The XXI century is called the century of depression. The prevalence of this suffering at the beginning of the 1990s in developed countries was 6% of the adult population. Depression, having long gone beyond the boundaries of psychiatric institutions, has become one of the main problems of general medicine: at least 15% of patients at an appointment with a general practitioner find signs of clinically expressed depression. It has been established that 10% of men and 20% of women may fall ill with various types of depression during their lifetime. Annually, at least 200 million people are diagnosed with depressive disorders. It should be noted that, unlike other types of psychopathological disorders, depressive conditions are not diagnosed in 40% of cases.
First of all, it concerns depressions of non-psychotic level, because in such patients affective pathology often manifests somato-vegetative symptoms of neurosis-like nature, and most of them are observed by internist doctors. Depression is the third most common after arterial hypertension and flu.
Depression is called "one of the most expensive diseases" by health economists. Expenses associated with depression in the U.S. alone are estimated at $47.5 billion annually (including the cost of inpatient treatment, drugs, the cost of additional research, losses due to loss of productivity, death from suicide, etc.). For comparison, the costs of cardiovascular and pulmonary diseases are estimated at $43 and $18 billion per year, respectively.
Unexpected and shocking results were given by studies conducted under the auspices of the World Health Organization: by 2020 mental illness will be included in the list of the main causes of disability, and depression will take second place among the main diseases after coronary heart disease.
In Russia, on the other hand, depression takes first place in terms of prevalence. We have a crisis of physical, mental, and moral health of almost all age groups: sickness rate is very high, mortality rate is very high, life expectancy has decreased, the share of able-bodied population is decreasing, crime, drug addiction, alcoholism, and suicide rates are increasing. The level of reproductive health has fallen, which is manifested by a sharp decline in the birth rate and an increase in the number of divorces and single-parent and dysfunctional families.
The reasons for this situation in Russia are diverse. It is partly due to social and economic depression, and partly to changes in the rhythm and lifestyle of the modern person: the nature of nutrition, low motor activity, informational and psycho-emotional overloads. "Behavior diseases" are becoming a leading form of modern man's pathology. The problem of psychological health of a person living in an unstable, changing world, complex, extreme social and environmental conditions comes to the fore at the end of the lived - the beginning of the new, XXI century - century of human sciences, among which the consolidation place belongs to psychology.
Nervous breakdowns at managers - a phenomenon common, but carefully hidden (from themselves, their subordinates, from their bosses). Everyone copes with the consequences himself. And to this process, the proverb "goes crazy in its own way" is perfectly applicable. It would seem who cares what's going on in someone's head if it wasn't for the real damage caused to the company. Working at a rabid pace, solving a mass of questions every day, not resting for a long time - all this leads to different kinds of mental and nervous disorders in businessmen. As a result, the vast majority of large entrepreneurs are in a state of chronic depression.
Modern psychology has a whole arsenal of techniques and technologies of psychological consulting, psychological therapy, psychological correction, psychological diagnostics. In my opinion, this range of issues refers to psychology, not medicine, and it can be defined as psychological health, not mental (medical approach). Such statement of the problem is fundamental, because it means a completely different approach to providing assistance not to the "patient" (refers to the search for a disease that should be treated with various medications), but to the "client" (who needs to be helped to form motivation: the desire to change, to solve their problem, to help find the most appropriate ways to effectively develop their personality, etc.).
Psychological features of depression in adulthood
Key concepts in defining depression. History of studying the psychological aspects of depression
In domestic psychiatry, depression is subdivided into endogenous (in the framework of schizophrenia, manic-depressive - TIR) and socially conditioned, psychogenic - reactive depression arising in situations or problems from which a person sees no way out, and therefore his perception of the world picture is perverted. Let's talk more about the causes of the latter, which push us on this path: stress - anxiety - depression - neurosis, psychosomatic diseases, alcoholism - disability - death.
Stress is always associated with emotions, and the latter play a big role in our lives. They change not only the appearance of a person (when anger flares up, fists clenched, eyes burned, lips clenched, etc.), but also the activity of internal organs, metabolic processes, the state of the nervous system. The scientific definition of the word emotion is a mental process that reflects a person's attitude towards himself and the world around him. When we like something, positive emotions appear and when we do not like it, negative emotions appear. We have only two positive emotions - interest and joy. They are the ones that keep a person in the best - the present time, where there is a union of soul and body, because the past is no longer there, and the future is no longer there. Negative emotions are separated, taking the soul either to the past or to the future from the body, which is always in the present time. One of the most common negative emotions is the anxiety that occurs in a person in the general evaluation of the situation as adverse. Anxiety can be situational and personal. The first appears before the exciting event (exam, competition, a date with a loved one, a visit to the boss) and is realized. Personal - no. Its symptoms: muscle clamps, fussiness, excessive activity - are considered by a person as features of his character. But this is a misconception. If personal anxiety persists, it gradually turns into depression. Depression is considered as a psychophysiological syndrome peculiar to healthy people in case of fatigue, experiencing severe emotional distress, prolonged mental discomfort, etc. It is considered as a psychological and physiological syndrome. However, in the absence of objective causes, depression can be a leading symptom of involutionary disorders. Depression in medicine is a mental disorder: a dreary, depressed mood with the consciousness of its own worthlessness, pessimism, monotony of ideas, reduced motivation, retardation of movements, various somatic disorders. Depression (from Latin depressio - reduction, deepening; in the old way - "melancholy"), in today's understanding, is more often than not just sadness, but a whole "bouquet" of related disorders, in general - painful, painful.
By etiology or origin, depressive disorders are divided into three large groups: psychogenic, somatogenic, and endogenous. The latter include neurotic depression:
- Psychogenic. Reactive. Depressions of exhaustion.
- Somatogenic (secondary). Organic. Symptomatic.
- Endogenous. Schizophrenic. Circular. Periodical. Revolutionary.
The formation of psychogenic depression is the response of the psyche to various psychotraumatic effects. In particular, at the heart of depressive reactions can be found long-term or short-term exposure to psychosocial stress, violation of interpersonal relationships, labor conflicts.
Somatogenic depressions (secondary, symptomatic) occur as a result of organic brain damage (brain injury, inflammatory processes), intoxication (alcohol, neuroleptic), various types of somatic pathology (arterial hypertension, atherosclerosis).
A certain role is played by epiphysis disorders, which lead to the so-called reduced melatonin syndrome. Deficiency of melatonin, produced by epiphysis, disrupts the circadian rhythm of cortisol secretion, which to some extent explains the circadian dynamics of mental status in endogenous depressive disorders, as well as the presence of dysomaniacal disorders.
Of course, the most frequently encountered most severe depressive disorder is dullness: gray, black mood with a sense of invented irreparability of some, exaggerated longing, everyday difficulties, with a sense of hopelessness, inescapable mental pain. Inquisitiveness may be accompanied by bad slow thoughts and bodily immobility. But it may be combined, for example, with a dreary and anxious run through the rooms, and with laughter mixed with sobs. The patient has a persistent decline in mood, which is accompanied by deep sadness and anxiety. There is no desire to work, to move - "everything falls out of hand. There is no interest in everything around, intellectual activity is reduced. A person is immersed in his or her thoughts, most often having negative coloring (the thought process is also slowed down). He or she is devoured by guilt and anxiety. He feels worthless and of little value. In severe cases, these feelings can turn into delusions of self-injection or sinfulness. Psychoemotional disorders are often accompanied by a physical feeling of heaviness and pressure in the chest area, pain in the heart. During the day, the depth of depression tends to change: in the morning a person is more depressed, by evening his condition improves somewhat. Sleep is usually restless, shallow, at the same time, during the daytime it torments sleepiness. Usually, the appetite, attention to one's own appearance decreases. In women, the menstrual cycle can be broken.
