Effective therapy for post-traumatic stress disorder - Edna Foa - a practical guide. Is online Skype psychotherapy as effective as traditional psychological help? Treatment of chronic bronchitis with folk remedies

Year of issue: 2005

Genre: Psychology

Format: PDF

Quality: OCR

Description: In preparing the materials presented in the book " Effective therapy post-traumatic stress disorder”, directly involved members of a special commission created to develop guidelines on methods of treating PTSD. This panel was organized by the Board of Directors of the International Society for Traumatic Stress Studies (ISTSS) in November 1997. Our goal was to describe various treatment modalities based on a review of extensive clinical and research literature, prepared by experts in each specific field. The book “Effective Therapy for Post-Traumatic Stress Disorder” consists of two parts. The chapters of the first part are devoted to an overview of the results of the most important studies. The second part contains short description the use of different therapeutic approaches in the treatment of PTSD. This guideline aims to inform clinicians of the developments we have identified as best for the treatment of patients diagnosed with post-traumatic stress disorder (PTSD). PTSD is a complex mental condition that develops as a result of experiencing a traumatic event. Symptoms that characterize PTSD include repeated replay of the traumatic event or episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often accompanied by other mental disorders and is complex disease, which may be associated with significant morbidity, disability, and impairment of vital functions.

In developing this practice guide, a special commission confirmed that traumatic experiences can lead to the development various violations, such as general depression, specific phobias; disorders of extreme stress not otherwise specified (DESNOS), personality disorders such as borderline anxiety disorder and panic disorder. However, the main focus of this book is the treatment of PTSD and its symptoms, which are listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994) of the American Psychiatric Association.
The authors of the Effective Treatments for Post-Traumatic Stress Disorder manual acknowledge that the diagnostic scope of PTSD is limited and that these limitations may be particularly evident in patients who have experienced childhood sexual or physical abuse. Often, patients diagnosed with DESNOS have a wide range of problems in relationships with other people, which contribute to impairments in personal and social functioning. Relatively little is known about the successful treatment of these patients. The consensus among clinicians, supported by empirical data, is that patients with this diagnosis require long-term and complex treatment. The Special Commission also recognized that PTSD is often accompanied by other mental disorders, and these comorbidities require medical personnel sensitivity, attention, as well as clarification of the diagnosis throughout the entire treatment process. Disorders requiring special attention, are substance abuse and general depression as the most common comorbid conditions. Practitioners may refer to guidelines for these disorders to develop treatment plans for individuals demonstrating multiple disorders and to the comments in Chapter 27.
The Effective Treatment for Post-Traumatic Stress Disorder guideline is based on cases of adults, adolescents, and children suffering from PTSD. The purpose of the guide is to assist the clinician in treating these individuals. Because PTSD is treated by clinicians with a variety of backgrounds, these chapters were developed using an interdisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family counselors and other specialists actively participated in the development process. Accordingly, these chapters address a wide range of professionals involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently being subjected to violence or insults. These individuals (children who live with an abusive person, men and women who are abused and abused in their home), and those living in war zones may also meet criteria for a diagnosis of PTSD. However, their treatment, as well as the associated legal and ethical issues differ significantly from the treatment and problems of patients who have experienced traumatic events in the past. Patients directly in a traumatic situation require special attention from clinicians. These circumstances require the development of additional practical guidelines.
Very little is known about the treatment of PTSD in industrialized regions. Research and development on these topics is carried out mainly in Western industrialized countries. The Special Commission is keenly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is found across many cultures and societies. However, there is a need for systematic research to determine the extent to which treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western societies will be effective in other cultures. In general, practitioners should not limit themselves to only the approaches and techniques outlined in this manual. The creative integration of new approaches that have demonstrated effectiveness in the treatment of other disorders and have a sufficient theoretical basis is encouraged in order to improve treatment outcomes.

The book “Effective Therapy for Post-Traumatic Stress Disorder” is based on an analysis of the results of research on the effectiveness of psychotherapy for adults, adolescents and children suffering from post-traumatic stress disorder (PTSD). The purpose of the manual is to assist the clinician in the treatment of such patients. Since PTSD treatment is carried out by specialists with various professional training, the authors of the chapters of the manual took an interdisciplinary approach to the problem. The book as a whole brings together the efforts of psychologists, psychiatrists, social workers, art therapists, family consultants, etc. The chapters of the manual are addressed to to a wide circle specialists involved in the treatment of PTSD.
The book “Effective Therapy for Post-Traumatic Stress Disorder” consists of two parts. The chapters of the first part are devoted to an overview of the results of the most important studies. Part two provides a brief description of the use of different therapeutic approaches to treat PTSD.

"Effective Therapy for Post-Traumatic Stress Disorder"

1. Diagnosis and evaluation

1. Psychological debriefing
2. Psychopharmacotherapy
3. Treatment of children and adolescents
4. Group therapy
5. Psychodynamic therapy
6. Treatment in hospital

1. Hypnosis
2. Art therapy

1. Psychological debriefing
2. Cognitive behavioral therapy
3. Psychopharmacotherapy
4. Treatment of children and adolescents
5. Desensitization and reprocessing using eye movements
6. Group therapy
7. Psychodynamic therapy
8. Treatment in hospital
9. Psychosocial rehabilitation
10. Hypnosis
11. Marriage and family therapy
12. Art therapy

Conclusion and conclusions

We write a lot about psychological trauma, but usually in a vague way. What is psychological trauma, why it is psychological, why trauma is absolutely impossible to understand.

Simply - “everyone has psychological trauma, everyone needs to be treated.” In fact, everything is much more interesting. Perhaps everyone has psychological traumas, but they turn into something serious relatively rarely. This serious condition is called PTSD (post-traumatic stress disorder) and it is PTSD that is actually the object of attention of psychologists. All other “psychological traumas” go away on their own, like a runny nose. A little longer, of course, but on your own.

Another thing is PTSD. Here I quote from the book: “In a study by Breslau et al. (Breslau et al., 1991) showed that approximately 25% of people who experienced a traumatic event subsequently developed PTSD, which resulted in approximately 9% long-term illness. Norris (1992) found PTSD in 5%, while Resnick and colleagues reported PTSD in 9% of women, 12% of whom had chronic PTSD. Estimates of the entire population also showed high rates of PTSD. In the National Morbidity Study, Kessler et al. (Kessler et al., 1995) found that PTSD occurs in 8% of the adult population during their lifetime.".

PTSD is real serious problem, but it doesn’t happen to everyone. For example, you most likely don’t have it.

It’s not hard to notice this yourself (another quote): “PTSD is characterized by the persistent experience of symptoms that include (1) recurrent and intrusive memories of the event, (2) recurring dreams about the event, (3) acting as if the event were happening again, (4) intense distress that was caused by an external or internal situation that is reminiscent of or symbolic of the traumatic event, and (5) physiological reactivity to stimuli or situations that recall the event.

The disorder also involves symptoms of avoidance and emotional numbing. These may include (1) efforts to avoid thoughts, feelings, or conversations about the event; (2) efforts to avoid activities, places, or people that are associated with the event; (3) inability to remember important aspects of the event; (4) a noticeable decrease in interest in what previously gave pleasure; (5) a feeling of alienation, detachment from other people; (6) limiting the range of emotional experiences; and (7) a sense of reduced life perspective accompanied by a significant lack of planning for the future.

The picture is completed by symptoms of agitation that were not observed before the traumatic event. It can be following symptoms: (1) difficulty falling asleep or poor sleep, (2) irritability or angry outbursts, (3) difficulty concentrating, (4) increased level alertness, hypervigilance, constant anticipation of danger or re-experiencing a life-threatening situation, and (5) an exaggerated startle response.”.

The vast majority of people who come to psychologists do not demonstrate even half of these symptoms. So I hasten to console - psychological trauma you do not have.

If we talk about the book itself, although it is old, it is still excellent. The authors took the matter extremely seriously. The first hundred pages are a story about how the book was prepared, what was included in it, what was not, why, and so on. People did not write out of thin air, but rather generalized their research experience.

Moreover, as conscientious researchers, they kept pointing out that the methodology was violated here, there was a small sample here, there was a mistake here, there was something else. In general, it is clear that a huge amount of work has been done.

