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Introduction

Psycho-emotional stress

Fragment of work for review

Social-psychological block. Any person, whether he wants it or not, is influenced by his social environment and, more broadly, by the social and subject environment. Under stress, the attitude towards the surrounding world, including the world of people, changes, especially under the influence of physical, physiological stressors, and as a result of contacts with people whose nature of communication is changed by stress (6, p. 183).
In the process of activity, motives are “filled” emotionally and are associated with intense emotional experiences, which play a special role in the emergence and progression of states of mental tension. It is no coincidence that the latter is often identified with the emotional component of activity. Hence the parallel use of such concepts as “emotional tension”, “affective tension”, “nervous-psychic tension”, “emotional arousal”, “emotional stress” and others. What all these concepts have in common is that they denote the state of a person’s emotional sphere, in which the subjective coloring of his experiences and activities is clearly manifested.
However, according to N.I. Naenko, these concepts are not actually differentiated from each other, the proportion of the emotional component in states of mental tension is not the same and, therefore, we can conclude that it is unlawful to reduce the latter to emotional forms. This opinion is shared by other researchers who tend to consider the concept of “mental stress” as generic in relation to the concept of “emotional stress”.
A simple indication of the obligatory participation of emotions in the genesis and course of mental tension is not enough to understand their place in the structure of the corresponding states. The work of N. I. Naenko reveals their role in reflecting the conditions in which activities are carried out, and in regulating this activity (22, p. 92).
G. N. Kassil, M. N. Rusalov, L. A. Kitaev-Smyk and some other researchers understand emotional stress as a wide range of changes in mental and behavioral manifestations, accompanied by pronounced nonspecific changes in biochemical, electrophysiological parameters and other reactions.
Yu. L. Aleksandrovsky associates the tension of the mental adaptation barrier with emotional stress, and the pathological consequences of emotional stress with its breakthrough. K. I. Pogodaev, taking into account the leading role of the central nervous system in the formation of the general adaptation syndrome, defines stress as a state of tension or overstrain of the processes of metabolic adaptation of the brain, leading to protection or damage to the body at different levels of its organization through common neurohumoral and intracellular regulatory mechanisms. This approach focuses only on energy processes in the brain tissue itself. When analyzing the concept of “emotional stress,” it is quite natural to ask about its relationship with the concept of “emotions.” Although emotional stress is based on emotional tension, the identification of these concepts is not legitimate. It was previously noted that R. Lazarus characterizes psychological stress as an emotional experience caused by a “threat”, which affects a person’s ability to effectively carry out his activities. In this context, there is no significant difference between emotion (negative in its modality) and emotional stress, since the influence of emotional stress on an individual’s activity is considered as a determining factor. In psychology, this constitutes a traditional and fairly thoroughly studied problem about the influence of emotions on motivational and behavioral reactions (30, p. 42).
According to V.L. Valdman et al., the phenomenon of emotional stress should be distinguished:
a) a complex of immediate psychological reactions, which in general form can be defined as the process of perception and processing of information that is personally significant for a given individual, contained in a signal (impact, situation) and subjectively perceived as emotionally negative (a “threat” signal, a state of discomfort, awareness conflict, etc.);
b) the process of psychological adaptation to an emotionally negative subjective state;
c) a state of mental maladjustment, caused by emotional signals for a given individual, due to a violation of the functional capabilities of the mental maladjustment system, which leads to disruption of the regulation of the subject’s behavioral activity.
Each of these three states (they are fundamentally similar to the general phases of the development of stress, but are assessed by psychological rather than somatic manifestations) is accompanied, according to the authors, by a wide range of physiological changes in the body. Autonomic, symptomatic-adrenal and endocrine correlates are found with any emotion or emotional stress (both positive and negative) during the period of psychological adaptation to stress and in the phase of mental maladjustment. Therefore, based on the listed set of reactions, it is not yet possible to differentiate emotion from emotional (psychological) stress, and the latter from physiological stress (30, p. 44).
G.G. Arakelov believes that the mechanisms of stress and emotions are different, but in the human mind, stress and emotions are updated simultaneously. Moreover, the strength of the subsequent stress reaction is realized and assessed by the severity of the emotion, while the initial manifestation of the stress reaction manifests itself at an unconscious level. The emergence of appropriate emotions after assessing the danger is necessary for subsequent conscious management and choice of behavioral tactics (25, p. 135).
In the activities of a human operator, the main attention is drawn to the problem of the influence of the dominant emotional (mental) state on the process of his functional activity and on the effectiveness of his work. The state of emotional (mental) tension is precisely determined by the occurrence of interference in this activity, the appearance of errors, failures, etc. During the period of development of the immediate psychological reaction to extreme exposure, most emergency situations occur. At the first stage of the stress reaction, acutely developing emotional arousal plays the role of a disruptor of behavior, especially if the content of the emotion contradicts the goals and objectives of the activity. The complex process of analysis and planning of activity formation, selection of its most optimal strategy is disrupted.
Chapter 3. The influence of psycho-emotional stress on diseases
In psychological studies, various complexes of emotional reactions are compared with a tendency to the formation of one or another psychosomatic pathology. In humans, the most common super-strong stress stimulus leading to the development of cortico-visceral disorders is mental trauma, caused in some cases acutely, once, often suddenly, and in other cases - chronically, repeatedly, often gradually, almost imperceptibly, but deeply affecting mental sphere and, as a rule, proceeding against the background of emotional accompaniment, enhancing the impact of the traumatic factor. Psychosomatic diseases are a frequent consequence of exposure to mental trauma.
In particular, G. Flang wrote in 1932 about the role of unreacted emotions in the formation of somatic disorders: “Sadness that is not cried out with tears makes other organs cry.” The general and main cause of hypertension, as well as peptic ulcer disease, which also belongs to the category of psychosomatic disorders, is increased neuropsychic trauma and excessive psycho-emotional stress, he believed, based on the experience of the Great Patriotic War, especially on the Materials collected during the 900-day period blockade of Leningrad, prominent domestic therapist M.V. Chernorutsky. (12, p. 383)
In 92% of cases, severe mental trauma and prolonged nervous overstrain were noted by T.S. Istamanova in the anamnesis of patients with neurasthenia, accompanied by functional disorders of internal organs. An increase in cases of peptic ulcer disease and its atypical course during the Second World War was observed in almost all countries at war. During the aerial bombing of London, Liverpool and Coventry by German aircraft, English doctors noted in these cities a sharp increase in the number of gastric perforations in patients suffering from peptic ulcers. Based on a medical examination of 109 thousand people, Z.M. Volynsky found that hypertension was twice as common among front-line soldiers and three times more common among survivors of the Leningrad siege and other horrors of war than among those who were in wartime in the rear.
Each emotion is characterized primarily by the intrapersonal state of the subject - experience. Experience is the impressive side of emotion. The expressive side of emotion is characteristic objective changes in the vital activity of the body, manifested by electrophysiological, biochemical, vegetative-vascular and motor effects. As a physiological phenomenon, emotion is the result of the activity of the entire brain; as a psychological phenomenon, it is a specific expression of the activity of the individual. Initially arising as a physiological phenomenon and never ceasing to be such at the level of complex personal relationships, emotion acts as an experience, i.e. as a mental phenomenon - in the form of a unique form of reflection of a person’s attitude towards objects and events that are significant to him. In other words, the mental and physiological act in emotions as two sides of a single nervous activity. As P.Kh.Shingarov points out, there is subjective in emotions, but there is no ideal: the external world is reflected not in the form of images created on the basis of temporary connections, but in the form of experiences of subjective states. (12, p. 384)
