Psychotherapist in the treatment of MS. Modern problems of science and education. Hell in a relationship

Irritable bowel syndrome, or IBS, is a persistent functional disorder in the intestines, expressed in chronic discomfort, pain and cramps in the abdomen and accompanied by changes in the frequency and consistency of stools in the absence of organic causes. This is not even a disease, but rather a syndrome that has a psychological basis and arises as a result of the reaction of an overly sensitive intestine to stress and other unfavorable life situations.

IBS is considered one of the most common diseases in the world, affecting up to 20% of the adult population of the Earth. Doctors note that the syndrome most often appears between the ages of 25 and 40, although it often begins in childhood and adolescence. In representatives of the fairer sex, this pathology is observed twice as often as in men. It has been noted that in most cases, people with irritable bowel syndrome do not seek medical help in a timely manner, as they consider the ailment to be the result of poor nutrition or physiological characteristics of the body.

Today, most doctors believe that main reason What causes IBS is stress and psycho-emotional stress. Permanent negative emotions, depression, anxiety, panic disorders negatively affect the state of the nervous system, constantly maintaining it in an excited state.

This leads to disturbances in intestinal motility and excessive sensitivity of its inner lining to any adverse effects. In such conditions, even minor errors in the usual diet or consumption of a particular food can trigger symptoms of IBS. In addition to this, there are a number of other possible reasons causing pain and discomfort. This:

The more of the above factors cause IBS, the stronger its symptoms will appear.

Symptoms of the disease

Irritable bowel symptoms usually appear after eating and are paroxysmal in nature. Uncomfortable and painful sensations last from two to four days, after which they disappear without a trace. About availability of this disease they say when the symptoms persist long time(more than a month) or unpleasant and painful manifestations are repeated over the last three months, and each month lasts 2-3 days in a row.

Main symptoms:

Abdominal cramps and pain that go away after bowel movements. The nature of the pain is wandering, the patient cannot accurately determine the location of its localization
Constipation (stool less than three times a week) or, in some cases, these conditions may alternate
Excessive gas formation (flatulence)
Swelling and bloating
Sudden and intense urge to defecate
Feeling incomplete emptying bowel after stool
The appearance of mucus in the stool

In addition to these symptoms, there are general signs diseases not related to intestinal symptoms:

Anxiety and depression, headaches
Pain in the lumbar region, heart rhythm disturbances
Decreased libido
Frequent urge and discomfort when urinating
Autonomic disorders
a (chilliness, lump in throat, difficulty breathing)

Signs of intestinal irritation may appear immediately after eating, or in a stressful situation. In women, symptoms of IBS may occur before menstruation.

Classification of irritable bowel syndrome

Depending on which symptom is the leading one, intestinal irritation is divided into three types:

IBS accompanied by diarrhea
IBS with constipation predominance
IBS accompanied by cramping abdominal pain and flatulence

How is IBS diagnosed?

Since this disease does not cause pathological changes in the gastrointestinal tract, there is no single test to determine the disease. To diagnose a disease, an experienced doctor must rule out other possible diseases with similar symptoms. If at least two of the following symptoms are present, a specialist may suspect that the patient has IBS:

The patient complains of constipation or diarrhea, pain or bloating that goes away after defecation
Frequent sudden urge to defecate, a feeling of incomplete bowel movement after it, the appearance of mucus in the stool
Unpleasant symptoms are most severe after eating

Having identified these symptoms, the doctor can prescribe a number of tests to help confirm the diagnosis. General and biochemical analysis blood. The study will determine the number of blood elements such as leukocytes, erythrocytes, and platelets. The erythrocyte sedimentation rate (ESR) and white blood cell count will indicate whether there is an infectious process in the body.

Test for celiac disease. It will help to exclude such a disease digestive tract like celiac disease. A blood test is done to check the body's immune response to gluten. This reaction leads to damage small intestine and calls frequent attacks diarrhea and indigestion.

Colonoscopy and sigmoidoscopy. to examine the rectum and colon, and sigmoidoscopy will allow you to examine the rectum and sigmoid colon. Such examinations are carried out after special preparation of the patient; the procedures are performed in medical institution experienced specialists.

MRI and CT scan . Prescribed in order to exclude such serious illnesses, fecal stones, inflammation of appendicitis or cancer.