Unfortunately, the book is somewhat outdated and can no longer serve as the most reliable reference book. But this is normal - science does not stand still, and in the book itself the authors indicated that they were only providing a snapshot that was relevant at the time of preparation of the book, and hoped that their work would be further refined and refined. That's how it works.

How to treat bronchitis in adults? Effective medicines and methods

Bronchitis is an inflammatory disease of the bronchial mucosa. Most often it develops against the background respiratory infections, but may have other reasons. To understand how to treat bronchitis in a particular case, it is important to identify these causes. Competent therapeutic tactics will help eliminate the main symptoms of the disease in a few days.

Basic principles of treatment of bronchitis in adults

Treatment of bronchitis is the competence of a pulmonologist, but in mild forms this disease is treated by specialists generalist- therapists.

What drugs and antibiotics help with the disease?

Before prescribing any drug, the doctor determines the cause of the disease. Bronchitis of a viral, bacterial and allergic nature requires a different approach.

Therefore, the list of drugs for the treatment of bronchitis includes drugs from different groups:

Antibiotics for bronchitis are prescribed only if an infection of bacterial origin is detected. Antiviral drugs are recommended for the treatment of infectious bronchitis viral nature. Bronchodilators - with the development of bronchospasms or in cases where hypersecretion of mucus is observed in the bronchi and they cannot get rid of mucus on their own.

Therapy for bronchitis of various origins also involves the use of anti-inflammatory and immunomodulatory drugs: Timogen, Aflubin, Immunal. Can be assigned and antihistamines- “Suprastin”, “Zirtek”.

Inhalations as a treatment method

Inhalations are a mandatory procedure included in the bronchitis treatment program.

Direct delivery of the drug to the bronchi helps achieve the following effects:

• thinning thick sputum;
• moisturizing the mucous membrane;
• reduction of inflammation;
• relieving bronchospasm.

You can carry out inhalation at home using the “old-fashioned” method - breathe over a hot solution, covered with a towel. But it is much more convenient and safer to perform this procedure using a nebulizer.

The nebulizer allows you to use pharmaceutical drugs for bronchitis for inhalation - “Fluimucil”, “Lazolvan”, “Gensalbutamol”, “Berodual”. In the absence of a device, steam inhalations homemade solutions, which will be discussed below.

Also, this procedure is contraindicated in case of cardiovascular diseases, a history of heart attacks and strokes, severe pathologies of the respiratory system (emphysema, pneumothorax, etc.).

Folk remedies

In the collection of folk remedies there are many useful recipes that can be used as aids in the treatment of bronchitis:

• Infusion for inhalation of chamomile and pine buds. Place 30 grams of chamomile flowers and 30 grams of pine buds in a thermos and brew 0.5 liters of boiling water. Screw on the lid and leave for 1 hour.
• Expectorant and anti-inflammatory infusion for inhalation. Make an herbal mixture: 1 tablespoon each of eucalyptus leaf, licorice root, calendula and chamomile flowers, sage herb. Place everything in a thermos, pour 0.5 liters of boiling water and screw on the lid. Leave for 2 hours.
• Propolis solution for inhalation. Pour 1 tablespoon of propolis alcohol tincture into 1 glass hot water and use for steam inhalation.
• Expectorant with honey and aloe. Mix 120 ml of honey, 150 grams of butter and 20 ml of aloe juice and store in the refrigerator. For bronchitis, dilute 2 teaspoons of the product in 1 glass of hot milk 2 times a day.
• Marshmallow root decoction. Add 2 tablespoons of dry crushed marshmallow root to 1 glass of hot water and place in a water bath. Keep covered for 30 minutes, cool, filter and consume 0.5 cups 4 times a day.

For bronchitis, it is useful to drink a lot of warm vitamin drinks. For this purpose, restorative infusions of rose hips and dried fruit compotes will be useful. At this temperature you can prepare fruit drinks from cranberries, lingonberries, black currant. Raspberry tea is another one universal remedy traditional medicine for the treatment of many respiratory diseases.

Massage and therapeutic exercises

Auxiliary methods for the treatment of bronchial inflammation are massage and breathing exercises.

Treatment of bronchitis at home: acute, chronic, folk remedies

Bronchitis most often begins as part of the flu or acute respiratory viral infection or as a complication of them, when a runny nose and red throat is accompanied by a dry, debilitating or wet cough, and if you help your body in time, quickly transform the dry cough into a wet one, then bronchitis can be cured faster than in 10 days.

Any treatment must be comprehensive:

• Active fight against virus and infection
• Improving bronchial patency, thinning mucus and removing it as quickly as possible
• Elimination of provoking factors

Regimen for bronchitis

At the very beginning of the disease, it is simply necessary to remain in bed for 2-3 days, then you can remain in semi-bed rest for another 3-4 days, when it becomes easier, the temperature is normal, you can go out and take small walks in the fresh air, preferably in the park, and not along the highway.

You should follow a predominantly plant-based - cereal, dairy diet; during illness, the body especially needs vitamins, it is better if these are natural vitamins - fruits and vegetables.

If a person smokes, quitting smoking should happen as if by itself, since smoking increases and provokes a dry cough so much, and delays the day of recovery that it’s not even worth talking about. Many heavy smokers who care about their health quit smoking precisely after acute bronchitis, pneumonia or obstructive bronchitis!

One of the options for a quick recovery from bronchitis is to quickly liquefy mucus and remove it from the body, and this is very easily achieved by drinking plenty of warm drinks. This is trivial advice, but the most correct and true: the more liquid a patient with bronchitis drinks, the faster the sputum is liquefied, and therefore the bronchi are released.

Also, during inflammation during intoxication, a mass of harmful toxic substances is formed that poison the body, and drinking plenty of water up to 2-3 liters per day is the path to cleansing of toxins and a speedy recovery.

You can drink any drinks, it is best if they are fortified natural vitamins- decoction of rose hips, raspberries, linden, mint, chamomile tea, milk-mineral honey cocktails ( mineral water without gases Borjomi, Narzan + milk + honey). And from strong tea and coffee should be avoided, since caffeine dehydrates the body, which is not advisable for any illness.

When the air is dry, the cough is much stronger, so try to humidify the air in the room where the patient is. It is best to use an air purifier and humidifier for this purpose. It is also advisable to carry out daily wet cleaning of the patient’s room to purify the air.

Are antibiotics needed for bronchitis?

There are cases of very severe bronchitis with obstructive syndrome and respiratory failure; in such a situation, hospitalization in the pulmonology department is indicated. At mild form bronchitis, uncomplicated by other pathologies, after consulting a doctor, you can treat acute bronchitis at home, using various medicines or traditional medicine.

Usually, it is not advisable to use antibiotics for bronchitis if it is caused by the influenza virus or a cold. A strong immune system copes well with bronchial inflammation. Antimicrobial agents, in the absence of corresponding changes in the blood and in the absence of purulent sputum, cannot be used for bronchitis, since they not only do not have an anti-inflammatory and antiviral effect, but also increase allergenicity and can provoke broncho-obstructive syndrome. But in case:

• High fever lasts for a long time, purulent sputum is released when coughing
• or after acute period after 4-5 days of illness, the condition suddenly worsens, a new jump in high temperature appears, purulent sputum (yellow or green) is released when coughing, the patient’s general condition worsens

You should once again consult a doctor who will examine, listen to the patient, refer you for tests and x-rays, and then recommend a course of antibiotics aimed at destroying the attached bacterial infection. You should never start taking antibiotics without a doctor's recommendation. 11 rules - how to take antibiotics correctly.

How to quickly cure bronchitis at home

Antiviral agents

If bronchitis occurs against the background of influenza, then antiviral drugs can be used for therapy. Interferon preparations can be used intranasally, that is, instilled into the nose for both children and adults; the use of other antiviral drugs for acute respiratory viral infections and influenza is today widely advertised and recommended, however, there are no convincing studies and evidence of their effect and safety, so the decision to use them - everyone's personal business.

Expectorants

To improve sputum discharge, the doctor prescribes expectorants, mucolytic drugs, there are many of them in the pharmacy network - the most popular and effective among them are: Lazolvan, Ambrohexol, Bromhexine, Herbion, herbal breast infusions (which can be used in the absence of allergies to medicinal herbs). At lingering cough and elements of bronchial obstruction, Ascoril (Joset, Cashnol) containing salbutamol is prescribed.