E. Gelgorn and J. Lufborrow find a certain connection between the quality (modality) of emotional experience and the specificity of changes occurring in the physiological systems of the human body. In particular, they believe that “emotions can be accompanied by a sympathetic tuning of some organs and systems and a parasympathetic tuning of others. With indignation and disturbance, sympathetic influences predominate in the vascular system, while parasympathetic influences predominate in the gastrointestinal tract.” In a state of anger, the excretion of catecholamines, especially norepinephrine, increases. When experiencing fear, against the background of an increase in the level of catecholamines, a predominant increase in adrenaline is observed. Swedish researcher M. Frankenhäuser calls adrenaline the “rabbit hormone,” in contrast to norepinephrine, the “lion hormone.”
Emotionogenic activation of autonomic systems under normal conditions is an adaptive reaction of the body and does not lead to pathology of internal organs. Emotional states, believe Yu.M. Gubachev, B.V. Iovlev, B.D. Karvasarsky, “become factors in the pathogenesis of somatic diseases either in the presence of sharply altered structures of target organs, the adaptive capabilities of which are sharply reduced, or under conditions of extreme strength and duration of such states." This position is based, in particular, on the results of studies by K.M. Bykov and I.T. Kurtsyn, in which it was shown that when any physiological system (organ) is weakened, it is involved in the pathological process, regardless of the specific psychological content conflict.
The physiological response to stress does not depend on the nature of the stressor, as well as on the type of organism in which it occurs. This reaction is universal and is aimed at protecting a person or animal and preserving the integrity of its body. The defensive reaction to ongoing or repeated exposure to a stressor includes three stages, united by the concept of “general adaptation syndrome.” (28, p. 141)
In the first stage - anxiety - changes occur in the body such as muscle tension, rapid breathing, accelerated pulse, increased blood pressure, and a feeling of anxiety. It reflects the mobilization of all resources in the body. At the same time, the body’s resistance decreases, and if the stressor is strong enough, death may even occur.
In the second stage, resistance, the body begins to adapt to the ongoing effects of the stressor. During this stage, increased resistance to stressors is established. The body's resistance (resistance) to it becomes higher than the initial level.
The third stage – exhaustion, which occurs when exposed to super-strong or super-long-term stimuli, is accompanied by a decrease in the body’s resistance and in severe cases can lead to its death.
Selye divided stress into constructive and destructive, emphasizing that not all stress is harmful. Constructive stress, having passed the stage of anxiety, ends with the body adapting to a new situation and increasing its stability. However, if the stress factor is of great intensity or duration, if it is incorrectly assessed, if several stress factors are combined and the body is weakened for other reasons (due to hereditary or congenital weakness of defense mechanisms), then stress can become destructive. In such cases, adaptation reactions reach the level of exhaustion and processes of destruction are launched - protection through illness, maladjustment.
Disadaptation is a state of disturbed homeostasis (the dynamic balance of the body and the external environment), which occurs when the protective mechanisms are exhausted and the effect of the stress factor has not been completely neutralized. (28, p. 158)
A stress factor is any influence coming from the external environment or occurring inside the body that causes a stress response.
There are two ways stress occurs: psychological and physiological. If a stress factor is not recognized by a person, but causes symptoms characteristic of stress, then such stress is regarded as physiological or systemic.
If a stress factor is refracted to a greater or lesser extent through a person’s consciousness, then the resulting changes are considered psychological stress. An impact becomes stressful if it is assessed by a person as threatening his social, psychological or physical well-being. It is important to understand iatrogenic stress, which occurs as a result of receiving information from health care workers that can cause anxiety in the patient. One of the reasons for the occurrence of psychological stress in a person is the inability to fulfill one or another significant need for him, caused, for example, by illness. Psychological causes of stress are called mental trauma (psychotrauma). Currently, the concept of psychological stress is often equated with the concept of frustration.
Frustration (from Latin: frustratio - deception, frustration, destruction of plans) is a mental state of collapse and depression, expressed in the characteristic features of experiences and behavior that are caused by the experience of failure. Difficulties that arise on the way to achieving a goal or solving problems are perceived as insurmountable. The situation in which such a mental state occurs is called frustrating. (1, p. 232)
Despite the variety of frustrating situations, they are characterized by two mandatory conditions:
the presence of an actual need as a source of activity, a motive as a specific manifestation of a need, a goal and an initial plan of action;
blocking the possibility of its implementation, the presence of resistance (obstacle - frustrator).
Types of obstacles.
1. Passive external resistance - the presence of an elementary physical barrier, a barrier on the way to the goal; remoteness of the object of need in time and space.
2. Active external resistance - prohibitions and threats from the environment, if the subject does or continues to do what he is prohibited from doing.
3. Passive internal resistance - conscious or unconscious inferiority complexes; inability to implement the plan, a sharp discrepancy between the high level of aspirations and the possibilities of execution.
4. Active internal resistance - remorse (2, p. 11).
The main subjective psychological manifestations of a stressful state are anxiety and fear, i.e. a feeling of vague threat, danger. It is due to the fact that a person cannot accurately determine the nature of the threat due to the absence or lack of information about the stimulus, its incorrect logical processing, or a combination of both. A mild degree of anxiety sometimes has a positive effect on a person’s intellectual and physical functioning. Examples of this are the improvement in the ability to remember the necessary material in an exam with mild anxiety; increased athletic performance with moderate pre-start stress, etc. As anxiety increases, productive activity decreases. But in all cases, anxiety is a signal of trouble that prompts a person to take certain actions to help him get rid of this feeling. Fear arises when a person does not currently find a way out of a situation that threatens him, but identifies as its cause some specific factor (phenomenon, object), which in fact may not be the true prerequisite for stress. Fear, like anxiety, has a protective meaning; it motivates a person to act for the purpose of self-preservation. However, when excessively expressed, fear can lead to disorganization of behavior.
Stress and blood cholesterol levels. Elevated cholesterol levels lead to the development of atherosclerotic plaques on the walls of blood vessels, which causes impaired blood flow (usually worsening). The consequence of this may be the occurrence of strokes and heart attacks. It is generally accepted that there may be several reasons for high cholesterol levels in the blood. It has now been shown that one important cause of increased cholesterol levels is increased stress levels. Thus, accountants experienced sharply elevated cholesterol levels when they had to complete a large amount of work in a short time - prepare a consolidated report or summaries for the tax authorities. Testing of medical students immediately before and after final exams shows that 20 out of 21 examined students had elevated levels of cholesterol in the blood serum before exams, i.e., in a stressful situation. (18, p. 339)
Arterial hypertension. This is increased and harmful blood pressure on the walls of the arteries. There may also be several reasons for high blood pressure. But there is no doubt that the action of stressors leads to increased blood pressure.
Emotional stressors are considered one of the main factors in the etiology of hypertension. Therefore, educational programs for hypertensive patients provide training in methods of managing stress levels.
Stroke and coronary heart disease. A stroke occurs when blood flow is blocked or a blood vessel ruptures in the brain, causing a lack of oxygen and nerve cell death. A stroke can result in paralysis, speech impairment, impaired motor function, or death. Stroke is believed to be associated with high blood pressure, stressors, and several other causes. (18, p. 340)
Coronary heart disease (CHD) and its connection with increased levels of stress are explained by increased activation of stress mechanisms under the influence of stressors: increased heart rate, increased blood pressure, fluid retention in the body. The typical victim of a heart attack is an overworked, overweight businessman with a cigarette in his mouth, who relieves stress with alcohol. Type A behavior style has been identified, which is most common in people who have had a heart attack. Usually these people are aggressive, vain, impatient, hostile, dependent on the evaluation of their work, and engaged in several things at once.

