RU2270036C1 - Method for treating children having thermal injuries for psychoemotional and psychosomatic disorders - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves treating children according to five personality-oriented programs. The first and the second programs are applied in acute burn disease and stress stage, the third one in subacute stage of posttraumatic stress, the fourth one in chronic stage and the fifth one is applied in treating burn injury consequences. Each program takes age, patient health condition and state, psychological characteristics, leading and personality-significant psychic activity, development, burn and stress severity into consideration and comprises five units like diagnosis unit composed of acquiring and analyzing anamnesis data and revealing personality specific of a patient; directive unit is applicable for creating trust atmosphere by means of empathic listening approach showing compassion and empathy; information unit gives suggestion to recovery and interest in psychotherapy exercises; correction unit serves for releasing acute emotional experience, activating a patient, paving the ways for transferring injury events from subconscious sphere to conscious one, developing and shaping role position of a child for achieving recovery, doing exercises aimed at learning professional and working skills, increasing motivation to learning and personality development by applying music, games, art, fable therapy within the framework of emotional stress and short-term rational therapy. Muscle relaxation is applied and the child is mildly transferred into hypnotic state with curative self-suggestion formulas being said. Assessment unit comprises determining changes in emotional and psychological status, in degree of mastering and acquiring emotional response skills and mental stability. Program-to-program transition takes place on successfully achieving desired results done by a patient.

EFFECT: wide range of functional applications.

Description

The present invention relates to the field of medicine, psychotherapy, correctional and medical psychology and can be used in a neurological clinic in the treatment of neurosis, post-traumatic stress disorder, in rehabilitation.

Closest to the claimed method is the method of Zakharov N.P. correction of psychoemotional and psychosomatic conditions, which consists in analyzing the anamnesis, formulating the goal of self-hypnosis, using a mantel-like sound combination selected by the patient from the proposed list, endowed with a hypnotic and suggestive power "key to health", rational psychotherapy, relaxation in a hypnotic state, therapeutic self-hypnosis: 4 the first contains information that the desired state will be achieved as a result of a self-hypnosis session (spoken out before a self-hypnosis session hypnosis); the second is self-hypnosis formulas in which the onset of a hypnotic state is associated with a repetition of a mantel-like sound combination and relaxation; the third - formulas of therapeutic auto-suggestion; the fourth - post-hypnotic auto-suggestion formulas. After rational psychotherapy, the patient is informed about the likeness of the human brain to the biocomputer and the possibility of self-programming, about the healing and harmonizing effect of certain sounds on the body. The patient is asked to formulate 4 consecutive programs: affirmative, positive, without a “not” particle in the text, specific and without contradictions (see Pat. N 2155076, A 61 M 21/00, 2000).

However, the known method, the task of which is to obtain a stable psychotherapeutic effect, does not ensure the achievement of this task in children with thermal injuries due to its extremely narrow focus, because provides for the possibility of psychocorrection only with an adult contingent through hypnosis with self-programming, repetition of manthropic sound combinations. The proposed tasks and formulas are difficult for children's perception, a weakened body, do not take into account the psychophysiological characteristics of a developing child, his leading psychological and personality-significant activities.

In addition, the achievement of a deep hypnotic state is extremely difficult for burnt children experiencing acute experiences associated with trauma, separation from their parents, severe pain, leading to their over-alertness, physical stress and mental tension, hyperesthesia, decreased attention and memory, especially in the acute period of a burn disease. Achieving a state of hypnosis and using your body as a means of self-regulation allows you to protect your consciousness only for a while, they don’t solve the problem as a whole and then after a while lead to a worsening of the patient’s condition and well-being, because the associative process becomes fixed on experiences of circumstances and the situation of getting a burn injury, therefore it is impossible to completely remove physical stress, which performs a psychological protective function, until the intensity of experiences decreases. Based on this, the known method is unacceptable for use in acute traumatic stress in children with burns.

The disadvantage of this method is the use of music only to illustrate the effect of sound signals on the psycho-emotional state in the framework of rational psychotherapy, thereby sharply limiting the possibilities of its impact and narrowing the scope.

The objective of the invention is to increase the efficiency of the method by observing a consistent, comprehensive, individual-personality, differentiated, system-structural, etiopathogenetic, clinical-functional, holistic and integrative approaches that determine the technical correction strategy and include a single system complex of clinical, psychological and psychotherapeutic effects , the unity of diagnosis and correction, the targeted formation of psychological neoplasms, leaving the essential characteristics of age, taking into account the zone of proximal development of the child, the cause of the sources of psycho-emotional, psychosomatic disorders, children's perception, the severity and course of burn disease, the specificity of experience of burn injury, the personal characteristics of each patient.

The problem is solved due to the fact that at the first stage they analyze the conditions of social development, personal characteristics, emotional response to stress, carry out testing using verbal and non-verbal methods of psychodiagnostics, tentatively identify the purpose of correction taking into account age, gender, and severity of the injury for a given period burn disease, stress, create a trusting relationship with the patient, inform the patient and his parents in the framework of rational, family, positive psychotherapy about the pathogenesis of burns illness, traumatic stress, about the peculiarities of caring for a burnt child and the construction of parent-child relationships in conditions of traumatic stress and burn disease, establish the final goal of correction taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity child, select correctional classes-modules, including exercises of varying complexity and orientation of psychotherapeutic effects, make up investigatively individual personality-oriented programs from the first to the fifth inclusive, characteristic for the corresponding periods of burn disease, traumatic stress and taking into account the patient’s age, state of health and well-being, his psychological characteristics, the child’s leading and personality-significant mental activity, the zone of his immediate development, severity burn and stress factor with the allocation in each program of five blocks: diagnostic - with the establishment of confidential contact and collection and data collection on the patient, the installation unit - with the creation of a trusting atmosphere, the formulation of the goal, the determination of the degree and form of participation of the patient, his environment in the classroom, information - with increasing motivation for recovery, interest in classes, the correctional block - with the consistent implementation of psycho-correctional exercises of a psychotherapeutic orientation with a gradual increase in the complexity and number of tasks from the first program to the fifth, observation of the patient’s emotional and behavioral reactions with at the same time expressing one’s feelings, feelings associated with both getting injured and arising during classes, and an assessment unit - with the establishment of the degree of mastering and acquisition of emotional response skills, overcoming traumatic stress, mental and psychological stability and the possibility of moving to the next stage to the appropriate the next program, and the transition from one stage to another is carried out when the exercises are successfully completed and the patient achieves the desired results and dynamic observation to determine Jelenia changes in emotional, psychological status of the patient.