At the very beginning of bronchitis, the patient usually experiences a prolonged, dry, nonproductive cough. Therefore, to alleviate the condition, you should take drugs such as Glaucin, Libexin, Tusuprex, Levopront, which suppress dry cough, and expectorants are taken later, when the cough turns into a wet one. You can also use combination drugs, such as Sinecode - instructions, Bronchicum, Broncholitin. For the treatment of bronchitis folk remedies, for dry cough, thermopsis, licorice, and coltsfoot are used.

After 4 days, as a rule, sputum begins to disappear, so cough suppressants should be discontinued and sputum thinners should be taken:

• Mucolytics - these include acetylcysteine ​​- ACC, Muconex, Fluimucil, as well as carbocysteine ​​- Fluifort.
• Expectorants are means that improve coughing up sputum, that is, a reflex effect, these include the well-known plantain (Gerbion), ivy leaves (Prospan), marshmallow, thyme, anise drops, as well as Chest collection.
• Mucokinetics are agents that facilitate the movement of sputum, for example, Bromhexine. Such popular medicines as Lazolvan (in Ambroxol tablets), Ambrobene, in addition, have the property of thinning sputum, making it less viscous, and easily remove it from the body.

Inhalations

Treatment of bronchitis is very effective using various inhalations. If you want to quickly cure bronchitis, then you should definitely do inhalations. Just make sure first that there is no high temperature or palpitations.

There are many recipes for steam inhalations for bronchitis - these include salt and soda solutions, and essential oils of eucalyptus, pine, washed, herbal infusions, inhalation of phytoncides, which are rich in essential oils of garlic, rosemary - reduce cough shocks and facilitate the process of coughing. However, it is not uncommon for essential oils and medicinal herbs to cause allergic reactions and therefore, people prone to allergies (hay fever) are better off not taking risks and avoiding the use of various herbs and essential oils.

Also for those who have home inhaler, you can carry out inhalations for bronchitis with a nebulizer with Lazolvan, Ambrobene, etc. with special medicinal solutions designed to improve the release of phlegm from the bronchi.

In the case of obstructive bronchitis in children or adults, the drug Berodual is an effective bronchodilator; special solutions are available for inhalation.

Massage, breathing exercises

Massage always effectively and quickly helps to cope with almost all diseases; for bronchitis, it can only be carried out if the body temperature is normalized; you can do it yourself, using various massagers, a Kuznetsov applicator, or vibration massage. Today there are many different types of massagers, so you can purchase any of them.

After the acute period of inflammation ends and there are only residual effects in the form rare cough, you can start doing therapeutic breathing exercises, for example, according to Strelnikova. Women can try to perform simple exercises from the Bodyflex breathing exercises, which not only strengthens the respiratory system, but also normalizes metabolism and promotes weight loss.

Oddly enough, but old proven remedies are forgotten by modern people, and methods such as cupping, mustard plasters, and warm compresses are rarely used by people. But these are safe and very effective procedures.

Treatment of chronic bronchitis with folk remedies

Every family has grandmothers and great-grandmothers who used to treat all diseases exclusively with folk remedies. Among all the methods of treating chronic bronchitis with folk remedies, we will talk about the simplest and most accessible to everyone:

Radish, honey

A very old and effective recipe is a radish, a small depression is made in it, into which a teaspoon of honey is placed. After some time, the radish produces juice and can be consumed 3 times a day. This is a good way to relieve cough if you are not allergic to honey.

Chamomile, St. John's wort, sage, calendula, calamus

Medicinal herbs such as chamomile, St. John's wort, sage, calamus, calendula have anti-inflammatory properties and, in the absence of allergies, you can make infusions - 1 tbsp is enough. spoons per glass of boiling water, leave for an hour and drink 3 times a day.

Garlic, dill, butter

Sandwiches with garlic, dill and butter - to prepare such a sandwich, take 5 cloves of garlic, squeeze through a garlic press, mix with 100 grams of butter, you can add finely chopped dill or parsley. Eat this sandwich 3 times a day.

Medicinal plants

• Plantain has always been valued traditional healers for its excellent expectorant properties. Therefore, to treat bronchitis, you can buy plantain leaves, 4 tbsp. Grind spoons of leaves, pour half a glass of boiling water, let it brew for 4 hours, strain and drink this amount throughout the day.
• Such medicinal plants like thyme, eucalyptus, pine buds, caraway, St. John's wort, fennel have an expectorant effect, so you can also make infusions and inhalations from them.
• Medicinal plants such as decoctions of plantain, yarrow, violet, marshmallow roots, and coltsfoot help to increase immunity in chronic bronchitis.
• Taking natural mumiyo, echinacea tincture, and licorice root syrup also helps improve immunity.
• Decoctions of parsley, juniper, horsetail, birch, lingonberry leaves. These remedies are not direct methods of treating acute bronchitis at home, but they are very helpful in strengthening the body and speedy recovery.

Sorbents

To relieve symptoms of intoxication in viral and infectious diseases, in order to quickly remove toxins from the body, you can also use pharmaceutical sorbents - Polysorb, Enterosgel, Filtrum STI, Polyphepan, etc., but they should be taken in the intervals between taking medications and food, preferably 1 time a day at night, 2 hours after the last meal and medication, and for a short course.

Psychological attitude

It may seem strange and unacceptable to many, but a psychological, emotional, positive attitude toward recovery is always of great importance, especially when chronic diseases. Belief in healing gives the brain a very strong impetus to intensify the body’s own fight against the disease. Daily Reading positive attitudes, which you can come up with for yourself, speaking affirmations, practicing self-hypnosis, meditation - can help more than some medications. The main thing is to believe that it works, to believe in the strength of your body and the disease will go away.

Juice therapy

Juice therapy has long been considered a powerful way to heal the entire body. Vegetable juices are especially useful:

• Beetroot juice is considered the most highly effective juice for cleansing the blood of toxins, it helps normalize blood composition, increases platelets especially well, the only condition for taking it is that you cannot drink freshly squeezed juice, first grate the raw beets, squeeze out the juice, and then put it in refrigerator, after 3-4 hours you can drink it.
• Carrot juice - a lot beet juice It is not recommended to drink, no more than 100 ml., it is better to dilute it with healthy freshly squeezed carrot juice. It is both tasty and extremely healthy.
• Lingonberry juice is very good for removing phlegm.
• Freshly squeezed cabbage juice is not very pleasant to drink, but if you add a little sugar, it is very effective as an expectorant. Besides, cabbage juice It also helps with stomach diseases.

Treatment of bronchitis at home in adults and children

One of the most common diseases of the human respiratory system is bronchitis. This disease is an inflammatory process that affects, among other things, the bronchi. Bronchitis occurs due to infection: in most cases, viral, less often bacterial in origin. In the international classification of diseases, bronchitis is presented in two forms: acute and chronic. They differ in etiology, pathogenesis and necessary therapy.

The main symptom of bronchitis is cough. In the first days of the disease it is dry with severe attacks at night. Because of the cough, the patient often cannot sleep normally and suffers from physical illness. After a few days, the cough becomes wet and with the right treatment tactics, bronchitis goes away within 10 days. Quite often there are cases when a cough, as a residual phenomenon after bronchitis, lasts much longer than the disease itself. This is due to the fact that the process of restoration of the bronchi after inflammatory process long enough.

The only cause of concern is a cough that lasts more than four weeks. In such cases, you need to consult a pulmonologist, who will determine the presence of third-party causes of cough. In addition, foreign inclusions in the sputum, especially blood, should alert you during bronchitis. They should prompt an immediate visit to the hospital, where they will be examined for tuberculosis and lung cancer, for which blood in the sputum is a fairly characteristic symptom.

Treatment of bronchitis

When considering the issue of therapy for bronchitis, first you need to identify two important points:

• The treatment tactics for bronchial inflammation are influenced by the form of the disease (infectious or bacterial) and the type of course (acute or chronic);
• Treatment of bronchitis must be comprehensive. The result of taking medications alone in most cases will not be effective enough.

At the same time, drug therapy for bronchitis is quite simple. In itself, it does not require any complex drugs or procedures. The main thing this disease requires is the correct identification of the causative agent of the inflammatory process and the form of its course.

