The use and implementation of programs for the rehabilitation and prevention of addictive behavior as an urgent task of Russian clinical psychology. Investigation of Strategies for Stress-Coping Behavior in Chronic Nonspecific Lung Diseases

NSC of Narcology of the Ministry of Health of the Russian Federation

Foundation "System of Prevention Programs"

ON THE. Sirota, V.M. Yaltonsky

Prevention of drug use and other psychoactive substances

among children and teenagers

Moscow 2003

Prevention of the threat of devaluation 4

Training program and support materials for professionals in the field of substance abuse prevention among schoolchildren in general education schools. 8

Basic concepts and terms 91

Prevention of the threat of devaluation

Necessary Barrier

It has been proven that the most effective way to combat the drug epidemic is prevention. It is she who helps to prevent young people from getting involved in drugs. It is also important that prevention is much cheaper than treatment and allows you to cover all segments of the population. It is she who is the necessary barrier to contain the epidemic of drug addiction and abuse of other psychoactive substances in most of the developed countries of the world.

The role of prevention is growing and will continue to grow. Despite the fact that a number of patients with developed chemical dependence stopped seeking medical help, this does not indicate a decrease in the drug threat. The use of opiates and especially heroin continues to be widespread. Synthetic drugs are confidently entering the Russian market.

What is the situation in the field of drug addiction prevention? Behind last years she has improved significantly. From the declarative recognition of the need for preventive work, society is moving to active actions. Strategic approaches are being developed, scientific research is being carried out. State and non-state organizations implement various programs and hold actions. Today we can say that society's attention has finally focused on the problem. Prevention of drug addiction in Russia is no longer just an ineffective attempt to inform young people about drugs and their consequences, but has clearly formulated goals, objectives, and strategies.

Methodological bases of primary, secondary and tertiary prevention of drug addiction and alcoholism have been developed. The risk factors that contribute to drug addiction, as well as factors that, on the contrary, ensure the stability of the individual, are identified. In prevention, medical-psychological, psychotherapeutic, social and pedagogical technologies are highlighted.

As for medical and psychological technologies, they provide for a system of actions aimed at developing a personality capable of effectively developing, overcoming life's difficulties and problems. Social and pedagogical technologies are associated with the competent provision of information, the ability to interest the ideas of a healthy life. And, what is especially important, - the formation of a social support system (training parents, teachers, peers, supporting behavior, creating a favorable climate).

Preventive programs have also been developed for children, adolescents and youth of various ages; for parents, for teachers. They are tested and implemented in schools and medical and psychological centers in various cities and regions of Russia.

However, it would be erroneous to say that the main tasks have been solved. There are serious problems, without the solution of which prevention on a national scale cannot become effective. First of all, the actions here are not systemic and widespread. Many programs developed in various regions of Russia are not professional enough; their implementation is often undertaken by persons who do not have special training and appropriate education. All this reduces the value of efforts aimed at reducing the demand for drugs.

Numerous public organizations are increasingly involved in preventive work. Their activities should be supported. However, for the most part, the work of these organizations is spontaneous, and most importantly, insufficiently qualified.

The most important issue is the participation of the media. We see the effective work of the Narconet publishing house. But, unfortunately, we continue to encounter non-professional speeches in the press, on radio and television.

How should we act so that our domestic prevention still takes place, does not turn into a series of formal measures and appeals? So that the generation of our children and the children of our children would be protected from the threat of drug addiction, suicide, self-destruction? What to do to overcome the threat of degeneration and extinction of our population, finally?

Let's try to consider the problems in order.

Doctor of Medical Sciences, specialty 19.00.04-Medical Psychology, professor.

Position: Dean of the Faculty of Clinical Psychology; Head of the Department of Clinical Psychology; has been working at MGMSU since 2003.

He has a diploma of a doctor in the specialty "General Medicine", a psychiatrist and a psychotherapist. Postgraduate education in the field of psychotherapy, medical and clinical psychology, issues of prevention and rehabilitation of socially significant disorders, psychosomatic relationships in cardiology, issues of psychosomatic medicine, etc. received in Moscow, St. Petersburg, Germany, Switzerland, Luxembourg, USA. She has experience working abroad as a temporary adviser to the WHO European Bureau on Addiction Prevention (1994). Constant participation and presentations in Russian, European and World congresses and conferences on psychiatry, psychotherapy and clinical psychology.

Subject and quantity scientific papers: author and co-author of 500 scientific publications. Over the past 5 years - 85 scientific publications. Hirsch index - 20.

The topic of the Ph.D. thesis is “Clinical and psychological features of hashish addiction in adolescence” (1990). Doctor's degree medical sciences(major in Medical Psychology). Subject of doctoral dissertation "Coping behavior in adolescence" (1994).

Ten monographs and teaching aids written on the topics “Prevention of drug addiction in adolescents from theory to practice”, “Guidelines for the prevention of substance abuse among students”, “Theoretical, methodological and practical foundations of alternative drug use activity of minors and youth”, “Program for the formation of a healthy lifestyle”, "Effective programs for the prevention of addiction and addictive behavior", "Prevention of drug addiction and alcoholism", "Guidelines for the rehabilitation of patients with dependence on psychoactive substances", "Problems of adolescent adaptation from the standpoint of prevention and psychotherapy of personality and behavioral disorders and dependence on psychoactive substances".

9 candidate and 1 doctoral dissertations were defended under scientific supervision.

Improvement in the last 5 years of the qualification of a psychotherapist certificate; advanced training of a psychiatrist-narcologist; additional diploma higher education majoring in High School Teacher.

Awarded with the Certificate of Honor for merits in the field of health care and many years of conscientious work of the Ministry of Health in 2011; Diploma of the Laureate of the Prize of the city of Moscow in 2006 in the field of medicine, diplomas of MGMSU.

Many years of experience in public speaking at international and all-Russian congresses, symposiums, meetings, speaking in media mass media, interdepartmental meetings. Scientific and pedagogical activity - more than 30 years as a direct executor, organizer and leader scientific research in the field of addiction psychology, adaptation disorders, prevention and rehabilitation of socially significant disorders, clinical psychology, supervisor of dissertations.

