RU2645117C2 - Method of correcting psychological state in patients suffering from chronic kidney disease receiving hemodialysis treatment - Google Patents

Abstract

FIELD: medicine; nephrology; medical psychology.

SUBSTANCE: invention relates to medicine, namely to nephrology and medical psychology, and can be used to correct psychological state of patients suffering from chronic kidney disease receiving hemodialysis treatment and to increase tolerance to the hemodialysis session. Psychological state of a patient is determined by examining his anxiety, depression, locus of control and coping strategies. Based on the results obtained, the patient is referred to an adaptive or non-adaptive subgroup. Patients should listen to playlists of four types, the first of which is aimed at reflection and self-regulation; the second type is aimed at relieving anxiety; the third type is aimed at structuring the time of hemodialysis; and the fourth type is aimed at achieving catharsis. Each playlist includes files of five pieces of music, of which the first, third and fifth are works of classical music, and the second and fourth - recorded sounds of nature. And the order of listening to playlists is determined by taking into account the patient's referral to the adaptive or non-adaptive subgroup, where the patient is referred to the adaptive subgroup in the case of a moderate level of anxiety, low rates of depression, the use of constructive coping-strategies and an internal control locus. Patient is referred to the non-adaptive subgroup in the case of high rates of anxiety and depression, the use of preferential non-constructive coping strategies, an external control locus. Psychological state of the patient is controlled by comparing the psychological state of the patient before and after the playlist listening session.

EFFECT: method allows to transfer the negative state of the patient on hemodialysis to neutral or positive one, and also to increase compliance and tolerance to hemodialysis sessions by determining the patient's psychological state and listening to the playlists in a certain order.

6 cl, 6 tbl, 4 ex

Description

The invention relates to medicine, namely to nephrology and medical psychology, and can be used to correct the psychological state of patients with chronic kidney disease receiving hemodialysis treatment, and to increase tolerance to a hemodialysis session.

Currently, it is widely known the use of musical, acoustic and audio effects aimed at:

- on the improvement of the human body, for example, a method of potentiating a therapeutic effect by a combination of musical-acoustic and medicinal effects (Patent RU 2240146, published 16.06.2003);

- for the correction of the coagulation system of human blood (Patent RU 2336098, published October 20, 2008);

- on neurohormonal correction and rejuvenation (Patent RU 2518538 published 06/10/2014);

- treatment of cancer patients (US 2010191037), etc.

Known solutions are focused on the physiological state of the patient’s body, but do not provide for the correction of the psychological state of patients by listening to audio objects.

There is a method of healing the human body through a constructive way out of stress (Patent RU 2150301, published 10.06.2000), the essence of which is that the parameters of the audio sequence are discrete in four levels of exposure, while at the first level they affect the functional and psycho-emotional state , at the second level, they provide restoration of the initial functional rhythms, for example, sleep, at the third level, they bring the internal vibration of a person into a state of harmony, and at the fourth level, they provide they bring information from the subconscious to consciousness, while at each level of exposure, the patient forms a motivational component in the process, concentrating consciousness on achieving a healing result, and at all four levels of exposure, the range of exposure parameters is 20–20000 Hz in frequency, 2– in density 6 dB / cm ² at the first level; at the second level in density of 7-8 dB / cm ² ; at the third level in density of 8-10 dB / cm ² ; at the fourth level, 6-7 dB / cm ² .

When using the method, a biological feedback is formed, diagnosing the patient using a dowsing frame, determining the location of the blocks preventing the flow of energy, eliminating the blocks due to the resonant effect of music with an external energy field at each level of exposure, and also using an integrated assessment of the psychophysiological tension of a person based on respiratory rate, heart rate, and blood pressure.

The exposure is carried out sequentially according to the exposure levels for 40 minutes at each level. According to the invention, as a result of the application of the invention, there is a complete harmonization of the work of all internal organs.

