Psychotherapy is a method of treating mental disorders. The mechanism of the development of the disease. Treatment of bronchitis at home: acute, chronic, folk remedies

generic drug, with several important pharmacological effects:
- anxiolytic (calming and vegetotropic)
- nootropic
- stress-protective

Effective Therapy vegetovascular dystonia in young patients

E. N. Dyakonova, doctor of medical sciences, professor
V. V. Makerova
GBOU VPO IvGMA Ministry of Health of the Russian Federation, Ivanovo Summary. Approaches to the treatment of vegetative-vascular dystonia in young patients in combination with anxiety and depressive disorders are considered. The study included 50 patients aged 18 to 35 years with vegetovascular dystonia syndrome, during treatment and after withdrawal, the effectiveness and safety of therapy were evaluated.
Keywords Key words: vegetovascular dystonia, anxiety-depressive disorders, asthenia.

Abstract. The treatment of vegetative-vascular dystonia in young patients in combination with anxiety and depressive disorders was discussed. The study included 50 patients aged 18 to 35 years with a syndrome of vegetative-vascular dystonia. In the course of the treatment and after its cancellation, the efficacy and safety of the therapy were evaluated.
keywords: vegetative-vascular dystonia, anxiety and depressive disorders, asthenia.

The term "vegetovascular dystonia" (VVD) is often understood as psychogenically caused polysystemic autonomic disorders, which can be an independent nosology, and also act as secondary manifestations somatic or neurological diseases. At the same time, the severity of vegetative pathology aggravates the course of the underlying disease. The syndrome of vegetovascular dystonia significantly affects the physical and emotional state of patients, determining the direction of their seeking medical help. In the structure of the general morbidity of vegetative disorders nervous system occupy one of the leading places (heading G90.8 according to ICD-10). Thus, the prevalence of vegetovascular dystonia in the general population, according to various authors, ranges from 29.1% to 82.0%.

One of key features VVD is a polysystemic clinical manifestations. As part of vegetovascular dystonia, three generalized syndromes are distinguished. The first is the psychovegetative syndrome (PVS), which is manifested by permanent paroxysmal disorders caused by dysfunction of nonspecific brain systems (suprasegmental autonomic systems). The second is the syndrome of progressive autonomic failure and the third is the vegetative-vascular-trophic syndrome.

Anxiety spectrum disorders are observed in more than half of patients with VVD. They acquire special clinical significance in patients with a somatic profile, including functional pathology, since in these cases there are always anxious experiences. varying degrees severity: from psychologically understandable to panic or to generalized anxiety disorder (GAD). As evidenced by daily practice, all patients with this kind of disorders are prescribed anxiolytic or sedative therapy. In particular, various tranquilizers are used: benzodiazepine, non-benzodiazepine, antidepressants. Anxiolytic therapy significantly improves the quality of life of these patients, contributes to their better compensation during treatment. However, not all patients tolerate these drugs well due to the rapid development side effects in the form of lethargy, muscle weakness, impaired attention, coordination, and sometimes symptoms of addiction. Taking into account the noted problems, in recent years there has been an increasing need for drugs with an anxiolytic effect of a non-benzodiazepine structure. These may include the drug Tenoten, which contains antibodies to the brain-specific protein S-100, which have undergone technological processing during the production process. As a result, Tenoten contains release-active antibodies to the brain-specific protein S-100 (PA-AT S-100). Release-active drugs have been shown to have a number of typical characteristics that allow them to be integrated into modern pharmacology(specificity, lack of addiction, safety, high efficiency).

The properties and effects of releasing active antibodies to the brain-specific protein S-100 have been studied in many experimental studies. The preparations created on their basis are used in clinical practice as anxiolytic, vegetostabilizing, stress-protective agents for the treatment of anxiety and autonomic disorders. The molecular target of RA-AT S-100 is the calcium-binding neurospecific protein S-100, which is involved in the pairing of informational and metabolic processes in the nervous system, signal transmission by second messengers (“mediators”), processes of growth, differentiation, apoptosis of neurons and glial cells. In studies on Jurkat and MCF-7 cell lines, it was shown that PA-AT S-100 realize their action, in particular, through the sigma1 receptor and the glycine site of the NMDA-glutamate receptor. The presence of such an interaction may indicate the effect of Tenoten on various mediator systems, including GABAergic and serotonergic transmission.

It should be noted that, unlike traditional benzodiazepine anxiolytics, RA-AT S-100 does not cause sedation and muscle relaxation. In addition, RA-AT S-100 contributes to the restoration of neuronal plasticity processes.

S. B. Shvarkov et al. found that the use of RA-AT S-100 for 4 weeks in patients with psychovegetative disorders, including those caused by chronic ischemia of the brain, led not only to a significant decrease in the severity of anxiety disorders, but also to a noticeable decrease in autonomic disorders. This gave the authors the opportunity to consider Tenoten not only as a mood corrector, but also as a vegetative stabilizer.

M. L. Amosov et al. when observing a group of 60 patients with transient ischemic attacks in various vascular regions and associated emotional disorders, it was found that the use of RA-AT S-100 can reduce anxiety. At the same time, the anxiolytic effect practically did not differ from the anti-anxiety effect of phenazepam, while the tolerability of the drug containing RA-AT S-100 turned out to be significantly better and, unlike the use of benzodiazepine derivatives, there were no side effects.

However, there are not enough works reflecting the effectiveness of Tenoten in the correction of autonomic disorders in young people.

The aim of this work was to evaluate the efficacy and safety of Tenoten in the treatment of vegetovascular dystonia in young patients (18–35 years old).

Materials and methods of research

In total, the study included 50 patients (8 males and 42 females) aged 18 to 35 years (mean age 25.6 ± 4.1 years) with autonomic dystonia syndrome, emotional disturbances, decreased performance.

The study did not include patients taking psychotropic and vegetotropic drugs during the previous month; pregnant women during lactation; with signs of severe somatic diseases according to the history, physical examination and/or laboratory and instrumental tests, which could prevent participation in the program and affect the results.

All patients received Tenoten orally, according to the instructions for medical use drug, 1 tablet 3 times a day for 4 weeks (28-30 days) without regard to food intake, sublingually. At the time of the study, the use of vegetotropic, hypnotics, sedatives, as well as tranquilizers and antidepressants was prohibited.