Corresponding member of the Russian Academy of Natural Sciences of the Russian Federation, member of the Dissertation Academic Council on Psychiatry and Medical Psychology, GBOU VPO MGMSU RF.

Sirota N.A., Yaltonsky V.M. (Moscow)

Annotation. The article presents the results of the authors' theoretical and practical scientific research in the field of coping behavior of adolescents and adults, which became the basis for developing strategies for the prevention of addiction to psychoactive substances and the rehabilitation of people addicted to drugs and alcohol. The article also presents the theoretical foundations of the methods of motivational counseling and therapy developed by the authors, the prevention of relapses, the formation of motivation for treatment and the moral and spiritual value orientations of the individual in the process of preventing and overcoming addiction.

Keywords: coping behavior, adolescents, active effective highly functional behavior, pseudo-adaptive behavior, maladaptive behavior, universal, selective, indicative prevention, motivation, motivational counseling, motivational therapy, relapse prevention, formation of spiritual and moral value orientations of the individual.

“As for your questions… Try to understand
that there is no single future for all.
There are many of them, and each of your actions creates one of them...
You will understand this ... You will definitely understand this ... "
(Arkady and Boris Strugatsky).

The problem of increasing the effectiveness of prevention and rehabilitation of addictive behavior in Russian Federation- this is, first of all, the problem of understanding this direction of activity, which is extremely necessary for our state and the whole world, as a scientifically based and highly professional clinical and psychological strategy. The desire to solve this problem with the help of increased, but insufficiently constructive and insufficiently professional activity did not lead to success. A kind of struggle for primacy in the field of prevention and rehabilitation, which for decades has included representatives not only and not so much of various scientific areas and practical disciplines, but more or less enterprising organizers, a tendency to hear predominantly their own voice and, ultimately, the low professional erudition of people carrying out preventive and rehabilitation projects has led to a significant devaluation of these efforts on the territory of the Russian Federation. Meanwhile, the problem of creating and implementing programs for the rehabilitation and prevention of addictive behavior is a problem of clinical psychology.

This article is a kind of summing up the work of the authors in this direction over the past fifteen years.

The results of a theoretical study of basic domestic and world scientific concepts and models that describe the possibilities and strategies for the formation and modification of human behavior, as well as many years of author's clinical and psychological experimental studies, made it possible to form important provisions for the psychological prevention and rehabilitation of addictive behavior.

The results of extensive studies of various groups of adolescents made it possible to develop three theoretical models of coping behavior and to determine the conditional extreme positions of the preventive and rehabilitation process of addictive behavior. In these studies, adolescents of younger (9-11 years old), middle (12-13 years old) and older adolescents (14-15 years old) took part. Their leading strategies of coping behavior and the severity of personal-environmental coping resources were determined both in terms of quantitative and qualitative characteristics. As a result, three different models of coping behavior were developed, on the basis of which universal prevention programs were created. These programs are being implemented in schools, boarding schools and correctional institutions in Moscow and other Russian cities. Their implementation has shown that under the condition of the work of well-trained specialists who have undergone special training and supervision, the structure of adolescent coping behavior changes markedly, which ensures their effective and adaptive development.

Active adaptive highly functional behaviors include:

Balanced use of age-appropriate coping strategies with a predominance of active problem-solving and seeking social support;

The balance of the cognitive, behavioral and emotional components of coping behavior and the development of its cognitive-evaluative mechanisms;

The predominance of motivation to achieve success in the process of overcoming stress and psychosocial problems over the motivation to avoid failure;

Readiness for active coping, and, if necessary, confronting the environment, and the associated conscious focus of coping behavior on the source of stress in order to eliminate it;

Personal and environmental coping resources developed in accordance with age, providing a favorable psychological background for coping with stress and contributing to the development of effective coping strategies (positive self-concept, developed perception of social support, internal locus of control over the environment, empathy, affiliation, relatively low sensitivity to rejection, the availability of effective social support from the environment and other coping resources).

A positive self-concept, being one of the most important personal coping resources, is distinguished by its formation in accordance with age, relative stability and, at the same time, pronounced dynamic characteristics (mobility), that is, the ability to develop. It is characterized by a high level of motives, a positive emotional tone, a formed positive body image, adequate positive family, social, sexual relations, a stable level of moral self-awareness, formed professional and educational aspirations, a subjective sense of control over the environment, a high ability to adapt to the environment, the formation of real and ideal components of self-esteem and a moderate discrepancy between them. These features of the self-concept contribute to the growth of self-awareness and the formation of effective strategies for personal-environmental interaction.

Based on the identified psychological characteristics of adolescents and young people, which are characteristic of their successfully adapting and effectively developing category, and which are predictors of the formation of effective coping behavior in general, we have made it possible to formulate the goals and objectives of universal psychological prevention of addictive behavior.

They are the following:

Formation of balanced and age-appropriate coping strategies with a predominance of active problem-solving and aimed at seeking social support;

Formation of a balanced in terms of cognitive, behavioral and emotional components of coping behavior and the development of its cognitive-evaluative mechanisms;

Formation of motivation to achieve success in the process of overcoming stress and psychosocial problems over the motivation to avoid failure;

Formation of readiness for active coping, and, if necessary, resistance to the environment;

The development of dynamic, mobile personal-environmental formations based on age-based dynamic, mobile personality-environment formations, such as the self-concept, predominantly internal rather than external locus of control over the environment, empathy and affiliation, etc.).

The model of adaptive coping behavior is also characterized by the presence of an effective social support process that ensures the development of the basic coping strategy for seeking social support, a personal coping resource for the perception of social support, the ability to actively independently choose a source of support, determine its type and dose volume, and successfully predict its capabilities. .