Treatment of IBS (irritable bowel syndrome): drugs and folk remedies

Complex therapy for the treatment of irritable bowel syndrome includes the use of medications in combination with the correction of psycho-emotional states and adherence to a certain diet.

Drug therapy for IBS includes the use of the following drugs:

Considering the fact that stress factors play a major role in the onset of the disease, psychotherapeutic measures will help to significantly improve well-being and reduce the intensity of IBS manifestations. Patients with a similar diagnosis are recommended to consult a psychotherapist. Psychological techniques will help reduce anxiety levels and help avoid panic attacks, will teach you to resist stressful situations and respond appropriately to problems.

Hypnotherapy successfully reduces the influence of the subconscious on the appearance of certain clinical symptoms diseases. Psychological training using relaxation techniques helps calm and strengthen the nervous system. Yoga classes, special breathing exercises and meditation will teach you how to relax quickly and correctly. And physical education and therapeutic exercises will help strengthen the body and improve the nervous system.

Diet for IBS: proper nutrition

With irritable bowel syndrome, a very important factor is following a certain diet. It should facilitate normal operation digestive system, be balanced, rich in vitamins and essential nutrients. For constipation, a proper diet performs a cleansing function, and for diarrhea, it reduces indigestion. You need to eat fractionally, in small portions, every three to four hours, the daily caloric content of the diet should not exceed 2500-2800 kcal.

In case of IBS, it is necessary to exclude from the diet foods that cause putrefactive and fermentation processes in the body, nausea and bloating. Give preference to products with high content squirrel and dietary fiber, and discard those that the body does not tolerate well.

If the syndrome is accompanied by constipation, include foods that improve motor function intestines:

For constipation, exclude from the diet flour and confectionery products made from butter dough, jelly, slimy soups, pureed porridge, chocolate, strong coffee, tea. If you suffer from flatulence during constipation, remove whole milk from your diet. Rye bread, legumes, grapes, cabbage, potatoes.

Nutritionists advise eating beets, prunes, freshly squeezed vegetable and fruit juices, carrots, and pumpkin. Avoid hot dishes; they should be served warm. If IBS occurs with diarrhea, the foods included in the daily menu should reduce intestinal motility. You should not eat foods that cause stool liquefaction and stimulate bowel movements. Products recommended for consumption:

Sausages, sugar, salt, spices, seasonings, sauces, spicy and pickled dishes are removed from the diet. Exclude from the menu fruits, vegetables, fatty fish and meats, whole milk and fresh fermented milk products, bran bread, baked goods, and carbonated drinks. Food is taken in small portions, as often as possible, up to six times a day. Such a low-calorie diet is not prescribed for a long time, as it can cause vitamin and protein starvation and lead to exhaustion of the body.

Treatment of IBS (irritable bowel syndrome) with traditional methods

Before using traditional medicine, you must consult with a gastroenterologist and your doctor and avoid factors that provoke the occurrence of the syndrome. During treatment, try to abstain from alcohol, smoking, eat right and avoid physical activity and nervous strain.

For diarrhea, medicinal plants such as sage, white cinquefoil, serpentine, and blueberry help well. You can prepare decoctions and infusions from medicinal herbs, and brew strong tea with blueberries. Herbs such as fennel, mint, and valerian will help relieve pain. With severe flatulence, anise, cumin and chamomile are great help.

As preventive measures for irritable bowel syndrome, doctors advise giving up smoking and alcohol, leading an active lifestyle, not overeating, including foods rich in fiber in your diet, exercising and avoiding stressful situations.

It is necessary to avoid foods that cause intestinal irritation, eat whole grain bread, dairy products with bifidobacteria, and drink up to one and a half liters of liquid daily. This will help achieve normal bowel function and avoid unpleasant symptoms.

In any case, patients with IBS should not neglect the disease, take into account their individual characteristics when drawing up a menu, do not look for recommendations and folk remedies on Internet forums, and in time to seek help from specialists. Doctors will conduct the necessary examination, help adjust the menu and prescribe all the necessary medications. Only through joint efforts can we achieve improved well-being and defeat the disease.

Is irritable bowel syndrome treated by a psychotherapist?