All patients were diagnosed with vegetative disorders according to the Wayne table (more than 25 points indicates the presence of vegetative-vascular dystonia); anxiety level assessment - according to the HADS anxiety scale (8–10 points - subclinically expressed anxiety; 11 or more points - clinically expressed anxiety); depression - according to the HADS depression scale (8–10 points - subclinically expressed depression; 11 or more points - clinically expressed depression). During the study period, the condition of patients was assessed 4 times: 1st visit - before starting the drug, 2nd visit - after 7 days of therapy, 3rd visit - after 28–30 days of treatment, 4th visit - after 7 days from the end of therapy (37th day from the start of therapy). At each stage, the neurological status, heart rate variability (HRV) and condition were assessed on the following scales: autonomic dysfunction by A. M. Vein, HADS anxiety / depression, as well as the SF-36 questionnaire (Russian version, created and recommended by the ICCL), which allows you to determine the level of physical functioning (PF); and mental health (MH). After the 30th day of taking Tenoten, the effectiveness of the therapy was additionally determined according to the CGI-I scale.

The analysis of HRV was carried out for all subjects initially in the supine position and under conditions of an active orthostatic test (AOP) in accordance with the “Recommendations working group European Society of Cardiology and the North American Society of Stimulation and Electrophysiology” (1996) on the apparatus VNSspectr. The study was conducted no earlier than 1.5 hours after eating, with the obligatory cancellation of physiotherapy and drug treatment, taking into account the timing of the removal of drugs from the body after a 5–10-minute rest. The vegetative status was studied by analyzing HRV using 5-minute cardiointervalogram (CIG) recordings in a state of relaxed wakefulness in the supine position after 15 minutes of adaptation and during an orthostatic test. Only stationary sections of rhythmograms were taken into account, i.e., records were allowed for analysis after the elimination of all possible artifacts and in the presence of a sinus rhythm in the patient. The spectral characteristics of the heart rate were studied, which allow one to identify periodic components in heart rate fluctuations and quantify their contribution to the overall rhythm dynamics. Variability spectra of R-R intervals were obtained using the Fourier transform. During the spectral analysis, the following characteristics were evaluated:

• TP "total power" - the total power of the spectrum of neurohumoral regulation, characterizing the total effect of all spectral components on sinus rhythm;
• HF "high frequency" - high-frequency oscillations reflecting the activity of the parasympathetic division of the autonomic nervous system;
• LF "low frequency" - low-frequency oscillations reflecting the activity of the sympathetic division of the autonomic nervous system;
• VLF "very low frequency" - very low-frequency oscillations, which are part of the spectrum of neurohumoral regulation, which includes a complex of various factors that affect heartbeat(cerebral ergotropic, humoral-metabolic influences, etc.);
• LF/HF - indicator reflecting the balance of sympathetic and parasympathetic influences, measured in normalized units;
• VLF%, LF%, HF% - relative performance reflecting the contribution of each spectral component to the spectrum of neurohumoral regulation.

All the above parameters were recorded both at rest and during an active orthostatic test.

Statistical analysis of the results of the study was carried out using Statistics 6.0 using parametric and nonparametric methods (Student's criteria, Mann-Whitney). The value of p = 0.05 was taken as the threshold level of statistical significance.

Results and its discussion

All patients complained of decreased performance, general weakness fatigue, hesitation blood pressure(in 72% it was reduced and amounted to 90–100/55–65 mm Hg; in 10%, blood pressure periodically increased to 130–140/90–95 mm Hg). Headaches in 72% of patients were not permanent and were associated with increased mental or emotional stress. In 24%, pain was periodically noted in the scalp and on palpation of the pericranial muscles. Sleep disorders had 72% of patients, cardialgia and sensations of interruptions in the work of the heart - 18%. Hyperhidrosis of the palms, feet, persistent red dermographism, acrocyanosis were noted by half of the patients. Clinical manifestations of functional disorders of the gastrointestinal tract (GIT) (constipation, flatulence, abdominal pain) were recorded in 10% of total number examined patients.

Analysis of anamnestic data showed that about 80% of the examined had a stress factor. During the survey, 30% of patients associated stress with professional activities, 25% with study, 10% with family and children, 35% with personal relationships.

Analysis of the Hospital Anxiety and Depression Scale (HADS) revealed subclinical anxiety in 26% of patients, and clinical anxiety in 46%. Half of the patients (50%) often experienced tension and fear; 6% of patients constantly felt a sense of internal tension and anxiety. Panic attacks occurred in 16% of the respondents. 10% of patients had subclinical and clinically expressed depression.

According to the SF-36 questionnaire, violations of the psychological component of health (MH) were significant, and they were associated with an increased level of anxiety. At the same time, physical functioning (PF) did not affect the daily activities of the subjects.

Evaluation of the effectiveness and safety of treatment showed a clear prevalence positive results when using the drug Tenoten.

Subsequently, according to the results of a dynamic study of heart rate variability, all patients were retrospectively divided into two groups.

The first group consisted of 45 people (90%) who initially had vegetative disorders with a clear positive dynamics according to the results of HRV after the 30th day of taking Tenoten. They were patients without signs of clinically pronounced depression. The initial data for this group of patients were: the number of points on the Wayne scale - 25–64 (average 41.05 ± 12.50); on the HADS anxiety scale - 4–16 (9.05 ± 3.43); on the HADS depression scale - 1–9 (5.14 ± 2.32). When assessing the quality of life on the SF-36 scale, the level physical health(PF) was 45.85 ± 7.31 and Mental Health Level (MH) was 33.48 ± 12.

After seven days of taking Tenoten, all patients subjectively noted an improvement in well-being, however, the average numerical values ​​revealed significant differences in this group only on the HADS anxiety scale (p
Rice. 1. Dynamics of scores on the HADS anxiety scale in patients of the first group (*р) Further analysis of the dynamics of indicators within the scales in the first group showed that the largest and significantly significant changes in the condition occurred after 30 days from the start of Tenoten administration. There was a positive trend in the form of a decrease in the number and the severity of symptoms of vegetative-vascular dystonia: according to the Wayne scale, the number of points significantly decreased to 8–38 (average 20.61 ± 9.52) (p
Rice. 2. Dynamics of scores on the A. M. Wayne scale in patients of the first group (*p)

Rice. 3. Dynamics of indicators of physical (PF) and mental (MH) health in patients of the first group (*p Analysis of the HADS anxiety scale showed that 68% did not experience tension at all versus 100% who experienced tension before treatment; in 6%, the number of points remained unchanged; in the remaining 26%, the number of points decreased (patients no longer felt fear. During the observation period, there were no periods of increased blood pressure in patients of the first group. Patients did not present active complaints of pain in the area of ​​the pericranial muscles, however, after focusing on this area, they noted rare headaches.Dermographism remained unchanged.Infrequent interruptions in the work of the heart were noted by 4% of patients.In 26 out of 40 people, sleep returned to normal.