A method for the correction of psychoemotional and psychosomatic disorders in children with thermal injury is as follows: in the acute period of a burn disease (shock, toxemia), traumatic stress is carried out from the first days and conditionally until 15-21 days the first program "Empathy and complicity", including a diagnostic unit , which includes the collection and analysis of anamnesis, conditions of social development, personal characteristics, emotional response to stress, the study of personal anxiety, tension, comfort, mental ktivnosti, mood, etc. using verbal and non-verbal methods of psychodiagnostics, clarification during the interview with the attending physician, medical staff, parents, monitoring and questioning based on the psychophysical state of the patient’s personal characteristics, indicative allocation of the correction goal taking into account age, gender, and severity of the injury for a given period of burn disease, stress the installation unit, which includes establishing contact and trusting relationships with the patient through empathic listening, empathy and complicity, providing the patient with the opportunity to be alone in the "solitude" under the supervision of a specialist in the framework of emotional stress psychotherapy; an information block, including informing the patient and his parents in the framework of rational, family, positive psychotherapy about the pathogenesis of burn disease, traumatic stress, the rules for caring for a burnt child and the construction of child-parent personal relationships in the acute period of traumatic stress and burn disease; a correction block that sets the ultimate goal of correction, taking into account the emotional response, individual and personality characteristics, the patient’s condition, the leading and personality-significant mental activity of the child, which is the basis for the selection of correctional classes-modules consisting of one to five exercises, determining the degree and form participation of the patient in the classroom, solving organizational and technical issues to ensure the possibility of carrying out and achieving the desired results, performing sequentially with alternating tasks of the first module, including simple exercises in terms of difficulty, with a gradual increase in the number of exercises, their complexity, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy), creating a gentle sensory atmosphere through calm relaxing soft music, providing free choice of musical themes in in accordance with the mood of the patient, the ability of the burned to listen, and if the physical condition allows, then sing or play music on the instrument max, i.e. to stay with the victim “alone” in the presence of a specialist who does not intervene in the process, who takes part and only monitors the patient’s emotional and behavioral reactions as part of music therapy, emotional stress therapy (first exercise for “solitude” and “complicity”); orienting the child and his relatives to the manifestation of natural typical stress reactions in case of burn injury as part of short-term rational psychotherapy (the second exercise on “smoothing” and “compliments”), aimed at relieving the severity of feelings, providing the burnt child with free expression of his feelings, feelings related as with the injury that occurs during the lesson, by speaking, discussing them in the framework of music therapy, art therapy, game therapy (the third exercise is “awareness of your feelings "); the opportunity to examine the “child’s place of disaster”, burn injury (fourth exercise to “return reality”) through a drawing (art therapy) or a game (game therapy), or a fairy tale (fairy tale therapy), or listening to and performing music (music therapy) followed by discussion arising feelings and sensations; exercises for muscle relaxation without immersion in a hypnotic state with techniques of figurative thinking and involving breathing, formulating therapeutic self-hypnosis formulas without pronouncing manthropic sound combinations; assessment unit, which consists in conducting dynamic monitoring in order to determine changes in the emotional, psychological status of the patient;