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PSYCHOEMOTIONAL STRESS.

Personality and its development. The nature of emotions.

Stress as a factor influencing human health. Physiological mechanisms of stress. Classification of types of stress: stress, eustress, distress, their significance for the human body. Causes of stress and distress: conflict situations, information overload, interpersonal relationships. Emotional distress (neurosis).

Protection and ways to overcome stress: “retreat” strategy, formation of a new dominant, breathing exercises, physical exercises, relaxation methods, psychophysiological and ideomotor training.

6.1. What is stress?

6.2. Selye's main ideas about stress.

6.3. Physiological basis of stress.

6.4. Psychological basis of stress.

6.5. Classification of stressors.

6.6. Functional disorders (adaptation diseases).

6.7. Ways to deal with stress.

6.7.1. Relaxation.

6.7.2. Relaxation exercises.

6.7.3. Concentration.

6.7.4. Autoregulation of breathing.

6.7.5. First aid for acute stress.

Control questions.

“A healthy mind in a healthy body”, that’s what the ancient Romans said, that’s what the Health System says. Health rules, contrasting air and water baths, proper nutrition, while creating physical health, simultaneously form powerful nervous strength and mental health.

But there is another, no less fair aphorism, belonging to the sages of the East: “A healthy mind has a healthy body.” By strengthening and improving his spirit, a person strengthens his physical health. The interaction of body and spirit improves not only the physical, but also the spiritual energy of a person, making him more harmonious, healthy, and creative.

A healthy nervous system helps a person to withstand all the adversities and storms that he is exposed to in life.

6.1. What is stress?

Translated from English, stress means “tension, pressure.” Canadian scientist (medical physician, physiologist, psychologist) Hans Selye defined stress as a nonspecific reaction of the body to any demand presented to it. The biological function of stress is adaptation. This reaction is intended to protect the body from various influences: physical, mental. Stress is a way to achieve the body's stability when exposed to a damaging factor.

Each requirement presented to the body is in some sense unique, i.e., specific, but in addition to the specific effect, the requirement gives a nonspecific need to carry out adaptive functions, i.e., to adapt to the difficulty that has arisen. It follows that specific phenomena require a nonspecific response.

Stress is currently an important cause of mortality because it disrupts psychosomatic balance. Stress places high demands on our psyche, while sparing our body, “saving” on it. This leads to disharmony of natural balance.

Still, stress should not be avoided. G. Silje noted “complete freedom from stress means death,” the level of psychological stress is lowest in moments of indifference, but is never zero.

The body does not care whether a person experiences positive or negative experiences; stress depends only on the intensity of the demand.

In Fig. 6.1. depicts the influence of a stress reaction on human performance.

Rice. 6.1. The relationship between stress response and performance.

Stress activation can be a positive motivating force that improves subjective “quality of life.” This positive stress is called "eustress" and debilitating, excessive stress - "distress".

As stress increases, overall well-being and health expression improves. However, as stress continues to increase, it reaches its peak. This point can be called the optimal stress level because if stress increases further, it becomes harmful to the body. The point at which optimal stress levels are achieved depends on innate biological as well as acquired physiological and behavioral factors.

The stress response mechanism was formed at an early stage of human development as a protective mechanism. Over the period of evolution, this mechanism has been polished to automaticity and works instantly. But during the period of its formation, humanity faced other tasks (to escape from a predatory animal, to kill an animal to feed the family, etc.). In the modern world, people solve other problems, but the mechanism of the stress reaction remains the same. A defensive reaction is triggered for a person to act; this is a command - “attack or run away.” Its task is the rapid mobilization of energy reserves, the goal is to survive. We live in a civilized world, and we do not follow this command, we restrain our emotions, and they have no other choice but to manifest themselves in one of the body’s functions.

Stress translated from English means “pressure, tension” and is a complex of physiological reactions that occur in the human body in response to the influence of various unfavorable factors (stressors).

The factors that cause stress are varied and varied. For example, a sharp sound, high or low temperature, fluctuations in atmospheric pressure, etc. can lead to stress.

Moreover, stress reactions are inherent not only to humans with their highly developed nervous system, but also to lower animals that do not have a nervous system at all, and even plants. Thus, it becomes clear that stress is not just nervous tension. This is the response of an organism or any living system or tissue to a demand placed on it. The main and ultimate goal of such a response is to adapt to changed conditions. This definition of stress was proposed by the Canadian physiologist G. Selye in 1936. It is appropriate if we talk about stress in general.

If we are talking about stress as a risk factor for arterial hypertension, then we mean psycho-emotional, nervous stress. Psycho-emotional stress is an integral part of the lives of people in developed countries. Here a person is constantly, every day, faced with an accelerated pace of nervously stressful life and work with a shortage of time, and difficult interpersonal relationships. In this case, long-term conflicts often arise, which are a source of negative emotions. Of these, the strongest, most persistent, and slowly passing are socially determined: work, family, everyday.

Particularly stressful for a person are life situations that are beyond his control (death of loved ones, natural disasters, etc.). Scientists Holmes and Rage, based on many years of research, have compiled a list of the most common changes in life that cause stress. Some of them are given below. The sequence in this list is determined based on the emotional significance of each event.

Life event	Unit of significance
1. Death of a spouse
3. Breaking up with your partner
4. Serving a sentence in prison
5. Death of a close relative
6. Injury or illness
7. Retirement
8. Illness of a family member
9. Change of place of work
10. Growing debts
11. Conflicts with superiors
12. Sleep disturbance
13. Fine for violating traffic rules

As can be seen from the table, the most dangerous for a person are intense traumatic events caused by the loss of very close people.

Is it possible to live without stress? Science says it's impossible. After all, we must constantly adapt to new conditions. Life is a constant source of change. By and large, life is the main source of stress, so you can completely get rid of it only with the arrival of death. It is impossible to eradicate stress, but we have the power to arrange our own lives in such a way that we receive pleasant stress and free ourselves from unpleasant ones. Yes, it turns out there are also pleasant stresses.

Stress is divided into emotionally positive (birth of a child, promotion, etc.) and emotionally negative. In everyday language, when we say “fighting stress”, “consequences of stress”, we usually mean the emotionally negative type of stress.

There is also a difference between short-term and long-term stress. They affect health differently. Long-term stress has more severe consequences.

How does stress occur?

When a conflict situation requires a quick reaction and an immediate response, the adaptive mechanisms inherent in nature are triggered in our body. Biochemical reactions occur at an accelerated pace, increasing the body's energy potential and allowing it to respond to threats with triple strength. The adrenal glands increase the release of adrenaline into the blood, which is a fast-acting stimulant. The “emotional center” of the brain is the hypothalamus. It transmits a signal to the pituitary gland and adrenal cortex, which increases the synthesis of hormones and their release into the blood.

Hormones change the water-salt balance of the blood, increasing pressure, increasing heart rate, increasing the need for oxygen in the heart muscle, narrowing the cerebral, renal and peripheral arteries, stimulating rapid digestion of food and releasing energy, increasing the number of leukocytes in the blood, stimulating the immune system, provoking the occurrence of allergic reactions, increase sugar levels and increase the breathing rate. The man is ready for battle. All the described changes are aimed at mobilizing the body’s resources according to the “fight-flight” principle and are of a protective, adaptive nature.

But the time for external reactions, unfortunately, has passed. In the modern world, stress most often has internal manifestations and causes. Now a person catches up with a bus, rather than running away from dangerous animals; he is afraid of boredom and old age, not an avalanche; he fights a bad mood or irritation, not enemies or wild animals.

Of course, in a stressful situation caused by such reasons, rest and relaxation would be more beneficial than increasing cardiac activity and blood pressure (BP). But our body reacts to unforeseen situations with a traditional cascade of reactions, from which none can be arbitrarily excluded.

If the stress is emotionally positive, the situation is short-lived and is under your control, then there is nothing to fear: the body has every opportunity to rest and recover after an explosion of activity in all systems. In such a case, the body’s reactions return to their normal, characteristic pace, the work of vital organs returns to their normal course, and the body continues to function in its usual mode. But if the stress is emotionally negative, prolonged, the situation is beyond your control and the body has no chance to normalize already activated processes, you need to prepare to face the consequences of the current critical condition.

