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12PSYCHOLOGICAL MECHANISMS IN PATHOGENESIS OF PSYCHOSOMATIC DISEASES
Abstract
It is known that psychological factors, in particular an alexithymia, is played a large role in etiology and pathogenesis of some psychosomatic diseases. In this regard psycho correction and psychotherapy becomes an integral part of treatment, rehabilitation and prophylaxis of a recurrence of the specified disease. As the alexithymia is characterized by inability to identification and verbalization of characteristic feelings, it is recommended to give preference to the nonverbal, body-oriented psycho correction methods. This work is devoted to the analysis of effectiveness of application of the body-oriented psycho correction on the example of such widespread psychosomatic disease, as asthma. It is shown that psycho correctional work with this category of patients plays an essential role in the reduction treatment of bronchial asthma and increases effectiveness of standard methods of therapy, promote preservation of results of treatment, maintaining of a complains, more adequate behavior of patients out of a hospital and to improvement of quality of their life.
Keywords
psychosomatic diseases, aalexithymia, body-oriented psycho correction, asthma
AUTHORS
Anna Vladimirovna Smyk
Researcher of Neuroimmunology Lab, State Research Institute of Fundamental and Clinical Immunology, Russian Academy of Sciences, Novosibirsk, Russia. E-mail: anna-v-smyk@mail.ru
Evgeniya Valeryevna Markova
PhD, head of Neuroimmunology Lab, State Research Institute of Fundamental and Clinical Immunology, Russian Academy of Sciences, professor, Novosibirsk State Pedagogical University, Novosibirsk, Russia. E-mail: evgeniya_markova@mail.ru
Ivan Vladimirovich Savkin
Researcher of Neuroimmunology Lab, State Research Institute of Fundamental and Clinical
Immunology, Russian Academy of Sciences, Novosibirsk, Russia. E-mail: i.v.savkin@ngs.ru
1. Introduction
Psychosomatic frustration make the considerable proportion of "civilization diseases" and for several last decades are an object of intensive researches within so-called psychosomatic medicine, in view of the increasing role in the common incidence of the population. Initially body reaction to conflictual experience, the bound to morphologically established changes and pathological violations in bodies is the cornerstone of their psychosomatic diseases. The corresponding predisposition can influence the choice of body. Originally allocated 7 psychosomatics ("holy seven"): asthma, ulcer colitis, essential hypertension, neurodermatitis, pseudorheumatism, duodenum ulcer, hyperthyroidism (Alexander, F., 1951). Later this list extended - carry cancer, infectious and other diseases to psychosomatic frustration (Nemiah, J.C., 1975).
The pathogenesis of psychosomatic frustration is extremely difficult and is defined by:
• nonspecific heritable and congenital burdeness somatic violations and defects;
• genetic predisposition to psychosomatic frustration;
• personal features;
• mental and physical condition during action of the psychoinjuring events;
• hum noise of adverse family and other social factors.
Thus, in the modern comprehension of a pathogenesis of psychosomatic diseases the multifactority admits an explanation of their nature. Now, in the context of a comprehension of a role of psychological mechanisms in a pathogenesis of psychosomatic diseases, the long-term forecast and the organization of preventive actions, the attention of researchers is drawn to the so-called alexithymic radical in structure of the premorbidal person as to one of possible psychological risk factors of psychosomatic frustration. Alexithymia is an inability of the patient to identify and describe verbally the feelings, inability to distinguish feelings from body feelings. It is considered that the intensive emotions which did not receive the verbal expression were somatized and expressed in symptoms of a disease (Boiten, F.A., 1994). Assessment of an alexithymia is important for several reasons. The patients with asthma allocated with this line, as showed a number of researches (Brown, E.L., 1981; Markova, E.V., 2016), demand more frequent and long-lived hospitalization. Alexithymia is considered as the psychological variable promoting maintaining of a disease in this connection the question of psychological impact on these personality traits of patient with asthma and complicate diagnosis and treatment, and the contact "doctor - patient (Brown, E.L., 1981; Moes-Wyjtowicz, A., 2012; Vazquez, I., 2010).