Antibiotic therapy for bronchial inflammation

Question of use antibacterial drugs for bronchitis causes quite a lot of debate. But official medical protocols state that the use of antibiotics to treat this disease is necessary in two cases:

• if inflammation of the bronchi is caused by a bacterial infection;
• if the course of viral bronchitis is accompanied by complications or the patient is diagnosed with concomitant diseases.

The list of antibiotics here is classic for bacterial infections: penicillins, cephalosporins, macrolides. The choice depends on the individual characteristics of the patient.
In most cases, with viral origin of bronchial inflammation, antibacterial drugs do not have the necessary effective effect. In addition, they can cause the development of broncho-obstructive syndrome - blockage of the bronchi caused by swelling of the mucous membrane.

The main symptom of bronchitis, which indicates the need to use antibiotics, is sputum with purulent patches. If it is present, the doctor prescribes an additional study, based on the results of which he prescribes antibacterial agent. But in no case should an antibiotic be prescribed independently for bronchitis. The probable harm from its use may significantly exceed the expected effect.

Inflammation of the bronchi in acute form It is almost always treated at home and requires only topical medications. Antibiotics for bronchitis are not a key medication.

Use of antiviral drugs for bronchitis

The fact that inflammation of the bronchi is provoked by a viral infection itself hints at the need to use antiviral drugs to treat this disease. But the issue of using medications in this group is very, very controversial. Many doctors are sure that antiviral agents there is no proven effectiveness and to fight viruses the body just needs to create optimal conditions. In some ways they will be right. Another group of doctors insists that viruses need to be suppressed with antiviral drugs and that without them the disease cannot be dealt with.

Two drugs are used for viral infections: interferon and oseltamivir. At the same time, no one takes them from a pharmacy without a prescription or drinks them without a medical prescription. The use of antiviral drugs is indicated for the treatment of chronic bronchitis, in most cases with concomitant hospitalization.

The truth, in fact, is somewhere in the middle. During normal course, bronchitis can be overcome without antiviral drugs, as well as without antibiotics. If the disease is accompanied by complications or there are individual prerequisites, the use of medications in this group may be justified and necessary.
Now let’s talk about what you really can’t do without when you have bronchitis.

Expectorants for bronchitis

Bronchitis always begins with a strong and dry cough. Therefore, the only group of drugs that are really necessary for inflammation of the bronchi are expectorants.
In medicine, this group of drugs is divided into two subgroups based on the way they affect the body:

• medications to stimulate expectoration,
• drugs to thin sputum.

Medicines to stimulate expectoration

This subgroup is also called secretomotor means. The action of stimulant drugs is aimed at irritating the gastric mucosa, which provokes increased activity of the cough and vomiting centers of the medulla oblongata. The consequence of this is an increase in the production of liquid secretion in the bronchi and an increase in cough reflexes.

The main drugs in this group are thermopsis herb, a number of essential oils, ammonium chloride and others. It should be noted that drugs to stimulate expectoration have a fairly short-term effect, and an overdose can lead to vomiting, nausea, nasal congestion and tearfulness.

Medications that thin phlegm

A subgroup of these drugs, also called mucolytics, thins sputum without causing it to increase in volume. This effect is achieved due to the fact that disulfide bonds in acidic mucopolysaccharides are broken. The main prerequisite for their use is the viscous sputum that is produced in diseases respiratory tract, including bronchitis.

The most popular thinning drugs are:

In principle, all these drugs can be considered as analogues of each other, and the prescription of a specific drug is carried out solely based on the preferences of the doctor and the individual characteristics of the patient’s body.

In addition to the above-mentioned groups of medications, the occurrence of bronchitis may require the use of antipyretics. In most cases, inflammation of the bronchi is accompanied by only a slight increase in body temperature, at which the body is given the opportunity to cope with the problem itself. But if the temperature goes beyond 38 degrees, then drug therapy you need to add classic ibuprofen or paracetamol.

On this drug treatment inflammation of the bronchi ends. In its normal course, this disease does not require other medications, but it does require a special regime for keeping the patient and physiotherapeutic procedures.

Changing your lifestyle and regimen for bronchitis

When wondering how to quickly cure bronchitis, you need to remember: with bronchitis, the main condition for recovery is to create as much favorable environment For natural recovery normal operation respiratory system.

The first and most important thing for bronchitis is moisture. At the same time, in addition to the moist air in the room where the patient is, he needs to be provided with as much fluid as possible. Moreover, you can drink absolutely everything, with the exception of soda: water, juices, herbal teas. The main thing is that the drinking temperature is comfortable.

To ensure sufficient humidity in the room, it is best to use humidifiers. If they are not there, hang them up wet towels on batteries, spray water with a spray bottle - do everything to increase the water content in the air.

Already these two rules will create favorable conditions for overcoming a dry cough and beginning the process of sputum separation.

In addition, with bronchitis, especially in the first three days, bed rest and lack of physical activity are necessary. Short walks are allowed only at the first relief, and they need to be carried out in places with clean air: in squares, parks, in the forest.

A separate point of the regimen for bronchitis is complete cessation of smoking. Inhalation of tobacco smoke is a provoking factor for dry cough and smoking during bronchitis can not only prolong the recovery process over time, but also cause the development of serious complications. By the way, doctors believe that inflammation of the bronchi is an excellent (so to speak) reason to quit smoking.

By adhering to these simple rules, treatment of bronchitis will take place in the shortest possible time and with a minimum of necessary medications.

Physiotherapy for bronchitis

• inhalation,
• massage,
• breathing exercises.

Inhalations for bronchitis

It is recommended to carry out inhalations using special devices - inhalers. Steam inhalations are also possible, but, especially for children, you need to be extremely careful to avoid burns to the mucous membranes.
Inhalation of the following drugs is effective for bronchitis:

• saline and soda solutions;
• essential oils of eucalyptus tree, pine, mint, garlic and rosemary;
• Lazolvan, Ambrobene and other medications whose action is aimed at removing phlegm from the bronchi.

There are only two contraindications for inhalation: high temperature and rapid heartbeat. But immediately after overcoming them, inhalations can be used. This is one of the most effective methods with inflammation of the bronchi.

Breathing exercises for bronchitis

There are quite a lot of methods of breathing exercises for respiratory tract pathologies. Regardless of who developed a specific set of exercises, they all have positive influence on the rate of overcoming bronchitis. You need to choose the appropriate breathing exercises yourself or on the recommendation of a doctor. The most popular are the methods of Strelnikova, Buteko, Kofler, as well as yoga and the martial art of wushu.
Any set of exercises for the respiratory system prioritizes the following goals:

• increasing the functional reserves of the respiratory system;
• changes in the functioning of organs, which are achieved by influencing the respiratory system.

And most importantly: when performing such exercises, you need to remember that they need to be carried out in the fresh air, which in itself has a positive effect on the condition of the respiratory system.

Massage for bronchitis

Massage during inflammation of the bronchi is prescribed when the disease has subsided: there is no high temperature, the cough has passed into the wet stage, there are no associated complications.
The massage should be preceded by a very warm bath, which will soften the skin and allow you to spend some time in a room with one hundred percent humidity. There are several massage techniques for bronchitis. Let's describe them:

• 1. The patient lies on his back on a hard surface. During inhalation, the massage therapist runs his hands along the sides in the direction from the chest to the back, and during exhalation, back. Rib cage during this it should squeeze a little.
• 2. Lying on his back on a hard surface, the patient needs to slightly raise his head with a pillow. With the pressed palms of the massage therapist's hands, movements are carried out from the abdomen to the shoulders. Similar movements are carried out with the patient lying on his stomach. Hand movements, respectively, are carried out along the back. This allows you to stimulate the removal of mucus from the bronchi.
• 3. Another massage procedure to improve phlegm removal is as follows: the patient lies on his stomach so that his head extends beyond the massage table and is slightly lowered down. At the same time, a pillow is placed under the feet so that they are raised. In this position, intercostal massage is performed. The recommended duration of the procedure is 25 minutes.

Finally, we note that the treatment of bronchial inflammation in its normal course is quite simple, but at the same time it requires competent tactics for taking medications and using physical procedures. Therefore, if you get bronchitis, consult a doctor. He will tell you how to treat bronchitis at home, accurately determine the characteristics of the disease and select therapy that will give the most effective result in a short time.