The described method is of little use in medical institutions, especially for the treatment of people with chronic kidney disease receiving hemodialysis treatment, because, firstly, the diagnosis of the patient according to the invention is carried out using dowsing frames, and secondly, examples of the results obtained after use are not disclosed in the description method, which raises doubts about the possibility of applying the invention for all these groups of patients (from sick people with somatic diseases, and for patients at the stage of recovery ruling and rehabilitation, and for the rehabilitation of drug addicts of various kinds). The invention is directed to the complex effect of the audio series on the human body, i.e. based on physiological effects, but adjusts the psychological state of the patient, which is especially important for people on hemodialysis treatment.

Hemodialysis is one of the methods of therapy that is widely used in both acute and chronic renal failure, consists in extrarenal blood purification. It is based on the principle of penetration of substances through a semipermeable membrane, which allows the removal of toxic substances and metabolic products from the blood. Before starting the dialysis procedure, the patient is examined by a doctor, measures blood pressure, pulse and temperature. Then the patient is given vascular access and connected to a dialysis machine. During the procedure, they constantly monitor the patient's condition. The doctor determines the duration and frequency of sessions individually for each patient. In most cases, hemodialysis is carried out 2-3 times a week for 4-8 hours.

Regular dialysis procedures allow patients to save their lives, but prolonged sessions often cause the development of stressful conditions in any life situations. Especially strongly such patients are worried about the threat of loss of independence. The thing is that all these patients are almost completely dependent on the medical staff or their relatives. Often they have to give up work or study only because at least 3 times a week they should devote time to this procedure. As a result, their rhythm of life changes completely, since they need to follow a certain schedule, which in no case should be avoided. It is also important to note the fact that regular procedures very often change the appearance of the patient, which also does not remain without his attention. Children undergoing such treatment very often lag behind in development, which sets them apart from their peers. In adolescents, self-esteem is significantly reduced due to such treatment. Older people also cannot remain alone without the physical or psychological support of relatives. The hemodialysis procedure may be accompanied by complications and gastrointestinal, bone, neurological pathologies. Experts recommend that patients undergoing hemodialysis regularly consulted with a psychologist. This is especially necessary for obvious behavioral disorders, prolonged depression, as well as the occurrence of problems directly related to physical restrictions or adaptation to such a rhythm of life [1].

From CN 202314804 (published 11.07.2012), a method is known for correcting the psychological state in patients with chronic kidney disease receiving hemodialysis treatment, including listening to audio objects. The method is implemented in a medical device and is aimed at solving problems when a patient suffering from kidney disease undergoes dialysis. The session lasts, as a rule, for about four hours, so that the patient is nervous and uncomfortable. The treatment device includes a humidifier and a CD player. The moisturizer uses an infusion of Chinese herbs. According to the invention, the combined action of the evaporating infusion and music soothes the patient and facilitates dialysis. Meanwhile, it should be noted that not every music is able to calm, it is necessary to take into account the personality traits and individual preferences of the patient, his psychological state, and the use of herbal infusion creates a risk of an allergy attack in patients whose body is weakened by the disease, but for allergic patients this method is not applicable. This method does not use the patient’s ability to self-regulation, the patient only passively perceives the impact. All this reduces the effectiveness of the correction of the psychological state.

The prior art method of psychological rehabilitation of patients with chronic kidney disease undergoing hemodialysis treatment, which is aimed at improving the effectiveness of psychological rehabilitation of patients by increasing the volume and quality of patient knowledge about the disease and its treatment, closer contact of the doctor-patient, group support of patients with a similar disease, the formation of more constructive ways to overcome difficulties in group learning (RU 2301688, A61M 21/00, A61M 1/34, publ. 06/27/2007).

The essence of the method, adopted as the closest analogue, is that simultaneously with drug treatment they have a psychological effect, for this, patients are told about the treatment and its features. As a result, the level of knowledge about treatment and disease is increased, as well as group psychological training using methods of behavioral therapy, ways to constructively overcome difficulties are being formed. Classes are not held during hemodialysis, but before or after the session. Certainly, the acquired versatile knowledge contributes to the development of disease and treatment control skills, however, as practice shows, this is not enough to correct the psychological state of the patient, especially who is directly at the hemodialysis session.