When the body systems that control your psycho-emotional state are overloaded and negative stress lasts for a long time, symptoms of physical and psychological exhaustion begin to appear. Thus, there is a breakdown in adaptability and the development of diseases. This is otherwise called distress or the stage of depletion of “adaptive energy”. And here it is important to remember G. Senier’s statement that “stress is everything that leads to rapid aging of the body or causes illness.”

If you have at least one of the following signs, then you are very likely to have chronic, long-term stress:

Inability to concentrate on something

Frequent errors at work

Memory impairment

Chronic fatigue

The number of cigarettes smoked increases sharply

Work doesn't bring the same joy

Addiction to alcoholic beverages

Headache

Sleep disorders (insomnia, drowsiness, etc.)

Back or neck pain

Attacks of irritation

Constipation or diarrhea (diarrhea)

Chest pain

Attacks of dizziness

A sharp deterioration in the condition of hair and nails

Skin diseases

Rheumatoid arthritis

Allergy

Heartburn, peptic ulcers and other digestive diseases

Cardiovascular diseases (hypertension, hypotension, atherosclerosis, heart attacks, heart failure)

Your symptoms and illnesses may not be caused by stress, but it is certain that stress aggravates them. For this reason alone, it is worthwhile to take care of your psycho-emotional state without delay.

The relationship between emotional stress and the development of hypertension has been studied in population studies. It has been shown that blood pressure levels are higher in population groups exposed to chronic stress: among the unemployed and people laid off from work, working under constant mental stress, living in overcrowded areas and communal apartments.

One of the serious problems of dealing with stress is that it causes feelings of anxiety, and together they involuntarily activate the nervous system. It is not uncommon to see patients surprised when they learn that all the numerous painful symptoms that seemed to them to be signs of a serious illness are “just” a reaction to stress. About 40% of referrals to cardiologists for palpitations and other cardiac abnormalities are directly related to a stressful situation. Approximately the same percentage of referrals to neurologists (for headaches) and gastroenterologists (for stomach pain) are also associated with stress.

Thus, you can be convinced that many of your health problems are associated with an inability to cope with stress. Then it will be enough for you to learn how to independently apply stress management methods. So, almost all methods of overcoming stress fall into three large groups:

1. Recognizing the problem

means being able to recognize the stress that has arisen and decide what you can handle. In such cases it is very useful:

Make a list of all the situations that cause you stress

Ask yourself why this is happening

Expand your understanding of the situation using your imagination.

Take some time in the evening and try to remember how you dealt with stressful situations during the day. Rate the “stress intensity” of each such situation, giving a score of 1 when the stress was minimal and 10 when it reached the maximum level that you can cope with.

Having determined the level of tension of the past day in the manner described, relax and do the following: sit comfortably, close your eyes, make sure that your clothes do not restrict you anywhere. Breathing evenly and deeply, carefully “look” at your body, as if you had a video camera hidden in your head, to identify “points” of tension. Focus your attention on the tense muscles and imagine how, with each exhalation, the tension goes drop by drop through your legs to the floor.

After a few minutes, think again about the stress level of that day. Ask yourself what issue or event was defining for him. Try to imagine the situation or this person from the perspective of an outside observer.

Now take a deep breath, open your eyes and ask yourself:

¨ why was the stress level assessed so high (low)?

¨ what was the most unpleasant for you?

Has this happened in your life before?

¨ How do you understand what happened?

¨ What other thoughts appeared when you imagined this stressful situation?

This exercise will help you identify the factors that cause stress, and this is the first and very important step that will allow you to choose a way to overcome it.

For example, Anna, a young mother, did this exercise like this. Having relieved general tension and enjoying complete relaxation, she thought about her stress level and rated it at 7. Sitting comfortably in her chair, Anna allowed her thoughts to freely appear and disappear. Then a picture appeared: her children were quarreling and fighting, which happened quite often, despite all her efforts to prevent this. After some time, she was able to tell herself the following about her feelings:

The stress rating was so high because I was very upset by the children's behavior, although nothing bad happened to them

The main problem for me was the noise the children made.

The same sensations arose with me before, when my husband, as usual, raised his voice in arguments with me, which offended me very much

Loud noise very quickly caused a reaction in me, expressed in general tension

Other thoughts concerned vague memories of fighting myself when I was a child. In addition, I realized that sometimes I myself feel the urge to beat children (although I never do this)

Thanks to the exercise, Anna understood which situations and why become stressful for her. And now, when necessary, she can use a specific technique for mastering a stressful situation. She mastered these methods and techniques gradually.

2. Self help

involves the acquisition of skills to control one’s thoughts or attitudes and, if necessary, their mandatory use, as well as the ability to take care of oneself. To do this, you need to learn to relax and create a positive feeling of self-confidence.

3. Solution

means mastering some special skills, such as, for example, the ability to manage time, training self-confidence, as well as awareness of the boundaries of your responsibility and the legitimacy of the demands placed on you.

It is well known about chronic diseases that they take longer and are more difficult to cure than acute ones. Long-term stress is no exception. If life causes a lot of pain, it’s time to take care of yourself. This is a daily and long process, but the results will be worthy of your efforts.

So, don't let conflicts drag on!

Resolve conflicts and misunderstandings as quickly as possible. If your attention is focused on resentment, it is difficult for you to escape stress. It is very important to get rid of irritation to protect your heart. This will give you the opportunity to maintain control over yourself and not take the conflict to a new level. Try to realize what emotions you are experiencing. If it's anger or resentment, tell the other person, "I'm angry" or "I'm hurt." Such honesty and, by and large, responsible behavior of a mature person will allow you to avoid the unpleasant consequences of incorrectly splashing out your emotions.

Unfortunately, many of us are accustomed to putting our anger into hurtful and cruel words. Moreover, we say them more often to the closest and most beloved people. It will be better if you immediately explain your irritation, and even better, its reasons, to your loved ones. Then there will be no unnecessary quarrels and unnecessary insults.

When expressing your grievances, do not generalize: talk about a specific incident that made you angry. When you feel the desire to quarrel, express indignation and anger, do not remember the past, talk only about the situation that is currently bothering you.

Ultimately, if a person is trying to explain himself to you, listen to them; if he apologizes, accept it. Try to end the unpleasant incident as soon as possible. Please note: showing restraint in the most fundamental conflict does not make you the weak party. On the contrary, you take on the role of the calm and strong Elephant, and your insufficiently wise opponent gets the role of the Pug.

Laugh! Smile! As often as possible!

It has long been known that laughter is the best medicine, which is especially effective against stress. When you laugh, your facial muscles relax, emotional tension drops, and a positive sense of perspective appears. This is the best way to fight diseases and, above all, yourself.

In the end, if you are not happy with something, you need to change either the situation or your attitude towards it. In many cases, when the situation cannot be changed quickly, you can afford to simply ridicule it. The ability to see humor or humor in your own difficulties is the best way to change your attitude towards a problem. The famous Danish cartoonist Herluf Bidstrup became famous precisely for noticing the comical in literally everything he saw.

Hope for the best

If you expect trouble, then more often than not it will happen. Due to anxiety and tension, your behavior changes; you have mentally replayed the situation and unconsciously carry its image in front of you. Such “prediction of the situation” may well be the cause of negative self-perception. You predict failure for yourself, your behavior changes, those around you react accordingly, and trouble happens. We can say with great confidence that you yourself are to blame for many of your failures.

Try a different, positive way of viewing the world and you will help yourself reduce your stress. Look at yourself with different eyes, change your idea of ​​yourself and your place in this world. Whatever the situation, a joyful perception of yourself and your prospects is much closer to real life than a pessimistic approach.

Avoid being alone with problems

Don’t be afraid to tell others that you have problems or what they actually are. Stoicism, which is necessary, for example, in the dentist's chair, is completely undesirable under stress. He deprives you of friendly support, the opportunity to accept and understand another point of view, depletes your mental and physical strength, denies sympathy and sympathy, the feeling of your friend’s elbow. People who have many friends find themselves in a more advantageous position: they can withstand difficult life situations. Cause or effect, social isolation often leads to depression and even suicide.

