of the body from top to bottom during exhalation to the sensation of relaxation, calmness, heaviness, warmth, weightlessness and lightness with the involvement of verbal therapeutic self-hypnosis, and at the fourth stage, relaxation is carried out sequentially in the first, second and third stages. Pam with the end of the session and the formulation of the attitude towards recovery and self-confidence.

The method of relaxation psychophysical regulation of children with thermal injury is as follows. At the first stage, an anamnesis, individual and personality characteristics, the specificity of the experiences of trauma, sadness, grief and pain are collected and analyzed. Then, the goal of psychological regulation is identified, the elements of rational psychotherapy are introduced with information on the affirmative achievement of the desired relaxation for exposure and interest. They give the patient the opportunity to freely choose the preferred relaxation musical accompaniment that matches his mood, as well as independently choose an individualized image (balloon, cloud, forest, house, river, lake, sea, etc.) to achieve any sensation in the body : relaxation, warmth, weightlessness, lightness, peace, coolness, the disappearance of pain, itching, burning. After that, they provide the opportunity for free and accessible verbal and non-verbal expression of sensations during the session. They control the achievement of relaxation and the development of tasks of the first stage by the subjective sensations of the patient (the disappearance of pain, itching, burning, feelings of loneliness, etc.). After mastering the tasks of the first stage, they move on to the second, which includes performing the tasks of the first stage and an exercise aimed at “rhythmic calm” breathing, accompanied by the sequential pronunciation of one of the vowels “O”, “I”, “U”, “A” in slow exhale. After monitoring the development of the tasks of the second stage, they proceed to the third stage and perform the exercise of tension and relaxation of the body muscles sequentially in groups from top to bottom (face, neck, shoulders, arms, hands, fingers, torso, legs, knees, feet, toes ), associating with the rhythm of breathing: on inspiration, tension, on exhalation, relaxation until a feeling of relaxation, heaviness, warmth, weightlessness, rest with the involvement of verbal therapeutic auto-suggestion. They exercise control over the development of tasks of the third stage and proceed to the fourth final stage with the formation of an attitude toward recovery and self-confidence. Each stage is accompanied by self-hypnosis formulas.

An example of a specific implementation of the method.

Patient A.V., 11 years old.

Diagnosis: Burn with a flame of 2-3 AB degrees of the face, neck, upper and lower extremities, hands, buttocks, perineum on an area of 45% of the body surface. Severe burn shock.

From the anamnesis: heredity is not psychopathologically burdened, upbringing without features, physical and mental development corresponds to age.

He received a burn with a flame while making a fire with a friend in a hut. A passerby pulled out choked children from a hut.

The boy was taken by ambulance to a specialized burn center.

He was hospitalized in the children's burn department, where a complex treatment was prescribed and carried out, including drug (anti-shock, antibacterial, infusion-transfusion, etc.) therapy and a course of relaxation psychophysical regulation according to the proposed method in the framework of early surgical rehabilitation. For 4 months of inpatient treatment, the patient underwent 6 operations to restore the skin and repeated dressings. He was discharged on recovery.

Objectively:

After removing from the shock, the patient complained of severe pain in the area of wounds, feelings of loneliness, guilt before his parents, fear of death, separation, helplessness, tiredness from the forced position of the body.

On examination, the patient noted emotional instability, decreased mood, reactions of moodiness, negativity, irritability, aggressiveness to medical manipulations (injections, dressings), staff and relatives, high anxiety, tension, sleep and appetite disturbances.

During the observation of the patient and in conversations with parents, the attending physician, medical staff, an anamnesis was collected, an individual psychological response to stress, pain, the nature of the burn injury (severe lesion with multiple localization) was established, individual psychological characteristics of the person, the specificity of the experiences of the injury were revealed and pain, an analysis of the information obtained.

The goal of psychological regulation was previously established and compactly formulated: reducing pain, improving mood, confidence in recovery.

After that, rational psychotherapy was carried out with the patient, consisting in informing about the affirmative achievement of the desired relaxation as a result of the session to increase motivation.

Together with the patient, the first self-hypnosis formula was formulated for self-pronunciation at the beginning of the session.

“Now I will be engaged in muscle relaxation. In the process, I will feel relaxed and calm, confident in recovery, I will feel a sense of relief. ”

For classes on this day, a concluding phrase is added to the text of the first formula: “Gradually, I finish the session. When pronouncing the magic words, I will return to the previous place and open my eyes. “Tamba-Kuramba-Paramba-Eyes open.” I open my eyes. I returned. I feel cheerful and rested. ”, Which the patient spoke at the end of the session.

Further, to select the musical accompaniment that matches the mood, a list of specially selected relaxing children's music was offered, from which he chose the “sounds of the sea”.