A study conducted on the 37th day (seven days after the drug was discontinued) did not reveal significant differences from the indicators on the 30th day of taking Tenoten, i.e., the effect obtained from taking the drug was preserved.

The second group included 5 people with a weak positive dynamics of indicators of the study of heart rate variability. They were patients who initially had signs of clinically pronounced anxiety and depression.

The data before the start of therapy for this group of patients were: the number of points on the Wayne scale 41–63 (mean 51.80 ± 8.70); on the HADS anxiety scale 9–18 (13.40 ± 3.36); on the HADS depression scale 7–16 (10.60 ± 3.78). When assessing the quality of life on the SF-36 scale, these patients had a significantly reduced level of physical health, which was 39.04 ± 7.88, as well as the level of mental health - 24.72 ± 14.57. Analysis of the dynamics of indicators in the second group after 30 days of taking Tenoten revealed a trend towards a decrease in autonomic dysfunction on the Wayne scale - from 51.8 to 43.4 points; anxiety and depressive symptoms on the HADS anxiety/depression scale - from 13.4 to 10.4 points and from 10.6 to 8.6 points, respectively; according to SF-36, the mental health index (MH) increased from 24.72 to 33.16, the physical health index (PF) - from 39.04 to 43.29. However, these values ​​did not reach statistically significant differences, which indicates the need for individual selection of the duration and regimen of therapy in patients with clinically expressed anxiety and depression.

Thus, a retrospective division of patients into two groups during an in-depth examination made it possible to identify signs of clinically pronounced anxiety and depression in one of the groups, which initially did not differ significantly from the bulk of the respondents. Analysis of the dynamics of indicators on the main scales after a month of taking Tenoten 1 tablet 3 times a day in this group did not reveal significant differences. The anxiolytic and vegetostabilizing effects of Tenoten in the group of clinically pronounced anxiety and depression in the usual (1 tablet 3 times a day) regimen of therapy appeared only in the long term, which can serve as a justification for correcting the treatment regimen and prescribing 2 tablets 3 times a day. Therefore, the data obtained indicate the need to select various schemes for the use of Tenoten, depending on the severity of anxiety and depressive symptoms, which provides individual approach for each patient, forming a high adherence to treatment.

Analysis of heart rate variability in patients of the first group showed significantly significant changes after 30 days of taking Tenoten, which persisted 7 days after drug withdrawal. At spectral analysis at the end of a month of therapy absolute values the powers of the LF- and HF-components, and due to this, the total power of the spectrum (TP) were significantly higher than in the study before taking the drug (from 1112.02 ± 549.20 to 1380.18 ± 653.80 and from 689, 16 ± 485.23 to 1219.16 ± 615.75, respectively, p

Rice. 4. Spectral indicators of HRV at rest in patients of the first group (* significance of differences: compared with the baseline, p In the spectral analysis in the process of conducting an active orthostatic test after therapy, a lower reactivity of the sympathetic division of the autonomic nervous system (ANS) was noted compared to the baseline data , this is evidenced by the values ​​of indicators LF/HF and %LF, namely LF/HF - 5.89 (1.90–11.2) and 6.2 (2.1–15.1), respectively, %LF - 51 .6 (27–60) and 52.5 (28–69) (p

Rice. 5. Spectral indicators of HRV during an orthostatic test in patients of the first group (* significance of differences: compared with the baseline, p Thus, in the first group, when conducting HRV after 30 days of taking Tenoten, there is an increase in the total power of the spectrum due to an increase in the influence of HF- component, as well as the normalization of sympathetic-parasympathetic influences during the background test.In the active orthostatic test, the same trends persist, but to a lesser extent.Analysis of the dynamics of the coefficient 30/15 suggests an increased reactivity of the parasympathetic division of the ANS and, consequently, an increase in the adaptive potential as a result of therapy in patients of the first group (Table 1).

Table 1
Spectral indices of HRV at rest and during orthostatic test in patients of the first group

In patients of the second group, spectral analysis of heart rate variability indicators (background recording and active orthostatic test) at the end of a month of therapy did not reveal significantly significant dynamics in the numerical values ​​of the power indicators of the LF and HF components, and due to this, the total power of the spectrum (TP) . All patients had hypersympathicotonia and high sympathetic reactivity before the start of therapy and a slight decrease in numerical values ​​at the end of therapy, however, the percentage contribution of the sympathetic division of the ANS "before", "during therapy" and "after its completion" remained unchanged (Fig. 6, 7 ).

Rice. 6. Spectral parameters of HRV at rest in patients of the second group

Rice. 7. Spectral indices of HRV during orthostatic test in patients of the second group

An analysis of the dynamics of the 30/15 ratio suggests low parasympathetic reactivity and reduced adaptive potential before the start of therapy with Tenoten and increased reactivity and, consequently, an increase in adaptive potential as a result of the treatment in patients of the second group by the end of therapy (Table 2).

table 2
Spectral indices of HRV at rest and during orthostatic test in patients of the second group

Thus, the drug Tenoten had positive influence on the state of the autonomic nervous system in patients with VVD in combination with clinically pronounced depression. However, the duration of treatment of 30 days for this group of patients is insufficient, which serves as a basis for continuing treatment or using an alternative regimen of 2 tablets 3 times a day.

Conclusion

Tenoten is a soothing and vegetative-stabilizing drug with a proven high level of safety. The use of Tenoten seems to be extremely promising in young patients with vegetovascular dystonia.

• In the course of the study, it was recorded that Tenoten leads to the normalization (stabilization) of the autonomic balance in any type of vegetative-vascular dystonia (sympathetic-tonic, parasympathetic-tonic), an increase in the autonomic provision of the body's regulatory functions and an increase in adaptive potential.
• Tenoten has a pronounced anti-anxiety and vegetostabilizing effect.
• During therapy with Tenoten, the level of mental and physical health (according to the SF-36 questionnaire) became significantly higher, which indicates an improvement in the quality of life of patients.
• Taking Tenoten by patients with clinically pronounced signs of anxiety and depression requires a differentiated approach to the treatment regimen and its duration.
• The study noted that Tenoten does not cause side effects and is well tolerated by patients.
• Tenoten can be used as monotherapy for vegetative dystonia in young patients (18–35 years old).

A post about serious medical research.

Recently, Pabmed published a comparative efficacy meta-analysis different methods treatment of anxiety disorders. Randomized controlled trial, all things. In total, almost 40,000 patients participated in this. Three "diagnoses" were investigated: panic disorder, generalized anxiety disorder and social phobia. The effectiveness of several drug treatment options and various "psychological" methods was evaluated and compared.