In some cases, the hypochondria joins. A person believes that he is terminally ill. He finds signs of the most serious illnesses, most often not really connected with any serious changes in the body. He is oppressed by the expectation of a severe death, there is a desire for suicide to prevent suffering.
Sometimes, the state of depression may have a hysterical coloring: a sense of despair and despair is accompanied by intense sobs, cramps, loss of speech, memory. A person is shaken by a large shiver, trembling hands and feet, hysterical hallucinations occur.
Due to the fact that a depressed state is often accompanied by thoughts of suicide and attempts to commit suicide, patients should be under constant supervision. Long-term depressive state requires constant medical supervision in clinical conditions.
However, quite often nowadays, depression without obvious sadness is encountered. Here, the mental decline finds itself as masks of other painful disorders, masks behind which the mental pain hides, and then it is difficult for a layman to see in such a depression depression. These masks are all kinds of obsession, fears, painful doubts, anxiety, and acute shyness. They are laziness, lethargy-apathy with a sad desire to want something at least, and tension-string in the soul, and piercing anger, and experience their own emotional change (depersonalization), hysterical, neurasthenic disorders, and unpleasant, including very complex, strange bodily sensations ("inflates the heart from the inside", "as if something unpleasant is poured under the skin and prevents", etc.). p.), even physical pains and vegetative disorders.
For these depressive masks, such depressions are called masked (hidden, vegetative, etc.). And all these masks, individually and in a mixture, are somehow permeated, permeated with a noticeable dullness. Usually something prevails here, or, for example, physical pain, painful sensation, obsession, or longing, or mental pain, or hysterical "shaking". Thus, sadness can give itself at the same time as physical pain, a painful bodily sensation in the chest (without some kind of somatic illness).
Depression as a pathological condition should be differentiated with a temporary decrease in psychophysical tone, typical for healthy people. Pathological depressive state can develop in the absence of objective causes of mood decline. If the cause still exists (chronic fatigue, grief, prolonged mental agitation), then pathological depression continues with the elimination of this cause.
The development of depressive syndrome is caused by deep functional psycho-emotional disorders at the level of the cortex, as well as subcortical and stem formations. A significant role belongs to the reduction of the activating effect of reticular formation and dysfunction of the limbic-reticular complex on the background of exo- or endogenous pathology.
In men, depression is often masked by alcoholism and social adaptation disorder. They are less likely to seek help and are more prone to suicide (suicide). In men, the cause of depression is psychosocial factors: inability to get along with people, to express their emotions, "inferiority complex", lack of professional knowledge, unwillingness to learn and develop their thinking, self - their personality, the presence of psychological fears, environmental stress.
Disability has a strong impact on men who serve as breadwinners of the family. They alcoholize. This leads to children having more contact with women (mothers).
The cause of depression can also be caused by problems in the marital relationship, which will lead to feelings of guilt, resentment, decreased affection and even decreased interest in sexual relations.
Women are more often depressed than men, especially those of reproductive age (capable of childbearing). In addition to the above psychosocial factors, there are added such factors as low status of women in society and family (work, kitchen, laundry, children), economic dependence on the spouse and - an additional risk factor - hormonal status changes that occur to a woman during pregnancy, postpartum, premenstrual and preclimactic periods.
A connection has been established between severe chronic course of depression in parents and psychopathological, adaptive disorders in children. Moreover, this connection is more pronounced in the presence of disease in the mother. She shows aggression to children: their moving games and demands for attention to themselves become unbearable for her. As a result, the mother can never hit the child and then suffer from remorse and guilt.
Mental disorders (mainly major depression) were found in 80% of children whose mothers suffered from depression. In children there were reported behaviors in school, a marked decline in social confidence and academic performance, and poor interaction with the mother. Postnatal depression has a particularly adverse effect on mother-child relations because it is associated with cognitive (cognitive, cognitive) insufficiency in a newborn and an early childhood child. The perception of the world is distorted in women who are depressed. They are all irritated, they do not react adequately to some situations, for example, instead of taking on hands and calming a crying baby, making it cry until it is blue or cursing with rough words.
In the clinical picture of reactive depression, as Karl Jaspers (1913) explained in his time, it is psychologically clear, "like in a mirror", as Jaspers put it, the content of mental trauma is seen: a depressed woman, for example, constantly thinks sadly about her dead husband, can not accept the fact that he is no longer there, torments himself to blame for the fact that he was looking badly, has not found any of the many drugs that her neighbor told her about. In case of non-reactive depression with pronounced dullness, there is no strict psychological understanding between the content of the traumatic event and the content of suffering. In the clinical picture of such depression, dullness is usually mixed with depressive masks. In the clinical picture of any depression, a chronic pain syndrome can be observed. Chronic pain, according to the International Association for the Study of Pain, is considered to be pain that lasts longer than normal healing period and at least 3 months. The symptoms of depression in chronic pain syndrome may be obvious or erased. Quite often, pain is a "mask" of depression and the depressive symptoms themselves are atypical and hidden behind the dominant pain in the clinical picture. Among the syndromes of masked depression, some authors separately distinguish the algosenestopathic syndrome. Patients with typical manifestations of depression quickly find themselves in the sight of psychiatrists. On the contrary, patients with atypically occurring, masked depression are long and sometimes fruitlessly treated by general practitioners, as it is difficult to recognize such depression.
And in conclusion, let us summarize all the key concepts we have considered in defining depression. Depression is a depressed, depressed mood often accompanied by anxiety, insomnia, weakness, reduced appetite and other symptoms. In order to be considered a disease, depression must be sufficiently pronounced and lasting (at least 2 weeks).
The depressive episode is called depression in the International Classification of Diseases (ICD). A depressive episode, depending on the severity of the condition can be mild, moderate and severe.
Recursive depressive disorder - a disorder characterized by repeated episodes of depression.
Bipolar affective disorder is a disorder characterized by recurring episodes of depression and mood swings, that is, when depression alternates with excessive mood swings.
Cyclotism - a state of chronic mood instability with multiple episodes of mild depression and mild recovery. It refers to chronic mood disorders.
Dystimia is a chronic depressive mood.
Manic-depressive psychosis - a disease that occurs in the form of depressive and manic phases or in the form of recurrent depression. This diagnosis means that a person periodically has depression, which in some cases is interspersed with episodes of high spirits.
Endogenous depression is depression that develops for no apparent reason.
Reactive (psychogenic) depression is a depressive response to severe stress, such as loss of employment or death of a loved one.
Psychological features of depression of businessmen. Midlife crisis
The specialists of the largest private clinic in Russia, the Family Medicine Corporation, in the course of research into the main diseases of their clients came to the following conclusions. Businessmen, whose income in families exceeds three thousand dollars per person per month, in addition to migraine and osteochondrosis have special, a kind of occupational diseases that are not typical for the so-called middle class.
Most often, the diseases of rich people are associated with nervous and mental disorders. For example, every second businessman has the syndrome of "unexpected wealth". He is afraid to lose the wealth. As a result, a person develops a so-called deferred life strategy: he puts everything off for tomorrow, which, as you know, may never come. The person closes himself in, which causes the appearance of "anhedonia". With this disorder of the nervous system, the ability to enjoy life reduces and there is a constant depression.