Then the patient independently chose the presented image, it turned out to be a balloon. An element of magic was included in this image.

The patient wished to achieve a feeling of peace, relaxation, and pain reduction.

After pronouncing the text of the first self-hypnosis formula, involving the imagination against the background of musical accompaniment, presenting the image, the patient was asked to describe his condition, the sensations that arose during relaxation. The patient performed the task with his eyes closed, lying on a special grid in his bed.

The patient noted that at the beginning of the lesson he saw a small ball of red color and under it a cradle, where he himself was. It was reminiscent of shots from a film, the patient saw himself from the side.

The ball swayed slowly and changed its color: from red to orange, purple, black, shades of blue and green. The patient noted the appearance of sensations of relaxation, peace, a decrease in pain with a change in the color of the ball to green and blue.

Only after two independent relaxation sessions did the patient notice the rapid appearance of the image and the achievement of the desired sensations.

The next day, the patient, under the guidance of a specialist, consistently completed the tasks of the 1st stage and began to master the exercises of the 2nd stage, which involved the involvement of “rhythmic calm” breathing accompanied by the sound “I” on a slow exhalation, with the pronunciation of the text of the second self-hypnosis formula against a background of preferred relaxation music.

“Now I'm starting to do muscle relaxation. I imagine that I have my own magic balloon, only mine, which can be inflated. The magic of this ball is that it can grow, change its size, its color, always be near or close to me, roll and return me to my place. It is made of very durable material. When he becomes big, the way I want, then with his help I can ride. Gradually, I will have a feeling of relaxation, peace, tranquility, lightness.

I call my ball to me with magic sounds. To do this, I switch to slow breathing: slow breath, pause and slow exhale. With each slow exhale, I utter a “And.” I see a ball ... A ball is small, red-yellow. I hold the ball by the rope.

I inflate the ball. Slow breath with the pronunciation of the sound “A”, pause and slow exhale with the pronunciation of the sound “U”. With each slow exhale, my ball grows larger and larger. The ball is getting big. The ball turned pink, then green. I feel like relaxing. I feel comfortable and easy. Slowly I rise with the ball. The ball rolls me.

I see the sky and the sun. I feel good. I feel calm and relaxed throughout my body. I feel light. The pain is gone. Unpleasant sensations are gone. Burning sensation, itching disappeared. I feel calm and weightless. The gentle rays of the sun pleasantly touch my body, caress me like mom’s hands. I can feel the heat spreading throughout my body. I feel good and comfortable. I love you.

I can ride as much as I want.

I will remember this pleasant feeling of flying.

My ball slowly decreases and puts me back in place.

I feel like I’m resting. I feel the strength to recover. I want to live. I’ll get better. ”

Only for classes on this day, the concluding phrase is specially added to the text of the second formula: “Gradually, I finish the session. When pronouncing the magic words, I will return to the previous place and open my eyes. “Tamba-Kuramba-Paramba-Eyes open.” I open my eyes. I returned. I feel cheerful and rested, ”which the patient pronounced at the end of the session.

Further, the patient described his feelings during relaxation. He noted that there were feelings of lightness, peace, weightlessness, warmth, a feeling of flying, pain, itching disappeared, a desire to live and a hope for recovery arose.

The patient several times during the day independently conducted relaxation sessions in case of severe pain, burning, itching, tried before and after dressings, during injections.

The patient noted that with each session he had the desired sensations more quickly.

Then, at the session under the guidance of a specialist, the patient, having sequentially completed the tasks of the first and second stages, smoothly proceeded to master the exercises of the third stage, aimed at tension and relaxation of the body muscles sequentially from top to bottom in groups (face, neck, shoulders, arms, hands, fingers, body, legs, knees, feet, toes), linking with the rhythm of breathing: on inspiration - tension, on exhalation - relaxation. Next, feelings of heaviness, warmth and, finally, lightness and peace were introduced.

During a relaxation session against the background of musical accompaniment, the patient pronounced the text of the third formula of therapeutic auto-suggestion to achieve deeper sensations of muscle relaxation.

“I do muscle relaxation. Gradually, I strain and relax the muscles of the body sequentially from top to bottom in groups (face, neck, shoulders, arms, hands, fingers, torso, legs, knees, feet, toes), associating with the rhythm of breathing: on inspiration - tension, and on exhalation is relaxation. With each exhalation, relaxation intensifies more and more. My face, neck, shoulders, arms, hands, fingers, torso, legs, knees, feet, toes relax. With each exhalation, relaxation intensifies even more and more. I feel calm and relaxed.

Gradually, I feel my face, neck, shoulders, arms, hands, fingers, torso, legs, knees, feet, toes becoming heavy. With each exhalation, the severity increases more and more. I feel heaviness all over my body.