Play sports

Choose a rival partner and a sport that you like. If you are constantly trying to prove your superiority, give preference to individual classes. At least some of the exercises should be repeated rhythmically. Just as a newborn baby falls asleep with calm, even rocking, so you, following rhythmic movements, regain lost feelings of control and security. Exercises should not be performed thoughtlessly. Some concentration on exercise can reduce the effects of stress. By focusing on doing the exercises, you narrow the scope of your world to a size that is not at all difficult to keep under control.

The exercises should be challenging enough so that the adrenaline that builds up during stress is fully utilized. If physical activity is insufficient, excess adrenaline will make you irritable and nervous.

Eat right

Eating balanced, vitamin-rich foods will help increase your resistance to stress. Eat at least 3 times a day, be sure to include in your diet:

¨ a lot of roughage, especially whole grains and cereals

¨ lots of fruits and vegetables

¨ plenty of fresh, clean water

¨ some fatty foods, vegetable oils and proteins (meat, poultry, fish)

Maintain your good habits

If you don’t have any, don’t be lazy to get them as soon as possible. Allow something to exist in your life that creates a feeling of regularity and consistency.

Along with this, use the following techniques:

1. relax in any situation as soon as you feel that things are not going the way you would like

2. do not accumulate, throw out the accumulated negative energy

3. Play with your children and pets

4. find time for pleasant little things and household chores

5. talk to loved ones about difficult issues

Try to follow these rules every day and after a while you will find that the events that previously unsettled you are no longer so scary.

In conclusion, we note that the main method of dealing with stress is psychorelaxation therapy. This includes autogenic training, meditative techniques, progressive muscle relaxation and many others. We will teach hypoxic relaxation breathing training, which is easy to master and reproduce at home, and is also effective for eliminating stress tension.

Guided by the rules that we talked about today, you will find that stress from an oppressor rival becomes your ally and even assistant. “Taken” stress is an excellent energy resource. Feel free to harness him to the cart of your destiny.

V. Rambovsky, Information Network “Health of Eurasia”

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DOCTOR VLAD ADVICES

My name is Vladimir Vitalievich Yachmennikov. I graduated from the Saratov Medical Institute in 1979 with a degree in pediatrician. Advanced training in military surgery 1983, ultrasound 1985, acupuncture (acupuncture) 1991. In Russia, starting in 1991, he worked as a general reflexologist (not only children). Successfully licensed to work in the State of Illinois. The internship took place at Gordin Medical Center. I currently work as a private reflexologist. Here on the site I talk about this technique. I give examples from my more than 20 years of practice in the field of reflexology. I also try to introduce site visitors to the latest, interesting news in the field of medicine and health from around the world. All the best!

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Systematic study of the influence of emotional reactions on physical health is an important element of the psychosomatic approach to illness. The role of emotions in the formation of psychophysiological relationships (i.e., the system of interaction of mental and biological factors) is determined by the fact that emotions, acting as a subjective experience of individually significant stimuli, also include reactions from various physiological systems. Taking this circumstance into account, in particular, the mechanisms of the pathophysiological effects of emotions were studied; connection between types of emotions and the nature of pathology; individual characteristics of emotional response and the significance of associated personality traits (including their ontogenesis) in susceptibility to certain somatic diseases. This article is devoted only to the most general aspects of psychosomatic relationships during emotional stress and consideration of their patterns using the example of several characteristic nosologies.

We can talk about emotional stress if the emotion acquires strength and (or) duration, at which the individual’s ability to restore mental balance by resolving a stressful situation is insufficient (by influencing this situation, eliminating stress factors, or by changing one’s attitude towards it). relationship). The ways in which an individual copes with emotional problems and their effectiveness are very important for his or her health. These methods are designated by the term “coping” (overcoming, coping). The process of resolving a stressful situation is the essence of mental adaptation. If the process of mental adaptation is not effective enough, the physiological components of emotions during emotional stress acquire pathogenetic significance in the formation of psychosomatic disorders.

In the study of nonspecific adaptation syndrome in relation to psychosomatic disorders, special attention should be paid to the characteristics of stressors of a psychological nature, which distinguish them from physical ones. The range of the latter is relatively limited; they are associated with a direct effect on the body. The set of reactions to these stressors in different people is basically the same, while the set of mental stressors and the nature of reactions to them are determined by the characteristics of individual experience and are therefore extremely diverse. The same impact can be stressful and intolerable for one and indifferent or even desirable for another.

Opinions have also been expressed about the difference in reactions to physical and mental stressors. According to some authors, the fundamental difference in the body's response to stressors of a physical or psychosocial nature is that physical stressors, such as infection, fever, heat exposure and intoxication, tend to cause vasodilation and a drop in blood pressure, and sympathoadrenal activation is a secondary protective response to these physiological changes. In contrast, psychosocial stimuli lead to direct sympathetic activation, without mediation through a drop in vascular tone and blood pressure, since the biological function of the nonspecific response to these stressors is, in particular, to bring the body into a state optimal for intense activity. However, this difference cannot be considered absolute. The reaction to the influence of mental stressors in some cases can also manifest itself mainly in vagoinsular changes (including vasodilation and arterial hypotension), in a decrease in the production of catecholamines. However, regardless of the initial reaction, further consequences for the body are the same for both physical and emotional stress.

Since emotional stress represents the mobilization of all body systems, which prepares it for physical activity (“fight-flight”), with chronic exposure to a stress factor, the initial stage of stress is the anxiety stage, characterized by changes in humoral regulation and transient autonomic reactions typical for this stage (more often total from the cardiovascular system), enters the stage of resistance. Chronic vegetative-humoral activation at the initial stage is manifested by symptoms of vegetative dystonia and can serve as the basis for the development of more pronounced psychosomatic disorders. It is necessary to take into account that in modern society, mental stress significantly prevails over physical stress, especially when you consider that people react not only to real, current situations, but also to imaginary dangers, to painful, emotionally charged memories, to many negatively colored messages, in particular delivered by the media. In addition, the body can react to mental stress much stronger than to physical stress. As a result, the possibilities of resistance are exhausted, and a stage of exhaustion occurs. Under the influence of ongoing emotional stress, various psychosomatic disorders develop, the formation and nature of which depend on genetic predisposition, on the insufficiency of certain body systems acquired in ontogenesis and personality characteristics.

For the development of psychosomatic disorders, it is especially important that during emotional stress, changes are noted in the entire multi-level system of regulation of psychophysiological relationships. At different levels of this system, such regulation is carried out mainly by psychological or predominantly physiological mechanisms. Psychological mechanisms are implemented mainly at the socio-psychological (interpersonal relationships, social interaction) and psychological (personality characteristics and current mental state) levels, and physiological ones - at the levels of integrative cerebral systems, peripheral vegetative-humoral and motor mechanisms, executive system or organ ( Fig. 1). For the formation of psychosomatic disorders during emotional stress, the changes observed at each of these interrelated levels are significant, and approaches to the treatment of psychosomatic disorders should be determined taking these changes into account.

Rice. 1. Multilevel system for organizing psychophysiological relationships 1 - macrosocial impacts; 2 - individual characteristics of persons with whom interaction is carried out; 3—nature of intragroup interaction; 4 - interpersonal relationships; 5 - personality characteristics and current mental state; 6 - neocortex; 7— limbic-hypothalamic-reticular complex; 8—peripheral mechanisms of vegetative-humoral regulation; 9—organ or executive system.