Pseudo-adaptive dysfunctional coping behavior, characteristic of an adolescent with addictive behavior, suggests two extreme, negative and positive, options for outcomes determined by the different effectiveness of the functioning of conjugated blocks of coping strategies and coping resources, which makes it possible to formulate initial positions for selective prevention, from which one should start. preventive process, define its “targets”.

This model is characterized by:

Imbalance in the functioning of the cognitive, behavioral and emotional components of coping behavior;

An increased share in the structure of coping behavior of age-inappropriate infantile coping strategies;

Lack of skills to actively use the coping strategy for solving problems and replacing it with a coping strategy of avoidance using a pharmacological mechanism for implementing this strategy (psychoactive substances);

Instability, fluctuation of motivation to achieve success, or to avoid failure, the predominant focus of coping behavior is not on the stressor, but on the reduction of the emerging psycho-emotional stress;

Subordination to the environment and pseudo-compensatory nature of behavioral activity;

The low efficiency of the block of personal-environmental coping resources, both in general and the individual components of its structure (unstable, negative, distorted self-concept; subjective perception of social support unevenly distributed across spheres and low level; ambiguous in effectiveness and orientation (from adequate and inadequate social networks) social support; unstable, low-level subjective internal locus of control over the environment; relatively high level of development of empathy and affiliation; no discrepancy between the real and ideal components of self-esteem).

This type of coping behavior is pseudo-adaptive. The resolution of life problems by adolescents is often associated with the resolution of problems associated with an addictive form of behavior, and the psychoactive substance itself is perceived as a means of overcoming problems of loneliness, impaired communication, problems of relationships with parents, the opposite sex, etc., which actually creates the illusion of solving problems in as a result of the use of a psychoactive substance. In addition, the pharmacological mechanism for implementing the avoidance strategy allows adolescents, using psychoactive substances, by changing their mental state, at least temporarily, to eliminate the feeling of environmental control over themselves and thus relieve psycho-emotional stress.

The social support process in this model also has a pseudo-adaptive character. Adolescents with pseudo-adaptive behavior try to overcome stress, hope for support from the environment, and in return receive negative examples of support for a drug- or alcohol-using group. With the development of the basic coping strategy for seeking social support, its subjective perception is directed mainly to the drug-loving social network, and to a lesser extent, to the pro-social supportive environment (family, friends, teachers, doctors, etc.).

The negative outcome of addictive coping behavior is the formation of a biopsychosocial drug, alcohol or other addiction, which rapidly leads a person to social disintegration, isolation, and maladaptation. The avoidance coping strategy used by adolescents with addictive behavior and a number of poorly developed coping resources increase their individual sensitivity to stress and are psychological risk factors for maladaptive coping behavior.

Psychological risk factors for maladaptive addictive coping behavior are the following:

Regular use of passive coping avoidance strategies

Low efficiency of the coping strategy for seeking social support,

Lack of active problem solving skills

The presence of a negative, distorted, deformed self-concept,

The low level of perception of social support and its orientation towards the asocial network of drug addicts,

Receiving social support from drug addiction partners,

Unstable, predominantly external level of subjective control over the environment,

High sensitivity to rejection

Imbalance and rigidity of the components of the self-concept, based on age-inappropriate, deficient cognitive processes.

At the same time, in the structure of coping behavior of adolescents with addictive behavior, there are also psychological factors of resistance to stress, which determine the ability to maintain health, form adaptive patterns of behavior and prevent the transition of addictive behavior into dependence on psychoactive substances.

Factors of resistance to stress in adolescents with addictive behavior are the following:

Developed basic coping strategy for seeking social support;

The orientation of the perception of social support not only towards the drug addicted group, but also towards pro-social support networks;

Having social support from family, friends, significant others;

Developed empathy, affiliation and other communication resources.

A negative variant of addictive behavior develops in the case of a clear predominance of psychological risk factors of maladaptive behavior in coping behavior of adolescents over psychological factors of resistance to stress, their poor development.

A positive outcome of stress coping behavior leads to social integration into the prosocial network and adaptation of the individual to the environment. It develops when the psychological factors of stress resistance predominate over the psychological risk factors for maladaptive coping behavior.

Based on these models, a system of psychoprophylaxis of addictive behavior has been developed.

Coping prevention or universal prevention of addictive behavior, based on the integrative coping concept, is non-specific and the most widespread. Its contingent is the general population of children and adolescents, and the goal is the formation of an active adaptive functional coping behavior aimed at promoting health, reducing the number of people with psychological risk factors for psychosocial adaptation disorders, and developing immunity to dysfunctional patterns of behavior. Coping prevention is the most effective, as it seeks to completely avoid pathological outcomes. The efforts of universal prevention change one developing process for another and are aimed not so much at preventing the development of the disease as at the formation of health.

The main way to implement the tasks of coping prevention is to teach effective behavioral strategies, social skills and skills to overcome stress, manage it, as well as providing adolescents with social support with adequate social support networks.

Preventive intervention includes the creation and implementation of various preventive programs, and the improvement of the social support network, its correction and the creation, if necessary, of a new social support network. In the Russian Federation, the author's programs of coping prevention of addiction, dependent and addictive behavior for children and adolescents of various ages "Ship", "Support", "Melancholy support" are widely implemented.

Selective coping prevention (which is already a fully psychological correction) includes both social and medical measures of a non-specific and specific nature. Its contingent is adolescents with risk behavior, having pseudo-adaptive and maladaptive patterns of behavior. In its focus on risk contingents, secondary coping prevention is mass, remaining individual in relation to the correction of the behavior of individual adolescents. Measures carried out as part of selective coping prevention lead to a decrease in the number of disorders and conditions common in the population through intervention on early stages their development.

The goal of selective coping prevention is to change pseudo- or maladaptive behavior to an adaptive form, interrupt the evolution of the pathogenetic process and, as a result, prevent the clinical manifestation of behavioral disorders.

Achieving the goal of selective prevention requires the following tasks:

1. Mastering the skills of practical application of active coping strategies for solving problems, improving the use of a coping strategy for seeking social support, psychological correction of options for using a passive coping strategy of avoidance.