Indeed, many experts note the need to correct the psychological state and psychological rehabilitation of patients during hemodialysis, which helps to increase compliance. There is evidence of the presence of such mental conditions as anxiety, depression, mood disorders [2, 3, 4, 5, 6] and their relationship with compliance disorders: hemodialysis omissions, session shortening, diet failure, water-drinking regimen, refusal to take medicines [7, 8, 9, 10, 11, 12, 13]. Also, the negative psychological state of patients directly during hemodialysis (fear, anxiety, pain, itching, boredom, low mood) needs to be corrected in order to increase tolerance directly to the session.

According to the authors of the proposed method, an individual approach to each patient is necessary, clarification of his psychological state, nature and severity of disorders. Accompanying patients with chronic diseases, it is important to carry out a correction of the psychological state and teach patients self-regulation skills. One of the elements of the correction of the psychological state and the activation of the adaptive potential of patients with stage V chronic kidney disease can be audiotherapy.

The present invention is aimed at increasing the patient's tolerance to the hemodialysis session and correcting the patient’s psychological state during the hemodialysis session using audio therapy by listening to special combinations of musical works, in particular classical music and recordings of nature sounds.

The technical result consists in translating the negative state of the patient undergoing hemodialysis into a neutral or positive one, as well as in increasing compliance and tolerance to hemodialysis sessions.

The technical result is achieved due to the fact that the psychological state of the patient is first determined by testing according to the parameters: anxiety, depression, locus control and coping strategies, then, based on the results obtained, the patient can listen to four types of playlists aimed at reflection and self-regulation, to remove anxiety, to structure the time of hemodialysis, to achieve catharsis; in addition, each playlist includes five pieces of music, of which the first, third and fifth are works of classical music, and the second and fourth are recorded sounds of nature; the order of listening to playlists is determined taking into account the patient’s assignment to an adaptive or non-adaptive group based on the tests performed; compare the condition of the patient before and after the session listening to playlists.

The essence of the proposed method consists in a directed change in the patient’s psychological state through the use of playlists based on a combination of classical music with certain characteristics in terms of tempo, timbre, instrumentation, frets, tonality with recorded sounds of nature, as described below. The number of musical works - 5. The number of sounds of nature - 2. The length of the playlist, which is understood as the complex of selected works and sounds of nature, is 25 minutes. Moreover, the patient’s playlist option is proposed not by chance, but on the basis of a diagnosis performed before the session in order to establish the patient’s condition, his needs, which will be discussed in more detail below.

A playlist is a sort of ordered list of files that are played in a certain sequence. The playlist takes into account the musical characteristics of the works (means of musical expression). The focus is on tonality (major-minor), tempo (fast, moderate, slow), harmony, chant, cantilency of the work, rhythm stability or instability, the presence or absence of sharp ups or downs in the work, the presence or absence of dissonances or consonances, the dynamics of the work , instrumentation works that create certain emotional states and moods while listening. Playlists include nature sounds that have a harmonizing and relaxing effect.

The works are selected based on the therapeutic target of listening and are grouped into four types in this order.

1. For reflection and self-regulation, a playlist includes: 1) tonality in C major, moderate pace, appeasement; 2) the sounds of nature - the sound of rain; 3) tonality in E flat major, pace moving, character leisurely, fun; 4) sounds of nature - birds singing; 5) tonality in F Sharp Major, moderate tempo, instrumentation: orchestra, character appeasement, positive.

2. To remove anxiety, the playlist includes: 1) tonality - minor, pace fast or moderate, character: anxious; 2) the sound of rain; 3) tonality minor, slow pace, sad, thoughtful character; 4) minor key, tempo is slow, pensive character, suggestive; 5) the key is major, the pace is slow, the character is calm, optimistic.

3. On structuring the time of hemodialysis, a playlist includes: 1) tonality of major, tempo is slow, character is calm, moderate, dreamy; 2) sounds of nature, birdsong; 3) tonality minor, slow pace, bright character, narrative; 4) the key is major, the pace is pretty soon, the character is calm, contemplative and pensive; 5) the key is major, the pace is calm, the character is calm, cheerful, pacified.