Tactics of drug treatment of bronchitis

Bronchitis is a disease bronchial tree inflammatory in nature, which is characterized by hypersecretion of mucus, productive or non-productive cough. Bronchitis occurs in acute and chronic forms. A special problem is chronic bronchitis, which occurs as a result of prolonged exposure to an irritating factor and entails processes of sclerosis of the bronchial wall and surrounding tissues, as well as a violation of the cleansing and protective functions of the bronchi. Worldwide, about 10% of the population suffers from chronic bronchitis. The majority are males over the age of 40.

Etiology of bronchitis

There are many reasons for the development of bronchitis.

In this case, it is more appropriate to talk about risk factors for developing the disease:

1. Smoking, including passive smoking.
2. The effect of various pollutants: street (exhaust gases, industrial emissions into the atmosphere); household (from finishing materials - benzene, formaldehyde, styrene, nickel, phenol, cobalt and others).
3. Occupational hazards among construction workers, weaving factory workers, miners, chemical workers, steelworkers.
4. Physiological factor – old age, male gender.
5. Congenital antitrypsin deficiency.
6. Infections, especially long-term persistent cytomegalovirus.
7. Chronic alcoholism and drug addiction.

Mechanism of disease development

The mechanism of development of bronchitis is based on morphological reversible and irreversible changes in the bronchi.

Reversible changes:

• hypertrophic changes in the bronchial glands;
• increased secretion of bronchial mucus;
• swelling of the mucous membrane;
• infiltrative changes in the mucous membrane and submucosal layer.

Irreversible changes (develop only in chronic form):

• inflammation outer shell bronchus;
• development of pneumosclerosis;
• development of emphysema;
• respiratory failure;
• "pulmonary heart" syndrome.

Clinical picture of bronchitis

The acute form of bronchitis is very often a complication of respiratory infectious disease. It is characterized by low-grade and febrile fever, the appearance of symptoms of general malaise - drowsiness, weakness, headache. Then a cough appears. As a rule, the cough at the beginning of the disease is dry and unproductive. During treatment, the cough becomes moist and the amount of sputum produced increases.

Exacerbation of chronic bronchitis manifests itself with the same symptoms, but the disease lasts longer. In addition, there are symptoms such as shortness of breath and a feeling of lack of air. Breathing is harsh and wheezing may be heard. Also, with chronic bronchitis, the patient may intensively lose weight. Weight loss occurs due to muscle and fat tissue. This is a sure sign of development respiratory failure. Possible sleep disturbances: intermittent, short sleep, accompanied by snoring, frequent awakenings. Sleep disturbances lead to irritability, increased fatigue, and sexual dysfunction.

Diagnosis of the disease

Diagnosis of bronchitis is mainly based on the clinical picture, as well as a survey of the patient. As a result of the survey, predisposing factors can be found out, which will help to make a correct diagnosis.

In addition to collecting anamnesis and examining the patient, complex diagnostic methods are used:

1. X-ray method. The method allows you to exclude pneumonia and suspect emphysema.
2. Sputum cytology examination. Allows you to determine the type of inflammatory process. Helps differentiate between catarrhal, purulent and hypertrophic bronchitis.
3. Microbiological analysis of sputum. Used to determine sensitivity to antibacterial agents.
4. Bronchoscopy allows you to exclude cancer of the lungs and bronchi, tuberculosis, and bronchiectasis.

Treatment of bronchitis

Before starting treatment, the patient and his relatives should explain the causes of the disease and predisposing factors. Compliance with certain restrictions will ease the course of the disease and help achieve high efficiency treatment. Treatment of acute bronchitis consists of prescribing antitussives, expectorants, anti-inflammatory drugs, and in more severe cases - the use of antibacterial therapy. Herbal medicine and physiotherapy are also indicated. Treatment of exacerbation of chronic bronchitis is always more complex and lengthy.

The basic principles of treatment of chronic bronchitis require more detailed consideration:

1. Complete smoking cessation required. If refusal is not possible, then replacement therapy is carried out with drugs containing nicotine in transdermal form or in the form of chewing gum.
2. An important point in treatment is maintaining hygiene at home and in the workplace.. Daily wet cleaning of the house and elimination of harmful production conditions are recommended. If it is impossible to comply with these conditions in the workplace, then you should consider changing your professional activity.
3. Compliance with seasonality in choosing clothes. Avoid drafts and hypothermia. It is advisable to wear clothes made from natural, simple fabrics that prevent heat loss and overheating.
4. Compliance with the rules therapeutic nutrition . The basic principles of nutrition for chronic bronchitis are quite simple: meals should be fractional - up to 5 times a day; the content of fats and carbohydrates in food should not exceed the norm, and the amount of protein should be significantly increased; dishes must be fortified; preferably a large number of warm drinks. Recommended: dairy and fermented milk products, lean meats, fatty fish, eggs, strong chicken broth, fruits and vegetables rich in vitamin C (cabbage, onion, tomatoes, citrus fruits, kiwi), rosehip decoction with honey.

Drug therapy:

Antibacterial drugs. Treatment with antibiotics is prescribed only if clinical picture there is a cough with purulent sputum, fever, increased ESR. The drugs of choice in this case are bactericidal antibiotics belonging to the group of semisynthetic penicillins, in combination with clavulanic acid. One of these drugs is Amoxiclav. It is also possible to prescribe a combination drug containing ampicillin and sulbactam. It is also possible to prescribe antibiotics from the group of 3rd generation cephalosporins and macrolides. As a rule, exacerbation of chronic bronchitis is treated on an outpatient basis, therefore medications prescribed in the form of tablets or suspensions for oral administration.

Important! Antibacterial drugs are not prescribed for prophylactic purposes!

Medicines that have a bronchodilator effect. Most often, a drug is used for this purpose, the active substance of which is Ipratropium bromide - Atrovent. The drug does not have a systemic effect because it does not have the ability to be absorbed into the bloodstream. The medicine is not used for emergency care, since its effect develops only 30 minutes after entering the body. Atrovent is used by inhalation. Also used to dilate the bronchi Berotek, Ventolin. Drugs are also administered by inhalation. Suitable for rendering emergency care, since they act after 3-8 minutes. Drugs from the theophylline group may be prescribed - Teopek, Theotard. These medications relieve fatigue of the respiratory muscles, reduce pressure in the pulmonary circulation, and moderately dilate the bronchi. It is worth highlighting the drug separately Erespal, which in addition to its bronchodilator effect has an anti-inflammatory effect.

Drugs that reduce sputum viscosity– mucolytics and mucoregulating agents. Mucoregulators include Bromhexine, Ambroxol. Drugs of this group disrupt the synthesis of sialomucoproteins, which entails a decrease in the viscosity of bronchial mucus. Mucolytics prescribed for chronic bronchitis: Acetylcysteine, Carbocysteine— destroy mucoproteins, which also leads to a decrease in sputum viscosity.

Expectorants. Herbal medicines are very effective in this group: Licorice syrup, Thermopsis tablets, Chest collection No. 2.4, as well as decoctions Coltsfoot, Thyme, Violets tricolor. The drugs have a reflex effect, as a result of which the action of the bronchial glands is enhanced.

Antitussives medicines used for dry cough with difficult to separate sputum. Drugs in this group suppress the cough reflex, affect the viscosity of sputum and promote moderate dilation of the bronchi. These include: Libexin, Sinekod, Omnitus, Herbion with plantain.

Hormonal drugs glucocorticoid series. for severe chronic bronchitis it is prescribed Prednisolone in individual dosages. During treatment with systemic glucocorticoids, the prescription of calcium supplements is indicated to prevent the development of osteoporosis.

Oxygen therapy. Oxygen treatment is carried out during the period of remission of the disease. With the systematic application of the technique, the prognosis of the disease improves and life expectancy increases to 10 years.