in the acute, subacute period of post-traumatic stress at the stage of a burn disease (septicotoxemia), the second Support program is carried out (conditionally from 15-21 days to 1-2-3-6 months), including a diagnostic unit, namely: collection and analysis of psychophysical data the state of the child according to the medical history, psychological status during the observation of the patient, clarification during a conversation with the attending physician, medical staff, relatives; the allocation of the approximate purpose of correction for the compilation of the second program of this stage, taking into account the ongoing changes in the patient’s state of emotional response, leading and personality-significant mental activity, the zone of the child’s closest development; in the installation block, they maintain contact and trust with the patient through active listening, provide the patient with the opportunity to speak freely and emotionally respond to experiences arising from memories of the event and the circumstances of thermal injury as part of emotional stress psychotherapy; in the information block inform the patient and his parents about the features of the course of traumatic stress and burn disease, care for a burnt child at the stage of septicotoxemia as part of short-term rational psychotherapy, about the peculiarities of building parent-child relationships in the framework of family, positive psychotherapy; in the correction block, the final goal of the second program is established taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity, the zone of the child’s closest development, which is the basis for the selection of correctional classes-modules, including from the sixth to tenth exercises , determine the degree and form of patient participation in classes, decide organizational and technical issues to ensure the possibility of conducting and achieving the desired cut ltats, they perform the exercises of the first program sequentially first and then smoothly proceed to the second, including exercises with a gradual increase in their number and degree of difficulty, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy), they are carried out in case of experiencing burnt discomfort caused by pain, itching, burning, etc., muscle relaxation without immersing the patient in a deep hypnotic state and without pronouncing manthropic sound combinations involving breathing and figurative thinking in the framework of psychodynamic psychotherapy, and then carry out the sixth exercise to overcome the exceptional situation of getting injured by orienting the child and his family on the general nature of stress reactions in burn injuries by depersonalizing, mitigating the circumstances of the injury and the experiences associated with it during an individual conversation with the patient and his communication with other recovering patients who have suffered a severe burn injury, in the framework of rational psychotherapy, then they perform the seventh Exercise aimed at optimizing and activating the patient, which consists in switching activities to help other severely burnt children who have recently been admitted to the hospital through the production of wish cards and humorous, fairy-tale drawings as part of art therapy, dolls as part of fairy tales, crafts as part of occupational therapy further ensure the creation of an atmosphere of support for the most burnt by others (medical staff, relatives, patients) by empathic listening, empathy, encouragement first in the course of an individual conversation, later discussion in the psychotherapeutic group about the traumatic event that occurred, provide the affected child with the opportunity to freely perform the eighth exercise “paradox”, aimed at understanding the circumstances of the injury and accepting them as an accomplished event, consisting in speaking about their feelings, feelings associated with received trauma, drawing an accomplished event as part of art therapy, playing with toys, dolls on the topics: “fire”, “illness”, “hospital”, “my doctor”, “tra Vmatic event ”,“ my fear ”,“ what I am afraid of ”, accompanied by music as part of music therapy and game therapy, a specialist’s request for a child who needs to try to see the circumstances of the injury in a dream; create the conditions for transferring from the unconscious sphere to the conscious self-awareness of stress reactions and the nature of pain in burn injuries by performing the ninth exercise on “enhancing personal identification”, which consists in keeping a patient's diary of monitoring their well-being and the nature of the pain with a mark of those circumstances that are accompanied or lead to a deterioration in well-being, and especially record an improvement in mood, reduction of pain (if the child does not have written skills or the patient cannot to complete the observation diary for health reasons, then caring relatives, parents, medical personnel are involved as observers of the reactions, the patient’s behavior and they are already responsible for filling the diary) and the patient and his surroundings discuss daily the observation data with attention to positive aspects , individual-personality characteristics of emotional response; after relieving the severity of the emotions, they perform the tenth exercise for muscle relaxation with the involvement of breathing, imaginative thinking, without deep immersion in a hypnotic state; in the evaluation unit conduct dynamic monitoring in order to determine changes in the emotional, psychological status of the patient and, if necessary, make a replacement in the content of the program;

in the subacute, chronic period of post-traumatic stress at the stage of burn disease (septicotoxemia, convalescence) during wound and skin healing, the third “Maintenance” program is carried out (conditionally from 1-2 months to 3-8 months), including a diagnostic unit, in which a comparative analysis of the child’s psychophysical state according to the medical history, psychological status in the process of dynamic monitoring of the patient, specify during a conversation with the attending physician, medical staff, relatives; allocate the approximate goal of correction for compiling the third program of this stage, taking into account the ongoing changes in the patient’s condition, emotional response, leading and personality-significant mental activity, the zone of the child’s closest development; the installation unit, in which they maintain contact and trust with the patient through active listening, provide the patient with the opportunity to speak freely and emotionally respond to experiences arising from memories of the event and the circumstances of thermal injury as part of emotional stress psychotherapy; an information block in which the patient and his parents are informed about the features of the course of traumatic stress and burn disease, caring for a burnt child during restoration of the skin at the stage of septicotoxemia, convalescence within the framework of short-term rational psychotherapy, about the peculiarities of building parent-child relationships within the framework of a family, positive psychotherapy;

correctional block, in which the final goal of the correctional third program is established taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity, the zone of the child’s closest development, which is the basis for the selection of correctional classes, modules starting from the eleventh until the fifteenth exercise, determine the degree and form of patient participation in classes, decide organizational and technical issues to ensure the possibility of studies and achieve the desired results, they first perform the exercise modules of the first and second programs sequentially, and then gradually move on to the third, including exercises with a gradual increase in their number and complexity, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy), perform the eleventh “piggy bank” exercise, which consists in discussing problems associated with trauma, staying in a hospital, changing appearance, personal relationships, in the process of rational psi otherapeutic conversations individually with the patient, in the group of victims and their parents close to find effective ways of emotional response to stressful situations (long-term fixed, forced position of the body in bed, medical procedures, surgical intervention, appearance of disfiguring scars, itching, burning, pain in areas of healing wounds and donor sites, loss or separation from friends, parents, first steps, walking, meeting friends, returning home, to a team, etc.); develop the child’s ability to comparative analysis in order to highlight the characteristic stresses and effective methods of emotional response (the twelfth exercise “target identification”); form and develop a child’s active role position in achieving success, in recovery (the thirteenth exercise “success”) by retelling, composing, playing a fairy tale (fairy tale therapy), individually or as a group playing music on instruments, singing (music therapy), compiling conditions, rules of the game , holding the game in the role of “leader”, “leader” (game therapy), drawing (art therapy), manufacturing of products (occupational therapy), then perform the fourteenth exercise to build and discuss plans for the future, relationships with the environment in the framework of rational, family, positive, psychodynamic psychotherapy, they then conduct the fifteenth exercise for muscle relaxation in the framework of psychodynamic psychotherapy, possibly with a smooth and gradual immersion in a hypnotic state with breathing techniques, imaginative thinking, without pronunciation of manthropic sound pronunciations, with pronunciation of treatment formulas auto-suggestion; assessment unit, in which dynamic monitoring is carried out in order to determine changes in the emotional, psychological status of the patient and, if necessary, make replacements in the content of the program;