According to the researchers of the clinic, the main disease of rich people in our time is work, more serious physical illness businessmen rarely suffer. And if they do, they still do not have time to be treated and run to doctors. Very close in symptoms to depression and "chronic fatigue syndrome", which is increasingly common among businessmen, bankers, in that group of people called "workaholics. The syndrome of "chronic fatigue" is aggravated by disynchronism - a condition associated with a rapid crossing of time zones, moving from the traditional zone of residence to other continents. The Journal of the British Medical Association recently published the results of a study that says that long and frequent flights of business people to different countries are dangerous not only for their own health, but, as it turns out, for their spouses as well. Business people, businessmen, whose work requires frequent absence from the family, usually suffer from high blood pressure, stomach and gut ulcers, depression and other emotional disorders. This way of abnormal life affects not only the businessmen themselves, but also their relatives. It turned out that spouses and other close business people have an increased risk of psychological and emotional disorders and even the risk of deep depression.
Other sources describe the "manager's syndrome", accompanied by insomnia, irritability, decreased potency. If everything in a person is subordinated to one goal - making money, whether to himself, to the state, and to relations with partners, and everything that goes beyond business interests falls out of the sphere of his communication, this demotionality is already the initial stage of mental disorder. The situation is aggravated by the fact that people's actions, leaders, have a special type of attitude towards the disease - ignore (until they fall down, will tolerate).
The reason for disruptions often lies in the fact that our businessmen have never learned to rest. More precisely, they have not learned to rest properly. Many of them quickly learned such methods of relaxation as bathing and drinking, but when "mixed" they give a short-term effect. Therefore, our entrepreneurs are characterized by psychosomatic diseases, when mental problems begin to manifest themselves on the physical level. Business people are always trying to keep the brand, hiding the true psychological state. They always have everything okay, "no problem". Mostly, today, wealthy people treat health as a prestigious consumption, not as a value. What matters is not how you feel, but how you look. At the psychotherapist, they appear already in a state of serious dependence. As a rule, they are "elitist" - from drugs (in particular, cocaine), alcohol and gambling.
In addition, business owners and managers have problems in sexual relations from constant neurosis and depression, which immediately affects the family.
Another "pain point" of the business elite: when they started a common business - everything was burning in their hands, there were arguments, then the first serious money appeared - disagreements began. Friends turned into enemies. The loss of school and college friends who could not manage to get out into people - they are automatically dismissed: other concerns, income, range of interests and problems. Gradually, a vacuum is formed around the businessman, although he would like to have a relationship of trust. But you can't trust anyone, you have to be alert all the time. As a result, the idea of human, friendly relations among business people is greatly distorted.
Another problem of the modern businessman is sleeplessness, which is a fertile ground for the development of various neuroses. They, in their turn, cause depression.
However, experts note that male depression is much more dangerous than female depression. This is due to the fact that men have more chances to find an "extreme" way out of depression than women: for men, it is mainly alcohol, drugs, and aggression. The main reason for men's depression is lack of money. It does not matter whether they lack enough money for a new sports car or for pants. At the moment, money is almost the first line of men's assessment of their solvency. A primitive "miner" has been living in every man for thousands of years. Depression begins when a man enters the money race and can not stop. And it is not enough to say to yourself - stop, this "milking machine" has no automatic shutdown button. The businessman's family, elderly parents and the circle of communication already depend on it. Practically, a person is forced to continue what he or she started, plunging more and more into the abyss of depression.
As a rule, a person reaches the greatest achievements in the professional sphere at the age from 30 to 50 years. We will take this as a period of average adulthood, although experts' opinions on periodization and criteria for which the nominal average age can be distinguished vary greatly. Psychologists, sociologists, and representatives of this age group themselves also differ in their opinion about whether a person can consider this stage of life as a time of realization of his possibilities, stability and potential leadership, or for him it is a period of dissatisfaction, internal confusion and depression. An individual's view of his or her average age may be determined by the economic conditions of life, social status, and the conditions of the time in which he or she has lived.
Average age can be a period of flourishing in a person's family life, career, but people increasingly think that they are mortal and that their time is running out. For some people, the motto during this period is: "We have to do all our things now. The way people relate to this urgent internal call, along with the events in their lives, determines whether the average age will become a stage of smooth transition and reassessment of values or a period of crisis in the middle of life.
There are two models related to middle age - the crisis model, which links normative age changes occurring during this period to predictable crises, and the transition model, which rejects the notion that a midlife crisis is a normative, age-related event.
According to the transition model, a person's development is characterized by a sequence of expected important events in his or her life, which can be anticipated and for which plans can be made. Although the transition associated with these events can cause considerable difficulties both psychologically and socially, most people successfully adapt to it due to the knowledge that these events are steadily approaching. For example, a 40-year-old small business entrepreneur, knowing that he is likely to retire from business somewhere around 60, regularly transfers money to a special (not taxed until the established term) pension account. By the time he reaches the age of 50, he will probably already look after the ideal home for a "well-deserved vacation". Thanks to the anti-cypator socialization, he will be able to plan these life events and avoid a midlife crisis.
The crisis model has methodological shortcomings, which limit its attractiveness. Many studies offering this model use data from clinical studies, rather than random samples, which more accurately reflect the full adult population. The Levinson and Wyllant study only concerns men. They found in their study that most men in their 40s could question, or at least begin to question, the value of the "manageable circumstances" of their lives from different angles. If he has previously managed to achieve his goals, he may ask, "Was it worth the effort? If he has been able to achieve what he wanted in his life, he can now clearly realize that he doesn't have many opportunities left to make a difference. He begins to question all aspects of his life, including his work and family relationships.
There is one thing that professionals agree on - the middle of life is a time when people critically analyze and evaluate their lives. Some may be satisfied with themselves, believing that they have reached the peak of their potential. For others, analyzing their past years can be a painful process.
Men react to reaching the middle of life individually, but still within a certain general scheme. Most of them feel a commitment both to work and to family. The quality of men's performance of their marital and parental roles significantly predicts their level of psychological distress and affects the degree of distress they experience at work.
Farrell and Rosenberg concluded from their research that there are 4 main ways for men to develop in the middle age. The first one is the path of a transcendent and generative man. He does not experience a midlife crisis as he has found adequate solutions to most of life's problems. For such a man, the middle of life is the time to realize his opportunities and achieve his goals. The second way is the path of a pseudo-developing man. This man copes with problems by pretending that everything that happens to him is satisfying or under his control; in fact, he usually feels that he has lost his direction, has reached a dead end or that he is fed up with everything. A man in a midlife crisis - the third way - is confused and feels that his whole world is falling apart. He is not able to meet the demands and solve the problems. For some men, this crisis can be a temporary phase of development; for others, it can be the beginning of a continuous decline. The fourth development path is the path of a man disadvantaged by fate. Such a man has been unhappy or rejected by others for most of his life and shows signs of a life crisis. Usually he is not able to cope with the problems. Only a few men manage to avoid the feeling of failure, internal discord or loss of self-esteem at the middle age - this is the conclusion of Farrell and Rosenberg.
Along with a reassessment of all life in the middle age there is a reassessment of professional career. One of the factors that can force middle-aged people to dramatically change their attitude to work, and the work itself, is the transition they have experienced in the middle of life. Levinson found that after 40 years of age adults can change their values and goals, which makes them think about changing the direction of their professional career. Some researchers believe that adults are best able to cope with this period of reevaluation if they systematically assess their abilities and the pros and cons of their current professional position. However, only a fraction of people change their professional career dramatically in the middle of their lives. This is usually done by those who feel that their abilities are not fully used in the work they have. The reason for this may be a change in the nature of the job or a decrease in the difficulty of tasks due to the professionalism that the person has achieved.
Thus, the depression of business people is characteristic:
- Decrease in efficiency.