Here I want to dwell separately on such a problem as irritable bowel syndrome (IBS) . This complex disorder is psychosomatic. The medical understanding of the term “psychosomatics” implies a disorder when there is physical discomfort and changes in the functioning of organs, but the reason for this is a violation of nervous regulation.

IBS usually develops in close connection with gastrointestinal disorders. But these disorders are not a disease of the intestine, but a violation of its nervous stimulation and irritation. And this causes great suffering to a person.

Usually, in the vast majority of cases, an infectious problem or dysfunction with intestinal dysbiosis is present at the very beginning of the development of this psychosomatic disorder, IBS.

For example, a person was poisoned and then got an intestinal disorder for a long time, which he could not cope with for a long time. Or it could be a consequence long-term use antibiotics for some other diseases.

But further, the basis of the mechanism of this chronic disorder is vegetative (sympatho-adrenal) disorders. They are associated with a combination of gut reflexes and unconscious stress. All this causes manifestations of irritable bowel syndrome.

As the disease progresses, phobias arise associated with intestinal discomfort, significant life restrictions and a lack of guaranteed control of the intestines, which causes increased anxiety.

A person suffering from IBS becomes accustomed to the fear of diarrhea or pain, and adjusts his life to avoid the consequences of expected troubles. After all, it is simply impossible to control your intestines, and a person is tied to toilets. And the fear of terrible shame, “if suddenly...”, increases the stressful anticipation of an exacerbation, thereby “charging” nerve impulses for this aggravation. That is, the fear of anticipation programs the next intestinal irritation. Irritable bowel syndrome is a variant of somatoform neurotic disorder (neurosis).

Gastroenterological examination does not reveal significant physical changes in the intestines. At the same time, patients suffer from symptoms of one of three forms of irritable bowel syndrome:

1. irritable bowel syndrome with diarrhea (diarrhea);

2. irritable bowel syndrome with spastic pain and bloating;

3. irritable bowel syndrome with constipation.

There are also cases where the predominant forms of IBS change over time.

What is the role of psychotherapy in IBS?

The best effect for irritable bowel syndrome is provided by cognitive behavioral therapy. There are several goals in psychotherapeutic work with a patient.

The first goal is fear of anticipation of subsequent attacks and a change in “avoidant” behavior. The stage of learning self-control when an exacerbation begins is very important here; techniques are used that help reduce the level of tension and fear. These are special concentration and breathing exercises. Improving self-control allows you to more manage your behavior and expand your comfort zone when moving around in your life. And as a result, the intestinal reflexes that lie in the reinforcement mechanism of IBS are weakened.

It is also very important to wean yourself from rituals of protective behavior when you feel better, because all this allows IBS to be reinforced. It happens that with IBS, the patient gets used to making sure that the intestines are emptied before leaving the house, that the route of movement is laid out only where there are toilets and where they are not, or there is no opportunity to leave at any time - to exclude movement and stay. Human sociality suffers significantly.

In addition, special attention is paid to the development of personality characteristics, because such states are characteristic of emotionally unstable and anxious individuals who throughout their lives have “learned” to restrain their stress inside the body. Analysis and psychological processing of current life difficulties, past catastrophes in life, anticipation of future failures and the impending meaninglessness of life.

Such A complex approach to the problem when a person suffers from irritable bowel syndrome, allows you to cope more reliably and with a stable result for the future.

What is the role of medications in IBS?

The use of special means that can regulate the nerve impulses of the intestines and the general emotional background is in some cases mandatory. There are also many such cases of IBS. And then we need to smooth out the deformed intestinal reflexes at the first stage of treatment, this helps the psychotherapy that has already begun. This is applied in a strictly verified course, under the supervision of a psychotherapist whom you visit for cognitive behavioral therapy for irritable bowel syndrome. Modern medicines They allow you to feel productive, and with a qualified approach they have virtually no side effects and addictive properties.

BE HEALTHY!!!

How should Irritable Bowel Syndrome (IBS) be treated in adults? This question is often addressed to doctors of various specialties, because treatment must be comprehensive: medications, diet, lifestyle changes, psychotherapy and even surgical operations.

Only timely and complete treatment of IBS guarantees complete relief from all symptoms of the disease and preservation of the patient’s physical health. Moreover, the sooner treatment is started, the greater the chances of recovery and the simpler the therapy itself will be.