The concept of an alexithymia was formulated by Sifneos in 1973 and generated interest in studying of a ratio between levels of identification and the description of characteristic emotions and susceptibility to psychosomatic frustration (Sifneos, P.E., 1973). It was suggested that inability the alexithymic individuals to regulate and modulate the emotions inflicting on them suffering at the neocortical level can develop into strengthening of physiological reactions to stressful situations, creating thereby the conditions leading to development, as well as to progressing of psychosomatic diseases (Kojima, M., 2012). Existence of an alexithymia significantly complicates process of a verbal psychotherapy, in some cases making it impossible. The particular therapeutic effect at this category of patients can be reached only with engaging of more wide range of the nonverbal, body-oriented methods of a psychotherapy and psycho correction.
Due to the above, the present research was conducted for the purpose of the analysis of effectiveness of application of the body-oriented psycho correctional influence at a psychosomatic frustration on the example of asthma.
2.Materials and methods
Under our observation there were 141 patients with asthma, including 62 men and 79 women who made 2 groups of a research: patients (70 people, including 32 men and 38 women) which reference standard medical therapy was added with a course of the body-oriented psycho correction, were entered into group 1; the group 2 (control) undergoing only reference treatment was made by 71 patients (30 men and 41 women). Groups 1 and 2 were randomized on a sex, age, severity, clinical forms of a disease and the carried-out medical therapy. All patients after the carried-out therapy leave the hospital in a condition of remission.
All patients at the time of receipt in clinic (before treatment), and also at an extract (after treatment) underwent the inspection including: determination of alexithymia level by means of the Toronto alexithymic scale (TAS); assessment of external respiration function; definition of activity of the main departments of the autonomic nervous system by a cardiointervalographya method; definition of the immune status (assessment of indexes of T - B -links of immunity, function of monocytes of peripheral blood and nonspecific factors of protection). Clinical assessment of a condition of patients was carried out by the allergist on prescription of a disease; to frequency of aggravations; to quantity of attacks, existence of cough and short wind in the period of an aggravation at the time of a appearance in clinic.
3.Results and discussion
We developed and approved the original program of the solid focused therapy of patients with bronchial asthma directed to decrease in degree of expressiveness of an alexithymia (Smyk, A.V., 2013; Markova, E.V., 2016). The program includes ten serial individual psycho correctional occupations which problems are: decrease in degree of expressiveness of an alexithymia, a normalization of hemispheric interaction, adaptation to an exercise stress due to increase in functionality of cardio respiratory system, training in skills of behavior, both in disease exacerbation phase, and in a remission phase, training in methods of relaxation, an autogenic training, formation of motivation to self-contained occupations. Considering the fact that the alexithymia is considered, including, and as a result of poor communication left-hand (conscious,
speech, low-emotional) and right subconscious, nonverbal, emotional) hemispheres, the emotional information (Taylor, G.J., 1999) leading to deterioration in hemispheric transfer, receptions of the program developed by us aimed also at impact on the functional activity of the central nervous system and hemispheres interaction.
Patients to which standard medical therapy was added with psycho correctional influence (group 1), showed decrease in alexithymia level to normative indexes, increase in absolute and relative measures of volume of the forced exhalation for the first second; increase in the parameters of the T-cell-like link of immune system (CD3+, CD4+) reduced to treatment to normative values, were also revealed change of a ratio of activities of the main departments of the autonomic nervous system towards strengthening of activity of sympathetic department and corresponding decrease of the activity of parasympathetic department in comparison with control group of patients where only medical therapy was carried out.
Three months after discharge from hospital all patients were evaluated on the level of subjective asthma control with the help of the Russian-language adopted version of the Asthma control test for definition of effectiveness of the carried-out complex therapy. It was shown that at patients to whom in the course of hospitalization a course of the body-oriented psycho correction was conducted night attacks of asthma were less often observed, they used an inhaler with rapid medicine less often, in comparison with patients to whom the specified psycho correctional influence was not carried out. At the same time the most expressed effect of the body-oriented psycho correction on the specified indicators was registered at male patients with a dominant left-hand cerebral hemisphere; at them in the next three months, according to the Russian-language adopted version of the Asthma control test, the complete control over asthma was reached.