Gradually, I feel warmth in my arms, chest, stomach, legs. With each exhalation, the heat intensifies. My whole body is warm.

I feel relaxed and light.

I have a feeling of weightlessness, lightness, peace in my whole body.

I feel good. I am increasingly embraced by calm, relaxation.

I feel lightness, weightlessness, a feeling of flying.

The feeling of pain, anxiety, fear completely disappeared.

I am all relaxed, calm.

My wounds heal. My skin is restored, the scars on my body dissolve.

I feel a surge of strength.

I will definitely recover. I want and can recover. I'm getting better.

I feel good. I'm resting. I am in a good mood. I am full of strength and energy. "

Further, the patient, describing his feelings that arose during relaxation, noted the achievement at the end of the session of a feeling of relaxation, weightlessness, peace, ease, the disappearance of pain, itching, burning, a surge of strength, strengthening the belief in recovery.

Only for classes on this day, a concluding phrase has been specially added to the text of the third formula: “Gradually, I finish the session. When pronouncing the magic words, I will return to the previous place and open my eyes. “Tamba-Kuramba-Paramba-Eyes open.” I open my eyes. I returned. I feel cheerful and rested, ”which the patient pronounced at the end of the session.

Then the patient expressed a desire to draw what he saw. As a result, he made two drawings with felt-tip pens, explaining that 1 drawing reflects the picture during the start of the flight, 2 drawing - the picture at the end of the flight.

In figure 1, the patient depicted a bright orange cat sitting on a yellow sandy shore near the bright blue sea, blue heavy clouds float in a transparent sky, and in the upper right corner of the sheet painted a bright orange sun. It was noteworthy that in this figure the choice of orange, red, and yellow colors prevailed, there were discontinuous, thick and thin uneven wavy lines, many strokes, large painted eyes of a cat, a picture of a cat with a small figure, located at the bottom of the sheet in the middle with “tail” nibbles fish emerging from the sea. ” The patient noted that the cat is very similar to him. “The cat is as lonely as me. The cat experiences loneliness and anger at the fish that nips him. It hurts him from tweaking. Cat really wants to kill this nasty fish. ”

This picture showed the child’s inner emotional world: high anxiety, loneliness, tension, fatigue and irritation, turning into aggression outside, insecurity.

In figure 2, the patient depicted a gray smiling big cat on the right side of the leaf sitting on a green lawn with flowers. In this figure, blue (clouds, flowers), green (grass), gray (cat) colors predominated. When discussing and comparing the two figures, the patient noted that the same cat sits on the 2nd figure, but is different, and noticed that he likes it more. To the question: “Why did the cat become different and what happened to it?”. The boy replied: “He shook off a heap of sand, which was covered with everything ... That's why the cat was orange! ... He went into the water and the fish lagged behind him ... She swam away ... And the cat bathed, ran to look for friends on the lawn ... They will definitely come to him ... Everything will be fine. ” The boy asked to put pictures next to him near the bed so that he could see them.

The plot of the second figure revealed the positive dynamics occurring in the psycho-emotional state of a seriously ill patient, the emergence of interest in life, creativity, play, faith in treatment.

The patient willingly conducted sessions several times a day on his own.

Further, at the session under the guidance of a specialist, the patient, having successively completed the tasks of the first, second, third stages, smoothly proceeded to assimilate the fourth final formula of self-hypnosis.

“I feel fresh, fresh.

I am returning to my former place. My ball slowly carries and lowers me.

I feel a light cool breeze. I inhale the cool air with the sound “And”, then with the sound “U”. Gradually coolness fills my whole body. I feel fresh, peppy even more.

The gentle rays of the sun gently touch my body, hug me. I am pleased and comfortable. I love you. I believe that everything will be fine. I release my magic balloon. See you soon, ball.

Gradually, I finish the session. When pronouncing magic words, I will open my eyes. “Tamba-Kuramba-Paramba-Eyes open.” I open my eyes. I feel like I’m resting.

I will remember the feeling of peace, warmth, love and lightness. With each session, I become healthier, calmer, more confident, more active. ”

Relaxation skills were acquired by the patient from the first session during 4 classes conducted under the guidance of a specialist, in between which the patient was engaged on his own.

After regular daily exercises for patients, both under the guidance of a specialist, and independently on the proposed method of relaxation psychophysical regulation for 4 months, a decrease in anxiety, improvement of well-being, good adaptation to hospital conditions, to medical procedures, the development of a sense of self-confidence were noted, self-control, relieving pain, itching, burning. The patient in a satisfactory psychoemotional state was discharged from the hospital, began to study, returned to his family, well endured social adaptation.