2. Increasing the potential of the block of personal-environmental coping resources (correction of the negative, distorted self-concept and subjective perception of social support, increasing the level of internal control, developing empathy and affiliation, correcting natural social support networks, changing the direction of receiving social support from inadequate social networks to adequate ones).

The implementation of the tasks of selective coping prevention can be carried out by providing various kinds social support by adequate natural as well as artificially created networks and by teaching effective social skills and skills to overcome stress, manage it (training in active coping strategies).

Real help in conducting selective coping prevention can be provided social networks"family", "peers", "significant others". In the social network, “significant others” professionals (psychologists, doctors, teachers, educators) who have undergone special training form the supporting core.

The preventive impact of social support networks includes the creation and implementation of various psycho-correction programs aimed at improving natural social networks, their correction and the creation of artificial social support networks. The preventive programs used can focus on the family, school, be of a public nature, influencing through the media, or alternatively, in the form of organizing leisure activities for adolescents. These can be affective and interpersonal learning programs based on behavioral skills training, etc. Their implementation should be carried out by specially trained specialists trained in coping prevention - psychotherapists, psychologists, teachers and educators.

Indicative coping prevention (rehabilitation).

The effect of preventive action is largely determined by the possibility of replacing potentially pathological links with non-pathological ones. This approach confirms the opinion of a number of authors who believe that preventive actions carried out within the framework of indicative prevention are in fact not preventive, since they begin after the fact of a deep violation of adaptation processes has already been established. Based on this, indicative coping prevention of psychosocial adaptation disorders in adolescents is predominantly a clinical, psychological and medical task, individual or group in form and aimed, in content, at preventing the transition of the formed pathological chain to a more severe stage, preventing exacerbations and directing the reverse process. development of maladaptive patterns of behavior towards more adaptive ones. It is carried out by teaching adolescents with severe social maladjustment active and effective strategies for coping with stress, providing social support, and conducting therapy by specially trained psychotherapists and clinical psychologists. A necessary condition for indicative coping prevention is the realization that a person must actively overcome the formed pathology as a pronounced and chronic distress. Expansion of the repertoire of coping strategies, reorientation of an addicted person from the dominant use of passive coping strategies (including the pharmacological version) to active ones, allows you to increase the remission period, reduce the frequency of relapses, and avoid pronounced social maladaptation.

Particular attention should be paid to the awareness, modification and development of coping resources (distorted self-concept, the formation of an adequate internal locus of control, perception of social support, empathy, affiliation), as well as affective, cognitive and behavioral processes.

Despite the extreme relevance and viability of the integrative model of coping prevention, an equally important, but not contradictory, but complementary aspect is the formation of a system of moral value orientations. It, as a regulator of behavior in various life situations, prevents the development of any form of dependent behavior. That is why in modern conditions the problem of developing and implementing programs focused on the formation of spiritual and moral value orientations is of particular importance.

Awareness and understanding of the system of spiritual and moral values, on the basis of which the internal control of behavior is formed, develops due to the active activity of a person in the intellectual, motor, emotional and volitional spheres. The readiness to subordinate one's impulses to ideas and knowledge about culture and the basic values that underlie human existence increases the self-esteem of the individual, develops self-esteem. The skills of internal control contribute to the further development of the moral qualities of the individual in the process of his training and education.

The psychological meaning of work aimed at the spiritual and moral development of a person is to help move from elementary behavioral skills to a higher level, where independence in decision-making and moral choice is required. The moral choice understood, accepted by a person and carried out by him in the process of a preventive program is fixed in a significant system of values and can be considered as the most important protective factor preventing addictive behavior.

The author's programs for the formation of a spiritual and moral value system for children of younger and older adolescence, as well as for young adults planning to create a family and perform parental functions in the future are being developed and widely implemented (“Rook”, “Living Water”, “Road Home”) .

Achieving the goal of universal prevention involves work in the following interrelated areas:

Motivating, providing the formation of motivation and the need for self-development of moral potential;

Developing, providing the development of personal resources that contribute to the regulation of behavior based on a conscious moral choice in a wide range of life situations as a factor of protection against the formation of elements of dependent behavior;

Educational, providing an increase in social and personal competence as a result of mastering information about oneself and the world around, moral values and their significance for the psychological well-being of the individual;

Forming understanding, providing a process of awareness, acceptance and internalization of spiritual and moral values that is specific to a person in the process of carrying out specific activities, the strategy and tactics of modeling which are presented in preventive programs as an innovative component.

The objectives of value-forming programs are:

Creation of conditions for obtaining a certain amount of moral knowledge, which can later be used as the basis for independent sustainable moral judgments and personal choices;

Creation of conditions for the formation of a stable positive attitude towards priority moral values;

Creation of conditions for the formation of the ability to make a moral choice and act in accordance with it, the ability to foresee the possible consequences of one's own behavior and evaluate them on a scale of moral value;

Creation of conditions for the development of such behavioral strategies in a situation of moral choice that would contribute to psychosocial adaptation and personal well-being of a person, and also prevent the formation of dependent behavior.

It is obvious that each of these programs has its own specifics, but the universal importance is the personal meaning of the activity aimed at finding moral solutions, at understanding the importance and necessity of moral choice.

Rehabilitation of people addicted to psychoactive substances is a problematic link modern society. The urgent need to develop evidence-based rehabilitation programs is obvious. Rehabilitation programs for people addicted to psychoactive substances should be based on the two most effective strategies from the point of view of evidence-based medicine - the relapse prevention strategy and the motivational therapy strategy. Both of these strategies are developed in line with clinical psychology and require the development of both theoretical and practical approaches. However, even today it is possible to determine the main positions, as well as to propose specific strategies and methods that have essential to build rehabilitation programs. The first most important strategy is the strategy of constant and adequate motivational intervention. The essence of this strategy is that if an addict does not come to understand the need to change his thinking and lifestyle, his treatment and rehabilitation will be ineffective. Rehabilitation, the essence of which is the purposeful overcoming of addiction, is a long process, individual in time for each patient, but its meaning lies in the fact that it has its own specific stages, each of which is characterized by its own goals and objectives, as well as approaches to solving.