in the conditions of the chronic period of post-traumatic stress at the stage of burn disease (convalescence), the fourth program “Perspective” is carried out (conditionally from 3-8 to 12 months), which includes a diagnostic unit in which a comparative analysis of the psychophysical state of the child according to the medical history, psychological status the process of dynamic monitoring of the patient, specify during a conversation with the attending physician, medical staff, relatives and identify the approximate purpose of correction for making up four that program of this stage, taking into account the changes in the patient’s condition, emotional response, leading and personality-significant mental activity, the zone of the child’s closest development; the installation unit, which maintains contact and trust with the patient through active listening, provides the patient with the opportunity to speak freely and emotionally respond to experiences arising from memories of the event and the circumstances of thermal injury as part of an emotionally-stressful, body-oriented psychotherapy; an information block in which the patient and his parents are informed about the features of the course of traumatic stress and burn disease, caring for a burnt child during restoration of motor functions at the stage of convalescence as part of rational psychotherapy, about the peculiarities of building parent-child relationships in the framework of family, positive psychotherapy; correctional block, in which the final goal of the correctional fourth program is established taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity, the zone of the child’s closest development as the basis for the selection of correctional classes, modules ranging from sixteenth to nineteenth exercises, determine the degree and form of patient participation in classes, decide organizational and technical issues to ensure the possibility of conducting and to achieve the desired results, they first sequentially perform the exercise modules of the first, second, third programs and then smoothly proceed to the fourth, including exercises with a gradual increase in their number and complexity, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy), perform the sixteenth exercise on development of independence, psychomotor, motor functions, self-confidence, activity, emotional stability, communicativeness within the framework of music therapy, with kazkoterapii, game therapy, art therapy, occupational therapy, communication training, personal growth, independence, confidence; then they carry out the seventeenth exercise aimed at reassessing values, motives, views in relation to trauma, illness, oneself and enriching life experience by transforming negative experiences into positive information; form the memory of the past and strengthen hope for the future by leaving the victim out of the traumatic situation a stronger, matured, wise person (the eighteenth exercise “sprout”); perform the nineteenth exercise for muscle relaxation in the framework of psychodynamic psychotherapy with immersion in a hypnotic state with the methods of involving breathing, imaginative thinking, without pronunciation of manthropic sound pronunciations, with pronunciation of therapeutic formulas of self-hypnosis; assessment unit, in which dynamic observation is carried out in order to determine changes in the emotional, psychological status of the patient and, if necessary, make a replacement in the program content;

in conditions of chronic post-traumatic stress, during the period of the consequences of burn injuries, the fifth program “Self-development, self-improvement, self-affirmation” (conditionally from 1 to 8-10-15-20 years) is carried out, including a diagnostic unit, in which a comparative analysis of the child’s psychophysical state is carried out diseases, psychological status in the process of dynamic monitoring of the patient, specify during a conversation with the attending physician, medical staff, relatives, identify the approximate purpose of correction for To draw up the fifth program of this stage, taking into account the changes in the patient’s condition, emotional response, leading and personality-significant mental activity, the zone of the child’s closest development; the installation unit, in which contact and trust with the patient are maintained through active listening, provide the patient with the opportunity to speak out and emotionally respond to experiences arising from memories of the event and the circumstances of the receipt of thermal injury; an information block in which the patient and his parents are informed about the features of the course of traumatic stress and burn disease in the long term after the injury, caring for the burnt child during restoration of motor functions, at the stage of convalescence, in the long term after receiving the burn injury in the framework of rational psychotherapy, features of building parent-child relationships in the framework of family, positive psychotherapy; correctional block, in which the final goal of the fifth correctional program is established taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity, the zone of the child’s closest development, which is the basis for the selection of correctional classes-modules, including from the twentieth until the twenty-third exercise, make adjustments to the program by replacing the module with another one, which is necessary and meets the patient’s needs at the moment they determine the degree and form of the patient’s participation in the classes, decide organizational and technical aspects to ensure the possibility of achieving and achieving the desired results, perform the modules of exercises of the first, second, third and fourth programs sequentially, and then gradually move to the fifth, including exercises with a gradual increase in their number and degree of complexity, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy), conduct the twentieth exercise on career guidance, labor therapies, in which they analyze the patient’s inclinations, needs, values, motives of the patient, then perform the twenty-first exercise to familiarize and master the first professional and labor actions, carry out the twenty-second exercise to increase motivation for training and personal development by providing the opportunity to master a general educational program in within the framework of an auxiliary school on the basis of the inpatient department and the acquisition of labor skills and knowledge in vocational education certification th e program as part of a course of study, as required from time to time perform twenty-third exercise on muscle relaxation with a deep immersion into a hypnotic state with the methods of respiratory involvement, creative thinking, without pronunciation mantropopodobnyh zvukoproiznosheniya, with pronunciation of medical formulas of self-hypnosis; assessment unit, in which dynamic monitoring is carried out in order to determine changes in the emotional, psychological status of the patient and, if necessary, make replacements in the program content.

As a result, they build a clear scheme of correctional classes-modules as part of a separate program. All programs taken together form a single complex - a system of correction of psychoemotional, psychosomatic disorders that meets the principles of differentiation, complexity, integrativity, systemicity, structurality, consistency, integrity, and phasing.

The principle of sequence and phasing is carried out by a smooth transition to the next task to the next stage only after completing the development of the tasks of the previous stage, the corresponding exercises of the next program.

In addition, all programs contain differentiated exercises that differ in the gradual complication of tasks with an increase in the degree of complexity, quantity and frequency of execution. This allows you to adequately select the load for a weakened patient, starting already from the acute period of a burn disease (from the first days of a burned patient in a hospital).