At the socio-psychological level of the psychophysiological regulation system, the development of psychosomatic disorders is facilitated by a large number of, firstly, psychosocial stressors that depend on macrosocial processes and affect large groups of people, and, secondly, individually significant stressors associated with certain areas of social interactions: psychosomatic disorders are usually found in individuals exposed to a large number of mental (psychosocial) stressors. Comparative studies have established that in psychosomatic disorders there is a steady tendency to increase the number of stressful situations, significant life events (and, in particular, events that were regarded as undesirable) not only in comparison with the control group of healthy subjects, but even in comparison with the group persons suffering from neurotic disorders, but not showing significant somatic pathology. Situations in which the realization of urgent needs was blocked (frustrating situations) could occur in any of the significant areas of the patient’s life and usually affected several areas at once. The differences in the number of significant life events between the control group and the group of people suffering from psychosomatic disorders were especially large in the family sphere and in the sphere of work, that is, where interaction with the environment is most important and is realized intensively. At the same time, life events were recorded significantly more often than in the control group, the perception of which was accompanied by negative emotions. The most characteristic of psychosomatic disorders were stressful situations related to conflicts in various areas of social interaction, exclusion from the social context (for example, migration, retirement, loss of work), loss of loved ones (especially the death of a spouse or actual breakup of a marriage), threats to social status and important life values.

Greater intensity and a certain specificity of negative influences that contribute to the occurrence of emotional stress in persons suffering from psychosomatic disorders (compared to healthy and neurotic people) are noted already in childhood. Disturbances in socialization and negative emotional experiences received by these individuals in childhood were determined by the personality and behavior of parents, causing a lack of social support and a sense of threat, preventing the adaptive expression of emotions and the assimilation of adequate sex-role stereotypes, 2 as well as the emotional instability of parents, contradictory tendencies in upbringing, creating an unpredictability of the future. Lack of social support in childhood was often combined with the fact that the health of parents was perceived by children as poor.

Stereotypes of response and emotional experience formed in childhood, which subsequently determine the individual significance of life events, a lack of a sense of basic security and inadequate behavior patterns create sensitization to mental stressors, expand their range and reduce the personal resources necessary to resolve stressful situations. The pathogenetic role of factors influencing in childhood also persists in the future because negative emotional experience is reactivated under similar conditions, regardless of how far in the past it lies. Thus, although the influence of stressors in the process of social interaction is significant for the occurrence of both neurotic and psychosomatic disorders, the latter are characterized by greater intensity at various stages of the life course.

For the formation of psychosomatic disorders, it is important that disturbances in interaction in the family and extra-family environment, the individual’s relationships with significant others, are positively correlated with physiological changes. These shifts can appear even with the mere expectation of such violations and even be more pronounced, especially in situations characterized by uncertainty and unpredictability.

The relationship between stressful influences caused by a violation of socio-psychological adaptation and changes in physiological parameters is indirect in nature and is realized through psychological mechanisms involved in the formation of psychophysiological relationships (psychological level of regulation). The influence of psychosocial stressors and disruption of social interaction are associated with the blockade of certain socially significant needs, which causes a state of frustration, manifested by a more or less pronounced feeling of dissatisfaction. For the formation of mental stress, it is essential that the effects of repeated and consistent frustrating influences (in which various, often unconscious needs can be blocked), accumulating, cause an increase in total frustrating tension, which is closely related to an increase in anxiety and emotional stress. The severity of total frustration tension and anxiety in psychosomatic disorders is significantly higher than in the healthy group. In turn, the level of anxiety correlates with the severity of physiological changes. The importance of anxiety in the pathogenesis of psychosomatic disorders is determined by its role as the main link in the formation of emotional stress and its place in the system of organizing psychophysiological relationships. For the development of psychosomatic disorders, not only a high level of anxiety is important, but also the proportion of physiological parameters in that complex psychophysiological reaction to a stressor, the central element of which is anxiety. A factor analysis carried out in our laboratory (F.B. Berezin, P.E. Dedik) showed that the proportion of variance in this complex characteristic explained by changes in physiological parameters in psychosomatic disorders is twice as high as in the control group.

One of the reasons for the increase in the intensity of physiological reactions in psychosomatic disorders may be the insufficient ability to adequately respond to emotions in behavior. Violation of this ability leads to a significant increase in autonomic-humoral activation when anxiety and emotional stress occur. The insufficiency of an adequate response to emotions may be associated with a pronounced tendency to control one’s own behavior. This tendency is largely determined by the need to follow the accepted norm, not to attract the attention of others to one’s emotional problems, to look socially prosperous, and a conscious desire to meet social expectations. Behavioral control has a dual effect: its high level helps improve social interaction and reduce the number of frustrating situations; at the same time, it makes it difficult to adequately respond to emotions, which leads to increased autonomic-humoral activation and an increase in physiological changes. A comparative study shows that in the group of people suffering from psychosomatic disorders, the level of behavioral control is significantly higher than in those with neurotic or personality disorders.

Difficulties in responding to emotions may also be due to insufficient ability to recognize and express them, including verbally. This feature (called “alexithymia”) may play an important role in the pathogenesis of psychosomatic disorders. More importantly, in psychosomatic disorders, emotional tension is usually determined not by an isolated emotion, but by the simultaneous existence of conflicting emotions, such as anxiety and aggression, anger and depression, feelings of dependence and ambition. The inconsistency of emotions largely arises due to personality disharmony, since stereotypes of emotional response are closely related to certain personal characteristics. Disharmonious personality traits include a combination of a tendency to “get stuck” in hostility, a tendency to blame others for the unfavorable development of a situation with anxiety, increased sensitivity to negative environmental signals, and sensitivity. There is also a combination of insufficient acceptance of social norms, readiness to protest with the need to control one’s behavior in accordance with these norms and maintain close positive connections with the environment.

A disharmonious combination of personality traits contributes to internal inconsistency, the simultaneous existence of comparable in strength, but incompatible needs (intrapsychic conflict). Intrapsychic conflict, on the one hand, increases frustration and anxiety, and on the other, prevents the awareness of emotions and leads to a blockage in the response of each of them. In addition, as a result of intrapsychic conflict, forms of behavior that, with effective mental adaptation, are determined by a certain emotion or personal characteristic, are mutually inhibited, which makes it difficult (or impossible) to overcome emotional problems, since it complicates the choice of an adequate behavioral strategy aimed at resolving the traumatic situation. A decrease in the ability to build integrated behavior (problem-oriented, taking into account the needs of the individual and the requirements of the environment, immediate and long-term consequences) is one of the risk factors for the occurrence of psychosomatic pathology.

You can avoid the consequences of emotional stress, including those leading to psychosomatic disorders, either by eliminating the external source of stressful influences, or by changing your attitude to the situation. The first is achieved either through active influence on the environment, or through leaving a frustrating situation (changing lifestyle, nature of activity, avoiding unwanted contacts, etc.). As for changing the attitude to the situation, it is realized with the participation of psychological defenses (mechanisms of intrapsychic adaptation), due to which the perception or awareness of anxiety-provoking stimuli is blocked, the range of stressors is narrowed, the intensity of blocked needs is reduced, their significance or ways of satisfaction change, and the interpretation of what is happening changes. As a result of the action of psychological defenses, the perception, processing and use of received information changes in such a way that the level of anxiety decreases and the likelihood of the appearance of emotions that are undesirable due to their excessive intensity or negative connotation decreases. Psychological defenses largely determine a person’s mental activity, are important factors involved in the formation of personality and play a significant role in its adaptation to the social environment. Psychological defenses can contribute to the construction of adequate and socially successful behavior. They may also provide relative or temporary relief from emotional distress by limiting behavior and modestly reducing quality of life and social functioning. However, when excessively expressed and stable, they acquire a pathogenetic role in the development of mental and psychosomatic disorders.