4. To achieve catharsis, the playlist includes: 1) minor key, moderate pace, calm character; 2) the sounds of nature rain; 3) minor key, medium tempo, meditation with dramatic notes; 4) sounds of nature birds singing; 5) the key is major, the pace is slow, the character is calm, peaceful.

In a specific implementation, playlists can be represented by the following options:

[1] 1. Bach I.S. Prelude and Fugue No. 13 2. The noise of rain. 3. Tchaikovsky P.I. Children's album. Waltz. 4. Bird singing. 5. Bach I.S. Prelude and Fugue No. 1.

[2] 1. Vivaldi A. Concert op. 8, No. 4, RV 297 “Winter” - 3 hours, rain, Bach I.S. HTK Prelude and Fugue No. 8, rain, calm minor, Tchaikovsky P.I. French song, calm thinking, positive F major, slow pace, Schumann R. Children's scenes No. 7, Dreams.

[3] 1. Tchaikovsky P.I. (Romance) from a cycle of 6 plays. Op. 51. Piece No. 5. 2. Bird singing. 3. Tchaikovsky P.I. Symphony 1, part 2 (Moody land, foggy land). 4. Sviridov G. Spring and Autumn from the cycle "Musical illustrations for the story of A.S. Pushkin. 5. Mozart V.A. Sonata for piano No. 5, K 283, 2 hours

[4] 1. I.S. Bach HTK Prelude and Fugue No. 18. 2. The sounds of nature rain. 3. Chopin F. Nocturne No. 1 opus 27. 4. Sounds of nature - birds singing. 5. Mozart V.A. String Quartet No. 10 K. 170.2 hours

There are no specific requirements for the acoustic parameters of sound, with the exception of the requirement for clarity of its reproduction and transmission of the entire sound palette, which can be achieved through the use of high-quality audio equipment. Listening to playlists is carried out at a comfortable volume level for patients. Listening to playlists is done using individual players and headphones directly during hemodialysis sessions. If desired, the patient can listen to the playlist several times.

Listening to playlists helps to translate the patient’s negative state into a neutral or positive one. The studies noted a decrease in anxiety, harmonization of feelings, calm, joy, optimism, hope, calm and relaxation; composure, expressed in decision-making, as well as a decrease in the level of depression. Increased tolerance to hemodialysis sessions. Correction of the psychological state of patients by the proposed method helps to increase compliance, which is confirmed by studies.

Important to achieve the result is that patients are offered playlists in accordance with its psychological state, needs identified during the diagnosis before the hemodialysis session. To do this, determine the nature and severity of the patient's disorders according to the following parameters: anxiety, depression, locus control and coping strategies. In contrast to the known solutions, the present invention is directed not at the physiological, but at the psychological and pedagogical impact, carried out individually (not in a group, as in the closest analogue). In the course of directly listening to playlists, the “internal work” of the patient takes place. Increasing the tolerance of a hemodialysis session is achieved due to the skills of self-regulation, estization of the hospital atmosphere.

Before starting a hemodialysis session, a study is conducted of the psychological and pedagogical characteristics of the patient, his well-being and needs during the hemodialysis session, a study of his musical preferences and cultural and educational level. This stage consists in the fact that on the basis of the psychological tests used, such as the Beck Depression Scale, the Lazarus Copy Test, the USK method, the Spilberger questionnaire for personal and situational anxiety, the patient's condition is determined, and based on the results obtained, the patient is assigned to one of the groups. The test methodology is known to specialists; we only recall that the test results are interpreted as follows:

Beck Depression Scale

- 0-9 - lack of depressive symptoms

- 10-15 - mild depression (subdepression)

- 16-19 - moderate depression

- 20-29 - severe depression (moderate)

- 30-63 - severe depression

Spielberger Questionnaire for Personal and Situational Anxiety

- up to 30 points - low,

- 31-44 points - moderate;

- 45 and more - high.

