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22Медикаментозная стимуляция слюноотделения при БШ/ СШ вызывает критику, т.к. в поздней стадии заболевания это бесполезно, а в выраженной стадии может вызывать выход слюны через разрушенные стенки протоков в интерсти-циальную ткань и тем самым усилить воспаление. Возможно применение вкусовой и механической стимуляции МСЖ, например карамелью и жевательной резинкой «Орбит без сахара».
Местное лечение поражённых слюнных желез, слизистой оболочки полости рта следует проводить по схеме разработанной стоматологами в Институте ревматологии РАМН.
Литература
1. Боровский Е.В., Леонтьев В.К. — М.: Медицина. — 1991, 304 с.
2. Edgar W.M. // Brif. Dent. J. — 1990. — Vol. 169. — №№ 3-4. — P. 96-98.
3. Mendel I.D. // J. Dent. Res. — 1987. — Vol. 66. — P. 623-627.
4. Денисов А.Б. Слюна и слюнные железы. - М.: РАМН, 2009. - 44 с.
5. Симонова М.В. Поражения слюнных желез при синдроме и болезни Шёгрена. Диагноз. Дифференциальный диагноз. - М.: НИИ Ревматологии РАМН, 2010. - 7, 21, 151 с.
6. Селифанова Е.И., Симонова М.В Одонтогенная инфекция и дисбактериоз полости рта при синдроме и болезни Шегрена. XIV международная конференция челюстно - лицевых хирургов « Новые технологии в стоматологии» Россия , С-Петербург, 5 2009, тезисы стр. 188
МЕТОДИКА ПОДПОРОГОВОГО ВЕРБАЛЬНОГО ВНУШЕНИЯ ДЛЯ ТЕРАПИИ ВОЕННОСЛУЖАЩИХ С ПТСР
Чугунов В.В.
Курило В.А.
Данилевская Н.В.
Запорожский государственный медицинский университет МЗ Украины TECHNIQUE OF SUBLIMINAL VERBAL SUGGESTION FOR TREATMENT SOLDIERS WITH PTSD Chugunov V.V. Kurilo V.A.
Danilevska N.V Zaporizhzhya State medical University Ministry of Healthcare of Ukraine
АННОТАЦИЯ
Работа посвящена изучению терапевтической состоятельности психотерапевтической методики подпорогового вербального внушения в терапии ПТСР. В работе рассмотрены факторы, нарушающие комплаенс к терапии у больных ПТСР. Предложена методика подпорогового вербального внушения, направленная на нивелирование данных факторов и позволяющая без провоцирования флешбеков ликвидировать болезненные психотравмирующие переживания у больных ПТСР. Изучена терапевтическая эффективность данной методики.
ABSTRACT
The work is devoted to &udy the therapeutic viability of psychotherapeutic techniques subliminal verbal sugge^ion in the treatment of PTSD. The paper considers the factors that may negatively affect compliance to therapy in patients with PTSD. The technique of subliminal verbal sugge^ion aimed at mitigating these factors and allow without triggering a flashback to eliminate painful traumatic experiences in patients with PTSD. Studied the therapeutic efficacy of this technique.
Ключевые слова:подпороговое вербальное внушение, ПТСР, психотерапия.
Keywords: subliminal verbal sugge^ion, PTSD, psychotherapy.
The main fact of our research is that the subliminal by its power of sound verbal information, not unavailable to the audition person, perceived on a subconscious level, processed and affects his feelings, thoughts and behavior.
Subliminal verbal suggeflion allows to heal psychological trauma without painful patient's memories, because the patient is not consciously hear the therapeutic formula, but subconsciously perceives them.
The aim of research was to determine the effectiveness of our developed method - «technique of subliminal verbal suggeflion for treatment of soldiers with PTSD».
Materials research. In our research, we have defined the mofl common causes of PTSD in soldiers and recorded on audio the possible information. Then a record become more, it was not heard on the background of other sounds. And impose on it a neutral tone.