- High level of anxiety, all kinds of phobias.
- Decrease in sexual activity.
- Alcoholism, aggressiveness - as a way of relaxation, negative energy release.
- Misrepresentation of friendship, total distrust.
- The inability to enjoy life.
The typical symptoms of depressive states are overlaid with problems and disagreements concerning the midlife crisis: reassessment of values, the search for the meaning of one's own life, a feeling of approaching old age, and therefore a decrease in physical strength and possibly infirmity. All this aggravates the course of depression in businessmen.
Psychodiagnostic features of depression
Diagnosis of depression is a complex task. To diagnose depression, one needs to know its diagnostic criteria. Diagnostic signs of depression are as follows:
- depressed or sad mood,
- loss of interest or sense of pleasure,
- increased fatigue.
- decreased ability to concentrate,
- underestimated self-esteem and insecurity,
- ideas of guilt and self-abuse,
- gloomy pessimistic vision of the future,
- suicidal thoughts or actions,
- sleep disturbances,
- appetite disorders.
The first three clinical manifestations are the main ones. The rest of the symptoms are additional. To verify a severe depressive episode in the clinical symptomatology of a patient, the first three main manifestations of depression, which are combined with at least four additional symptoms, should take the leading place. To make a diagnosis of a moderate depressive episode, two major and three additional symptoms should be present. For a mild depressive episode, the presence of two major and two adjunctive symptoms is sufficient. In all three types of depression, the main symptoms should last at least 2 weeks. If the depressive episodes lasting at least 2 weeks are repeated at least twice at a few months' intervals, they will diagnose repeated or recurring depressive disorders. Repeated depressive episodes may be triggered by a stressful situation.
Sleep disorders in depression can be manifested in many ways: sleep disturbance, frequent night wake-ups, sleep dissatisfaction, awakening difficulties, increased duration of night sleep, daytime hypersomnia. The most specific sign of depression is considered early morning wake-up, in which the patient wakes up at 4 - 5 a.m. for no apparent reason and can no longer sleep.
Very often, general practitioners and psychologists are faced not only with atypical depression, but also with a chronic version of its course. In this regard, it is necessary to know the diagnostic criteria of chronic depression, which can coexist with chronic pain syndrome, which is distinguished by the name of "dystymias". It should be emphasized that dystymias include mild chronic depression in which there are no suicidal thoughts and actions and pronounced social maladaptation. Dystymia is a chronic condition that is characterized by depressed mood for most of the day for more than half of all days in the past two years. Chronic depressed mood should be accompanied by at least two of the following symptoms:
- reduced or increased appetite,
- sleep disturbances or increased sleepiness,
- low performance or increased fatigue,
- underestimated self-esteem,
- concentration disorder or indecision,
- sense of hopelessness.
These symptoms are often combined with long painful sensations. Dystemia may last indefinitely long, begin at almost any age, often dystemia is preceded by a pronounced psychological trauma.
A person in a state of depression is characterized by carelessness in clothing, preference for gray and dark colors, lack of hair, cosmetics and jewelry in women, scarcity of facial expressions and movements sometimes resembling stiffness, bent position, inexpressiveness and monotony of speech, single-complex answers, etc.
There are different combinations of chronic pain syndrome with different types of depression. We should emphasize the frequent occurrence of depression anxiety disorders, which often come to the fore, overshadowing the depressive symptoms themselves. The combination of depression and anxiety, according to A.F. Shatsberg, reaches 62%. The combination of anxiety in combination with muscle tension and depression is especially specific in chronic pain syndromes.
In atypical depression, complaints of chronic pain are often combined with complaints of other unpleasant, poorly described and often poorly localized feelings throughout the body, sleep disorders, appetite, sex drive, increased fatigue, weakness, reduced performance, constipation, dyspepsia; women may have complaints of menstrual cycle disorders that have no organic cause, premenstrual syndrome. In the case of depression, there may be poor appetite and reduced body weight and, conversely, increased appetite when patients "jam" their depression, and thus increase body weight. In these cases, eating remains the only way to get positive emotions - all other needs are sharply reduced. Typical depression is more characterized by a decrease in appetite and weight, while the opposite is often the case for atypical depression.
The abundance of complaints, their unusual combination, which does not fit into the clinical picture of any somatic illness, first of all, suggests a disguised depression.
The focus of diagnosis on the investigation without taking into account the cause, when the secondary somatovagetative manifestations are formed on the basis of affective psychopathological disorders, leads to weighting and chronization of mental pathology. The most dangerous is that undiagnosed and inadequately treated depressive disorders in some cases end in suicide.
Since depressive conditions are so difficult to diagnose, it is recommended to conduct a psychological examination using special standardized methods. The method of differential diagnostics of depressive conditions B can be used for diagnostics of depressive conditions. A. Zhmurova. This questionnaire consists of 44 groups of indications, each of which includes 4 answer options. According to the results of the questionnaire the following levels of depression can be revealed: deep, expressed, moderate, mild, minimal or no depression.
In addition, there are hospital scale for anxiety and depression, Zung scale for self-rated depression, additional MMPI scales for depression, Hamilton scale for depression, Montgomery-Asberg scale for depression, Beck's Depression Scale, Goldberg scale for anxiety and depression.
Psycho-correction work of depression in business people
Depression is a disease that is quite common in medical practice. It primarily manifests itself in the affective sphere and is accompanied by pronounced somatic, motivational, vegetative disorders. In the therapy of depression two directions are developing: pharmacological and non-pharmacological.
Widespread and well-founded pharmacotherapy for depression is still not effective enough in 25% of cases due to poor drug tolerance and resistance of the disease itself.
In this regard, a significant role and non-pharmacological methods of treatment, which also have their pathogenetic justification.
- breathing and relaxation training;
- light therapy (phototherapy);
- sleep deprivation (sleep deprivation);
- electroconvulsive therapy.
Psychotherapeutic treatment methods are divided into psychodynamic, non-directional, rational and interpersonal psychotherapy.
The basic principles of psychodynamic therapy have been developed by Bullak. There are ten most important psychic manifestations to be investigated and corrected (self-esteem, self-blaming, anger, frustration, feeling of loss, narcissism, denial of hidden anger, etc.). Classical psychoanalysis in severe depression is not shown.
Non-directional psychotherapy is based on the concepts of Rogers, Maslow and Perls. The patient expresses his thoughts and feelings, and the psychotherapist, without imposing his interpretations, helps to understand himself. An important condition for treatment is empathy - the psychotherapist's ability to put himself in the patient's place, to see the world through his eyes. The main focus is on the current situation.
Rational psychotherapy is aimed at eliminating irrational ideas expressed by patients with depression. It is more effective in patients with depression in comparison with the psychodynamic method. There are indications that it is comparable or even more effective than drug therapy, especially in mild and moderate depression.
Interpersonal psychotherapy has been developed by Kleermann, Weisman, and others. It improves the social adaptation of patients and interpersonal contacts, reduces the secrecy of patients, allows them to express their thoughts and feelings. It has been shown that interpersonal therapy with regard to certain manifestations of depression, such as social maladaptation, can effectively reduce it, which is comparable to drug therapy.
Thus, it should be noted that psychotherapy is particularly effective for mild to mild depression, characterized by mood decline and some somatic complaints. In general, it should be noted that psychotherapy should be performed by an experienced specialist. However, the treatment of vegetative and sleep disorders is better correlated with medication therapy.