Motivational therapy, which is based on the works of D. Prochazka and K. Diklimente, S. Rolnik and V. Miller, is based on the idea of the stages of changing the behavior of a person dependent on drugs: preliminary stage, reflection, preparation for action, active action, saving the result and continued preservation of the result, or relapse. More early work contain a fairly detailed description of motivational therapy. More advanced versions of motivational therapy actively use the principles of cognitive psychology, client-centered, cognitive-behavioral and integrative psychotherapy. Nevertheless, motivational therapy is fundamentally distinguished by a unique balance of directiveness and non-directiveness, which undoubtedly allows it to be attributed to an independent direction that is intensively developing in the world. Its popularity is growing in Russia, however, mandatory professional training of specialists is required in order for motivational therapy to be carried out correctly in the process of rehabilitation of psychoactive substances.

The second leading rehabilitation strategy is the relapse prevention strategy. Previously, we described 8 psychological principles for overcoming dependence on psychoactive substances, in violation of which a relapse of the addiction disease develops. The first principle is called "self-regulation". It states that the risk of relapse decreases in parallel with an increase in the patient's ability to self-regulate thoughts, feelings, memories, vital important decisions and the process of development of his personality and behaviour. The second principle is called "integration". It indicates that the risk of relapse decreases with increased awareness, understanding and appreciation of life situations and events, as well as the use of strategies to avoid the risk of relapse to substance use. The third principle, called “understanding,” states that the risk of relapse decreases with the process of understanding the underlying factors that cause relapse. The fourth principle of "development" indicates that the risk of relapse will decrease with the constant development of personality resources and stress coping behavior. The fifth principle - "social support" indicates that the risk of relapse will decrease with constant activity aimed at building a social support network and developing skills to perceive and use social support. The sixth principle - "social competence" states that the risk of relapse decreases with a constant increase in knowledge about environment, developing empathy and affiliation skills. The seventh principle - "self-efficacy" says that the risk of relapse will decrease with the constant development of strategies for effective behavior and understanding of oneself as an effective person. The eighth principle - "responsibility" indicates that the risk of relapse will decrease as the patient takes responsibility for his activities aimed at overcoming addiction.

Thus, eight directions of the rehabilitation process are determined, aimed at preventing relapse and relapse. These are the following directions:

1. Psychotherapeutic and advisory activities of the medical and psychological staff of the rehabilitation center, aimed at teaching the patient to independently determine and regulate thoughts, emotions, memories and the process of making momentary and vital decisions, as well as the regulation of their behavioral activity. This direction requires skillful use of cognitive-behavioral therapy in the process of rehabilitation, the targets of which are defined above, and the methods have been repeatedly described and continue to develop and improve.

2. Psychotherapeutic and advisory activities based on the principles and approaches, primarily cognitive-behavioral psychotherapy, aimed at the patient's awareness, understanding and evaluation of life situations and events that can lead him to a breakdown and relapse of the disease, as well as those that will help him avoid it.

3. Activities aimed at exploring, together with the patient, the main personal and environmental factors that contribute to the breakdown and relapse, provoking them.

4. Psychotherapeutic activity aimed at the patient's awareness of the need for constant development and change, as well as aimed at developing personal resources, psychological training, expanding knowledge, horizons and opportunities, as well as acquiring communication skills, stress-overcoming behavior, resistance to the pressure of the narcotic environment.

5. Psychological and social activities carried out jointly with the patient, targeted construction and development of a social support network (family, friends, a group of anonymous drug addicts and alcoholics, other support groups). However, people who are addicted to drugs, in addition to the fact that social networks are destroyed, as a rule, have not sufficiently developed skills for understanding and accepting social support, the ability to seek help, competently request it. These people need help in developing socially supportive behavior in general.

6. Activities aimed at increasing self-competence, social competence in general in patients in the process of rehabilitation, that is, understanding themselves and their characteristics, manifestations, "strong" and "weak" sides, as well as increasing knowledge about other people, patterns and features of human behavior.

7. In addition, professional activity is necessary, aimed at developing the patient's effective behavior, the ability to win, "win" in various social situations that require competitive activity, to cope with difficulties, to be happy for oneself and others in cases of success.

8. A particularly important task is to help the patient develop an internal locus of control, the ability to take responsibility for their decisions, thoughts, actions, behavior in general in the process of overcoming addiction.

Prevention of relapse must be planned in the process of rehabilitation of each patient. According to T. Gorsky (21), successful planning for relapse prevention leads to the fact that a person no longer uses drugs and alcohol, feels comfortable in sobriety, knows about the symptoms - precursors of a relapse, has an action plan to interrupt these symptoms and a list of his problems. for a counseling course, and regularly works with a psychotherapist to resolve deeper problems related to personality, inadequate thinking, emotional regulation and behavior. Relapse prevention planning consists of the following steps: stabilization of the patient's condition, assessment of his condition in the maximum number of aspects of the interaction of his personality with the environment, patient education, identification of the precursors of relapse, revision of the program to overcome addiction, training in assessing the condition and making decisions to change behavior, interrupting the dynamics relapse, adequate involvement of significant people, consistent implementation of actions to restore mental state and behavior, and reinforcement of their success.

After the stabilization of the physical condition and the cessation of the use of a psychoactive substance, the patient must come to understand the nature of the motivational crisis he is experiencing, which arose as a result of a previous relapse. It is especially important to explore in detail with the patient the sequence of events that unfolded before the breakdown. This is a difficult process, and it is during this period that symptoms occur that should be identified as precursors to a relapse. The activation of symptom-harbingers is an unconscious process. With the help of special interviews and open-ended questions, it is necessary to help the patient reconstruct the events that preceded the breakdown.