The proposed method of relaxation psychophysical regulation of children with thermal injury allows you to quickly master the relaxation technique.

The duration of the sessions under the guidance of a specialist was 30-60 minutes. The duration and frequency of the sessions depended on the severity, location of the lesion, and the well-being of the patient. With severe extensive burns, the duration and frequency of sessions increased and reached 45-60 minutes 4-5 times a week with daily daily exercises conducted independently by the patient.

With mild and limited burns, the duration and frequency of sessions under the guidance of a specialist was reduced and amounted to 30-45 minutes 2-3 times a week with daily daily exercises conducted independently by patients themselves.

In the acute period of a burn disease (after getting out of shock, the stage of toxemia), sessions under the guidance of a specialist with patients are carried out more often (for 45-60 minutes 3-4-5 times a week) with daily daily exercises conducted independently by the patient.

In the stage of septicotoxemia, less often (40-45 minutes 2-3 times a week) with daily daily exercises conducted independently by patients themselves.

In the stage of convalescence, sessions under the guidance of a specialist are conducted with patients for 30-40 minutes 1-2 times a week with daily daily exercises conducted independently by the patient on their own.

In the long term after the injury - 30 minutes 1-2 times a week with repeatedly daily self-administered exercises by the patient independently.

Based on the results of a verbal discussion about the state that occurs during and after the session, we judged the effectiveness of mastering the relaxation technique. According to observations of 300 patients with burns during the relaxation session, the presence of red and orange colors in the arising images of the patients testified to high anxiety, tension, black - a decreased mood up to depression, hypochondria, a combination of red, orange, purple, brown, and black - about emotional instability, blue and green - about relaxation. The change of colors from alarming to calmer shades indicated the achievement of feelings of peace and relaxation. As necessary, a correction was made to the conditions of the sessions (place, frequency, duration, pace).

If at the first stages the patient during the session, as a rule, closes his eyes, then the session is carried out with his eyes open, then in the conditions of strangers, noise, then during physical exercises (before, during, after training).

Thus, the novelty and feature of the proposed method lies in the fact that the relaxation method includes 4 stages, which makes it possible to reduce the duration of the session and reduce the complexity of the tasks performed, to eliminate the difficulty of memorizing tasks for severe patients who have suffered injuries since childhood (from 3 years) and at various periods of burn disease, traumatic stress. The simplicity and accessibility of the presented image for the perception of children, weakened patients can be used already at the stage of early surgical and conservative rehabilitation. The pronunciation of self-hypnosis formulas, starting from stage 1 through stage 4, inclusive, allows the patient to master relaxation psychotechnics for independent conduct. Providing a free selection of musical accompaniment and the choice of an individualized image presented to patients with thermal trauma, especially affected children, allows you to tune in to the specific mood and well-being of the patient, both the patient himself and the specialist who conducted the session. Providing the patient with a free choice of the verbal and non-verbal way of expressing feelings allows him to reflect his thoughts, feelings that arise during relaxation more tactfully and correctly without exacerbating grief and traumatic experiences, take into account the severity and location of the lesion, the age and sex of the patient. Providing the presented individualized image with the inclusion of the elements of “magic”, “affection”, “love” allows the victim, especially children, to increase interest and motivation for relaxation, to take into account the age and psychophysiological characteristics of the growing organism, the level of development of cognitive activity, including the level of development of imagination, attention, thinking, speech, eliminate feelings of loneliness, loss, loss and separation from loved ones, increase self-confidence. Gradual stepwise complication of tasks, achieved not by complicating the presented images and increasing their number, but by increasing the relaxation elements. The proposed method can be used in patients with thermal or mechanical trauma of both childhood and adult age in clinical, domestic conditions.

Claims (1)

A method of relaxation psychophysical regulation of a person, including phased muscle relaxation using a figurative representation and involving breathing, characterized in that at the first stage of relaxation they highlight the goal of psychological regulation, inform the patient about the affirmative achievement of the desired relaxation, select an individualized image with the inclusion of self-hypnosis formulas against the background of musical accompaniment , provide an opportunity for verbal and non-verbal expression of the sensations that have arisen, in the second stage e carry out relaxation in the first stage and involve rhythmic calm breathing with the pronunciation of one of the vowels during slow exhalation, in the third stage carry out relaxation in the first and second stages and first perform tension of the muscle groups of the body from top to bottom by inspiration, and then relax the muscles of the body from top to bottom on exhalation to a feeling of relaxation, calmness, heaviness, warmth and lightness with the involvement of verbal therapeutic self-hypnosis, and in the fourth stage, relaxation is carried out sequentially in the first, second and t to the three stages with the completion of the session and the formulation of the attitude towards recovery and self-confidence.