Respiratory Relaxation Training (RTT). Depressive disorders are often combined with anxiety, according to A.F. Schatzberg (1995), in 31 - 62%. Therefore, in these cases, it is advisable to use MRT, which combines elements of mental and muscle relaxation with chest excursions in the rhythm of breath - exhalation. At carrying out of DRT it is necessary to observe several principles: gradual inclusion of a diaphragm in breath, formation of a certain ratio between the duration of breath and exhalation - ratio 1:2. Transition to abdominal type of breathing causes the Goering-Breyer reflex, which helps to reduce the activity of the reticular formation of the brain stem, reducing mental stress, hyperventilation syndrome and anxiety. Thin and deep breathing optimizes the processes of pulmonary ventilation and diffusion, improves microcirculation.
Light therapy (phototherapy). Among the recently used non-medical methods of treatment of depression and related various somato-vegetative disorders began to use therapy with bright white light. Interest in this method has increased in recent decades due to the treatment of seasonal affective disorders (W.Rosental, A.Levy; 1982-1984.) With the lengthening of the dark phase of the day in the autumn period, patients with seasonal affective disorders appear and increase depression, daytime hypersomnia, selective hyperphagia of carbohydrates. The body weight increases. In patients with ADS increases melatonin levels in the blood. With the increase in the light phase of the day the severity of symptoms decreases. In 1980 A. Levy made a report about melatonin blockade with bright white light. After that, light therapy began to be used in the treatment of various disorders: seasonal and non-seasonal affective disorders, insomnia, etc. Bright white light treatment is based on its action through the retina, hypothalamus, b-adrenor receptors of the pinealocyte membrane. Light helps to reduce melatonin, increase serotonin and dopamine. Experience (Ya.I. Levin, A.R. Artemenko, 1996, A.D. Solovyova, E.Y. Fishman, 1997) has shown that bright white light reduces depression, improves sleep, as well as vegetative manifestations accompanying depression.
Phototherapy is carried out by the method that the patient daily (preferably in the morning hours) accepts sessions of light. The lamp cover is installed at an angle of 45 degrees with respect to a straight line from the center of the eyeball to the horizontal axis of the lamp. The patient is 60 cm away from the lamp; the session lasts 60 minutes and the patient receives about 3500 - 4000 lux per session.
Sleep-deprivation (sleep deprivation). In 1966, W. Schulte introduced the treatment of depression with sleep deprivation into psychiatric practice. They were shown that deprivation improves the condition of patients with psychogenic and organic depression. Later on, other researchers noted its pronounced effect in depressive disorders. Sleep disorders are known to occur in 83-99% of depressed patients. Sleep disorders, along with other symptoms, are a criterion for diagnosing depression. Study of sleep in patients with depression showed a decrease in its depth and an increase in motor activity during sleep. In the works of A.M. Vein, R.G. Airapetov, 1983, 1984 it is shown that in different forms of depression the latent periods of the first, second and third phases of sleep increase, there is a pronounced reduction of the fourth, the deepest phase, the slowest phase of sleep, a reduction of the latent period of the fastest sleep phase (SLE) is revealed, which is associated with the pressing of the fastest phase of depression. Thus, subjective complaints of patients about sleep disorder are combined with objective changes during the night on the EEG.
Treatment is carried out with total sleep deprivation. Patients do not sleep from the morning of the day preceding the sleepless night until the evening of the next day, i.e. sleep deprivation is 36 - 38 hours. This is followed by two restorative nights, during which the patients sleep naturally. After that, the deprivation is repeated, if the condition improves, a third sleep deprivation is carried out. Sleep deprivation stops, if the patient's condition does not change or worsens after two sessions. If the condition improves, it is recommended to carry out two sleep deprivation per month. Sleep deprivation provides an improvement in mental condition in 90% of patients. According to R.G. Airapetov (1984), the positive effect of sleep deprivation is especially marked in dull depression, where it is not inferior in effectiveness to antidepressants, adynamic depression. It is less effective in asthenic and anxious depression and has no positive effect in masked depression. Deprivation has a proper thymoleptic and disinhibition effect, stimulating activity, while improving mood and increasing motor activity. There is an activation of the fast sleep phase and synchronization in the waking EEG, which is compensatory in nature and provides emotional stabilization.
Sleep deprivation therapy is indicated for any depression without psychomotor agitation. It itself has a positive effect by reducing depression and significantly increases the effect of antidepressant treatment, which can significantly reduce the dose of pharmacological drugs. The best results are usually achieved in combination therapy: sleep deprivation in combination with antidepressants.
Electroconvulsive therapy (ECT). This type of therapy for depressive disorders was especially widely used in psychiatry in the 30's - 50's, then came the period of rejection. In recent years, there has been renewed interest in this therapy. ECT is used mainly in patients suffering from severe depressive disorders in specialized psychiatric hospitals, as well as in patients with contraindications to pharmacotherapy and in cases where other treatments are ineffective. ECT is a method of choice in cases of extraordinary suicide attempts or persistent refusal to eat, when ineffective antidepressant therapy can lead to a loss of time. It is believed that ECT is most effective for depressive seizures and is a method of treatment for depression that prevents manic attacks. Therefore, it is effective in TIR, where antidepressants increase the frequency of seizures, in the psychotic form of depression, where antidepressants help little or no.
In cases where we encounter mild forms of depression, where non-medical treatment is possible, it is possible to buy the process using the above methods and achieve a relatively stable state of stabilization in clients. In more severe cases, a variety of antidepressants may be used. A detailed program on depression management in business clients will be discussed below.
Depression diagnosis of business people at the Zdravitsa private clinic
Selection for the control and correction group
Objective of the research: to study the depressive states of businessmen.
Objective: to study the depressive states of businessmen.
Subject: Evaluation of the influence of corrective measures on depressive states of businessmen.
Based on the analysis of literature sources, we proposed the following hypothesis: in the course of correctional work, depressive manifestations in businessmen are reduced.
Research base: a group of businessmen (20 people) who sought medical care in a private clinic "Zdravitsa", male sex, age 35-45 years. All clients were divided into 2 subgroups of 10 people each: control and correction. The corrective group is a group that has been directly influenced experimentally during the study. The control group was placed in the same conditions, except that the subjects in it were not experimentally exposed. In order to achieve approximately equal severity in both groups of significant features, test subjects were randomly assigned to the control and correction groups. Random selection of subjects allows to assert with a known certainty that subjects recruited for all experimental influences are approximately equal in their characteristics (subjective variables).
The course of the experiment:
- Conducting a validating experiment for the control and correction group - the Hamilton scale for assessing depression.
- Carrying out corrective actions (forming an experiment) for the control and correction groups.
- Conducting a control experiment for a control and correctional group - a Hamilton scale for assessing depression.
Thus, in our study we used the Hamilton Scale test method to assess depression. It is one of the most widely used tools for clinical assessment of depression. The original version of the scale was first published in England and then translated into all European languages, as well as Japanese, Korean, etc. The original version contains 23 items, 2 of which are in two parts. The scale provides an easy way to assess the severity of depression and reflects the dynamics of changes in the patient's condition.
The time of examination is from 20 to 30 minutes. Evaluation time is defined as "now" or "during the last week". The value of points for 9 points - from 0 to 4. Six points, in which the variables cannot be expressed quantitatively, are evaluated qualitatively from 0 to 2 points. The sum of points as a result of evaluation of persons not suffering from depression is equal to 0. The maximum possible total score is 52 and reflects the extreme severity of the depressive syndrome. The last four points do not measure the severity of depression; they reflect types of depression or rare symptoms. In this study, we were interested in depression severity levels, so we used only the first 17 scales for diagnosis.
Contingent experiment in a study of depression in control and correctional groups
The control and correction groups were tested using the Hamilton scale to determine the level of depression severity.