- This is a fairly severe functional disease, which manifests itself as abdominal pain, digestive disorders and changes in stool.

The reasons for the development of IBS are interesting; this disease can develop with complete physical health, without organic intestinal pathologies. The main cause of the disease is considered to be psycho-emotional factors: stress, nervous tension, sedentary lifestyle life and poor nutrition.

The disease can also be triggered by hereditary diseases, bad habits, previous infectious diseases and hormonal disorders.

Today, IBS is considered one of the most common gastrointestinal diseases. intestinal tract, it affects both adults, mainly aged 25-40, and children - from toddlers to teenagers.

Irritable bowel syndrome manifests itself:

a feeling of pain, fullness, heaviness in the abdomen - symptoms occur immediately after eating or after some time;
bowel dysfunction – there may be constant constipation, diarrhea or their alternation;
the appearance of mucus, blood, pieces of undigested food in the stool;
frequent urge to defecate and a feeling of incomplete bowel movement;
additional symptoms: headache, feeling of constant fatigue, decreased performance and concentration.

The diagnosis of IBS is made only after excluding organic intestinal pathologies and infectious diseases, as well as when several symptoms of the disease persist for 3 months or more.

Treatment of the patient must be comprehensive and must include not only medication, but also psychotherapy, diet and lifestyle changes.

Treatment

Treatment of the syndrome must begin using several methods simultaneously:

All patients with irritable bowel syndrome need to be prepared for long-term and fairly intensive treatment.

Drug therapy

Drug therapy helps to get rid of the main symptoms of the disease: abdominal pain, digestive and bowel problems, as well as relieve anxiety and nervous tension that always accompany this disease.

For treatment use:

Diet

One of the most important conditions successful treatment for IBS is diet. The diet and nature of nutrition depend on the form of the disease: with a predominance of constipation or diarrhea, but there is general principles meals that are the same for all patients with digestive disorders:

Diet for constipation

Products should stimulate intestinal function, speeding up digestion and facilitating bowel movements.

The basic principles of diet No. 3 according to Pevzner do not differ from those listed above:

It is forbidden to eat: smoked meats, meat fatty varieties, butter dough, fried eggs, pasta, rice, legumes, mushrooms, onions, garlic, cabbage, radishes, quince, dogwood, any products containing fats;
allowed: stewed and boiled vegetables, fermented milk products, buckwheat, egg grits, millet, lean boiled or steamed meat and fish, bran, wheat bread, dried fruits, sweet fruits and berries.

Diet for diarrhea

Diet No. 4 according to Pevzner, used for frequent diarrhea, should provide the body with all the necessary nutrients. The number of calories with it is slightly reduced, the dishes are subjected to minimal heat treatment, eating only warm.

Psychotherapy

Psychotherapy is the only treatment method that can be called etiological for irritable bowel syndrome.

Since this is a disease, it is treatment by a psychotherapist that will help cope with the problems that caused the development of the disease: nervous tension, constant stress, inability to build relationships with other people. Only by getting rid of internal problems and changing their lifestyle will patients be able to fully cope with the symptoms of the disease and avoid relapse of the disease.

Cognitive behavioral therapy, psychoanalysis and hypnosis are most often used to treat the disease.

One of the most important goals of such treatment is to combat the fear of attacks of the disease. All patients with IBS are afraid that the symptoms of the disease may arise suddenly: under stress, fear, in an unpleasant situation, and so on. As a result, they diligently avoid such situations, try to leave the house less, or go only to well-known, nearby places where there is always an opportunity to visit the toilet. The ability to control their body helps such patients get rid of fear and significantly increases their social activity.

It is very important to teach patients relaxation techniques and the ability to “reset” negative emotions, since this is the area that usually suffers in patients with IBS.

Cognitive behavioral therapy and psychoanalysis help the patient understand exactly what thoughts, attitudes and actions cause the development of stress, negative experiences, and so on. Having learned to cope with these situations, patients get rid of most nervous tension and their condition is improving.

Hypnosis is recommended in cases where the patient cannot remember the cause of the illness or has had serious psychological trauma. A hypnosis session helps to cope with fear and remove the “barrier” remaining in the subconscious.