Among other things, when summing up the results, Pabmed's publication included the following phrase: "Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects" (c). Seeing her, some agitated personalities with attention deficit disorder began to joyfully exclaim in capslock: I knew, I believed, I hoped that psychotherapy is ineffective, it's all a swindle, the effect is like a placebo ... Say "who would doubt it" (c).

Since these enthusiastic cries began to diverge in reposts across the network, even on the pages of quite serious people related to both science and medicine, I consider it necessary to analyze in detail the essence of the study. Since the topic is interesting, and a lot of work has been done by researchers to simply skim through the text without bothering to try to understand the essence of what is written. But this essence can be quite unexpected for someone who reads inattentively >: 3

In the first lines, a little obligatory skepticism. Publication in pubmed is the so-called abstract, only brief results are indicated there and that's it. There is no description of research methods and other important details on which the interpretation of the results depends.

For example, there is no description of the exact clinical picture of anxiety disorders. Agree that to evaluate the effectiveness of therapy:
- in a person experiencing psychological discomfort from large crowds of people in public transport or in a crowd ...
- an agarophobe who panics if it is necessary to cross the threshold of his house ...
-to a terry persecuted schizophrenic who is experiencing panic anxiety from the fact that huge orangutans from the future with lasers in their hands are chasing him right now across the roofs of houses ...

It's three big differences, although in all three options can be diagnosed including "anxiety disorder". In all three options, the effectiveness of the same techniques will be completely different - and this is not surprising, darling. That's the way it should be.
There is no description of the universal indicator of effectiveness and the method of its calculation for different methods of therapy.
There is also no detailed description of the research methodology, that is, for example, it is not known how the researchers formulated and defined the "psychological placebo" - yes, they have a similar indicator in the publication.

But - chu! I do not want the post to look like an attempt to justify by looking for a mote in someone else's eye. Yes, it is not clear from the abstract what conditions were studied (the form of the clinic, the severity of anxiety, and so on), it is not clear how the analysis was carried out and by what criteria. This is a moment of mandatory skepticism. Let's take it as an axiom that this study was organized correctly, the indicators were formulated accurately and reliably, and the methods were fully consistent with the clinic.

So, the researchers evaluated the effectiveness of therapy. For this, the universal indicator "effect sizes" (hereinafter ES) was used.

Treatment success rates for anxiety disorders are as follows:

ES not selective inhibitors serotonin reuptake = 2.25
ES of selective serotonin reuptake inhibitors = 2.09
ES of benzodiazepines = 2.15
ES of tricyclic antidepressants = 1.83

Mindfulness Cognitive Psychotherapy ES = 1.56
ES "relaxation" (no explanation, take it as you wish) = 1.36
ES of individual cognitive behavioral therapy = 1.30
ES of group cognitive behavioral therapy = 1.22
ES of psychodynamic therapy = 1.17
ES of remote impersonal psychotherapy (for example, psychotherapeutic correspondence on the Internet) = 1.11
Francine Shapiro's ES Method for Processing Emotional Trauma with Eye Movements = 1.03
ES of interpersonal (interpersonal) therapy = 0.78

ES of a combination of cognitive psychotherapy and "drugs" (that is, medications without specifying which ones) = 2.12

ES of "exercise" (whatever that means) = 1.23

ES of drug placebo = 1.29
ES of psychological placebo = 0.83
ES waitlists = 0.20

Here are all the main figures that can be compared and analyzed.

It can be seen from these data that indeed individual cognitive psychotherapy the effectiveness exceeds the drug placebo, and the group is a little less effective than the drug placebo.

But let's remember for a second what a drug placebo is. The "placebo effect" refers to a situation where medical research patients in the quiet are fed pacifiers - and patients still get better. That is, the patient from the control group is sure that he is being treated with real medicines, like everyone else, but he is secretly given a dummy. placebo. This is done with patients in the control groups to compare the result of treatment with the drug and no treatment.

The placebo effect is a pronounced psychological effect. A classic example is when patients of group 1 are given a dummy by an ugly, vicious, rude and always irritated nurse, and patients of group 2 are given a dummy by a kind and smiling manager. department. The nurse rudely makes you drink and show your tongue, and the head of the department talks about the achievements of medicine and describes the dummy given as the newest, unique and very effective remedy. And in the second group, the placebo effect is significantly higher than in the first.

When a person receives a medical placebo, he is sure that he is participating in the study of the drug, and a new one at that (the person was notified, he signed the consent to participate). A person is convinced that he is fully treated with the latest medicines, all the conditions, all the treatment, all the events, actions, the environment - point to this. And his conviction helps him recover. This is nothing but an element of "suggestion", that is, it is an element of psychotherapeutic influence.

Thus an ecstatic shriek" PSYCHOTHERAPY WAS AS EFFECTIVE AS PLACEBO DRUG" actually makes sense " PSYCHOTHERAPY WAS THE SAME EFFICIENCY AS PSYCHOTHERAPY IS EFFECTIVE".
It was not in vain that the researchers separated the medical placebo from the psychological placebo (no matter how they defined the latter, but the skepticism was higher).

Efficiency drug therapy higher than the effectiveness of psychotherapy, especially when it comes to a generalized clinic of psychiatric conditions
- the effectiveness of cognitive psychotherapy is 1.5-2 times higher than the effectiveness of "psychological placebo". Drug therapy is also about one and a half times more effective than drug placebo.
- the total effectiveness of cognitive psychotherapy and drug therapy exceeds almost all isolated methods in efficiency.
- the effectiveness of cognitive psychotherapy is much higher compared to the Shapiro method and interpersonal ( interpersonal) psychotherapy

If these conclusions are expressed in simple human language:

-In severe cases, medication helps better than psychotherapy
-Psychotherapy is proven effective.
-Psychotherapy and medication are more effective together than alone.
-Psychotherapy is the more effective, the less "dance with a tambourine" in it. The more of these dances, the less result.

And now, with your hand on the fifth intercostal space on the left, tell me: did these conclusions turn out to be breaking news for you, or did you yourself guess about something like that before?)))

I can't say enough about the effectiveness of exercise. Go and understand what they meant: an active lifestyle and physical labor in the fresh air, regular fitness in a club, yoga meditation in a Tibetan monastery, the author's semi-secret program for the recovery of special forces and athletes ... A detailed text of the study would help here, for sure there " physical exercise at least somewhat more detailed >:3

How does psychotherapy help, by what mechanisms does the psychotherapist achieve the desired changes in the patient's thinking and behavior? The literature describes several factors of therapeutic action, called differently by different authors. We will consider a combined classification based on those described by R.Corsini and B.Rosenberg (1964), I.Yalom (1970), S.Kratochvil (1978). Some of the factors considered are characteristic of both individual and group psychotherapy, while others are characteristic only of group psychotherapy.