Of the variety of psychological defenses that are essential for the formation of psychosomatic disorders, the somatization of anxiety should be noted as one of the most important, as a result of which anxiety is attributed to somatic rather than psychological factors. Somatization of anxiety provides a socially acceptable way out of intractable and emotionally significant problems (usually related to interpersonal interactions), shifting the focus from these problems to bodily sensations. It may be preceded by a defensive blocking of the ability to recognize the causes of a stressful situation, resulting in vague (“free-floating”) anxiety, which is then fixed on somatic sensations and disorders. The psychological genesis of such disorders is often denied, even if a direct dependence of the deterioration of the condition on a stressful situation is discovered. It is also important that under the influence of psychological defenses, previously significant needs may be devalued and the direction of emotional reactions may change (in particular, aggression may shift from an external object to oneself). This is typical for depressive conditions, which can contribute to the development of somatic pathology.

The influence of emotional stress on somatic functions is realized due to the fact that the inclusion of integrative cerebral systems in the process of psychophysiological regulation is associated with emotional mechanisms, frustration and anxiety. The structures of the limbic-hypothalamoreticular complex in close interaction with the frontal cortex (considered as a neocortical continuation of the limbic system) act as the neurophysiological substrate of such regulation at this level, and both clinical and experimental data indicate a special role in this complex of hypothalamic structures. This is due to the fact that the hypothalamus, while playing an important role in the formation of motivations and emotions, at the same time represents the central link of the system coordinating vegetative-humoral and motor mechanisms for ensuring behavior. Emotional tension that occurs during mental stress leads to somatic changes due to the implementation of hypothalamic influences through the nervous pathways, the system of releasing factors and tropic hormones of the pituitary gland, which causes changes in autonomic-humoral regulation. Hormones and mediators involved in this regulation, in turn, influence the mechanisms of activation and maintenance of certain emotional states. The physiological changes noted in this case are characterized by an increase in the activity of the sympatho-adrenal and hypothalamic-pituitary-adrenal systems with increased production of catecholamines and glucocorticoids, as well as activation of thyroid function with a change in the binding of iodine by proteins. Norepinephrine and adrenaline enhance the release of releasing factors by the hypothalamus, and under the influence of corticotropin releasing factor, the production of ACTH increases with a subsequent increase in the production of glucocorticoids and even greater activation of the synthesis of catecholamines. In parallel, insulin production may increase as a result of its activation by an increase in blood sugar, as well as due to the influence of catecholamines through β-adrenergic receptors. Increased sympathoadrenal activity is accompanied by hemodynamic (increased cardiac output and stroke volume, increased peripheral vascular resistance and blood pressure) and metabolic (increased blood sugar and lipid levels due to the β-adrenergic effect of lipolysis of free fatty acids, as well as low-density lipoproteins) changes. Blood clotting increases. Due to metabolic changes, changes occur in the intima of blood vessels with the accumulation of neutrophil fats and acidic polysaccharides. This set of shifts, reflecting the body’s readiness for action and called “ergotropic syndrome,” is most typical of emotional stress. At the same time, the intensity of the described changes reflects the severity of anxiety, the intensity of which determines the production and metabolism of catecholamines and corticosteroids, and, accordingly, vegetative and metabolic changes, in particular, the intensity of cardiac activity, blood pressure level, blood sugar, triglycerides, cholesterol , low density lipoproteins.

In addition to vegetative-humoral and metabolic changes, the described syndrome also includes an increase in muscle tone, diffuse or structured, i.e., spreading to certain muscle groups depending on the predominance of postures and movements that would be realized in accordance with a stressful situation (for example, flight or aggression), if they were not consciously restrained in the living conditions of modern man. The consequences of muscle hypertension are especially noticeable in the lumbar and cervical regions, where they contribute to the occurrence of dislocations in the spine, as well as spondyloarthrosis and myositis.

When assessing the effect of stress on the state of autonomic-endocrine regulation, it is important to note that the concentration of glucocorticoids and catecholamines in the blood, which always increases in the anxiety stage, in the resistance phase varies widely depending on the severity of the state of tension. If stable and intense exposure to the stressor continues, their concentration is constant or remains high most of the time. Such a development of the situation during emotional stress is especially likely, since, as already noted, emotional stress in modern society is characterized by significant intensity. This is due to the severity and speed of changes in social stereotypes, an increase in the feeling of threat, and the frequency of negatively colored interactions. The tendency to reactivate negative emotional experience further contributes to the maintenance of high concentrations of glucocorticoids and catecholamines in the resistance phase. Against this background or after the onset of the stage of exhaustion, certain psychosomatic disorders develop, the nature of which depends on the characteristics of the psychophysiological response, which are reproduced in each individual case quite constantly.

As a result of emotional stress, in addition to the described ergotropic syndrome, vegetative-humoral changes are also observed, characterized by activation of the vagoinsular system (trophotropic syndrome). The occurrence of such changes may be the result of reciprocal relationships between the sympathoadrenal and vagoinsular systems (when vagoinsular changes are overcompensation of the primary sympathoadrenal reaction) or individual characteristics of psychophysiological relationships. Somatic changes are manifested in arterial hypotension, increased secretory activity and dyskinesia of the gastrointestinal tract. In real conditions, we are often talking not about an exclusively ergotropic or trophotropic direction of changes, but only about a more or less significant predominance of these vegetative-humoral systems in reciprocal relationships. A decrease in sympathoadrenal and increased vagoinsular activity is more often observed in individuals who, due to the characteristics of individual development, are prone to dependence and are oriented towards outside help, although in the case of overcompensation for this tendency they are oriented towards high personal achievements. A similar set of reactions can occur if the state of stress is accompanied by a feeling of hopelessness and refusal of coping behavior.

An important role for the development of psychosomatic disorders is played by the influence of emotional stress on the immune system, which is found in the inhibition of immunological reactions by increased production of hydrocortisone, in glucocorticoid-mediated thymic atrophy, and in changes in the T-system of immunity. With chronic emotional stress, changes in the level of immunoglobulins, activation of antibody production, and increased autoimmune processes have also been noted.

All of the above gives reason to believe that the pathogenetic patterns of development of psychosomatic disorders are associated with a certain stereotype of the organization of psychosomatic relationships. Such a stereotype includes the presence of individually significant frustrating situations, an increase in frustration tension, increased anxiety, leading to an intensification of psychological defenses (the type and severity of which are associated with the characteristics of the psychological state and psychophysiological relationships), insufficient response of emotions, mainly due to disharmonious personality traits. An increase in anxiety and emotional stress leads to the inclusion in the described stereotype of the development of psychosomatic disorders of the integrative cerebral systems discussed above, including hypothalamic structures, through which a complex of physiological changes is realized, which determines, along with the state of the mental sphere, the nature of psychosomatic disorders, general and specific features of psychophysiological reactions. The type of this reaction depends on the characteristics of the subject, which are based on a combination of genetic prerequisites and factors affecting the individual during the life course, in particular, during the period of early socialization. When implementing the described stereotype of the development of psychosomatic disorders, two points are significant: the nature of psychological reactions associated with a certain constellation of personality traits, and the special relationship between the mental and somatic aspects of the response (Fig. 2).

Rice. 2. Stereotype of the development of psychosomatic disorders

The variety of physiological changes that occur during emotional stress suggests that emotional stress can act as a pathogenesis factor in various forms of somatic pathology. This circumstance, as well as the results of a continuous psychodiagnostic study of patients with various somatic diseases accumulated to date, indicate the inappropriateness of dividing diseases into psychosomatic and non-psychosomatic, or isolating psychosomatic diseases as a special class of conditions. At the same time, the proportion of mental factors in the genesis of individual somatic diseases varies significantly. The data obtained allow us to believe that somatic diseases form a certain series (“psychosomatic continuum”), in which the importance of psychological mechanisms in their occurrence and development, the frequency of violations of mental adaptation in them decreases gradually (Fig. 3).

