МЕТОДОЛОГИЧЕСКИЕ ОСНОВАНИЯ РАЗРАБОТКИ КОМПЛЕКСНОГО ПОДХОДА В ПСИХОЛОГИЧЕСКОЙ КОРРЕКЦИИ И ПСИХОТЕРАПИИ ПАЦИЕНТОВ КАРДИОЛОГИЧЕСКОГО ПРОФИЛЯ ДО И ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

Описываются методологические основания выбора психокоррекционных и психотерапевтических методик для работы с пациентами кардиологического профиля до и после коронарного шунтирования. Исследованы и описаны особенности когнитивно-эмоциональной сферы пациентов с нарушениями по типу «лобного» синдрома. С учетом нейропсихологической симптоматики и специфики эмоционально-волевой сферы данной категории пациентов предложен комплекс методик, базирующийся на техниках и приемах когнитивно-бихевиорального подхода психотерапии и методах программированного обучения больных с «лобным» синдромом Л.С. Цветковой и восстановления планирования речевого высказывания М.К. Шохор-Троцкой. В предлагаемом комплексе выделено три блока по формированию и закреплению определенных психологических навыков: рационально-поведенческий, прогностический, когнитивно-коммуникативный.
This article describes the methodological bases of the choice of psychocorrectional and psycho-therapeutic techniques in working with cardiological patients before and after coronary bypass surgery. The features of the cognitive-emotional sphere of patients with frontal lobe syndrome are presented. A clinical psychologist action algorithm for the diagnosis and prevention of behavioral and psycho-emotional disorders in patients preparing for surgery was worked out. The article highlights the "targets" of psychocorrectional exposure with the aim to overcome patients' "frontal" dysfunctions and to restore cognitive functions after coronary bypass surgery. In the paper we present a list of existing and most commonly used therapeutic approaches when working with patients suffering from somatic diseases. The paper describes a number of physiological mechanisms which patients with anxiety or depressive disorders may encounter. To prevent the influence of a negative stress response on the cardiovascular system we suggested to use the problem-oriented approach, in particular, the method of the rational-emotive therapy by A. Ellis. The techniques of this approach, unlike other types of psychotherapy, prevent the patient from coming back to the traumatic situation. The advantages of the rational-behavioral therapy were presented, where the main aim is to change the irrational patient's settings and to produce the optimal behavior during the preparation for the surgery. Taking into account neuropsychological symptoms and the specificity of emotional and volitional aspects of this category of patients, the complex of methods based on techniques and methods of cognitive-behavioral therapy approaches was chosen including the methods of programmed training for patients with frontal lobe syndrome by L.S. Tsvetkova, and the recovery method of verbal planning by M.K. Shokhor-Trotsky. The scheme of psychological support of patients before and after coronary bypass surgery was developed. In the proposed complex we identified 3 blocks allocated for the formation and consolidation of certain psychological skills: rational-behavioral, predictive, and cognitive-communicative. Positive changes in the psychological sphere by using this methodical complex are expected, such as: reducing attention deficiency; enhancing voice and task oriented behavioral activity; reducing anxiety; actualization of time perspective. The complex of psychotherapeutic methods is oriented to improve the quality of life and to form the patient's personal responsibility for the treatment, which could become the basis for the psychological preparation for the surgery and for the rehabilitation in the postoperative period.