1. VERSATILITY. Other designations for this mechanism - "a sense of community" and "participation in a group" - indicate that this factor is observed in group psychotherapy and is absent in individual.

Universality means that the patient's problems are universal, to one degree or another they manifest themselves in all people, the patient is not alone in his suffering.

2. ACCEPTANCE (ACCEPTANCE). S.Kratochvil calls this factor "emotional support". This last term has taken root in our psychotherapy.

With emotional support great importance has the creation of a climate of psychological safety. Unconditional acceptance of the patient, along with the therapist's empathy and congruence, is one of the components of the positive attitude that the therapist seeks to build. This "Roger's triad", which has already been mentioned, has great value in individual therapy and no less in group therapy. In its simplest form, the emotional support of an individual is manifested in the fact that the therapist (in individual therapy) or group members (in group psychotherapy) listen to him and try to understand. What follows is acceptance and empathy. If the patient is a member of the group, then he is accepted without regard to his position, his disorders, his behavioral characteristics and his past. He is accepted as he is, with his own thoughts and feelings. The group allows him to differ from other members of the group, from the norms of society, no one condemns him.

To a certain extent, the mechanism of "emotional support" corresponds to the "cohesion" factor according to I.Yalom (1975). "Cohesion" can be seen as a mechanism for group psychotherapy, identical to "emotional support" as a mechanism for individual psychotherapy. Indeed, only a close-knit group can provide a member of the group with emotional support, create psychological safety conditions for him.

Another mechanism close to emotional support is "inspiring hope" (I.Yalom, 1975). The patient hears from other patients that they are getting better, he sees the changes that are happening to them, this inspires him with hope that he can change too.

3. ALTRUISM. A positive therapeutic effect can have not only the fact that the patient receives support and others help him, but also the fact that he himself helps others, sympathizes with them, discusses their problems with them. A patient who comes into a group demoralized, unsure of himself, with the feeling that he himself can offer nothing in return, suddenly begins to feel necessary and useful for others in the process of group work. This factor - altruism - helps to overcome a painful focus on oneself, increases the sense of belonging to others, a sense of confidence and adequate self-esteem.

This mechanism is specific to group psychotherapy. It is absent in individual psychotherapy, because there the patient is exclusively in the position of a person who is being helped. In group therapy, all patients play psychotherapeutic roles in relation to other members of the group.

4. RESPONDING (CATHARSIS). strong manifestation affects is an important part of the psychotherapeutic process. However, it is believed that reacting in itself does not lead to any changes, but creates a certain basis or preconditions for changes. This mechanism is universal - it works in both individual and group psychotherapy. Emotional response brings significant relief to patients and is strongly supported by both the psychotherapist and the members of the psychotherapeutic group.

According to I.Yalom, responding to sadness, traumatic experiences and expressing strong, important emotions for the individual stimulates the development of group cohesion. Emotional response is supported by special techniques in psychodrama in "encounter groups" ("encounter groups"). Encounter groups often stimulate anger and its response by strong blows on a pillow symbolizing the enemy.

5. SELF-DISCLOSURE (SELF-EXPLORATION). This mechanism is more present in group psychotherapy. Group psychotherapy stimulates frankness, the manifestation of hidden thoughts, desires and experiences. In the process of psychotherapy, the patient reveals himself.

In order to better understand the mechanism of self-exploration and the mechanism of confrontation described below in group psychotherapy, let us turn to the scheme of J. Luft and H. Ingham (1970), known in the literature as the "Jogari window" (from the names of the authors - Joser and Harry), which clearly conveys the relationship between the conscious and unconscious areas of the psyche in interpersonal relationships.

1. The open area ("arena") includes behavior, feelings and prayers that are known both to the patient himself, there and to everyone else.
2. The area of ​​the blind spot - what is known to others, but not known to the patient.
3. Hidden area - what is known only to the patient.
4. Unknown, or unconscious - that which is not known to anyone.

In self-exploration, the group member assumes responsibility, as he runs the risk of realizing feelings, motives and behavior from his hidden or secret area. Some psychotherapists talk about "self-undressing", which they consider the primary mechanism of growth in the group (O. Mowrer, 1964 and S. Jourard, 1964 - cited in S. Kratochvil, 1978). The man takes off his mask, begins to talk frankly about ulterior motives that the group could hardly have guessed. We are talking about deeply intimate information that the patient would not trust everyone. In addition to various experiences and relationships associated with guilt, this includes events and actions that the patient is simply ashamed of. Things can only come to "self-undressing" if all other members of the group react with mutual understanding and support. There is, however, a risk that if the patient opens up and does not receive support, then such "self-undressing" will be painful for him and cause psychological trauma.

6. FEEDBACK OR CONFRONTATION. R. Corsini calls this mechanism "interaction". Feedback means that the patient becomes aware from other members of the group how they perceive his behavior and how it affects them. This mechanism, of course, also takes place in individual psychotherapy, but in group psychotherapy its significance increases many times over. This is perhaps the main healing factor of group psychotherapy. Other people can be a source of that information about ourselves, which is not quite available to us, is in the blind spot of our consciousness.

For greater clarity, we will use the Jogari window again. If, during self-exploration, the patient reveals something to others from his secret, hidden area, then with feedback, others reveal to him something new about himself from the area of ​​his blind spot. Through the action of these two mechanisms - self-exploration and confrontation - the hidden area and the blind spot area are reduced, due to which the open area ("arena") is enlarged.

In everyday life, we often encounter people whose problems are directly written on their faces. And everyone who comes into contact with such a person does not want to point out his shortcomings to him, because. afraid to seem tactless or offend him. But it is precisely this information that is unpleasant for a person that provides him with material with the help of which he could change. There are many such sticky situations in interpersonal relationships.

For example, a person who tends to talk a lot and does not understand why people avoid talking to him, in the therapy group, receives information that his way of verbal communication is very boring. A person who does not understand why many people treat him unfriendly will find out that his unconscious ironic tone annoys people.

However, not all information about a person received from others is feedback. Feedback must be distinguished from interpretation. Interpretation is an interpretation, an explanation, these are our thoughts, reasoning about what we saw or heard. Interpretation is characterized by statements like: "I think you are doing this and that," and feedback: "When you do this, I feel this..." Interpretations may be erroneous or may represent own projections of the interpreter. Feedback, in fact, cannot be wrong: it is an expression of how one person reacts to another. Feedback can be non-verbal, manifested in gestures or facial expressions.