Lazarus copy test

In accordance with the percentages for each of the strategies of the test itself:

- an indicator less than 40 points - a rare use of the appropriate strategy;

- 40 points ≤ indicator ≤ 60 points - moderate use of the appropriate strategy;

- an indicator of more than 60 points - a pronounced preference for the appropriate strategy.

Non-constructive copings include Flight-Avoidance and Confrontation

The rest are constructive and relatively constructive.

USK technique

For the purpose of the invention, the USK method is interested in the following parameters: general internality / externality (Io) and internality / externality in the field of health (From).

A high score on each scale (the closer to 10) indicates externality, a low score (the closer to 1), somewhere in the middle (around 5.5 - moderate indicators).

According to the results of all tests, patients are assigned to one of the groups:

- if the depression indicators are low, moderate anxiety, coping strategies are adaptive, the locus of control is close to normal - the patient is referred to the first adaptive subgroup;

- if the indicators of anxiety, depression are high, non-adaptive coping is actively used, the locus of control is external (less than 5), then to the second subgroup it is less adaptive.

Based on the results obtained, they motivate patients to participate in the audiotherapy program by talking about the audiotherapy method, its features, self-regulation methods during the audiotherapy session, and they also select a playlist aimed at solving the urgent problem: reducing anxiety, harmonizing feelings, translating them into calmness, joy, optimism, hope, thinking; to relaxation as calming and relaxing; aimed at composure - decision making; to reduce depression.

The first subgroup of adaptive patients with a high level of anxiety and a high level of depression are working on a gentle principle, using the “soft patient input” method in a dialogue with a specialist and playlists aimed at harmonizing the hospital environment. A session of audiotherapy is carried out at the time of the hemodialysis procedure twice a week for three months.

For an adaptive group of patients, the following recipe for listening to playlists is recommended:

When working with the second less adaptive group, less sparing techniques are used in terms of bringing the patient to catharsis and fixing this condition.

For a non-adaptive patient group, the following recipe for listening to playlists is described:

Listening to playlists compiled and selected taking into account the patient’s psychological state ergonomically and sparingly creates a positive dominant in the patient’s mind and evokes positive emotions in relation to the hospital environment.

Based on the results of listening, the patient’s condition is compared before and after listening (self-feeling, the patient’s mood using a visual analogue scale are assessed), joint reflection occurs, analysis of feelings, thoughts, sensations during listening, reflection skills training, analysis of self-regulation experience, formation of reflection skills and self-regulation.

To confirm the results of the invention in the hemodialysis unit PSPbGMu them. Acad. I.P. Pavlova studies were conducted. For the study, a group of patients with stage V chronic kidney disease receiving hemodialysis treatment was selected. A total of 61 patients with stage V chronic kidney disease who received hemodialysis treatment were examined. In the examined group there were 30 women and 31 men, age 50.48 ± 15.13, the duration of hemodialysis was 6.68 ± 6.39 hours. Social status is heterogeneous. The following methods were used to diagnose patients: the Beck Depression Scale, Spielberger’s personal and situational anxiety questionnaire, USK method (subjective control level), Lazarus copy test, interviewing.

According to the results of the first stage, the patients were divided into control and experimental groups. Initial psychological and pedagogical research showed that the indicators of some patients were close to normal, other patients showed high levels of anxiety, depression, externalism, and the use of unconstructive coping strategies. In accordance with this, the patients were divided into 2 subgroups within the experimental and control groups, which made it possible to form subgroups and use the data obtained when analyzing the results of audiotherapy in order to obtain more differentiated psychotherapeutic targets for audiotherapy.

The first subgroup in the experimental and control group included patients with no depressive symptoms, low, moderate situational anxiety, low, moderate or high personal anxiety (when combined with high anxiety and no depression, interactivity and the predominance of constructive coping strategies), medium, approximate to the norm or internal indicators of the locus of control, the most used coping strategies were “Planning a solution to a problem”, “Self-control”, “Positive reoc NCA "," Acceptance of responsibility. " Representatives of this subgroup contacted more easily and expressed a desire to participate in the study and in audiotherapy.