As a rule, patients dependent on psychoactive substances have a long history of repeated relapses and relapses. It is important to study it together with the patient. Determine if the patient is making progress in overcoming addiction in general. After all, a breakdown is not always a sign of failure or unsuccessful treatment. If the patient's history includes lengthening periods of sobriety followed by relapses of progressively shorter duration and with fewer negative consequences, then this means that in fact the patient is in the process of successfully overcoming addiction.

When interrupting the dynamics of a breakdown, the patient should be assisted in recognizing the presence of the precursors of a breakdown and taking actions to eliminate them. To this end, the principles of the problem-solving process should be used, which involve the implementation of the following steps. Together with the patient, one should a) identify the problem - define it as accurately as possible; b) clarify, explore the problem from all sides, discarding false, unverified, inaccurate, emotional interpretations of information, identify and clarify false beliefs; c) identify alternative solutions to the problem using the “quantity-to-quality transition law”, which states that the more solutions are offered, the more options there will be and the more likely the most suitable solution will be found. The second "law" to be used in this process is the "law of deferred decision". It lies in the fact that one should not be afraid to generate alternative solutions to the problem, since it will need to be solved not right now, but at delayed intervals. c) determine the likely consequences for each of the proposed alternatives in order to choose the most correct solution; d) make a decision, having received professional and social support; e) fulfill it, using as much as possible all types of support, both from professionals and members of the team overcoming addiction, relatives, close people; e) to bring the action to the end and evaluate its results. In evaluating the results, professional psychological support is extremely important.

The most important component of relapse prevention is both maintenance therapy and active assistance in creating a group, a team whose activity will be a powerful therapeutic and rehabilitation factor.

Psychological prevention of addictive behavior is a discipline included in the state educational standard for training clinical psychologists third generation. Its importance is growing more and more due to the urgent need to train specialists who are able to develop and actively and highly professionally implement preventive and rehabilitation programs in the field of overcoming addictive behavior both in the Russian Federation and around the world. In this regard, international research and cooperation in the field of practical preventive efforts are of particular importance.

In conclusion, it should be said that the integration of professionals and professional efforts in the field of prevention and rehabilitation of addictive behavior is necessary and should be carried out on the basis of professional support and development.

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Sirota N.A., Yaltonsky V.M. The use and implementation of programs for the rehabilitation and prevention of addictive behavior as an urgent task of Russian clinical psychology. [Electronic resource] // Medical psychology in Russia: electron. scientific magazine 2012. N 2..mm.yyyy).

All elements of the description are necessary and comply with GOST R 7.0.5-2008 "Bibliographic reference" (entered into force on 01.01.2009). Date accessed [in the format day-month-year = hh.mm.yyyy] - the date when you accessed the document and it was available.

Sirota N. A., Yaroslavskaya M. A. (Moscow)

Sirota Natalya Alexandrovna

- Member of the scientific and editorial board of the journal "Medical Psychology in Russia";

Doctor of Medical Sciences, Professor, Dean of the Faculty of Clinical Psychology, Head of the Department of Clinical Psychology, Moscow State University of Medicine and Dentistry.

Email: [email protected]

Yaroslavskaya Maria Alexandrovna

Candidate of Psychological Sciences, Clinical Psychologist of the Psychiatric clinical hospital No. 12" of the Department of Health of the city of Moscow.

Email: [email protected]

Annotation. The present study is devoted to the study of strategies for stress coping behavior in chronic nonspecific lung diseases. The role and significance of the use of certain forms of coping behavior in patients with chronic nonspecific lung diseases in the process of adaptation and maladjustment to the disease are determined. This allows expanding modern scientific understanding of the role of mental factors in the occurrence, course and treatment of chronic somatic diseases.

Keywords: ways of adaptation, coping behavior, bronchial asthma, chronic obstructive pulmonary disease.

Introduction.

The study of the characteristics of the subject's adaptation in stressful situations is widespread in foreign and domestic psychology and medicine. The concept of "adaptation" is a general scientific one. It is used in the humanities, philosophy and natural sciences. The interdisciplinary nature of the presented phenomenon determines the existence of different definitions of the concept of "adaptation" depending on what aspects of it are considered - biological, personal or social. There is no single definition of adaptation. Adaptation is a dynamic aspect of the functioning of the subject in changing conditions. Mechan D. defines the process of adaptation as a way of active protection from adverse influences by changing behavior (overcoming - coping) and protection (nerence). Adaptation is determined by the degree of psychological, social and physiological coping of the patient with chronic diseases. This phenomenon should be studied at different levels of generalization.

One of the main purposes of adaptation is adaptation to stressful situations. Lazarus R. S. distinguishes between physiological and psychological views stress . Mental (emotional) stress is an assessment of the upcoming situation as complex, threatening on the basis of individual knowledge and experience; physiological - associated with a real stimulus. The requirement of the environment, assessed by the subject as threatening, which violates his adaptation, control, prevents self-actualization, causes stress. Events perceived as stressful usually include elements of exposure and undesirability. In addition, events that are perceived as uncertain, as a rule, are regarded as quite stressful.

Stress-adaptation models provide a framework for studying interventions to promote adaptation to chronic disease, and it is believed that adaptation can be seen as an active process in which an individual adjusts to the environment and the challenge of chronic disease. One of the leading personality traits is the use of mechanisms to overcome stressful situations.