The average results of the control and treatment groups showed some difference between depression rates. We statistically processed the results to verify the validity of these differences.
Analysis of the results of the validation experiment
The results obtained during testing of the control and correction groups we tested were processed using Mann-Whitney U criterion.
The results of statistical processing of the data of the confirming experiment:
- The average rank of the control group - 9.1
- Average rank of the control group - 11.9
- U of Mann-Whitney Criterion - 36.0
- Significance level - 0.288
The differences between the results of the control and correction groups are not reliable. In other words, test subjects of control and correctional groups do not differ in the level of depression severity.
On this basis, we can draw the following conclusions:
- the level of depression experienced by the control group does not differ significantly from the level of depression experienced by the correctional group.
- In general, for both groups, we can see a mild degree of depression manifesting itself:
- average insomnia - complaints about restless sleep during the night;
- presence of mental anxiety - subjective tension and irritability;
- manifestation of somatic anxiety with a low degree of severity;
- general somatic symptoms, expressed in muscle pain, heaviness in the extremities, head, a sense of loss of strength;
- mildly pronounced genital symptoms;
- attribute their painful condition due to overwork and the need for rest.
Correction of depressive states of businessmen at the private clinic "Zdravitsa"
Formative experiment (corrective measures)
Corrective measures were taken only with the subjects of the correctional group.
Correction work included:
- breathing and relaxation training;
- sleep deprivation.
Psychotherapeutic work included both group sessions and individual consultations. Psychotherapy work was based on cognitive psychotherapy A. Beck Psychotherapy.
А. Beck sees the causes of nervous disorders in information processing disorders. He identifies three main groups of mechanisms in which the disorders are possible: cognitive elements, cognitive processes and cognitive content.
Cognitive elements are divided into basic assumptions (which contain deep ideas of the individual about the world around him, other people and himself) and automatic thoughts (which accompany the processing of information at a given moment in time). Examples of basic parcels: "It is dangerous to trust people", "Nobody needs me and therefore nobody loves me". Automatic thoughts got their name because of their involuntary, fleeting and unconscious. A person does not choose information for reflections but focuses on it involuntarily. These thoughts sharply differ from the conscious ones, in which a certain degree of control over an object is preserved, but subjectively they are experienced as plausible.
Cognitive processes are the connecting link between basic assumptions and automatic thoughts, ensuring that the information that comes into the consciousness again is in line with previous ideas. For example: "Nobody likes me because I am fat. And if anyone loves me, I will not deal with him - he has a bad taste. Cognitive content combines elements and operations around a specific topic ("I am sexually inferior", "I will never marry", etc.).
Among the main logical violations that accompany automatic thoughts are arbitrary inference, selectivity and excessive generalization, "black and white" thinking (tendency to think in categories like "beautiful - horrible", personalization (desire to refer to personally neutral events), underestimation or exaggeration of the importance of individual events or actions.
Cognitive psychotherapy too proceeds from the fact that perception is mediated by thinking, and if it is the middle link to realize, it is possible to understand emotional and behavioral aspects of a person's reaction. At the cognitive stage Beck identified the following information processing disorders that distort the vision of an object or situation and cause false perceptions: designation, selection, integration and interpretation.
Therefore, the purpose of cognitive counseling is to correct inappropriate cognitions, and at the same time, to understand the rules of inadequate information processing and to replace them with correct ones. It is considered very desirable to use that experience in the positive solution of life's problems and transfer of the rules of their solution to problem areas that the client has. The client and the counselor should agree at the outset on the purpose of the consultation - the central problem to be corrected, the means to achieve it, the possible duration of the consultation. Establishing contact may begin with the consultant's acceptance of some of the client's ideas about the problem, with a gradual rational transfer to a cognitive consulting position.
At the initial stage, it is important to reduce problems - identify problems that have the same causes and group them. The next stage is to recognize and verbalize non-adaptive cognitions that distort perception of reality. The term "inappropriate cognitions" applies to any thought that causes inadequate or painful emotions and makes it difficult to solve any problem. The counselor may suggest that the client focus on thoughts or images that cause discomfort in or similar to a problem situation. Inappropriate cognitions are "automatic thoughts" that arise without prior reasoning and for the client are the most plausible, unquestioned. They guide his actions, although they are involuntary and do not attract his attention. Repeatedly approaching or immersing oneself in a situation makes it possible to first realize, collect them and then present them in a rolled-up form.
After the stage of training the client to identify his or her non-adaptive cognitions, he or she should be taught to consider them objectively. This process is called alienation in cognitive counseling. The client sees his non-adaptive cognitions and automatic thoughts as separate from reality, separate psychological phenomena. Removal is important because, first, it helps the client to increase the ability to distinguish between those opinions that need to be justified and undeniable facts, and second, it allows the client to differentiate (differentiate) the outside world and their attitude towards it.
The next stage was conditionally named the stage of changing the rules of behavior regulation. According to cognitive psychotherapy, people use rules (prescriptions, formulas) to regulate their lives and the behavior of others. This system of rules to a large extent predetermines the designation, interpretation and evaluation of events. Absolute rules of conduct entail regulation of behavior that does not take into account the real situation, causing problems in the person; therefore, the client needs to modify these rules, make them more flexible, less generalized and more responsive to reality. The content of behavioral regulation rules revolves around two axes: danger - safety and pain - pleasure. A well-adapted person has a sufficiently flexible set of rules to relate them to reality. In situations of psychological or psycho-social threat, it is difficult to assess the existing risk level.
For example, a person who follows the rule "If I don't get to the top, it will be terrible" finds it difficult to communicate because of the unclear definition of "getting to the top" and the same uncertainty is associated with his or her assessment of the effectiveness of his or her relationship with the partner. The client projects his assumptions about failure on the perception of others. The consultant's task is to change the rules related to the danger/safety axis, restoring the broken contact with the avoidable situation.
Example relating to the axis of pain/friendliness: a person who follows the rule "I will not be happy if I am not famous". Here, hypertrophied pursuit of some targets damages others. The client condemns himself to ignoring other areas of his relationship to please the rule. By identifying such a position, the consultant will help him understand the inferiority of such a rule and explain that the client would be much happier if he was guided by more realistic rules (which the client should find himself with the help of a consultant).
Changing the attitude towards the rules of self-regulation, training the client to see hypotheses in their thoughts instead of facts, to check their truth and replace them with more flexible ones - this is the next task of consulting. The counselor uses the client's existing "resources" (i.e., skills to effectively solve problems in other areas) and then helps to generalize and transfer them to the problem area.
For depressive disorders, cognitive psychotherapy assumes that depression or neurosis is the result of irrational and unrealistic thinking. A person's feelings and behaviors are highly dependent on their opinions, beliefs, thoughts and perceptions. A. Ellis and A. Beck call it cognitions. Thoughts and opinions can be divided into several groups: descriptive (descriptive), evaluative, causal (causal) and prescriptive (prescriptive). All of them are rigidly connected with each other, forming a kind of system of life rules to live by, which means to be inevitably unhappy. According to A. Beck, a list of these neurotic rules (a kind of "moral code of neurotics") may be as follows:
- To be happy, I must be lucky in all my endeavors.
- To feel happy I must be loved (accepted, admired) by everyone and always.
- If I make a mistake it means I am stupid.
- If I haven't reached the top, it means that I have failed.
- How wonderful it is to be famous, rich, popular and how terrible it is to be an ordinary, mediocre person.
- My value as a person is determined by what others think about me.
- I cannot live without love. If my boss (wife, child, mistress) does not love me, it means that I am not suitable for anything.