Rehabilitation treatment:

1. Medical examinations up to four times a year, preferably with consultation of a pulmonologist.
2. Monitoring laboratory parameters of blood (ESR), sputum (cytology, bacteriology, general analysis).
3. Assessment of immunological status.
4. Pneumotachometry is a method for determining air flow during inhalation and exhalation. Widely used in the diagnosis of bronchopulmonary diseases.
5. Preventive administration in the spring and autumn of expectorant drugs containing herbal ingredients: Thermopsis, Ledum, Thyme, Althea, Coltsfoot, Plantain.
6. Maintenance treatment with inhalation methods. For inhalations during the period of remission, sodium chloride 0.9% solution, Sodium bicarbonate 2% solution, Eucalyptus tincture are usually used. Oil inhalations using natural oils of Eucalyptus, Sea Buckthorn, and Almond are also shown. Oil inhalations should not be prescribed to people who are employed in dusty industries. Oil in combination with dust can form crusts that can affect the patency of the bronchi.
7. Immunorehabilitation treatment. Most often it is carried out with the drug Ribomunil. The drug causes an immune response, which provides lasting immunity against pathogens of respiratory infectious diseases. It has been noted that after treatment with Ribomunil, the incidence of exacerbations of bronchitis is noticeably reduced. In addition, they are cured accompanying pathologies- sinusitis, rhinitis, tonsillitis with a predominance of purulent processes.
8. Sanatorium-resort treatment in specialized institutions year-round is also recommended.

Features of drug therapy for certain categories of patients:

• pregnant women. Antibiotics are prescribed that are not capable of negatively affecting the development of the unborn child. These are penicillin drugs and cephalosporins. The bronchodilator drug Atrovent is contraindicated. According to indications, it is possible to prescribe glucocorticoids in small doses, expectorants and mucolytics;
• elderly and old age. Before prescribing antibacterial drugs, it is necessary to determine sensitivity to antibiotics. Drugs without nephrotoxic effects are used. M-anticholinergics are used extremely rarely, as they can cause constipation, urinary retention, increased intraocular pressure. Glucocorticoids are prescribed only in hospital settings under the strict supervision of a physician. In conjunction with hormones, it is recommended to take mineral complexes for the prevention of osteoporosis. Antitussive drugs should be prescribed very carefully, as they can depress the respiratory center.

Treatment of bronchitis is always complex and difficult. It can only be effective combination therapy. It is highly not recommended to treat bronchitis on your own, since irrational therapy can lead to chronic process and the development of severe complications

JMedic.ru

Chronic bronchitis is an inflammatory disease of the bronchial tree, characterized by cough with sputum and shortness of breath. The inflammatory process occurs with constant exacerbations and remissions.

Therapy methods

Chronic bronchitis should be treated only conservatively. What methods are considered conservative treatment? These are all non-invasive treatment methods, namely drug treatment, treatment using inhalation via inhalers, folk and physiotherapeutic treatment.

It should be noted that drug treatment is the most effective remedy against chronic bronchitis. This treatment includes both tablet and injection forms of drugs. Typically, to treat the disease in adults, medications such as antibiotics and antiviral drugs are prescribed, followed by anti-inflammatory drugs, mucolytics, antitussives, antihistamines, hormones and bronchodilators.

Medicines in tablets and injections

• One of the very first drugs for the treatment of chronic bronchitis in adults are antibiotics, which act against bacteria that cause an exacerbation of the disease in the bronchi. It should be remembered that if within 3 days after starting antibiotic treatment the general condition has not improved and the temperature has not returned to normal, then another antibiotic must be prescribed, since this one did not give the desired effect.

The following antibiotics are used to treat chronic bronchitis:

Penicillin antibiotics: Amoxicillin (Amoxil, Flemoxin), Amoxicillin with clavulanic acid (Augmentin, Flemoxin Solutab), which have broad-spectrum antibacterial activity, i.e. effective against gram-positive (staphylococcal, streptococcal, pneumococcal flora) and gram-negative (legionella, proteus, mycoplasma, ureaplasma, Pseudomonas aeruginosa) infections. Penicillin antibiotics are prescribed at a dose of 1000 mg, they must be taken 2 times a day. They need to treat chronic bronchitis for 7–14 days.

Cephalosporin antibiotics - Norfloxacin, Ciprofloxacin, Ofloxacin - have a pronounced antibacterial and bacteriostatic effect only for gram-negative flora; such a narrow focus on bacteria makes their effect much stronger than simply broad-spectrum antibacterial drugs. For adults, the drug is prescribed 200 mg 2 times a day. The course of treatment is on average 10–14 days.

Antibiotics from the macrolide group - Klabax, Fromilid, Azithromycin, Rovamycin - have a bacteriostatic effect and are effective primarily for intracellular forms of infections, which makes them indispensable in the treatment of chronic bronchitis. For adults, the drugs are prescribed at a dose of 500 mg; it should be taken at the same time, on an empty stomach, 1-2 times a day. This disease needs to be treated for 3–7 days.

Antibiotics from the fluoroquinolone group - Ciprofloxacin, Levofloxacin, Lefloc - are broad-spectrum antibacterial drugs, but these drugs are effectively used only for treatment bronchopulmonary system, another name for this group is respiratory fluoroquinolones. Chronic bronchitis in adults should be treated with these drugs for no more than 7 days at a dose of 500 mg once a day. Leflock has an injection form of release, which allows intravenous or intramuscular injections. It is also necessary to remember that antibiotic injections should only be taken for severe exacerbations.

• If viruses have contributed to the exacerbation of the disease, then medications against viruses are prescribed:

• Mucolytics are substances that promote expectoration of sputum. Depending on which cough predominates in the patient, different drugs are prescribed:

When a dry cough predominates, medications are prescribed that help thin the sputum, i.e. reduce its viscosity - this is Acetylcysteine ​​(Acysteine, Mukobene, Mukonex) 200 mg 4 times a day, 400 mg 2 times a day or 800 mg 1 time a day. You can also use plantain syrup, which you take 1 tablespoon 3 times a day. The cough first becomes unproductive, and then productive with the release of a large amount of sputum. It takes quite a long time to treat a cough, up to 10–15 days.

When a wet cough immediately appears during illness, drugs from the ambroxol group (Flavamed, Abrol, Ambroxol) are prescribed for adults. The drugs are prescribed at 75 mg 1 time per day or 30 mg 3 times per day. If the cough is with a large amount of sputum, then Erespal should be added to this group of drugs, which is taken 1 tablet 2 times a day; if the cough is with a small amount of sputum, then this drug is not needed. The cough must be treated for 10–20 days.

One of the representatives of this group, Lazolvan, has injection form release and allows intramuscular injections. Due to the speed of action medicinal substance, injections are considered more effective.

Inhalation therapy

Inhalations with delivery medicinal substances through inhalers directly into the bronchi are one of the effective methods of treating chronic bronchitis.

Inhalations are done with medicines– hormones, antihistamines, mucolytics and bronchodilators. With the help of inhalation, the active substances enter in sufficient quantities directly into the focus of the inflammatory process, and do not require initial passage gastrointestinal tract and absorption into the blood. Inhalations deliver unchanged medications in active forms.

Inhalations can also be carried out with soda and aromatic oils, which have an antibacterial and bronchodilator effect. The following oils are suitable for inhalation: pine, lavender, tea tree, eucalyptus and thyme.

For inhalations, you can use special inhalers - nebulizers, as well as, although less effective, inhalers, but at home from a saucepan or kettle.

Unconventional methods

Traditional methods treatments are well suited for chronic bronchitis in remission. Traditional methods reduce the frequency of exacerbations of the disease, and also improve general health, increase immunity and give strength.

Traditional methods of treatment using decoctions and infusions of herbs help the body fight cough and reduce the amount of sputum secreted by the bronchi. Suitable for decoctions: plantain herb, medicinal chamomile, licorice root, sage, mint, linden leaves, marshmallow root.

Traditional methods of treatment using rubbing help to better cleanse the bronchi from bacteria, viruses and sputum, and normalize the function of the lungs and bronchi in general. Honey, goose, lamb or badger fat are suitable for rubbing.

Video: Chronic bronchitis. Description, symptoms and treatment

I chose inhalation treatment for myself. Since childhood, I remember how potatoes and herbs quickly put my brother and me on our feet. I bought a nebulizer and Prospan drops for my family. I dilute 20 drops in saline and let my son breathe for 10 minutes several times a day. This is how we treated bronchitis a month ago.

Is online Skype psychotherapy as effective as traditional one? psychological help?

Until now, the very topic of online psychotherapy causes controversial statements, skepticism and even outright denial, both in academic circles and among practicing psychologists. At the same time, the rapid growth of the practice of psychological assistance on the Internet does not allow one to remain on the sidelines.
Perhaps the most main question, which interests potential clients and a number of psychologists and psychotherapists, is how effective online psychotherapy is, compared to traditional methods(face to face) psychological help?