The availability of differentiated feedback is also of significant value to patients. Not all behavior can be evaluated unambiguously - negatively or positively - it affects differently on different people. Based on differentiated feedback, the patient can learn to differentiate his behavior.

The term confrontation is often used for negative feedback. G. L. Isurina and V. A. Murzenko (1976) consider confrontation in the form of constructive criticism a very useful psychotherapeutic factor. At the same time, they point out that when confrontation alone predominates, criticism ceases to be perceived as friendly and constructive, which leads to increased psychological protection. Confrontation must be combined with emotional support, which creates an atmosphere of mutual interest, understanding and trust.

7. INSIGHT (AWARENESS). Insight means understanding, awareness by the patient of previously unconscious connections between the characteristics of his personality with non-adaptive ways of behavior. Insight refers to cognitive learning and, together with emotional corrective experience (see below) and the experience of new behavior, is combined by I.Yalom (1970) into the category of interpersonal learning.

S.Kratochvil (1978) distinguishes three types or levels of insight:
Insight N1: awareness of the connection between emotional disorders and intrapersonal conflicts and problems.
Insight N2: awareness of one's own contribution to the emergence of a conflict situation. This is the so-called "interpersonal awareness".
Insight N3: awareness of the underlying causes of present relationships, states, feelings and behaviors rooted in the distant past. This is "genetic awareness".

From a psychotherapeutic point of view, insight N1 is an elementary form of awareness, which in itself has no therapeutic value: its achievement is only a prerequisite for effective cooperation of the patient in psychotherapy. The most significant therapeutic insights are N2 and N3.

The subject of relentless dispute of various psychotherapeutic schools is the question of whether genetic awareness alone is sufficient or, conversely, only interpersonal awareness. S.Kratochvil (1978), for example, is of the opinion that only interpersonal awareness is sufficient. You can go straight from it to learning new ways of behaving. Genetic awareness, from his point of view, can be useful in leading the patient to abandon childhood forms of response and replace them with adult responses and attitudes.

Genetic awareness is the exploration of one's own life history, which leads the patient to an understanding of their present ways of behaving. In other words, it is an attempt to understand why a person became the way he is. I.Yalom (1975) believes that genetic awareness has a limited psychotherapeutic value, in which it strongly disagrees with the position of psychoanalysts.

From a certain point of view, insight can be seen as a consequence of psychotherapy, but it can be said healing factor, or mechanism, since it is primarily a means of changing low-adaptive forms of behavior and eliminating neurotic symptoms. In achieving these goals, it usually always turns out to be very effective, but not necessarily. necessary factor. Ideally, based on deep awareness, symptoms can disappear and behavior can change. However, the relationship between awareness, symptoms, and behavior is actually much more complex and less visible.

8. CORRECT EMOTIONAL EXPERIENCE. Corrective emotional experience is an intense experience of actual relationships or situations, due to which there is a correction of an incorrect generalization made on the basis of past difficult experiences.

This concept was introduced by the psychoanalyst F.Alexander in 1932. Alexander believed that since many patients suffer psychological trauma in childhood due to their parents' bad attitude towards them, the therapist needs to create a "corrective emotional experience" to neutralize the effects of the primary trauma. The therapist reacts to the patient differently than the parents reacted to him in childhood. The patient emotionally worries, compares relationships, corrects his positions. Psychotherapy takes place as a process of emotional re-education.

The most striking examples can be taken from fiction: the story of Jean Valjean from Les Misérables by V. Hugo and a number of stories from the works of A.S. Makarenko, for example, the episode when Makarenko entrusts all the money of the colony to one guy, a former thief. Unexpected trust, in contrast to earlier justified hostility and distrust, corrects existing relationships through strong emotional experience and changes the guy's behavior.

During emotional correction, the surrounding people behave differently than the patient with inadequate forms of behavior can expect based on his false generalization (generalization). This new reality makes it possible to re-differentiate, that is, to distinguish situations in which a given reaction is appropriate or not. This creates the prerequisites for breaking the vicious circle.

So, the essence of this mechanism is that the patient in a psychotherapeutic situation (be it individual or group psychotherapy) re-experiences an emotional conflict that he has not been able to resolve until now, but the reaction to his behavior (of a psychotherapist or group members) different from the one he usually provokes in others.

For example, a patient with a strong sense of mistrust and aggressiveness towards men as a result of her experiences and disappointments in the past can be expected to bring this mistrust and aggressiveness to male patients in a psychotherapy group. Unexpected manifestations on the part of men can have an effective impact here: they do not move away from the patient, do not show irritation and discontent, but, on the contrary, are patient, courteous, affectionate. The patient, who behaves according to her previous experience, gradually becomes aware that her initial generalized reactions are unacceptable in the new situation, and she will try to change them.

A variation of the corrective experience in the group is the so-called "corrective repetition of the primary family" proposed by I.Yalom (1975) - the repetition of the patient's family relations in the group. The group is like a family: its members are largely dependent on the leader; group members may compete with each other to gain "parental" favor. The therapeutic situation can evoke a number of other analogies with the patients' families, provide remedial experiences, and work through childhood unresolved relationships and conflicts. Sometimes a group is consciously led by a man and a woman so that the group situation imitates the family situation as closely as possible. Maladaptive relationships in the group are not allowed to "freeze" in rigid stereotypes, as happens in families: they are compared, re-evaluated, the patient is encouraged to test a new, more mature way of behavior.

9. CHECKING NEW BEHAVIORS ("REALITY CHECK") AND LEARNING NEW BEHAVIORS.

In accordance with the awareness of old non-adaptive stereotypes of behavior, the transition to the acquisition of old ones is gradually being carried out. The psychotherapy group provides a number of opportunities for this. Progress depends on the patient's readiness for change, on the degree of his identification with the group, on the stability of his former principles and positions, on individual character traits.

In fixing new reactions, the impulse from the group plays an important role. A socially insecure patient who tries to win recognition by passive expectation begins to become active and express his own opinion. Moreover, not only does he not lose the sympathy of his comrades, but they begin to appreciate and recognize him more. As a result of this positive feedback, the new behavior is reinforced and the patient is convinced of its benefits.

If a change occurs, it triggers a new cycle of interpersonal learning based on ongoing feedback. I. Yalom (1975) speaks of the first turn of the "adaptive spiral", which originates within the group, and then goes beyond it. With a change in inappropriate behavior, the patient's ability to build relationships increases. Thanks to this, his sadness, depression decreases, self-confidence and frankness grow. Other people enjoy this behavior much more than the previous behavior and express more positive feelings, which in turn reinforces and stimulates further positive change. At the end of this adaptation spiral, the patient achieves independence and no longer needs treatment.