Treatment at home

If you suspect the development of irritable bowel syndrome or the first signs of the disease, you can try to cope with the symptoms of the disease at home.

To do this, you need to stick to a diet, be sure to stop drinking alcohol and smoking, as well as change your daily routine and reduce your stress level.

The following activities will help restore the health of the nervous system and the entire body as a whole:

reduce mental and physical stress - no more than 7-8 hours a day;
sleep at least 8 hours a day;
spend at least 1 hour outdoors;
do physical exercise;
Every day, relax for at least 2-3 hours, engage in hobbies, take a walk, but do not use any gadgets during this time, including watching TV;
reduce the time spent at the computer and its analogues;
Be sure to relieve nervous and muscle tension once a day: this can be yoga, meditation, breathing exercises, sand or art therapy, or any other suitable method.

There are folk remedies that can also help treat IBS at home:

Pine baths are a relaxing remedy. To prepare such a bath, add 15-20 drops to warm (38-39 degrees) water aromatic oil or 0.5 liters of pine needle infusion.
Peppermint infusion. 1 tsp. dry raw materials per 1 tbsp of boiling water, leave for 10-15 minutes, take 1/2 tbsp 2-3 times a day after meals.
Infusion of herbs or dill seeds. 1 tbsp. l. 2 tbsp of boiling water, leave for 10-15 minutes and take 1/2 tbsp 3 times a day before meals.
Infusion pomegranate peels. 1 tbsp. l. crushed peels in 1 tbsp of boiling water, leave for several hours, take once a day before meals.

Irritable bowel syndrome is a serious and serious disease, so you should not get carried away only with traditional methods or treat it at home, refusing to see a doctor. Only timely and comprehensive treatment can completely relieve the patient from the symptoms of the disease and maintain the health of his digestive system.

Keywords

PSYCHOTHERAPY / PSYCHOSOMATIC DISEASES / INTESTINAL DISEASES/ PSYCHOTHERAPY / PSYCHOSOMATIC DISEASE / DISEASES OF AN INTESTINE

annotation scientific article on clinical medicine, author of the scientific work - Esaulov V.I., Marilov V.V.

The work is devoted to studying the effectiveness of psychotherapy in patients with irritable bowel syndrome (IBS). 200 patients with IBS were examined. (150 women and 50 men), who were observed over time during complex treatment, including psychotherapy. Therapy was based on the stage of the disease and personal characteristics. In the early stages of IBS, the main goal of psychotherapy was the psychological resolution of the main conflict that caused the disease; therapy was also aimed at working with various manifestations of somatized depression. Subsequently, psychotherapeutic efforts were aimed at correcting existing mental disorders, and for relief somatic condition, correction of the scale of illness experiences, and comprehensive rehabilitation of patients. The study showed the need to add to traditional, previously used psychotherapeutic techniques for IBS, modern techniques(NLP, Ericksonian hypnosis, short-term positive therapy, transactional analysis, etc.), increasing the effectiveness of treatment. The advisability of combined treatment of patients with IBS by both gastroenterologists and psychiatrists who are proficient in modern methods of psychocorrection was noted. In the chronic course of the disease, when pathological changes in the character of patients have been observed, psychotherapy should be combined with small doses sedatives and/or antidepressants.

Complex psychotherapy of irritable bowel syndrome

The authors have studied psychotherapeutic approaches to the treatment of patients with Irritable Bowel Syndrome (IBS). The monitoring of two hundred IBS patients (150 women and 50 men) has pointed to an integrated approach as the optimal one. The therapy of such patients should be linked to the particular stage of the disease and a patient's personality. At the early stage of IBS the main tasks are to resolve the conflict which had provoked the illness as well as to treat different forms of depression In the case of sustainable IBS the treatment should be geared to the correction of mental disorders and easement of somatic condition as well as adjustment of the scale of the disease and rehabilitation. The study has demonstrated the desirability of complementing traditional psychotherapy with modern psychotherapeutic methodologies (NLP, Ericson's hypnosis, short-term positive therapy, transaction analysis, etc.) that boost the effectiveness of the treatment. The study has also pointed to the crucial role of treating IBS patients by both gastroenlerologists and psychiatrists who have mastered modern methods of psycho-correction. As for chronic with pathological personality mutations the psychotherapy should be integrated with infinitesimal doses of sedatives and/or antidepressants.