Relaxation exercises begin to be carried out with a patient experiencing discomfort caused by pain, itching, burning in the wound area, only after reducing the intensity of the severity of the experiences associated with the trauma, achieved as a result of the first four exercises at the first stage without immersion in a hypnotic state, then continue performed up to the fifth stage inclusive with a gradual complication of tasks and increasing multiplicity, with the possible immersion of the patient in a hypnotic state from the third, h tvertogo stages, with a deep immersion into a hypnotic state at the fifth stage.

Correction is carried out comprehensively and simultaneously with four categories of victims - with burnt children, their parents, medical personnel, and auxiliary and pedagogical personnel.

The use of a variety of psychotherapeutic areas, verbal and non-verbal methods of psychodiagnostics, auditory, visual, olfactory, tactile sensory channels can enhance the therapeutic effect and increase the efficiency of achieving the desired results.

An example of a specific application of the method:

Patient M.D., medical history N 175202.

Diagnosis: Burn with a flame of I-II-III AB-IV degree of the face, head, neck on an area of 10% of the body surface (III B-2%, IV-1%) ATS. Shock 2 tbsp.

From the anamnesis: born on time, grew and developed according to age, parenting without features with parents in a complete large family. Heredity is not psychopathologically burdened.

He received a burn at home at the age of 7 months with the ignition of a curtain on a crib from an electric fireplace.

An ambulance was delivered to a specialized burn center. He was hospitalized in the children’s burn department of the Russian Burn Center (RTC), where he was prescribed and carried out complex treatment, including medication (anti-shock, antibacterial, infusion-transfusion, etc.) and began a course of correction of psychoemotional disorders according to the proposed method in the framework of early surgical rehabilitation. The patient underwent multiple dressings, 3 operations to restore the skin. The postoperative course is smooth, the graft engraftment is complete. He was discharged home to recover with a recommendation to be observed in the clinic NNIIITO.

Objectively: the patient’s mother complained of moodiness, poor sleep, and her son’s appetite.

The state is serious, consciousness is clear, the patient’s position is passive.

On examination, the patient noted lethargy, moodiness, reactions of protest with crying for honey. staff, medical manipulations, reduced interest in toys, impaired sleep and appetite, fatigue. High anxiety and tension were noted in the patient’s mother, who felt guilty about her son and fear for his life.

At the first informational and installation stage in the acute period of a burn disease (shock, toxemia), traumatic stress was drawn up taking into account the child’s age and was carried out from the first days of the patient’s stay in the hospital until 15 days after the injury, the program “Compassion and empathy”, including diagnostic , installation, information, correction, evaluation blocks.

In the process of monitoring the patient and in conversations with parents, the attending physician, honey. the staff collected an anamnesis of the child’s development, established the nature of the burn injury (severe lesion with multiple localization), identified the individual psychological characteristics of the mother’s personality and its specificity of the experiences of the injury through testing, determined parent-child relationships in the family through questionnaires, and analyzed the information obtained. It was found that the mother considers herself guilty of the incident, because left the child unattended, her carelessness, in view of which she had a sense of guilt for what had happened, fear for his life, which had grown into self-accusation and the emergence of excessive concern for his son, which did not allow the thought of his dream, accompanied by excessive demands on himself, which led to the development of a neurosis-like state against the background of acute traumatic stress in the mother. Taking into account the boy’s age and the severity of the injury, the approximate goal of correction for this period of a burn disease was identified - reducing tension in the child and mother, removing feelings of guilt in the mother (diagnostic unit).

Contact and trusting relationships were established with the child through the creation of a gentle sensory atmosphere through calm relaxing soft music. Empathic listening, empathy, and complicity helped the patient's mother to share their experiences in a confidential conversation (installation block).

In the framework of rational, family, positive psychotherapy, the parents of the injured boy were informed about the pathogenesis of burn disease, traumatic stress, the rules for caring for a burnt child and the construction of child-parent personal relationships in the acute period of traumatic stress and burn disease (information block).

Further, the final goal of the correction was established - sensory stimulation of the child to relieve the severity of experiences associated with trauma, reduce tension in the mother, the disappearance of fear for the life of her son, self-accusation. We determined the degree (passive-active) and the form (individual) of the patient's participation in the classes. We decided organizational and technical aspects to ensure the possibility of carrying out and achieving the desired results. We performed muscle relaxation sessions as part of psychodynamic psychotherapy with the patient’s mother and music therapy with the child. They provided a free choice of musical themes in accordance with the mood of the patient’s mother and by observing the child’s reaction to music. The reaction of the child in the first session of listening to music was one of the criteria for the individual selection of a music program. Various forms of music therapy were used: listening to audio cassettes, mother's singing, musical accompaniment of classes. The main melodies were lullabies, folk, lyric, children's songs, romances, marches, fragments from classical and popular works. They gave the burnt mother and her mother the opportunity to listen, to be “alone” with her experiences in the presence of a specialist who participated and only monitored the patient’s emotional and behavioral reactions as part of music therapy, emotional stress therapy (the first exercise for “solitude” and “complicity” ) They oriented the child and his mother to the manifestation of natural typical stress reactions during burn injuries as part of short-term rational psychotherapy (the second exercise on “smoothing” and “compliments”) aimed at relieving the severity of experiences. They provided the burnt mother with a free expression of her feelings, feelings associated with both her son getting injured and arising during the lesson, by speaking, discussing them in the framework of music therapy, art therapy, game therapy, and a sick child to freely manifest their emotional and behavioral reactions under the supervision of a specialist in the presence of the mother (the third exercise is "awareness of their feelings"). The patient’s mothers were given the opportunity to examine the “scene of the disaster”, burn injuries (the fourth exercise to “return reality”) through a drawing (art therapy), followed by a discussion of emerging feelings and sensations. A training session was conducted with the mother of the patient with muscle relaxation with techniques of imaginative thinking and breathing involvement, the formulation of self-hypnosis therapeutic formulas (correction block). With the child, the fifth relaxation exercise was carried out with the involvement of breathing without immersing him in a hypnotic state to the sounds of calm relaxing music.