The study of behavior aimed at overcoming difficulties, stressful situations in foreign and domestic psychology is given in the framework of studies devoted to the analysis of "coping" mechanisms or "coping behavior". Coping behavior is understood as a special type of social behavior that allows the subject, with the help of conscious actions that are adequate to personal characteristics and situations, to cope with stress or a difficult life situation. The choice of an adequate coping strategy largely depends on the subject's ability to make a cognitive assessment of the situation. The result of cognitive assessment is the subject's perception of the situation as solvable, under control or as unresolvable, uncontrollable. The use of various forms of coping behavior by the subject is provided by the coping resources of the personality, which include: sensory and cognitive resources, personal structures, communicative and psycho-emotional components. The formation and choice of coping strategies are associated with the age stages of the development of the subject. After the formation of the subject 's individual coping style is quite stable . At the same time, the possibility of learning coping behavior should be emphasized by mastering a certain sequence of actions that can be described and perceived by the subject. The effectiveness of coping behavior depends on the characteristics, values and goals of the individual, the type and phase of stressful events, as well as the specific results selected for evaluation. Numerous studies have found that children and adolescents with chronic illnesses use wide range Coping Strategies Just like adults, children use a variety of coping strategies when faced with a "disease situation." Health and its recovery in a disease situation are determined by the degree of coping with the disease, taking an active position in relation to it. The determining factor of activity is the potential of the individual's coping resources. Coping plays a proximate role between adaptation and stressful events that can lead to depressive and anxiety disorders. Thus, coping with stress is a process that can promote or hinder adaptation. Models of stress and disease coping provide a useful framework from which to understand how health hazards, problem solving, and behaviors are linked.

aim research was the study of strategies for coping with the stress of disease behavior as psychological ways of adaptation in patients with chronic nonspecific lung diseases.

Materials and methods.

The study involved 180 people aged 30 to 60 years. The main group included 120 patients suffering from chronic nonspecific lung diseases. Most of the patients were hospitalized in the departments of the City Clinical Hospital No. 70 in Moscow.

A sample of 120 patients was divided into 2 groups. The first group included 60 patients diagnosed with bronchial asthma(BA) (code according to ICD-10 J45.0 - J45.9), the average age was 47.2 ± 10.2.

The second group consisted of 60 people diagnosed with chronic obstructive pulmonary disease (COPD) (ICD-10 code J44.1), mean age - 52.7±6.1.

The comparison group consisted of 60 conditionally healthy individuals with no diseases. respiratory tract, the average age was 42.8±8.7.

To study the frequency of use and evaluate the degree of effectiveness of coping strategies, the Ways of Coping Questionnaire (WCQ) was used. R. S. Lazarus, S. Folkman, adapted in the laboratory of the Psychoneurological Institute. V. M. Bekhterev under the guidance of L. I. Wasserman, the method of "Proactive Coping Behavior" (L. G. Aspinwall, R. Schwarzer, S. Taubert, 1999, adapted by E. S. Starchenkova in the modification of V. M. Yaltonsky, 2009).

During statistical processing of the results, arithmetic mean values, standard deviations, and significance of differences between groups were calculated. The latter indicator was calculated using the Mann-Whitney U-test. When processing the results, the computer statistical program "Statistica 6.0" was used. The MICROSOFT EXCEL 2003 program was also used. The calculation was performed with a confidence p ≤ 0.05.

Results of the study and their discussion.

In the course of the study, it was found that BA patients, in order to cope with stressful and problem situations, in particular, to the disease, significantly more (P<0,05), в сравнении со здоровыми испытуемыми и больными ХОБЛ, обращаются к эмоционально-ориентированным копинг-стратегиям, таким как: «конфронтация», «дистанцирование», «поиск социальной поддержки», «бегство-избегание» (диаграмма № 1).

Patients with asthma, on the one hand, tend to deny that they have problems and avoid solving them, not to recognize their personal role in the occurrence of difficulties and deterioration of their condition. On the other hand, they are fixed on their somatic sensations and emotional experiences, which predisposes them to the formation of a hypochondriacal radical. In an attempt to relieve the emotional stress that has arisen, patients may resort to drinking alcohol, smoking, overeating, i.e. reaction by the type of avoidance in stressful situations, on the one hand, allows to reduce the degree of emotional involvement, on the other hand, indicates the difficulties of patients to flexibly regulate interpersonal relationships, insufficient development of personal resources, psychological and physiological weakness of the body due to the disease.

During the period of deterioration of the somatic condition, emotionally expressive reactions, non-personalized emotional hostile response, and insufficient purposefulness of actions are also noted. Patients are prone to authoritarian and conflict behavior, often shifting responsibility for their actions and health status to other people. Emotionally destructive response to emerging problems and difficulties contributes to the development of emotional exhaustion, waste of individual resources, leads away from a productive solution to the difficulties that have arisen, thereby leading to an excess of the adaptive capabilities of the individual.

Despite the demonstration of aggressive behavioral tendencies, asthma patients show a high search activity for social support: the desire to receive informational, emotional and effective support from the immediate environment, recommendations for treatment, which indicates that patients are aware of the need to seek medical help, limiting activities during an exacerbation of the disease as well as the need for social support itself. Excessive appeal to social support can, on the one hand, lead to the formation of a dependent position on society, on the other hand, contribute to the development of a cynical and dehumanized, consumer perception of the social environment.

As can be seen from diagram No. 2, significantly lower values (P<0,05) получены у пациентов, страдающих БА по шкалам: «проактивное преодоление», «рефлексивное преодоление», «стратегическое планирование». У больных БА недостаточно развиты навыки самостоятельного разрешения трудностей, целеполагания, рассмотрения вариантов разрешения конфликтных или затруднительных ситуаций.

We see that in the structure of the personality of AD patients there are rather protective mechanisms that deny, distort the perception of reality, contribute to the formation of non-adaptive variants of coping strategies, including behavioral passivity in solving, weak emotional regulation, characterized mainly by affective outbursts, the desire to shift responsibility and blame for the state of health, their actions, for the immediate environment, i.e. maladaptive dysfunctional response in a stressful situation is revealed to a greater extent.

Unlike patients with asthma, COPD patients to cope with stressful and problematic situations, in particular to the disease, use more coping strategies focused on self-control, a balanced rational approach to decisions, containment and suppression of emotions (diagrams No. 1, No. 2). Patients with COPD significantly more (P<0,05), в сравнении с больными БА и здоровыми испытуемыми, привержены проблемно-ориентированным стратегиям совладающего поведения, таким как: «стратегическое планирование», «самоконтроль», «принятие ответственности», «планирование решения проблемы».