- If somebody doesn't agree with me it means he/she doesn't love me.
From here it turns out that events in themselves do not mean much, true feelings cause only opinions and assessments of a person. He/she feels what he/she thinks about what he/she perceives. At the same time, they may also contradict each other - and the person still feels unhappy.
Absolutist, dogmatic thinking is at the heart of depressive perception of the world. The neurotic seems to close his eyes to the positive aspects of the world and his own life and sees only the negative ones. Ellis draws a clear line between what he calls "adequate negative emotions" (sadness, resentment, fear, sadness, frustration, regret and anger) and neurotic, depressive experiences. From his point of view, people naturally get upset when their plans or intentions do not come true, when others assess them lower than they should, when they get sick or lose loved ones. "However, when they turn (consciously or unconsciously) their desires or goals into unconditional demands and orders, starting to convince themselves that they have to, just have to succeed and satisfy all their desires in any conditions and under any circumstances, then they sink into depression" - as A. Ellis himself writes in one of the articles.
Another cause of depression is a specific self-relationship, in which a person tends to punish himself more for his miscalculations than praise for success, or when the praise he received looks less than deserved. Self-punishable behavior may be perceived as volitional, masculine, or cultivating, but an unconscious (and irrational) transition from observation, desire to prescription, and evaluation is necessary for the desire to punish oneself as a transition to neurotic depression. For example: "I see how terrible it is to be (short, fat, poor with higher education, provincial)," etc.
Also, people fall into depression, anger or rage when there are few unexpected joys, luck and random success in their lives - and especially if, from their point of view, a neighbor or rival is "luckier". The deficit of positive reinforcement, in terms of behaviorism) creates that tension, which can be discharged in any negative emotional state. From the point of view of M. Seligman and L. Abramson, the neurosis can be based on anticipation of the coming troubles. At the same time, there is a tendency to ascribe internal, stable and global causes to negative external events, and yet if something good happens, it is only by chance, and it passes quickly. Unrealistic expectations of future disasters are especially characteristic of our unstable times.
To sum up, it can be noted that in rational-emotional therapy depression and neurosis are considered to be the product of the following life attitudes:
- The individual has a negative self-esteem, along with the belief that you can not have serious shortcomings, otherwise you will be inappropriate, inappropriate and inadequate for anything;
- The person has a pessimistic view of his or her environment. He is absolutely convinced that it should be much better, and if it does not work out, it is absolutely terrible;
- The future is perceived in a dark light, trouble is inevitable, and the inability to become happier makes life meaningless;
- A low level of self-approval and a high inclination to self-judgment are combined with the notion that a person must be perfect and must be approved by others, or else they do not deserve to be treated well and must be punished;
- Expecting trouble implies that it is inevitable and that the person somehow has to deal with it, and if it does not happen, then he is the worst.
The psychotherapeutic goal was achieved gradually, according to the step therapy model. The sequence of setting a therapeutic goal with the concept of step therapy is as follows:
- Unloading and symptomatic measures to reduce mental pain (in typical depressive conditions).
- Gradual activation, streamlining of the day mode (when there is an improvement or in shallow depression).
- Consolidation of non-depressive behavior (when depression recedes).
- Developing (with the help of psychotherapy) traits in the structure of the personality, able to resist the risk of depression, as well as to counteract depression in everyday life.
- Changes in environmental factors that contribute to depression (at obvious biological risk: drug prophylaxis).
Regardless of the barriers to approaching a depressed client/tangata whai ora and the variety of personal challenges, it is still possible to identify some of the basics of psychotherapeutic support for a depressed client/tangata whai ora. These possible rules are as follows:
- Control over one's own feelings about the patient (emptiness, irritation, empathy).
- Observation with participation (empathy and internal distance).
- Give the client time; don't waste your time.
- Maintain structured progression ("define frames").
- Actively pose targeted questions.
- Soothing confidence (diagnostic clarity).
- Give real hope.
The basic rule should be strictly observed: give a person hope. This does not mean false consolation or embellishment of suffering. On the contrary, therapeutic support requires to recognize that renunciation and hopelessness are integral features of a depressed client, that pessimistic assessment of the future, contrary to expectations and expectations of others, can protect him from the overloads created by the disease. Even thoughts of death and suicidal ideation sometimes mean relief for a depressed client, at least until these thoughts master them and capture them in their entirety. In the case of depressive despair, superficial consolation, taken from the everyday vocabulary (as in "everything will be fine") does not reach the goal, is perceived by the patient as a demand, and deepens the gap between him and his accompanying therapist.
In correctional work, a method of work such as "spore reduction" based on cognitive therapy A was used. Beck. "When, with milder and moderate depression, the patient's thoughts are smooth, but they are still colored negative, the patient can be helped by reasonable objections to his depressive ideas. The American scientist Aaron Beck developed a special form of therapeutic conversation with a depressed patient, called "cognitive therapy", based on initially psychoanalytic and later behavioral therapeutic approaches. This therapy focuses in particular on negative worldviews and related distortions of reality in depressed patients. This therapy, used in modern research (meaning changing self-esteem and reducing feelings of helplessness), has proven to be equal to other methods. This form of conversation is a pronounced opposition to a depressive patient, because it does not provide for a more in-depth revision of the events of the biography and due to the therapist's leadership in the conversation of its end, to which depressed patients, doubtful and slowed down, can be grateful. In addition, this therapeutic method affects the tendency of many depressed patients to self-control. By asking in Socratic manner negative opinions of the patient, the doctor encourages the patient to think about the need to make independent decisions on vital issues, which the doctor offers in the form of homework.
Careful, gentle style of cognitive conversation does not devalue the patient's judgment, but takes it as the basis for an experiment to build non-depressive behavior. Strengthening an active position is also important for a person, because the presence of depressive symptoms at first causes his or her loved ones to sympathize gently, and later may increase the risk of long-term depression. After all, this sympathy is the only benefit a person can count on.
Later, after individual consultations with clients, a group psychotherapeutic work was carried out, the so-called group crisis therapy. Group crisis therapy with the help of various means and methods solves the following tasks:
- Stabilizing the personality. People who have survived critical events in life, for a time severely disturbed mental balance. Emotional problems do not allow to respond to the requirements of life situation in accordance with reality. In order to create prerequisites for overcoming a destabilizing event and interpret it, maybe as a development task, crisis intervention has at its disposal such elements as: expression of empathy, confidence building events, as well as the formation of new attitudes.
- Promoting the development of competence depending on the patient's characteristics and type of events has specific learning objectives. In case of loss, it may be the ability to grieve. In our case - the ability to express emotions and accept support from other people, the ability to form new satisfactory social relationships. These goals are oriented to the individual and consist in finding internal resources.
- Disclosure of social resources and social integration (if necessary - in a new environment). In crisis therapy, the social environment is called upon to help the patient, and they contribute to helping the patient.
The composition of the group of 10 people, different in age, at different stages of the disease, which removes the idea of the uniqueness of their own problems, promotes the exchange of life experiences and different ways of adaptation.
Frequency and duration of classes: 2 times a week, 1.5-2 hours.
The role of group cohesion in such a group differs from its value in an interpersonal group, where it is used for empathy training and arises in the process of this training. In a crisis group, cohesion of its participants develops in the course of mutual support and is used to resolve their situation. In this regard, the group members are encouraged to communicate outside the classroom.
"It is necessary to note the complexity of the work of a psychotherapist in such a group. Expressed need of crisis patients for psychological support, summing up when they join a group, can lead to emotional overload of the psychotherapist. In addition, it is necessary to record changes in the states of the group members, prevent the spread of aggressive and autoaggressive tendencies.