A dynamic observation was carried out in order to determine changes in the emotional, psychological status of the patient and his mother. Positive dynamics was noted in the well-being of the child and his mother. Improved sleep, appetite in both. Tension decreased and self-flagellation of the mother disappeared, the child became less likely to be capricious with crying and protest reactions, and interest in others and toys appeared. However, the boy remained lethargic, quickly tired, there was a high need for the presence of his mother. Only after completing the exercises of the first program smoothly switched to the second.

At the second reconstructive stage, in the acute period of post-traumatic stress at the stage of burn disease (septicotoxemia), the Support program was carried out (conditionally from 15 days to 1 month from the moment of injury), which included a diagnostic unit: collection and analysis of the child’s psychophysical state according to the medical history, psychological status in the process of monitoring the patient, clarified during a conversation with the attending physician, medical staff, relatives, taking into account the changes in the patient’s condition, emotional response tion, the master and student-significant mental activity (game-informative), the nearest child development zone allocated indicative target correction to produce the second program of this phase - the removal of aggression, anxiety in children, increase confidence in the mother to recover her son (diagnostic unit). They maintained contact and a trusting relationship with the patient’s mother through active listening, giving her the opportunity to speak freely and emotionally respond to experiences arising from memories of the event and the circumstances of the son’s thermal injury as part of emotional stress therapy (installation block). They informed the patient's parents and close relatives about the features of the course of traumatic stress and burn disease, caring for a burnt child at the stage of septicotoxemia in the framework of short-term rational psychotherapy, about the peculiarities of building parent-child relationships in the framework of family, positive psychotherapy (information block). The final goal of the correctional second program was established - reducing pain, burning, itching, aggressiveness and anxiety in a child and increasing emotional tone, confidence in the mother, taking into account the emotional response, individual and personality characteristics, the condition of the patient and his mother, leading and personality-significant mental activity , the zone of proximal development of the child, which was the basis for the selection of correctional classes-modules. We determined the degree (passive-active) and the form (individual group) of the boy’s participation in classes, decided organizational and technical aspects to ensure the possibility of carrying out and achieving the desired results. First, the tasks of the first program were completed sequentially and then smoothly switched to the tasks of the second program, including from the sixth to tenth exercises with a gradual increase in their number and degree of difficulty, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy). A training session was conducted with the mother of the patient with muscle relaxation with techniques of figurative thinking and involving breathing, the formulation of therapeutic self-hypnosis formulas as part of psychodynamic psychotherapy.

With the child, the relaxation exercise was carried out without immersion in a hypnotic state as part of music therapy. Next, they performed the sixth exercise to overcome the exceptional situation of getting injured by orienting relatives of the burned person to the general nature of stress reactions during burn injury by depersonalizing, mitigating the circumstances of the injury and the experiences associated with it, during an individual conversation with them and communicating with other parents and recovering patients who have suffered severe burn injury, as part of rational psychotherapy. Then they did the seventh exercise to optimize and revitalize the patient’s mother, which included switching activities to helping other heavy burnt children who had recently been admitted to the hospital through making them wish cards and humorous, fairy-tale drawings as part of art therapy, dolls as part of fairy tale therapy, and crafts as part of occupational therapy. Then they ensured the creation of an atmosphere of support for the child from others (medical staff, relatives, patients) through encouragement, empathic listening, empathy. They provided the opportunity for the injured child and his mother to freely perform the eighth exercise, “paradoxes”, aimed at understanding the circumstances of the injury and accepting them as an accomplished event, consisting in the expression of their feelings, feelings associated with the injury, through emotional and behavioral reactions in the game with toys, puppets on themes: “fire”, “hospital”, “doctor-Aybolit” accompanied by music as part of music therapy and game therapy and in speaking by the mother, in addition, the mother of the burnt mother was asked try to see the circumstances of the injury in a dream. They created the conditions for transferring from the unconscious sphere to the conscious self-awareness of stress reactions and the nature of pain due to burn injury by performing the ninth exercise on “enhancing personal identification”, which consisted in maintaining a diary for the mother of the child to monitor her well-being and the nature of the pain and well-being of the child with a mark of those circumstances that were accompanied or led to a deterioration in his and her well-being. Especially recorded improvement in mood, reduction of pain. In the subsequent daily discussion with the patient’s mother of the observation data, attention was paid to the positive aspects, the individual-personality characteristics of the emotional response (correction block). Next, a dynamic observation was carried out in order to determine changes in the emotional, psychological status of the patient and his mother. There was a decrease in the severity of pain, itching and burning in the child according to his emotional and behavioral reactions, an increase in mood, and confidence in the mother in the recovery of her son. Due to the need to replace exercises in the content of the program, the emphasis was on music therapy, game therapy (assessment unit).

At the third recovery stage in the subacute period of post-traumatic stress at the stage of burn disease (convalescence) during the healing of wounds and skin, the “Support” program was implemented (conditionally from 1 month to 3 months from the moment of injury), which included a diagnostic unit: a comparative analysis of psychophysical data was carried out the child’s condition according to the medical history, psychological status in the process of dynamic monitoring of the patient and his mother, was clarified during a conversation with the attending physician, medical rsonalom close relatives. Taking into account the changes in the state of the sick and caring mother, emotional response, leading and personality-significant mental activity, the areas of the child’s closest development identified the approximate goal of correction for drawing up the third program of this stage - increasing the motor activity, interest, mood in the child and the development of emotional self-control at the mother.