The second subgroup in the experimental and control group included patients with a combination of mild, moderate, severe or severe depression, moderate or high situational or personal anxiety, mainly external control locus. Patients used coping strategies “Planning a solution to a problem”, “Self-control”, “Searching for social support”, “Distance”, “Positive reassessment”, somewhat more actively than “Confrontational coping” and “Flight-avoidance” were used in the first subgroup. Such a division allowed a more differentiated assessment of its effectiveness.

In the experimental group, 11 people were assigned to the first subgroup, the average age was 50.73 ± 14.99, and the duration of HD was 5.58 ± 5.91. In the control group, 5 people were assigned to the first subgroup, the average age was 39.4 ± 11.6, and the duration of HD was 2.88 ± 1.43.

In the experimental group, 19 people were assigned to the second subgroup, the average age was 48.52 ± 18.15, and the duration of HD was 6.35 ± 6.73 hours. In the control group, 26 people were assigned to the second subgroup 53.89 ± 12.85, the duration of HD was 8.07 ± 6.72 hours.

The nature and severity of the disorders were used at the preparatory stage of audiotherapy, to create playlists focused on the condition of patients and homogeneous groups of patients.

Audiotherapy sessions were conducted for three months during hemodialysis. The audio therapy session was as follows: directly during the hemodialysis session, the patient was offered an individual player and headphones. The patient was offered playlists in accordance with his psychological state, the needs identified during the interview before listening, and also taking into account his wishes and musical preferences.

According to the results of listening to audiotherapy during hemodialysis sessions for 3 months, the following results were obtained:

According to the results of the study, when comparing patients from the first subgroup of the experimental and control groups, there were no significant differences. It can be assumed that patients of this group had a high adaptive potential and their mental and psychological state was quite stable.

An analysis of the data revealed that the main changes occurred in the second subgroup of the experimental group. Some patients (6 people) from the second subgroup of the experimental group, according to the results of the course of audio therapy, could be transferred to the first subgroup. In order to analyze these changes, the second subgroup of the experimental group was also divided into 2 parts (group A included patients who can be attributed to the first group, group B included patients whose indicators remained at the level of the second subgroup). The following results were obtained: before the course of audiotherapy, subgroups A and B of the second subgroup of the experimental group did not differ in situational anxiety, depression, coping strategies and locus of control. After the completion of audiotherapy, differences in anxiety and depression were revealed, however, in the field of copying strategies and the locus of control, differences were mainly not observed.

Thus, it can be assumed that some patients have high adaptive potential, most of these patients in the first stage of the study fell into the first group. However, there were those who had higher levels of anxiety, depression, locus of control, which tended to be external, than representatives of the first group, while after psychological correction these patients decreased their level of anxiety, depression, there were changes in the scope of the locus of control, coping strategies not significantly changed.

An analysis of the changes that have occurred with some patients suggests that some patients have high adaptive potential, which can be activated, including using audiotherapy. Most of these patients already in the first stage of the study fell into the first subgroup. These patients made contact more easily and expressed their willingness to participate in audiotherapy. However, there were patients who had higher levels of anxiety, depression, locus of control, which tended to be external, than representatives of the first group. After psychological correction, the level of anxiety and depression in these patients decreased, some changes occurred in the sphere of the locus of control, copying strategies did not change significantly.

Based on interviews conducted with patients of the experimental group regarding listening to audio therapy programs (name), the following was revealed: 66% of patients reported that during listening they had various images (imagination intensified); 33% of patients reported that during listening they had various memories (usually related either to the situation of listening to certain works, or to positive memories during childhood and adolescence or before illness). These effects can be used to harmonize and aesthetize the hospital environment, helping patients to "distract" from the treatment situation.

When listening to relaxation playlists, 80% of patients reported physical relaxation while listening. At the same time, 67% of patients added that they felt a sense of calm and conciliation.

50% of patients noted that listening to audio objects changed the subjective perception of an unpleasant somatic state (patients were "distracted" from unpleasant sensations, such as pain, itching, cramps, lowering or increased pressure).