In group psychotherapy, systematically planned training can also be used - training based on the principles of learning. For example, an insecure patient is offered "assertive behavior training", during which he must learn to insist on his own, assert his opinion, and make independent decisions. The rest of the group at the same time resist him, he must convince everyone of the correctness of his opinion and win. Successful completion of this exercise earns approval and praise from the group. Having experienced satisfaction, the patient will try to transfer the new experience of behavior to a real life situation.

Similarly, in a group, one can learn to resolve conflict situations in the form of a "constructive dispute", disagreement with the established rules.

When teaching new ways of behavior, modeling plays an important role, imitating the behavior of other members of the group and the therapist. I. Yalom (1975) calls this mechanism of therapeutic action "imitating behavior", and R. Corsini (1989) - "modeling". People learn to behave by observing the behavior of others. Patients imitate their fellows by observing which forms of their behavior the group approves of and which they reject. If the patient notices that other members of the group are behaving openly, taking some risk associated with self-disclosure, and the group approves of such behavior, then this helps him to behave in the same way.

10. REPRESENTATION OF INFORMATION (TEACHING BY OBSERVATION).
In the group, the patient receives new knowledge about how people behave, information about interpersonal relationships, about adaptive and non-adaptive interpersonal strategies. What is meant here is not the feedback and interpretations that the patient receives about his own behavior, but the information that he acquires as a result of his observations of the behavior of others.

The patient draws an analogy, generalizes, draws conclusions. He learns by watching. Thus, he learns some laws of human relations. He can now look at the same things with different sides to get different opinions on the same issue. He will learn a lot, even if he himself does not take an active part.

Many researchers especially emphasize the importance of observation for positive change. Patients who simply observed the behavior of other members of the group used their observations as a source of awareness, understanding and resolution of their own problems.

R. Corsini (1989), when studying the factors of the therapeutic effect of psychotherapy, divides them into three areas - cognitive, emotional and behavioral. The author refers to cognitive factors as "universality", "sounding", "modeling"; to emotional factors - "acceptance", "altruism" and "transfer" (a factor based on emotional ties between a therapist and a patient or between patients of a psychotherapeutic group); to behavioral - "reality check", "emotional response" and "interaction" (confrontation). R. Corsini believes that these nine factors underlie therapeutic change. Cognitive factors, writes R.Corsini, are reduced to the commandment "know thyself"; emotional - to "love your neighbor" and behavioral - to "do good". There is nothing new under the sun: philosophers have taught us these precepts for thousands of years.

THE EFFICIENCY OF PSYCHOTHERAPY

In 1952, the English psychologist Hans Aysenck compared the effectiveness of traditional psychodynamic therapy with the effectiveness of conventional medical treatments for neurosis, or with no treatment in several thousand patients. The results obtained by the psychologist surprised and frightened many therapists: the use of psychodynamic therapy does not increase the chances of patients to recover; actually got better more untreated patients than those who received psychotherapeutic treatment (72% versus about 66%). In subsequent years, Aysenck reinforced his conclusions with additional evidence (1961, 1966), as critics continued to claim that he was wrong. They accused him of excluding from his analysis several studies that supported the effectiveness of psychotherapy. As counterarguments, they cited the following: it is possible that patients who did not receive therapy suffered from less profound disorders than those who received it; untreated patients may actually be receiving therapy from frequent psychotherapists; general practitioners evaluating untreated patients may have used different, less stringent criteria than psychotherapists evaluating their own patients. A lot of controversy arose about how to interpret the results of H. Aysench, and these disputes showed that it was necessary to develop more reliable methods for evaluating effectiveness.

Unfortunately, performance evaluation work still varies greatly in quality. In addition, as D. Bernstein, E. Roy et al. (1988), it is difficult to define exactly what is meant by successful therapy. Since some therapists seek change in the area of ​​unconscious conflicts or ego strength, while others are interested in changes in overt behavior, different efficacy researchers have different judgments about whether the therapy was effective for people. this patient. These points must be kept in mind when considering research on overall efficiency psychotherapy.

Recent reviews are more optimistic than H. Aysenck's studies. A number of works disproved the "null hypothesis" of H. Aysench and now the real percentage of spontaneous recovery ranges from 30 to 45.

Using a special mathematical procedure called meta-analysis ("analysis of analyzes"), Smith M. L. , Glass G. V. , Miller T. J. (1980) compared the results of 475 studies reporting on the condition of patients who underwent psychotherapy and those who did not receive treatment. The main conclusion was the following: the average patient who underwent psychotherapy felt better than 80% of those patients who did not receive therapy. Other meta-analyses supported this conclusion. These reviews showed that if the results of all forms psychological treatment considered together, the point of view on the effectiveness of psychotherapy is confirmed.

However, critics of the meta-analysis argue that even such a complex combination of results, which is a "mixture" of good and mediocre studies on the effectiveness of treatment with various methods, can be misleading. According to critics, these studies do not answer more important question: what methods are most effective in the treatment of certain patients.

Which of the main psychotherapeutic approaches is the most effective overall, or which approach is preferred for treating specific patient problems? Most reviews find no significant differences in the overall effectiveness of the three main lines of psychotherapy. Critics have pointed out that these reviews and meta-analyses are not sensitive enough to identify differences between individual treatments, but even studies that have carefully compared psychodynamic, phenomenological, and behavioral treatments have not found significant differences between these approaches, although they have noted their advantage over no treatment. When the differences between the methods are identified, there is a tendency to reveal a higher effectiveness of behavioral methods, especially in the treatment of anxiety. The favorable results of behavioral therapy and the appeal of phenomenological therapy to many psychotherapists have led to the fact that these two approaches are becoming more popular, while the use of psychodynamic therapy as the dominant method of treatment is less and less popular.

Evaluation of studies on the effectiveness of psychotherapy can be approached from a completely different perspective and the question can be formulated as follows: are attempts to measure the effectiveness of psychotherapy correct?

On the issue of the effectiveness of psychotherapy, many share the opinion expressed back in 1969 by H.H. Strupp, Bergin A.E. (quoted by R. Corsini): the problem of research in psychotherapy should be formulated as a standard scientific question: what specific therapeutic interventions cause specific changes in specific patients in specific settings?

R. Corsini, with his usual humor, writes that he finds the "best and most complete" answer to this question in C. Patterson (1987): before any model under investigation can be applied, we need: 1) taxonomy problems or psychological disorders of the patient, 2) a taxonomy of the personalities of patients, 3) a taxonomy of therapeutic techniques, 4) a taxonomy of therapists, 5) a taxonomy of circumstances. If we were to create such classification systems, the practical problems would be insurmountable. Suppose that the five classes of variables listed contain ten classifications each, then the research project will require 10x10x10x10x10, or 100,000 items. From this, C. Petterson concludes that we do not need complex analyzes of many variables and we should abandon the attempt to accurately study psychotherapy, because this is simply not possible.