They maintained contact and trust with the patient through active listening, free expression, and emotional response to experiences arising from the recollection of the event and the circumstances of the receipt of thermal trauma as part of emotional stress therapy.

The patient and his parents were informed about the features of the course of traumatic stress and burn disease, caring for a burnt child during restoration of the skin at the stage of septicotoxemia, convalescence within the framework of short-term rational psychotherapy, about the peculiarities of building parent-child relationships within the framework of family, positive psychotherapy (information block) .

Then, the final goal of the correctional third program was established taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity, the zone of the child’s closest development, which was the basis for the selection of correctional exercises, and the active-passive degree and the individual group the form of the patient’s participation in the classes, decided organizational and technical aspects to ensure the possibility of carrying out and achieving the desired results (core ektsionny block).

After the successive execution of the exercises of the first and second programs, we smoothly switched to the implementation of the third program, including exercises with a gradual increase in their number and degree of difficulty, psychotherapeutic orientation (music therapy, art therapy, game therapy, fairy tale therapy). Then, the eleventh piggy bank exercise was performed with the patient’s mother, which consisted of discussing problems associated with trauma, staying in the hospital, changing appearance, personal relationships, in the process of rational psychotherapeutic conversation individually with the patient’s mother, in the group of victims and their parents close to search for effective ways of emotional response to stressful situations (long-term fixed, forced position of the body in bed, medical procedures, surgical intervention, appearance ugly scars, the occurrence of itching, burning, pain in the area of healing wounds and donor sites, separation from relatives, first steps, walking, meeting a mother with an injured child, with friends, returning home, to the team, etc.), developed the mother of the burnt child, the ability of comparative analysis in order to highlight her characteristic stresses and effective methods of emotional response (the twelfth exercise “target identification”), formed and developed an active role position in the child’s mother in reducing success, in recovery (the thirteenth exercise “success”) by retelling, composing, playing a fairy tale (fairy tale therapy), individually or as a group playing music on instruments, singing (music therapy), drawing up conditions, rules of the game, playing the game as a “leader”, “Leader” (game therapy), drawing (art therapy), product manufacturing (occupational therapy), performed the fourteenth exercise with the patient’s mother on building and discussing plans for the future, relationships with others in a rational, family, positive , psychodynamic psychotherapy, and then carried out the fifteenth exercise with the patient’s mother, namely muscle relaxation with easy immersion in a hypnotic state with imaginative thinking methods and pronunciation of therapeutic self-hypnosis formulas, with the boy by listening to relaxing music and breathing (correction block). Then we conducted a dynamic observation in order to determine changes in the emotional, psychological status of the patient and his mother (assessment unit). The mother of the victim noted a significant improvement in her well-being, increased faith in the recovery of her son, an optimistic attitude towards the disease appeared, relations with the child and her husband changed, the feeling of guilt in front of her son disappeared, and irritability on herself. The boy normalized sleep and appetite, became active. When the mother was discharged, recommendations were given to continue the corrective exercises of the third program for training and strengthening skills at home and contacting a neuropsychiatrist at the place of residence.

At the fourth formative stage, in the conditions of a chronic period of post-traumatic stress at the stage of a burn disease, convalescence (conditionally from 3 to 12 months after receiving the injury) and in the long term (conditionally up to 15 years) after receiving the injury, the Perspective program was implemented. During this time, the patient was admitted to the ROC six times for inpatient treatment for plasty due to cicatricial deformity of the face after a flame burn. He underwent seven reconstructive operations in the area of the right shoulder, head, face, neck, hands, many dressings. The patient's condition was satisfactory. No complaints. However, there was emotional lability, there was a high need for continued psychocorrectional work. In the conditions of inpatient treatment, a comparative analysis of the psychophysical state of the child according to the medical history, psychological status in the process of dynamic observation of the patient was repeatedly carried out, clarified during the conversation with lay down. doctor, honey the staff, relatives, taking into account the changes in the patient’s condition, emotional response, leading and personality-significant mental activity, the zone of the child’s closest development, identified the approximate goal of correction for drawing up the fourth program of this stage (diagnostic unit).

Constantly maintained contact and trust with the patient through active listening, provided the patient with the opportunity to speak freely and emotionally respond to experiences arising from memories of the event and the circumstances of the receipt of thermal trauma in the framework of emotional-stressful, body-oriented psychotherapy (installation block). The patient and his parents were informed about the features of the course of traumatic stress and burn disease, caring for a burnt child during restoration of motor functions, at the stage of convalescence and in the long term after receiving an injury in the framework of rational psychotherapy, about the peculiarities of building parent-child relationships within a family, positive psychotherapy (information block). The goal of the fourth program was determined taking into account the emotional response, individual and personality characteristics, the patient’s condition, leading and personality-significant mental activity, the zone of the child’s closest development, which was the basis for the selection of corrective exercises, the degree and form of the patient’s participation in the classes was determined, and organizational technical aspects to ensure the ability to conduct and achieve the desired results, performed sequentially first exercises of the first, second, third programs and then gradually move on to the fourth, including exercises with a gradual increase in the number of them and the degree of difficulty, psychotherapeutic orientation (music therapy, art therapy, igroterapiya, skazkoterapiya). We performed the sixteenth exercise on the development of independence, psychomotor, motor functions, self-confidence, activity, emotional stability, communicativeness within the framework of music therapy, fairy tale therapy, game therapy, art therapy, occupational therapy, communication training, personal growth, independence, confidence, performed the seventeenth exercise on the revaluation of values , motives, views in relation to trauma, illness, oneself and enrichment of life experience by transforming negative experiences into positive information They performed the eighteenth exercise “sprout” to build the memory of the past and strengthen hope for the future by leaving the victim out of the traumatic situation a stronger, matured, wise person, conducted the nineteenth exercise for muscle relaxation in the framework of psychodynamic psychotherapy with immersion in a hypnotic state involving breathing and figurative thinking, music therapy (correction block). Further, dynamic observation was carried out in order to determine changes in the emotional, psychological status of the patient and, if necessary, made changes to the program content (evaluation unit). Each time, upon discharge, the patient was recommended to conduct independently mastered exercises at home and contact specialists at the place of residence.