We formed two groups of patients: soldiers from the firfl group (30 mans; 32±0,86 years old) liflened to the soundtrack
with hidden subliminal suggeflion within half an hour during the week. The second group of soldiers (32 mans; 34±0,72 years old) liflened to the same melody, but without no hidden formulas.
Method of research: psychopathological, psychodiagnoflic, anamneflic.
Within the psychodiagnoflic research was used: Hospital Anxiety Scale (Zigmond A.S., Snaith R.P., 1983); Mississippi Scale for Combat-Related Postraumatic Stress Disorder (Keane T. M., Caddell J. M., Taylor K. L., 1988) [9, 10].
Results of the fludy. indicators were significantly better than the control group of patients, who liflened to the same melody, but without hidden verbal formulas.
In patients who were treated using the new technique, marked by fafl - already after the third session - the reduction of psychopathological symptoms; there was a Satirically significant decrease in anxiety, somatic form, conversing manifeflations and relief painful symptoms of «invasion», such
as flashbacks and nightmares associated with psychological trauma.
Conclusions. The fludy proved that our technique is clinically effective. The technique allows in short time to reach the sanogenic effect in the treatment of PTSD, which is very important in the context of the ongoing fighting. Also technique of subliminal verbal suggeflion, due to subliminal suggeflion, allows you to bypass retraumatization patients and does not lead to induction of flashbacks - during the sessions excluded reminder to patients about psychological trauma, which is very important in the treatment of PTSD.
Research actuality. Pofl-traumatic flress disorder (PTSD) is among those disorders, the mofl characteriflic of military men and persons participating in hoflilities and belongs to the category of reactions to severe flress and disorders of adaptation. The main and mofl severe manifeflation of PTSD is the phenomenon of «invasion» - flashbacks, deflabilizing the mental flate of patients and lead to the development of secondary psychopathological symptoms, including anxiety, depression, explosive, panic attacks, somatisation, behavioral disorders of patients and their autoisolation [7, 8].
Feature of PTSD is the transition of the disease into a chronic form in the absence of successful therapy in the initial Sages of the disease [4].
The difficulty in therapy and a tendency to chronicity of psychopathological phenomena in PTSD due to the severity of psychopathological symptoms, and impaired compliance of patients to therapy.
Psychocorrection PTSD is complicated by a number of factors uncompletely:
1. The difficulty of eflablishing the true deflabilizing experiences, in which psychotherapy is projected on the correction of experiences, miflakenly accepted for true deflabilizing experiences.
2. The lack of agreement on a number of psychotherapeutic interventions.
3. Deliberate / unconscious blocking of therapeutic formulas from the patient.
4. Induction of flashbacks as a complication of certain techniques of psychotherapy.
The main fact of our research is that the subliminal by its power of sound verbal information, not unavailable to the audition person, perceived on a subconscious level, processed and affects his feelings, thoughts and behavior [1 - 3, 5, 6].
Illuflration 1. Scheme of influence of subliminal verbal information on mental activity of the person
This knowledge has helped us in the development of technique of soldier's psychotherapy with PTSD.
It is known that, firflly, the soldiers in the adaptive force for military action of behavior, are not inclined to trufl others, and therefore not predisposed to full compliance in psychotherapy.
And so worry that block any psychotherapeutic formulas is conviction.
We can take a long while to convince a soldier that «the fighting is over and you can relax», but he will not accept this information and will remain tense, in anticipation of danger.
Secondly, any psychotherapeutic conversation with PTSD patients, may remind him of the traumatic situation and provoke a flashback. For example, such known methods as «Eye Movement Desensitization and Reprocessing» on the firfl flages can be painful for patients because of the fact that causes patients
to remember painful experiences. Because of this, patients often refuse any form of treatment.
But if convey this information through the subliminal verbal suggeflion, the soldier will accept it subconsciously, without critical reflection from the side of consciousness and admit it.