Most patients from the experimental group (93%) noted that listening had a positive effect on the structuring of hemodialysis time and the perception of its duration (patients did not experience feelings of boredom and the session time “passed” faster).

Patients also evaluated their condition on a visual-analogue scale before and after listening. According to the results, a statistically significant improvement in mood was recorded (p = 0.021).

The method is confirmed by the following examples.

Example 1. Patient, 52 years old. The duration of hemodialysis is 3 years. Prior to the start of audiotherapy sessions, situational anxiety was 42 points (according to the Spielberger personal and situational anxiety questionnaire), personality anxiety was 41 points, depression was 10 points (according to the Beck scale), the patient experienced anxiety during hemodialysis. The session was carried out twice a week for three months using the listening technique (order) for patients assigned to a non-adaptive group (see table 1). After listening to a course of audiotherapy, situational anxiety was 36 points, personality anxiety was 39 points, depression was 0 points (on the Beck Depression scale). Based on the results of the interview, the patient stated that her mood changed for the better from 4 to 8 points (on a visual-analogue scale). When listening, pleasant memories related to nature were updated, which helped to abstract from hemodialysis sessions and the hospital atmosphere. The hemodialysis session became easier to tolerate.

Example 2. Patient, 62 years old. The duration of hemodialysis is 8 years. Prior to the start of audiotherapy sessions, situational anxiety was 47 points (according to the Spielberger personal and situational anxiety questionnaire), personality anxiety was 27 points, depression was 7 points (according to the Beck scale), the patient experienced anxiety during hemodialysis. The session was performed twice a week for three months using the methodology (order) of listening to playlists for patients assigned to a non-adaptive group (see table 1). After listening to the audiotherapy course, situational anxiety 38 was scored, personality anxiety was 32 scores, depression was 5 scores (on the Beck Depression scale). Based on the results of the interview, the patient stated that her mood changed for the better from 7 to 8 points (on a visual-analogue scale). When listening, imagination was updated, which helped to abstract from hemodialysis sessions and the hospital atmosphere. The hemodialysis session became easier to tolerate.

Example 3. Patient, 21 years old. The duration of hemodialysis is 1 year. Prior to the start of audiotherapy sessions, situational anxiety was 30 points (according to the Spielberger personal and situational anxiety questionnaire), personality anxiety was 37 points, depression was 12 points (according to the Beck scale), the patient experienced anxiety during hemodialysis. The session was carried out twice a week for three months using the listening technique (order) for patients assigned to a non-adaptive group (see table 1). After listening to the audiotherapy course, situational anxiety 39 was scored, personality anxiety was 28 scores, depression was 8 scores (on the Beck Depression scale).

Patient 4. Patient, 62 years old. The duration of hemodialysis is 18 years. Prior to the start of the audiotherapy sessions, situational anxiety was 25 points (according to the Spielberger personal and situational anxiety questionnaire), personality anxiety was 38 points, depression was 12 points (according to the Beck scale), the patient experienced anxiety during hemodialysis. The session was carried out twice a week for three months using the listening technique (order) for patients assigned to a non-adaptive group (see table 1).

The general conclusion of the experiment. In the complex support of patients with chronic kidney diseases, it is important to pay attention to their behavior and psychological status, in particular, to correct the psychological state and teach patients self-regulation skills. Audiotherapy helps to increase patient tolerance to hemodialysis, relaxation and distraction from the hospital setting. As a result, it was revealed that the psychological and pedagogical interaction through listening to playlists can be used as part of the correction of the psychological state and increase the tolerance of hemodialysis sessions.

1. Listening to playlists has an effect on a statistically significant effect on reducing the levels of Situational and Personal anxiety, depression.

2. Using playlists, it is possible to correct the psychological state of patients directly during hemodialysis sessions.

3. Listening to playlists helps to distract from the hospital environment or harmonizes it (by activating imagination or memories).

4. Listening to playlists has an effect on improving mood during hemodialysis (statistically significant differences were obtained when patients assessed their moods on a visual-analogue scale before and after listening).