At the age of sixteen, the patient, being a pupil of the tenth grade, a disabled person of the second disabled group, entered the ROC for the eighth time in a hospital treatment for plastics in the area of the head arch due to a defect in the hairline after a burn. Two reconstructive operations were performed. Discharged home in satisfactory condition with restored hairline for outpatient monitoring.

At the fifth final stage in conditions of chronic post-traumatic stress, during the period of delayed long-term manifestations after receiving an injury, in stationary conditions with a sixteen-year-old patient, the fifth correctional program "Self-development, self-improvement, self-affirmation" began.

Upon admission to the hospital, the patient noted tension, anxiety, and low mood due to the lack of professional skills, did not know who to be and where to study.

According to the test results, the patient revealed a state of mild depression, high anxiety, an attitude towards the disease according to the anosognostic option, i.e. overresponsible, obsessed attitude to study, work, social maladaptation according to the intrapsychic orientation, introverted character, i.e. independence, rebellion, the desire to get away from restrictions, the accentuation of character on the pedantic type (ultra-precise), character traits were accompanied by high personal anxiety, a tendency to selective contacts, the orientation of the person to communicate. In the motivational-demanding sphere, inclinations and interest in the creative process in work prevailed, i.e. labor itself was more important than achieving results and material reward. The scope of labor activity "person-person" was identified, ie preference was given to working in a team with people based on communication. In the structure of labor motivation, internal motives prevailed, i.e. interest and propensity for growth, self-development, self-improvement. The need for material, social, psychological, career guidance assistance and vocational training was revealed. Against the background of a positive educational and labor motivational attitude, the choice of a teenager was made on a course in the specialty - a user of personal computers, which was recommended for acquaintance with the profession, training. After a psychological examination, identifying the goal, determining the form and degree of patient participation in classes, informing the patient during individual psychotherapeutic conversations, consultations about the characteristics of the course of chronic post-traumatic stress, burn disease in the long term, the patient sequentially performed first tasks of the first, second, third, fourth programs and then smoothly moved on to the fifth. Classes were held with the patient in group psychotherapy, career counseling, treatment and training, career guidance occupational therapy, fairy tale therapy, art therapy, music therapy, game therapy, social psychological and professional psychological consultations, professional psychological testing. The patient was given the opportunity to continue to master the general education program as part of an auxiliary school on the basis of the inpatient department and to acquire labor skills and knowledge in a vocational educational certified program as part of the course training in the specialty of a personal computer user based on the Research Institute of Traumatology and Orthopedics. Muscle relaxation was repeatedly performed with the patient with immersion in a deep hypnotic state within the framework of psychodynamic psychotherapy.

The patient successfully mastered the program of the vocational training course as part of surgical rehabilitation, passed the exam and received a certification certificate on the development and acquisition of professional skills in working with a personal computer.

According to the results of psychological testing conducted after the course, the patient revealed significant positive changes in the emotional and psychosomatic spheres: reduction to the norm of personal anxiety, the disappearance of depression, the emergence of social and psychological adaptation, an increase in the locus of control and the meaning of life.

According to the results of a psychological examination as part of a longitudinal observation, an eighteen-year-old patient revealed the achievement of a high level of resocialization by increasing social and labor activity, expanding the scope of work, restoring working capacity, returning to study with admission and studying at a university, full employment, and significantly improving psychological, social status, well-being, use in everyday life activities of acquired psycho-emotional skills stability and to respond in stressful situations, professional activities, communication, independence, improve the overall quality of life.

Thus, using the proposed method, 114 patients who suffered burn injuries in childhood passed a course of correction of psycho-emotional and psychosomatic conditions.

Claims (1)

A method for the correction of psychoemotional and psychosomatic disorders in children with thermal injury, including an anamnesis analysis, rational psychotherapy and relaxation, characterized in that the correction is carried out according to five personality-oriented programs: the first and second programs are carried out in the acute period of burn disease and stress, the third - in the subacute period, the fourth - in the chronic period of post-traumatic stress and the fifth - in the period of consequences of burn injury; each correctional program takes into account the patient’s age, state of health and well-being, his psychological characteristics, the child’s leading and personally significant mental activity, his development, the severity of the burn and stress factor, and includes five blocks: a diagnostic block containing a history collection and analysis, as well as identification of personal patient features; the installation unit includes the creation of a confidential atmosphere through empathic listening, empathy, participation; the information block includes increasing motivation for recovery and interest in psychotherapeutic classes; correction block, in which, using the methods of music therapy, art therapy, game therapy, fairy tale therapy within the framework of emotional stress and short-term rational psychotherapy, relieve the severity of experiences, activate the patient, create conditions for the transfer of trauma events from the unconscious to the conscious, develop and form a role in the child in achieving recovery, conduct exercises to master professional and labor actions, increase motivation for training and personal development, while doing muscle relaxation, and in 3-5 programs they smoothly transfer the child into a hypnotic state with the pronunciation of therapeutic self-hypnosis formulas; assessment unit includes the determination of changes in the emotional, psychological status, the degree of development and acquisition of skills of emotional response, mental and psychological stability; however, the transition from one program to another is carried out when the patient successfully achieves the desired results.