4.Conclusion
Thus, results of the present research demonstrate that the body-oriented psycho correctional influence plays an essential role in the rehabilitation treatment of asthma, increases effectiveness of standard methods of the therapy, promotes more adequate behavior of patients out of a hospital and improves quality of their life.
5.Recommendation
The above confirm positive influence of the body-oriented psycho correctional at patients with asthma on the course of pathological process that is justification of its inclusion in complex therapy of this disease and expediency of differentiated approach to therapy of the patients having asthma taking into account specific features of functioning of their nervous system.
REFERENCES
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2. Boiten, F.A., Frijda, N.H. (1994). Emotions and respiratory patterns: review and critical analysis // Int. J. Psychophysiol. - V. 17. - P.103-128.
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5. Markova, E.V., Smyk, A.V., Nepomnyashchikh, V.M. and Demina D.V. (2016). Alexithymia in the pathogenesis of asthma: an innovative approach to correction / Science today: from theory to practice. Proceedings of the 7nd International Academic Conference. Saint-Louis, Missouri, USA. - P. 54-55.
6. Moes-Wyjtowicz, A., Wyjtowicz, P., Postek, M. and Domagala-Kulawik, J. (2012). Asthma as a psychosomatic disorder: the causes, scale of the problem, and the association with alexithymia and disease control // Pneumonol. Alergol. Pol. - V.80. - N.1. - P.13-19.
7. Nemiah, J.C. (1975). Denial Revisited: Reflections on psychosomatic theories // Psychother. Psychosom. - V. 26. - Р. 140-147.
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ИССЛЕДОВАНИЕ ОТНОШЕНИЯ К СМЕРТИ СТУДЕНТОВ-КЛИНИЧЕСКИХ ПСИХОЛОГОВ
Аннотация
Отношение к смерти как к физическому и социальному феномену, связано с характером социальной среды, в которой вырос и сформировался человек, с ценностными ориентациями, предпочтениями. Также оно связано эмоционально-психическим состоянием, уровнем религиозности, образования, и в целом содержанием эпохи. Студенты-психологи формируют свое отношение к смерти в процессе обучения.
Ключевые слова
смерть, отношение, страх
АВТОР
Анна Сергеевна Мусагалиева
Студент, Амурский государственный университет, Благовещенск, Россия.
E-mail: musya-anna95@mail.ru
Отношение человека к смерти - относительно новая, но важная тема исследований. Смерть - естественное завершение жизни любого из нас и каждого из наших близких. В зависимости от жизненной мудрости, культуры, типа вероисповедания, местных стереотипов и собственной философии жизни, разные люди переживают факт смерти по-разному. [4].
На психологическом уровне смерть имеет личную значимость и личное значение для самого умирающего и его родных и близких. Умереть - значит прекратить чувствовать, покинуть любимых людей, оставить незаконченные дела и уйти в неведомое. [5, с. 546].
Отношение к смерти как к физическому и социальному феномену, связано с характером социальной среды, в которой вырос и сформировался человек, с ценностными ориентациями, предпочтениями, эмоционально-психическим состоянием, уровнем религиозности, образования, и в целом содержанием эпохи. Большое значение имеет возраст человека, именно этим определяется доля оптимизма в отношении к проблеме жизни и смерти, а также в целом насколько человек успешен по жизни. [3, С. 27]. Страх перед смертью -исключительно результат научения: дети изначально к смерти не относятся никак, никакого страха и ужаса перед смертью у них нет. [4].
Таким образом, для того, чтобы у человека не было страха смерти, его постоянно не тревожили мысли об этом, является чрезвычайно важным сформировать адекватное отношение к смерти.
Целью настоящего исследования было выявление того, как относятся к смерти студенты - клинические психологи.
Выборка составила 24 человека (студенты клинические психологи 3 и 4 курсов). База исследования - Амурский Государственный университет.
Были использованы следующие методики: Опросник «Отношение к жизни, смерти и кризисной ситуации» (А.А. Баканова); методика «Отношение к смерти», разработанная И.Ю. Кулагиной и Л.В. Сенкевич.
Были получены следующие результаты:
В методике «Отношение к жизни, смерти и кризисной ситуации» всего 14 шкал. Что касается отношения к жизни и кризисной ситуации, то у большинства респондентов