Patients with COPD strive to evaluate the goals set and create conditions for their more successful achievement, consciously and responsibly approach the importance of following medical prescriptions in maintaining and maintaining their own health and well-being.

Along with the above, patients with COPD are significantly less likely (P<0,05) больных БА и здоровых испытуемых, обращаются к копингу «положительная переоценка» и эмоционально-ориентированным стратегиям: «поиск инструментальной поддержки», поиск эмоциональной поддержки», «конфронтация», «дистанцирование», «бегство-избегание».

That is, patients with COPD have pronounced difficulties in a positive rethinking of problem situations. Often they negatively overestimate the past, present and prospects for the future, experience a feeling of dissatisfaction with their achievements. They do not use the mechanisms of detachment and distraction enough, they are prone to excessive suppression and containment of emotions, they have difficulty in verbalizing their experiences, needs, desires, thereby provoking an increase in the accumulation of negative experiences, internal tension, excessive focus on a stressful situation, which leads to emotional exhaustion, waste of individual resources, reduces the energy and functional reserves of the body. The inability to adequately convey one's emotional state to others, an excessive desire to control one's behavior and the desire to hide one's state and feelings, isolation leads to deformation of relations with the social environment, social isolation, and a lack of interpersonal interaction. Patients rarely seek advice and recommendations, which can lead to limited funds for solving difficult and stressful situations, thereby increasing the risk of developing a maladaptive response of the patient in a problematic environment.

Thus, excessive recourse to coping strategies focused on self-control, a balanced rational approach to solving problem situations, containment, concealment and suppression of emotions, as well as insufficient use of the mechanisms of detachment, distraction, provokes the emergence of psychological and physical stress, reduces energy and functional reserves of the body, leads to deformation of relations with the social environment, social isolation, lack of interpersonal interaction, which provokes the deterioration of the psychological and somatic state, dysfunction of the body.

Conclusions.

1. Psychological strategies for adapting to the disease in patients with bronchial asthma and patients with chronic obstructive pulmonary disease are different. Patients with bronchial asthma, when coping with difficult life situations and the disease, use more emotionally oriented strategies. For patients with chronic obstructive pulmonary disease in situations of stress and disease, the most preferred coping strategies are problem-oriented.

2. Patients with bronchial asthma, when coping with difficult life situations and the disease, show behavioral passivity, poor emotional regulation, characterized mainly by affective outbursts, the desire to shift responsibility and blame for the state of health, their actions to the immediate environment.

3. In patients with chronic obstructive pulmonary disease, there is an excessive use of coping strategies focused on self-control, a balanced rational approach to solving problem situations, containment, concealment and suppression of emotions, as well as insufficient use of the mechanisms of withdrawal, distraction, and a rare appeal to social support.

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Sirota N.A., Yaroslavskaya M.A. Investigation of Strategies for Stress-Coping Behavior in Chronic Nonspecific Lung Diseases. [Electronic resource] // Medical psychology in Russia: electron. scientific magazine 2011. N 6. URL: http://medpsy.ru (date of access: hh.mm.yyyy).

Sirota Natalya Aleksandrovna — Professor, Doctor of Medical Sciences with a degree in Medical Psychology (Medical Sciences), Dean of the Faculty of Clinical Psychology and Head of the Department of Clinical Psychology at the Moscow State University of Medicine and Dentistry.

Chairman of the problem commission on preventive aspects of narcology of the Scientific Council on narcology of the Russian Academy of Medical Sciences. Corresponding member of the Russian Academy of Natural Sciences. Certified specialist in the field of narcology, psychiatry and psychotherapy.

PhD thesis “Clinical and psychological features of hashish addiction in adolescence was defended in 1990. Doctoral dissertation "Coping behavior in adolescence" was defended in 1995 at the St. Petersburg Psychoneurological Institute. V.M. Bekhterev.

Author of over 200 scientific publications. Member of the Dissertation Council of the Moscow State University of Medicine and Dentistry on Psychiatry and Medical Psychology. Member of the editorial boards and collegiums of the journals "Medical Psychology in Russia" and "Issues of Narcology".

Together with V.M. Yaltonsky, he is the founder of a new direction of research in medical psychology and narcology - coping with stress (disease) behavior as the basis for prevention, rehabilitation and psychotherapy. The original author's concept of primary, secondary and tertiary coping - prevention of substance-dependent behavior and HIV / AIDS is highly appreciated by the scientific community and is widely used in the practice of doctors, psychologists, teachers in Russia and the CIS.

Books (5)

Prevention of addiction to psychoactive substances

Guidance on the development and implementation of programs for the formation of life skills in adolescents at risk.

The development of materials was carried out within the framework of the project 2007/124-155 "Using a partnership approach in limiting the spread of drug use among young people" with the financial support of the Delegation of the European Commission to the Russian Federation within the framework of the Institutional Development Partnership Program (IBPP).

Prevention of drug addiction and alcoholism

The textbook outlines the theoretical foundations for the emergence and development of alcoholism and drug addiction, as well as the prevention of these diseases; special attention is paid to practical work, special prevention programs, ways to reduce the harm from the use of psychoactive substances, the basics of psychological rehabilitation of people addicted to alcohol, drugs, etc. are presented.

Prevention of drug use

Prevention of the use of drugs and other psychoactive substances among children and adolescents.

It has been proven that the most effective way to combat the drug epidemic is prevention.

It is she who helps to prevent young people from getting involved in drugs. It is also important that prevention is much cheaper than treatment and allows you to cover all segments of the population. It is she who is the necessary barrier to contain the epidemic of drug addiction and abuse of other psychoactive substances in most of the developed countries of the world.

Effective Addiction Prevention Programs

Effective programs for the prevention of drug addiction and other forms of addictive behavior.

The book is of particular importance to those who are interested in programs for the prevention of drug addiction and other forms of addictive behavior, who are preparing to conduct these programs as a specialist trainer.

It outlines modern ideas about prevention, presents specific programs for adolescents and a training program for professionals. Special psychological techniques and prevention technologies are covered.