Looking ahead, I will say that most published studies on the effectiveness of online psychological assistance report comparable results of success as if clients were working face-to-face with their therapists. Therefore we can conclude that Internet-based therapy , on average, also effective or nearly as effective as face-to-face therapy.

To date, several hundred studies have been conducted, in which several tens of thousands of people took part. And there is no reason not to trust the data received. This conclusion is based on many comprehensive reviews of the effectiveness of psychotherapy, such as the Consumer Reports studies (see Seligman, 1995), and meta-studies conducted by Smith and Glass (1977), Wampold and colleagues (1997), and Luborsky and colleagues ( 1999).
In this article I have summarized research data.

Questions of the effectiveness of online psychological assistance.

The main questions that the authors of the studies consistently tried to answer:
can therapy delivered online be effective at all;
whether the therapy could be delivered effectively (that is, achieve its therapeutic goals) via the Internet;
– was it as effective as traditional therapy;
– and how did the different methods and variables associated with online therapy affect effectiveness?

At what age is online psychotherapy effective?

Among the four age groups, the effectiveness of online therapy with middle-aged adults (19-39 years old) was higher than with older or younger clients. But this factor may also be due to more low level use of Internet-related skills. Therefore, there is evidence of successful psychological assistance to children and the elderly.

What is more effective: individual online therapy or group therapy?

So far, the data is in favor. And although this advantage is insignificant, it is most likely due to the need for a person to simultaneously focus on several sources of information (several windows on the monitor), as a result, more low concentration, as well as emotional tension during the session, due to a situation of psychological insecurity.
In any case, online group therapy can be safely recommended as a way to solve a variety of problems.

What problems is online psychotherapy effective for?

In the studies, patients were treated for a variety of problems and psychological distress (sometimes related to medical problems such as lower back pain or headaches). They were able to classify and group them into eight specific problems. So post-traumatic stress disorder (PTSD), had greatest effect from online therapy, weight loss received the least effective therapy.

Conclusions: online help is better suited to therapy for problems that are more psychological in nature - that is, dealing with emotions, thoughts and behavior - and less suitable for problems that are primarily physiological or bodily (although they obviously have psychological components as well ).

A short list of studies on the effectiveness of online psychotherapy.

Marital problems (Jedlicka and Jennings, 2001), sexual problems(Hall, 2004), addictive behavior (Stofle, 2002), anxiety and social phobia (Przeworski and Newman, 2004) and disorders eating behavior(Grunwald and Busse, 2003); and group therapy for a variety of problems (e.g., Barak & Wander-Schwartz, 2000; Colo`n, 1996; Przeworski & Newman, 2004; Sander, 1999).

B. Klein, K. Shendley, D. Austin, S. Nordin A pilot study of the Panic Online program as a self-managed therapy for panic disorder
S.J. Linton, L. von Knorring, L.G. Ost Computer-Based Cognitive Behavioral Therapy for Anxiety Disorders and Depression

Is it worth seeking online psychological help?

As you can see, there are practically no serious arguments against online therapy. Whether to turn to traditional forms of working with a psychologist face to face, or, is up to you. If you have the opportunity to regularly meet in a psychologist’s office, you should prefer this option. If this is not possible, or the online help option can significantly save money and time, of course, you should resort to the help of the Internet.

Like any new phenomenon in life, it takes time to recognize new forms and methods of work. Once upon a time, the professional community did not want to recognize the emerging group therapy, calling it “psychoanalysis for the poor,” however, over time, it became clear that group therapy is a completely different form of psychotherapy.

It is important to be competent in the treatment of intervertebral hernia, and to know not only how to relieve pain, but also how to keep the spine as healthy as possible, to understand what absolutely should not be done when back pain occurs in order to avoid complications, and also to know what needs to be done in the event of back pain. mandatory.

Intervertebral hernia is one of the most common and potentially dangerous diseases, since during its development, damage to the spine occurs in the immediate vicinity of the nerve roots and spinal cord, through which nerve impulses pass from all organs to the brain. This is the cause of complications that can lead to limitation of movements, disruption of vital organs, and sometimes to paralysis.

Intervertebral hernia often occurs in people of working age (20-50 years), condemning them to temporary disability, and sometimes to disability!

Military Medical Academy named after. CM. Kirov, St. Petersburg;

biophysicist, full member of the Academy of Medical and Technical Sciences Fedorov V.A.

What is an intervertebral hernia? Stages

Intervertebral hernia is a disease that is caused by destructive changes in the tissues of the intervertebral disc located between the vertebrae. The intervertebral disc, thanks to its structure, acts as a kind of shock-absorbing pillow, providing springiness to the spine, softening and absorbing shock loads when walking, running, jumping, etc.

The intervertebral disc consists of a nucleus pulposus with a gel-like consistency, and a fibrous ring around it, which holds this gel inside. The function of depreciation is performed nucleus pulposus, which (in an adult) is 70% water. It also contains carbohydrates that have the ability to quickly bind and “give” water.

When there is a load on the spine (for example, when walking), the nucleus pulposus flattens and decreases in size up to 2 times, as water is pushed out of it. When the load is reduced, water returns to the core, it restores size and shape.

Intervertebral hernia is usually preceded by degenerative changes fibrous ring: it loses its density (its structure becomes more loose, gaps appear between the fibers, ruptures of individual fibers occur without violating the integrity of the entire ring).

As damage develops in the annulus fibrosus, the nucleus pulposus begins to move from the center of the disc to the periphery.

There are several stages of hernia development:

1. Disc prolapse- slight displacement of the nucleus (by 2-3 mm), the fibrous ring moves outward, but its integrity is not compromised;
2. Protrusion disk– displacement of the nucleus pulposus by 4 mm or more;
3. Disc extrusion or prolapse(actually, a hernia) - a violation of the integrity of the fibrous ring with the release of the nucleus pulposus into the spinal canal;
4. Disc sequestration– the nucleus pulposus loses connection with the vertebrae, fragments and moves along the spinal canal.

Symptoms of intervertebral hernia

The main symptom of intervertebral hernia is pain, and it is pain that makes people see a doctor. Often, back pain can simply be muscle pain unrelated to pressure on a nerve root.

As a rule, pain occurs suddenly and intensifies with movement in the corresponding segment of the spine. The lumbar region is most often affected, as it is subject to the greatest stress. Less often - thoracic; when a hernia occurs in this section, patients often complain of very severe pain, reminiscent of a feeling of “a stake in the back”.

However, pain does not always accompany a hernia, especially in the early stages of its occurrence.

Symptoms of intervertebral hernia vary depending on the direction in which the protrusion and prolapse of the nucleus pulposus occurs.

The disease occurs in close proximity to the spinal cord and the roots extending from it, so other symptoms associated with impaired conduction of nerve pathways may also be observed:

• decreased skin sensitivity;
• decreased muscle tone in the limbs and deterioration of movements in them;
• weakening tendon reflexes (involuntary movements limbs when a tendon is struck, for example, under the kneecap);
• disruption of internal organs; for example, with a hernia in the lumbar region, the functioning of the intestines, bladder, and genital organs is affected;
• dizziness, memory loss, changes blood pressure- with a hernia in the cervical spine.

In some cases, intervertebral hernia may develop heavy complications, such as:

• Radiculopathy (radicular syndrome, outdated name - radiculitis) associated with pressure from the hernia on the nerve root.
• Spinal cord compression caused by a narrowing of the spinal canal by a hernia, tissue swelling, impaired blood supply, and, sometimes, direct mechanical compression.
• Compression of the artery supplying the spinal cord- acute or gradually increasing - leading to the death of nerve cells.
• Clamping of the veins that drain blood from the spine, which leads to severe swelling and compression of the spinal cord.

All these complications are fraught with disruption of the spinal cord and muscle atrophy (shrinkage). With complications of a hernia in the lumbar region, internal organs may suffer, fecal and urinary incontinence, and impotence may occur. IN extreme cases Kidneys and other vital organs may fail, and if blood vessels in the cervical region are compressed, the blood supply to the brain may be disrupted and death may occur.

One of the most dangerous complications is cauda equina syndrome - compression of a bundle of nerve fibers, originating at the level of the first lumbar vertebra. This can lead to immediate paralysis lower limbs, failure of the pelvic organs and death of the patient.