Text of scientific work on the topic “Complex psychotherapy of irritable bowel syndrome”

COMPLEX PSYCHOTHERAPY FOR IRRITABLE BOWEL SYNDROME

V.I.ESAULOV, V.V.MARILOV

Department of Psychiatry and Medical Psychology of RUDN University. Moscow. 117198, Miklouho-Maklaya, no. 8. Faculty of Medicine

The work is devoted to studying the effectiveness of psychotherapy in patients with irritable bowel syndrome (IBS). 200 patients with IBS were examined. (150 women and 50 men), who were observed over time during complex treatment, including psychotherapy. Therapy was based on the stage of the disease and personal characteristics. In the early stages of IBS, the main goal of psychotherapy was the psychological resolution of the main conflict that caused the disease; therapy was also aimed at working with various manifestations of somatized depression. Subsequently, psychotherapeutic efforts were aimed both at correcting existing mental disorders and at alleviating the somatic state, correcting the scale of illness experiences, and comprehensive rehabilitation of patients. The study showed the need to add modern techniques (NLP, Ericksonian hypnosis, short-term positive therapy, transactional analysis, etc.) to the traditional, previously used psychotherapeutic techniques for SRTC, which increase the effectiveness of treatment. The feasibility of combined treatment of patients with IBS has been established by both gastroenterologists and psychiatrists who are proficient in modern methods of psychocorrection. In the chronic course of the disease, when pathological changes in the character of patients have been observed, psychotherapy should be combined with small doses of sedatives and/or antidepressants.

Key words: psychotherapy, psychosomatic diseases, intestinal diseases.

Among patients with diseases of the gastrointestinal tract (GIT), a significant proportion are patients with irritable bowel syndrome. Currently, IBS is considered a typical psychosomatic disease of the gastrointestinal tract. The clinic consists of stool disorders, abdominal pain, flatulence and various mental disorders of the borderline level. Symptoms characteristic of those suffering from IBS include: anxious depression, hypochondriacal fixation on well-being, cancerophobia. The long course of the disease leads to persistent pathocharacterological changes, expressed in various options psychosomatic development personality.

Treatment of this group of patients remains a challenging clinical problem, mainly due to the tendency for frequent relapses under the influence of numerous stress factors. In most cases, psychotherapy is indicated for patients with IBS.

A number of publications describe the successful use of psychotherapy methods in patients with IBS. Foreign authors emphasize that the best effect is achieved by combining various psychotherapeutic methods.

In domestic practice, in the treatment of IBS, methods of rational, hypnosuggestive therapy, “abdominal” auto-training, and muscle relaxation have been used for many years. At the same time, such effective psychotherapeutic techniques as gestal therapy, transactional analysis, Ericksonian hypnosis, neuro-linguistic programming (NLP), positive therapy and others were practically not included in the treatment of IBS in our country. modern methods psychotherapy.

In order to study the effectiveness of complex psychotherapeutic effects on patients suffering from this pathology, we examined over time 200 patients with IBS (150 women, 50 men) who were treated in a gastroenterology clinic. The age of the patients ranged from 21 to 60 years. In all subjects, the diagnosis of IBS was made by gastroenterologists after excluding organic gastrointestinal pathology. Clinical-catamnestic, clinical-psychopathological and experimental-psychological methods of examining patients were used. Based on the prevailing psychopathological picture, we identified various variants of irritable bowel syndrome: melancholic, depressive-anxious, depressive-hypochondriacal, depressive-phobic and schizoform.

When constructing treatment tactics, the leading psychopathological syndrome, personality traits of patients, stage of the disease.

The targets of psychotherapy for various variants of IBS were: pathological anxiety, characteristic of all variants of the course of the disease, depressive disorders, hypochondriacal orientation of experiences, various phobias (primarily cancerophobia). An important point therapy for this category of patients was also its focus on the resocialization of patients, because The chronic course of IBS led to the development of certain social restrictions, avoidant behavior, and the formation of a distinct socio-psychological position of self-isolation.