Psychotherapy is an art based on science, and just like art, simple measurements of such a complex activity do not apply here.

Is online skype psychotherapy as effective as traditional psychological help?

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

Looking ahead, most of the published research on the effectiveness of online counseling reports comparable success rates as if clients were working face-to-face with their therapists. Therefore, it can be concluded that internet based therapy , on average, also effective or almost as effective as face-to-face therapy.

To date, several hundred studies have been conducted, in which several tens of thousands of people have taken 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 Reporting studies (see Seligman, 1995), and meta-studies by Smith and Glass (1977), Wampold and colleagues (1997), and Luborsky and colleagues ( 1999).
In this article, I have summarized the research findings.

Issues of the effectiveness of online psychological assistance.

The main questions that the authors of the studies have consistently tried to answer are:
can online therapy be effective at all;
whether the therapy could be delivered effectively (i.e., achieve its therapeutic goals) via the Internet;
– was it as effective as traditional therapy;
- And How various methods and variables associated with online therapy affected effectiveness?

At what age is online psychotherapy effective?

Among the four age groups, online therapy efficacy rates were higher for middle-aged adults (19-39 years old) than for older or younger clients. But this factor may also be due to the lower level of use of skills related to the Internet. 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, but most likely, it is due to the need for a person to simultaneously focus on several sources of information (several windows in the monitor), as a result, lower 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.

With what problems is online psychotherapy effective?

In the studies, patients were treated for a variety of problems and psychological distress (sometimes related to medical problems such as back pain or headaches). They were able to classify and combine 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 the treatment of 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(Zal, 2004), addictive behavior (Stofle, 2002), anxiety and social phobia (Przeworski and Newman, 2004) and eating disorders (Grunwald and Busse, 2003); and group therapy in the treatment of a variety of problems (eg, Barak & Wander-Schwartz, 2000; Colo`n, 1996; Przeworski & Newman, 2004; Sander, 1999).

B. Klein, K. Shandley, D. Austin, S. Nordin Pilot Study of Panic Online as a Self-Administered Therapy for Panic Disorder
S.J. Linton, L. Von Knorring, L.G. Ost Computer-Based Cognitive Behavioral Therapy for Anxiety and Depression

Is it worth it to seek 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 meet regularly in a psychologist's office, you should prefer this option. If this is not possible, or the option of online help 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 turned out that group therapy is a completely different form of psychotherapy.

Year of issue: 2005

Genre: Psychology

Format: PDF

Quality: OCR

Description: In the preparation of materials presented in the book "Effective therapy for post-traumatic stress disorder”, members of a special commission created to develop guidelines for the treatment of PTSD were directly involved. 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 the various therapies based on a review of the extensive clinical and research literature prepared by experts in each specific area. The Effective Therapy for Post-Traumatic Stress Disorder is a two-part book. The chapters of the first part are devoted to reviewing the results of the most important studies. The second part provides short description application of different therapeutic approaches in the treatment of PTSD. This guideline aims to inform clinicians of the developments we have identified as the best for treating 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 are repetitive reproduction of a traumatic event or its episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often accompanied by other psychiatric disorders and is a complex illness that can be associated with significant morbidity, disability, and impairment of vital functions.

In developing this practice guide, the task force confirmed that traumatic experiences can lead to the development various violations such as general depression, specific phobias; disorder caused by acute stress, not defined anywhere else (disorders of extreme stress not otherwise specified, DESNOS), personality disorders such as borderline anxiety disorder and panic disorder. However, the main topic 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 illness(Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994) American Psychiatric Association.
The authors of the Effective Therapy for Post-Traumatic Stress Disorder acknowledge that the diagnostic scope for 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 others that contribute to impaired personal and social functioning. Relatively little is known about the successful treatment of these patients. The consensus of clinicians, supported by empirical data, is that patients with this diagnosis need a long and complex treatment. The Task Force also recognized that PTSD is often accompanied by other psychiatric disorders, and these accompanying illnesses demand from medical staff sensitivity, attention, as well as clarification of the diagnosis throughout the entire treatment process. Disorders requiring special attention are the abuse chemicals and general depression as the most common comorbid conditions. Practitioners may refer to the guidelines for these disorders to develop treatment plans for individuals presenting with multiple disorders and to the comments in Chapter 27.
The Effective Therapy for Post Traumatic Stress Disorder guide is based on cases of adults, adolescents, and children with PTSD. The purpose of the manual is to assist the clinician in the management of these individuals. Since the treatment of PTSD is carried out by clinicians with different professional backgrounds, these chapters have been developed on the basis of a multidisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family counselors and other specialists actively participated in the development process. Accordingly, these chapters are directed to a wide range professionals involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently 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 who live in war zones, may also qualify for a diagnosis of PTSD. However, their treatment, as well as the associated legal and ethical issues significantly different from the treatment and problems of patients who have experienced traumatic events in the past. Patients who are directly in a traumatic situation need 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 clearly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is seen across many cultures and societies. However, there is a need for systematic research to determine whether treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western society will be effective in other cultures. In general, professionals should not limit themselves to only those approaches and techniques that are outlined in this manual. The creative integration of new approaches that have been shown to be effective in the treatment of other disorders and have sufficient theoretical basis in order to improve the results of therapy.

Effective Therapy for Post-Traumatic Stress Disorder (PTSD) is based on an analysis of the results of studies 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 management of such patients. Since PTSD therapy is carried out by specialists with different professional backgrounds, 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 counselors, and others. The chapters of the manual are addressed to a wide range professionals involved in the treatment of PTSD.
The Effective Therapy for Post-Traumatic Stress Disorder is a two-part book. The chapters of the first part are devoted to reviewing the results of the most important studies. The second part provides a brief description of the use of different therapeutic approaches for the treatment of PTSD.

"Effective therapy for post-traumatic stress disorder"

1. Diagnosis and assessment

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

1. Hypnosis
2. Art therapy

1. Psychological debriefing
2. Cognitive Behavioral Therapy
3. Psychopharmacotherapy
4. Treatment of children and adolescents
5. Desensitization and processing through eye movements
6. group therapy
7. Psychodynamic Therapy
8. Treatment in a hospital
9. Psychosocial rehabilitation
10. Hypnosis
11. Marriage and family therapy
12. Art therapy

Conclusion and Conclusions