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Claims (9)

1. A method for correcting the psychological state in patients with chronic kidney disease receiving hemodialysis treatment, including psychological impact, characterized in that the psychological state of the patient is determined by examining his anxiety, depression, locus of control and coping strategies, based on the results obtained, refer the patient to adaptive or non-adaptive subgroup and provide listening to patients with playlists of four types, the first of which is aimed at reflection and self-regulation; the second type is aimed at relieving anxiety; the third type is aimed at structuring the hemodialysis time; and the fourth type is aimed at achieving catharsis; in addition, each playlist includes files of five musical works, of which the first, third and fifth are works of classical music, and the second and fourth are recorded sounds of nature; moreover, the order of listening to playlists is determined taking into account the patient’s classification as an adaptive or non-adaptive subgroup, where the patient is referred to the adaptive subgroup in case of moderate levels of anxiety, low rates of depression, the use of constructive cooking strategies and the internal locus of control and the patient is classified as non-adaptive subgroup in the case of high indicators anxiety and depression, the use of predominant non-constructive coping strategies, external locus of control; and control the psychological state of the patient by comparing the psychological state of the patient before and after the session listening to playlists, while for patients of the adaptive subgroup, use the following procedure for listening to playlists for three months twice a week: in the first week, the first and first types; in the second week of the second and second types; in the third week, the third and first types; in the fourth week, the fourth and fourth types; in the fifth week, the fourth and third types; at the sixth week, the fourth and second types; in the seventh week, the first and first types; in the eighth week, the fourth, second and fourth, first types; in the ninth week, the fourth and third types; in the tenth week, the fourth and second types; at the eleventh week, the first and first types; and at the twelfth week, the fourth, fourth and fourth, first types, and for patients with a non-adaptive subgroup, the following procedure for listening to playlists for 3 months twice a week is used: in the first week, the third and third types; in the second week of the second and second types; in the third week of the second and second types; in the fourth week, the first and first types; in the fifth week, the first and first types; in the sixth week of the second and second types; at the seventh week, the third and third types; in the eighth week, the fourth and fourth types; in the ninth week, the first and first types; in the tenth week of the second and second types; at the eleventh week, the third and third types; and in the twelfth week the fourth and fourth types. 2. The method according to p. 1, characterized in that the length of the playlist, which is understood as a complex of selected works and sounds of nature, is 25 minutes. 3. The method according to p. 1, characterized in that the playlist of the first type includes sequential works with characteristics: the first work in key of C major, moderate tempo, character: appeasement; the second work - the sounds of nature - the sound of rain; the third work in key in E flat major, pace moving, character: leisurely, fun; the fourth work - sounds of nature - birds singing; and the fifth piece in the key in F Sharp Major, moderate tempo, instrumentation: orchestra, character: peace, positive. 4. The method according to p. 1, characterized in that the playlist of the second type includes sequential works with characteristics: the first work in key, minor, tempo fast or moderate, character: alarming; the second work is the sound of rain; the third work in key is minor, the pace is slow, the character is sad, thoughtful; the fourth work in key is minor, the pace is slow, the character is pensive, suggestive; and the fifth work in key major, the pace is slow, the character: calm, optimistic. 5. The method according to p. 1, characterized in that the playlist of the third type includes sequentially arranged pieces: the first piece in key, major, slow tempo, character: calm, moderate, dreamy; the second work - the sounds of nature - birds singing; the third work in key is minor, the tempo is slow, the character is light, narrative, the fourth work in key is major, the pace is pretty soon, the character is calm, contemplative and pensive; and the fifth work in key major, the pace is calm, the character is calm, cheerful, pacified. 6. The method according to p. 1, characterized in that the playlist of the fourth type includes sequential works: the first work in key, minor, moderate tempo, calm character; the second work - the sounds of nature - rain; the third work in key minor, tempo average, meditation with dramatic notes; the fourth work - sounds of nature - birds singing; the fifth piece in key major, the pace is slow, the character is calm, pacified.