In order to reduce the above mentioned difficulties, it is desirable to conduct a crisis group together with a co-therapist, whose functions are as follows.
At the first stage, together with a leading psychotherapist, he or she participates in creating an atmosphere of unconditional acceptance of the personality and experiences of patients.
At the second stage, ensures that the group members are included in the discussion, control their condition, and provide the necessary psychological assistance in case of deterioration.
At the third stage, in the process of role-playing, she acts as an assistant director and commentator, loses the role of the patient or persons from his or her immediate environment, and conducts autogenic training aimed at improving emotional self-control.
In the final phase of the training, the final session summarizes the patient's therapeutic achievements and supports the patient's confidence in his or her ability to realize his or her plans.
Classes in a psycho-training group during the first three weeks relieve depression in 90% of participants. Many people get rid of certain forms of behavior that have interfered with them, get rid of sicknesses, acquire skills to overcome stressful situations and solve life problems: some people get promoted, others establish relationships in the family, and others begin to feel happy. During the classes, people recover their potency, faith in themselves, their abilities, strength, and a desire to learn and do their interesting work.
But most importantly, those who have taken these courses develop new algorithms of behavior that help to respond adequately to real life, to remove complaints to other people, to feel joy. And in the future, studying again in a psycho-training group, they strive to maintain their optimal state of mind and spirit, and this is a complete victory over depression.
During the treatment process, depressed patients learn, under the guidance of a therapist, to help themselves and each other, of course, not only with the mind, but also with the creative healing of the soul, temporary (by circumstances) or with a gradual entry into the healing and creative lifestyle. "I listen to my depressed companion for a long time, and then ask if he can remember something bright. It turns out that not only can't, but, according to him, there is nothing to remember, because there was simply no light in his life. I can say the same about me. And if I recall the undoubtedly light episode, I will answer that it was only a mirage, but there was no real light. There wasn't and there isn't any light episode, moreover, it won't be anymore - here is a typical depressive motif, repeated in different ways. And it's not about a more or less gloomy view of life, but about the fact that positive life ideas, including the idea of counteraction to the disease, are discredited, making it difficult, if not impossible, to stop the positive movement. These are the memories of one of the clients about their first session in a psychotherapeutic group. By the end of the class, he also presented to the rest of the group a poem of his own, imbued with hope and faith in the future.
As mentioned above, in addition to psychotherapy, other methods of depression correction were used.
Respiratory Relaxation Training (RTR) combines elements of mental and muscle relaxation with excursions of the chest in the rhythm of breath - exhalation. The transition to abdominal breathing causes the Goering-Breyer reflex, which reduces the activity of reticular formation of the brain stem, reduces mental tension, reduces hyperventilation syndrome and anxiety. Thin and deep breathing optimizes the processes of pulmonary ventilation and diffusion, improves microcirculation. The frequency of breathing and relaxation training for this client group is 3 times a week.
Light treatment was also used - light therapy (phototherapy). Treatment with bright white light is based on its action through the retina, hypothalamus, b-adrenor receptors of the pinealocyte membrane. Light helps to reduce melatonin, increase serotonin and dopamine. Daily in the morning hours, clients receive sessions of light. The lamp cover was installed at an angle of 45 degrees with respect to a straight line from the center of the eyeball to the horizontal axis of the lamp. The patient was 60 cm away from the lamp; the session lasted 60 minutes.
The common treatment of depression through sleep deprivation was also used in this course of correction. The treatment was carried out with total sleep deprivation. Clients were awake from the morning of the day preceding the sleepless night until the evening of the next day, i.e., sleep deprivation was 36-38 hours. This was followed by two recovery nights, during which clients slept naturally. There were 2 sleep deprivation nights.
After corrective actions in the correctional and control groups, a control experiment was conducted - repeated testing with the Hamilton Scale to assess depression in order to identify the level of depression severity.
Repeated measurements were made independently of the confirming experiment. During the repeated study, the therapist did not see the results of previous measurements, filling in only the blank form of the scale. The therapist in every possible way avoided questions related to changes in the client's state since the last measurement.
On the average, we can see that the depression level in the control group is higher than in the correctional group. In order to validate these differences, we processed the results using the Manna-Whitney U Criterion. The validity of differences was found to be 0.01 significance.
The differences between the results obtained from the study of the control and correctional groups are valid at the significance level 0.01.
Based on this, we can draw the following conclusions:
- A validating experiment found no significant differences in depression severity between controls and correctional groups, i.e., they have approximately equal symptoms and the severity of a depressive condition assessed as mild;
- In the correctional group, there was a decrease in depression severity after the activities of the formative experiment compared to the recording experiment;
- In the control group, the level of depression severity increased over the same time period (without corrective action);
- After the forming experiment, the corrective group noted a change in depressive symptoms: normalization of sleep, reduction of subjective tension and irritability, reduction of somatic anxiety, increase in physical activity and decrease in fatigue, normalization of sexual activity.
Thus, we can state that our initial hypothesis that in the course of correctional work depressive manifestations in businessmen are reduced has been confirmed.
In the course of studying theoretical literary sources, we found out that depression is a mental disorder: dreary, depressed mood with the consciousness of its own worthlessness, pessimism, monotony of ideas, reduced motivation, slow motion, various somatic disorders. Depressions can be both explicit and atypical, and disguised. There is often a simple mood disorder with depressive features.
Depression as a pathological condition should be differentiated with a temporary decrease in psychophysical tone, typical for healthy people. Pathological depressive state may develop in the absence of objective causes of mood decline. If the cause still exists (chronic fatigue, grief, prolonged mental agitation), then pathological depression continues with the elimination of this cause.
Diagnostic signs of depression are as follows: the main - low or sad mood, loss of interest or sense of pleasure, increased fatigue; additional - reduced ability to concentrate, low self-esteem and insecurity, ideas of guilt and self-esteem, gloomy pessimistic vision of the future, suicidal thoughts or actions, sleep disorders, appetite disorders.
Depression of business people is characterized by decreased efficiency, high level of anxiety, various phobias, decreased sexual activity, insomnia, alcoholism, aggression - as a way of relaxation, the discharge of negative energy, distortion of ideas about friendship, total distrust, inability to enjoy life. The typical symptoms of depressive states are overlaid with problems and disagreements concerning the midlife crisis: reassessment of values, the search for the meaning of one's own life, a feeling of approaching old age, and, consequently, a decrease in physical strength and, possibly, infirmity. All this aggravates the course of depression in businessmen.
To diagnose depression, in addition to individual conversations with a doctor, standardized questionnaires and scales can be used: the technique of differential diagnosis of depression B. A. Zhmurova, hospital scale for assessment of anxiety and depression, Zung scale for self-assessment of depression, additional scales of the MMPI questionnaire for assessment of depression, the Hamilton scale for assessment of depression, Montgomery-Asberg scale for assessment of depression, Beck's depression questionnaire, Goldberg scale of anxiety and depression.
Depression treatment is comprehensive and depends on the severity of the condition and level of depression. Along with drug treatment with antidepressants, non-drug methods of treatment are used: psychotherapy; breathing and relaxation training; light therapy (phototherapy); sleep deprivation (sleep deprivation); electroconvulsive therapy.
In our practical work we put forward the hypothesis that in the course of correction work depressive manifestations in businessmen are reduced. To confirm the hypothesis in the correctional group we carried out measures aimed at reducing the level of depression severity. According to the obtained results of the research, the results of statistical processing, we concluded that the hypothesis was confirmed. In other words, in the course of the correction work depressive manifestations of the businessmen are really reduced.
By: Alexandra Dimant