The choice of therapeutic techniques was influenced by the limited length of stay of patients in the gastroenterology department, and the need to achieve a quick positive effect from the first sessions (to strengthen the motivation of patients to continue psychotherapy). That is why, at the stage of inpatient treatment, preference was given to short-term psychotherapy techniques focused on quickly solving problems and changing the condition. These included primarily relaxation techniques, as well as short-term positive therapy, NLP, some Gestalt therapy techniques, and Ericksonian therapy using resource trances. At the stage of maintenance treatment after discharge, or when patients requested deeper work, psychoanalytic and personal growth techniques were used.

The use of various relaxation techniques, the “abdominal version” of auto-training for almost all types of IBS, reduced internal tension and anxiety, which indirectly had a beneficial effect on the activity of the gastrointestinal tract and general health patients. At the same time, only with the help of these methods it was not possible to resolve many interpersonal and intrapersonal conflicts, which were both the trigger point of the disease and contributed to its chronicity.

The additional inclusion of transactional analysis, positive therapy, Gestalt therapy, NLP and other modern psychotherapeutic techniques in therapy helped to solve many problems and conflicts, realize the psychological “gains” from the disease, strengthen faith in the ability of patients to cope with their difficulties and manifestations of the disease, and also teach patients make positive decisions on your own, stop “hiding behind illness,” and abandon the usual role of “weak and helpless.”

Psychotherapy tactics were based on the stage of the disease. At the initial stages of IBS, when the theme of a psychotraumatic situation clearly sounded in the experiences, pathogenetic psychotherapy was first used, aimed at restructuring the patient’s system of relationships and attitudes, optimizing the action of mechanisms psychological protection. Efforts were directed primarily at psychological awareness and the search for adaptive methods of psychological defense aimed at resolving the main conflict that caused the disease. The work was aimed primarily at reducing the severity of experiences, switching from a traumatic situation, and providing the opportunity to verbally respond to negative experiences.

With a longer course of IBS, when patients experienced a process of somatization of affect, fixation on the state of health increased, and “vicious psychosomatic circles” were formed, the role of psychotherapy remained very significant, it gradually acquired a distinct “symptomatic” orientation. At the same time, medications were additionally included in the therapy (small doses of sedatives and/or antidepressants).

With a long-term course of the disease, leading to qualitative changes in personality, an increase in egocentrism, which contributes to greater withdrawal from the disease, the occurrence of persistent psycho-emotional disorders, expressed in various ways

pathocharacterological (psychosomatic) personality development, the effectiveness of psychotherapy decreased. More and more active drug correction existing mental disorders. At this stage of the disease, psychotherapy was aimed at supporting patients, maintaining emotional connections sick, social adaptation. Psychotherapy at the stage of pathocharacterological changes also included work with a persistent fixation on somatic complaints and was aimed at correcting the “scale of experiences” of the disease and correcting the internal picture of the disease.

As a result of the use of psychotherapy, positive dynamics were observed in the patients’ condition, primarily manifested in the disappearance or significant reduction of anxiety, the disappearance of fears, and better social adaptation.

A follow-up examination six months after discharge from the hospital showed that patients who continued to attend psychotherapeutic classes subjectively felt better and had significantly less dyspeptic symptoms, pain and bowel disorders compared to those who interrupted classes after discharge.

Thus, the experience of treating 200 patients with IBS showed that combined treatment should be based on the stage of the disease and must include modern psychotherapeutic techniques. Positive clinical dynamics showing disappearance or significant reduction in the intensity of gastroenterological complaints, improvement in psycho-emotional state, and psychological testing data after complex therapy with the inclusion of psychotherapy, showing positive changes in the patients’ condition, confirm the need for joint treatment of IBS by both gastroenterologists and psychiatrists.

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COMPLEX PSYCHOTHERAPY OF IRRITABLE BOWEL SYNDROME

V.I. ESAULOV, V.V. MARILOV

Department of Psychiatry and Medical Psychology RPFU. Moscow 117198, Micluho-Maklaya str. 8, Medical Faculty.

boost the effectiveness of the treatment. The study has also pointed to the crucial role of treating IBS patients by both gastroenterologists and psychiatrists who have mastered modern methods of psycho-correction. As for chronic with pathological personality mutations the psychotherapy should be integrated with infinitesimal doses of sedatives and/or antidepressants.

Key words: psychotherapy, psychosomatic disease, diseases of an intestine.