Destructions in the fibrous ring are not quickly restored, so when a hernia occurs, the main load falls on the back muscles. Intervertebral discs weakened by a herniation do not secure the vertebrae well. The body cannot allow such vital damage to occur. important body like the spinal cord located in spinal column, That's why muscles begin to work hard center the spinal axis. The muscles also try to compensate for the lack of shock absorption that the intervertebral disc(s) previously provided. Untrained muscles have poor centering spinal canal, especially if there are already other problems in the spine () or the muscles were not previously trained due to a sedentary lifestyle. Even a small load can cause complications. The most dangerous are shocks and sudden movements.

Effective measures No. 1. Maximum protection from additional overloads muscles and spine:

Muscles experience enormous stress in new conditions. The presence of pre-existing problems in the spine () and the hernia itself can seriously impair their functioning, since nutrition and transmission of nerve impulses are disrupted. The muscles may simply not be prepared, as they were previously untrained due to a sedentary lifestyle. In this situation it often occurs muscle spasm. Due to muscle spasm, blood vessels are pinched, muscle cells stop receiving adequate nutrition and die, and in their place they grow connective tissue. Adhesions and scars occur - all this leads to poor posture. This creates conditions for the development of repeated cases of the disease (relapses) and the emergence of new foci of damage.

Due to increased work, muscle tissue cells die faster. An excess of dead cells can also occur due to the fact that the nucleus pulposus, when leaking out, compressed the vessels, and the affected area was deprived of nutrition. The body's reaction to such an accumulation of dead cells is edema(a necessary measure for cleaning fabrics). However, edema compresses nearby vessels, impairs muscle nutrition, and cell death progresses. But the main problem is that dead cells are excreted only with lymph through the lymphatic vessels, and the movement of lymph is ensured, in turn, by the contractile activity of the muscles (even at rest). When the muscles are already overworked, Tothe circuit closes: To relieve edema, active lymph flow and muscle activity are needed, but the muscles are already overloaded and, due to edema, are deprived of nutrition and cannot recover.

Swelling increases especially quickly during prolonged lying down, for example, during sleep, since overall muscle activity is reduced and is not enough to ensure sufficient lymph flow to cleanse the tissues in the affected area. Therefore it is better to avoid bed rest. During the day, it is advisable not to lie down for a long time and not take fixed positions on long time. It is much more beneficial to move - but with caution so that new painful sensations do not arise. Night sleep It is advisable to interrupt every 3 hours for 15 minutes to walk or do exercises while lying in bed.

It is necessary to improve the nutrition (blood supply) of the back muscles. The muscles need resource replenishment so that they can cope with the new load of supporting the spine in conditions of a hernia.

The root cause of the development of intervertebral hernia

As already mentioned, an intervertebral hernia begins to develop due to the fact that the fibrous ring, which forms part of the intervertebral disc, becomes flabby, loose, and the nucleus pulposus along with the disc begins to “float out”. This is caused by a lack of nutrition to the intervertebral disc. Why is it getting worse?

In children and adolescents, the intervertebral discs receive nutrition and oxygen directly from the vessels that are suitable for them, which, however, cease to function by the age of 18-20. In an adult, the nutrition of the discs (as well as the removal of waste from the cells) is carried out by diffusion - “pushing” substances through microscopic channels in the cartilage covering the vertebral body.

Required delivery condition nutrients, oxygen and water through the cartilage to the cells of the intervertebral disc (as well as the vertebrae) is coordinated and dynamic work of the back muscles and disc:

• Only with physical exertion is sufficient blood flow created for good nutrition spine, and also provides lymph flow and venous outflow to clean the tissues of cartilage, vertebrae, and intervertebral discs from dead cells.
• It is during movement that pressure changes occur in the spine itself, which ensures the “suction” and “extrusion” of substances in the nucleus pulposus.

It follows from this that the intervertebral disc begins to gradually deteriorate long before a hernia occurs for three main reasons:

• muscles do not work dynamically, that is, we are talking about about physical inactivity (sedentary lifestyle),
• the muscles do not work coherently, which indicates.
• affects muscles and disc excessive load, exceeding the current capabilities of the body ( professional sports, debilitating or excessive physical labor, professional destructive factors, etc.).

Physical inactivity

Sedentary image life-threatening because:

The spinal muscles relax and do not provide sufficient flow of blood, nutrients and oxygen to the vertebrae.

1. Due to lack of movement in the spine, the diffusion (passage) of nutrients, oxygen and water through the cartilage to the discs is impaired. As a result, cells die and the nuclei pulposus are dehydrated.
2. Due to the deterioration of lymph flow, dead cells begin to accumulate in the vertebrae and discs, preventing recovery.
3. With sedentary work (lifestyle), an indispensable condition in the prevention and treatment of the disease is a constant micro change in the “sedentary” posture itself. This is necessary for it to work different groups muscles, and not the same ones, because otherwise they are overstrained. This change is achieved when sitting on a swinging (dynamic) support. A person intuitively changes his posture to ensure a stable position on a chair. Accordingly, the groups of working muscles constantly change.

6 reasons why you should include phonation in the treatment of intervertebral hernia:

1. Phonation promotes cleansing tissue in the damaged area of ​​the spine from dead cells and breakdown products due to stimulation of lymph flow. And this necessary condition recovery.
2. Happening blood flow stimulation, due to which the nutrition of muscle cells, vertebrae, and spinal cord improves. Also transport of nutrients and water into the cartilage plate and intervertebral discs is activated, which is necessary for the nutrition of their cells and elasticity.
3. Outflow improves venous blood from the affected area, which reduces swelling and compression of the spinal cord, nerves and blood vessels.
4. Improving impulse conduction nerve fibers , which was proven by studies carried out at the Moscow Regional Research Clinical Institute. As a result, the functioning of neuromuscular shock absorption systems is restored and the development of recurrent cases of the disease is prevented.
5. Phonation improves kidney function, which helps restore the water-electrolyte balance of the blood and improve the functioning of all muscles. The work of the adrenal glands is also stimulated and the production of hormones that activate regenerative processes in the body increases.
6. Spinal phonation promotes the release of the original stem cells, which can be transformed into any functional tissue (including cartilage). RF patent No. 2166924.

It is important that phonation helps get rid of pain- the effectiveness of the method was proven by a study conducted as part of the preparation of T. I. Yakushina, candidate of medical sciences. Of the 52 patients with osteochondrosis and hernia, in 45 people (86.5%), the use allowed:

• reduce pain and relieve muscle spasms on the 4th day of treatment
• restore skin sensitivity in 7-8 days;
• improve physical activity on days 10-11.

Dynamics of pain syndrome as a result of vibroacoustic influence

The diagram shows the dynamics of pain reduction, which was observed during treatment using phonation with the " " device.

Treatment effectiveness different methods physical impact

Note: VAV - vibroacoustic impact; VAV+IK - vibroacoustic and infrared exposure using the device " "; Magnet - magnetic influence.

There is a possibility that your doctor may not be aware of this new modern method treatment (phonation) and corresponding devices, therefore, before going to your appointment, we suggest you print it out with information about contraindications and methods of treating intervertebral hernia.

Conclusion

Thus, phonation today is modern medical method, which:

1. It has proven effectiveness at 80-93%, confirmed by Russian and European scientific research .
2. Solves all the main problems of treating intervertebral hernia: allows you to cleanse tissues of dead cells, activate restoration processes, relieve swelling, improve nutrition of the spinal cord, muscles, intervertebral discs.
3. Effective in eliminating pain syndrome and improving the quality of life of patients.
4. Helps prevent recurrence of the disease, because helps restore the functioning of the neuromuscular shock absorption system (improves the conduction of impulses along the nerves, has a positive effect on the functioning of all muscles)., with delivery throughout Russia and abroad.

At the end of the acute period of the disease, when the pain will go away, comes to the fore in the restoration of the intervertebral disc regular physical therapy. It is she who should restore the former health and mobility to the spine.

The patient should listen to his body and avoid exercises that cause new pain in the damaged intervertebral segment. One of the most effective ways providing non-traumatic physical activity is swimming, since in water the body is not affected by gravity and a large number of muscles are simultaneously activated.

It is necessary to take into account what will be most effective only complex treatment