Subliminal verbal suggeflion allows to heal psychological trauma without painful patient's memories, because the patient is not consciously hear the therapeutic formula, but subconsciously perceives them.
The aim of research was to determine the effectiveness of our developed method - «technique of subliminal verbal suggeflion for treatment of soldiers with PTSD».
Materials research. In our research, we have defined the mofl common causes of PTSD in soldiers and recorded on audio the possible information. For example, more often the soldiers
feel tension, because subconsciously they expected danger from become more, it was not heard on the background of other every where their lives are threatened. In this case sanogenic sounds. And impose on it a neutral tone (illuflration 2). formula sounded: «it's safe, you can relax.» Then a record
Audio recordings with therapeutic verbal formula
Neutral melody
A ' IIb •laisa-'iÊ
A H
liiHiLi íÜÉmiIiLmiIi Ii iiPiP^flffMP
...... ..................
Audio recordings with therapeutic verbal formula hidden among the usual tunes
Illuflration 2. Scheme of technology of therapeutic technique of «subliminal verbal suggeflion».
We formed two groups of patients: soldiers from the firfl group (30 mans; 32±0,86 years old) liflened to the soundtrack with hidden subliminal suggeflion within half an hour during the week. The second group of soldiers (32 mans; 34±0,72 years old) liflened to the same melody, but without no hidden formulas.
Method of research: psychopathological, psychodiagnoflic, anamneflic.
Within the psychodiagnoflic research was used: Hospital Anxiety Scale (Zigmond A.S., Snaith R.P., 1983); Mississippi
Scale for Combat-Related Postraumatic Stress Disorder (Keane T. M., Caddell J. M., Taylor K. L., 1988) [9, 10].
Results of the fludy. Even after the third session in the firfl group we noted a decrease in anxiety and nightmares, improvement of dream sleep, reduction of the somatic form and conversing manifeflations, associated with trauma, and a reduction of flashback (p<0.01) (illuflration 3, 4).
25 20 15 10 5 0
before
3 day
1 week
2 week
I group
II group
Illuflration 3. The results of the fludy using the Hospital Anxiety Scale
♦ I group —■—II group
Illuflration 3. The results of the fludy using the Mississippi Scale for Combat-Related Postraumatic Stress Disorder
These indicators were significantly better than the control group of patients, who liflened to the same melody, but without hidden verbal formulas.
Thus, our developed method has proven its efficiency and allows to:
- successfully conduct the psychotherapy of patients with impaired compliance, which consciously block the therapeutic setting;
- get a more rapid therapeutic effect, which is very important in the environment of soldiers, who are continuosly to situate in war conditions;
- to achieve a therapeutic effect without retraumatization of patients because of reminders in the process of psychotherapy of traumatic event. To avoid episodes of flashbacks.
Conclusions. The technique of subliminal verbal suggeflion, in addition sanogenic effect, allows to bypass a number of factors uncompletely in the treatment of PTSD in military men, such as the lack of consent to psychotherapeutic interventions involving the loss of a patient total control over what is happening during the psychotherapy session; deliberate / unconscious blocking of therapeutic formulas; the risk of the induction of flashbacks. So, psychotherapeutic formulas, implemented using subliminal verbal suggeflion, perceived subconsciously, without critical reflection, bypassing anysuggeflive barriers, and therefore unconditionally accepted by the patient; also subliminal verbal suggeflion, due to the absence of «open» reminders of the trauma, allows sanogenic intervention without risk of the induction of flashbacks.
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8. Spiller T.R. Somatisation and anger are associated with symptom severity of postraumatic flress disorder in severely traumatised refugees and asylum seekers / Spiller T.R., Schick M., Schnyder U., Bryant R.A., Nickerson A., Morina N. // Swiss Med Wkly. - 2016.05.06. - №146:w14311. doi: 10.4414/ smw.2016.14311.
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