In diseases located at the top of this continuum, such as neurocirculatory dystonia, coronary heart disease, hypertension, paroxysmal heart rhythm disturbances, bronchial asthma, peptic ulcer disease, rheumatoid arthritis, pathogenetically significant disorders of mental adaptation are found in the majority (66– 90%) of those examined. Disorders of mental adaptation in diseases located at the upper part of the psychosomatic continuum are manifested not only by somatic symptoms, but also by neurotic reactions or even delineated neurotic syndromes, which in this case do not constitute a “second disease”, but act as an integral component of psychosomatic disorders. Under conditions of chronic emotional stress, their frequency increases even more. For diseases located at the lower end of the continuum (for example, acute pneumonia or post-traumatic disorders of the musculoskeletal system), such disorders are detected much less frequently (in 30-40% of those examined).

The significance of psychosomatic relationships can be traced through the example of some somatic diseases characterized by various ergo- or trophotropic phenomena, or associated with immune changes.

If somatic symptoms resulting from emotional stress are limited to polymorphic autonomic manifestations that directly reflect changes in autonomic-humoral regulation, autonomic-vascular (neurocirculatory) dystonia is usually diagnosed. Autonomic symptoms (tachycardia, blood pressure lability, transient hyper- or hypotension, functional disorders of the gastrointestinal tract, psychogenic shortness of breath, hyperhidrosis, muscle tremors, cervical-brachial syndromes caused by increased muscle tone) are usually combined with fleeting pain and neurotic phenomena . The described symptoms are closely related to a high level of anxiety (largely somatized) and can be considered as its physiological correlates. Psychophysiological relationships are also characterized by a decrease in the threshold of frustration and an increase in the proportion of the psychophysiological component of a single psychophysiological reaction to a frustrating situation. In the tenth revision of the International Classification of Diseases (ICD-10), the designation “somatoform autonomic dysfunction” is used to characterize this common condition, although the previously proposed term “general psychovegetative syndrome” may better reflect its pathogenetic essence.

Vegetative-vascular dystonia of the hypertensive type can persist indefinitely. But in the presence of a personal and biological predisposition, with certain psychophysiological relationships, transient hypertension is replaced by stable hypertension in the process of developing hypertension (essential hypertension). Frustrating influences in this disease are most often associated with situations that are characterized by an unsatisfied need for achievement, with the expectation of such situations, with a blocked need for self-affirmation and dominance, as a rule, observed in the field of professional activity. A family predisposition to essential hypertension is combined with a tendency to strong and prolonged emotions that are formed in these frustrating situations. An adequate response to the aggressive reactions that arise in this case is blocked, since in parallel with the increase in aggressiveness, anxiety, sensitivity and the need to comply with accepted social norms increase. Disharmonious personal characteristics and psychological defenses that cause blockade of aggressive reactions are given great importance in the pathogenesis of essential hypertension. It is also important that the resulting anxiety, the level of which in essential hypertension is significantly higher than in controls, due to the rigidity of affect, does not fade for a long time, which contributes to increased emotional stress during repeated frustrations. At the same time, “stuck” hostility finds a socially acceptable way out through the mechanism of somatization. Significant correlations between increased blood pressure, the severity of somatization of anxiety, rigidity of affect, and blocked aggressiveness are detected already at the stage of transient hypertension and persist with a stable increase in blood pressure. The results obtained in our laboratory (together with E. M. Kulikova) make it possible to identify (based on factor analysis) a complex psychophysiological characteristic in which an increase in blood pressure, peripheral vascular resistance and plasma triglyceride levels are combined with such psychological indicators as the need for dominance , the tendency to focus attention on frustrating situations for a long time, total frustration tension and anxiety. The possibility of identifying such a characteristic serves as confirmation of the considered psychophysiological dependencies, typical of hypertension.

Long-term exposure or repeated occurrence of frustrating situations (mostly similar to those noted in hypertension), increased emotional vulnerability, high level of anxiety, accompanied by changes in the neurohumoral regulation of cardiac activity with increased sympathoadrenal influences, may underlie paroxysmal cardiac arrhythmias (in particular , paroxysmal atrial fibrillation) even with intact myocardium. The frequency, duration and severity of paroxysms in these cases correlate with the severity of neurotic phenomena, the level of anxiety, and the tendency to long-term processing of situations that cause negative emotions. Intrapsychic conflict in this group of patients is largely determined by a combination of demonstrative tendencies, the desire to attract and retain the attention of others with anxiety and vigilance, which prevent the implementation of these tendencies. As a result, the ability to build integrated behavior decreases, dissatisfaction increases (with stimulation of negative emotiogenic zones of the hypothalamus), anxiety and the intensity of sympathoadrenal influences. The final result of these disturbances at the level of the heart in paroxysmal atrial fibrillation is the re-entry of excitation into the myocardium, caused by its functional fragmentation and leading to atrial fibrillation. A likely intermediate link in this chain is the occurrence of functional weakness of the sinus node. A similar mechanism leading to ventricular fibrillation appears to underlie emotionally induced sudden cardiac death, the genesis of which is still not well understood.

Psychiatric correlates of coronary heart disease (CHD) are reflected in Rosenman and Friedman's classic description of a behavioral pattern they term “type A,” which is characterized by aggressive involvement in the continuous struggle to achieve greater results in less time, even in the face of resistance and with constant readiness to compete.

The described behavioral stereotype is associated with an increase in the number of frustrating situations, an increase in emotional stress, and at the physiological level - with chronic sympathoadrenal activation and the ensuing consequences for the cardiovascular system in general and coronary insufficiency in particular. Sympathoadrenal activation in IHD increases to an even greater extent due to the fact that adequate response to emotions is hampered by a high level of behavioral control. Increasing anxiety is initially due to the uncertain outcome of activities and tense interpersonal relationships, however, the appearance of angina attacks (or myocardial infarction) is accompanied by the somatization of anxiety, which provides a socially acceptable way out of competition or other activities that cause emotional stress.

Increased emotional stress and the production of catecholamines are correlated with an increase in vascular resistance, an increase in plasma levels of low-density lipoproteins and an increase in blood clotting. Factor analysis made it possible to show that anxiety, emotional instability, levels of triglycerides and low-density lipoproteins are included in one complex psychophysiological characteristic with approximately equal factor loading.

Angina attacks often occur in direct connection with emotional stress. If this occurs with existing stenosis of the coronary vessels, then the pathogenic effect of emotional arousal is indirect, indirect in nature and is the result of myocardial circulatory failure due to an emotiogenic increase in cardiac activity. At the same time, data is provided that about 1/3 of all patients with complaints typical of angina suffer from its angiopathic (vasomotor) form, i.e. coronary spasm of psycho-vegetative origin with organically intact vessels. Clinical studies and modeling of emotional states with simultaneous cardiography have shown that among the emotional states for reproducing vasospastic reactions in angina pectoris, the most significant is anxiety, which appears in situations of threat to one’s own existence, the well-being of loved ones or other persons for whose fate one feels responsible. In general, in the formation of psychophysiological relationships that play a pathogenetic role in the development of angina pectoris, psychophysiological influences that contribute to the atheromatous process and spasm of the coronary vessels are apparently equally significant, since in most cases of the disease vasoconstrictor reactions develop against the background of more or less pronounced sclerotic changes in the coronary vessels .

When studying the differences between patients suffering from angina pectoris and those who had myocardial infarction, it was shown that the first group of patients was distinguished by more pronounced neurotic features and emotional instability. Similar results were obtained in our laboratory. A generalization of studies on the relationship between the state of the emotional sphere, angina pectoris and myocardial infarction suggests that anxiety and neuroticism have a greater prognostic value in relation to angina pectoris and cardiac death than in relation to myocardial infarction.

Peptic ulcer disease and bronchial asthma can be considered as typical forms of pathology in which emotional stress, frustration and anxiety are associated with trophotropic syndrome.

Regarding the psychophysiological relationships in peptic ulcer disease, it should be noted that the very fact of changes in gastric secretion and blood supply to the gastric mucosa under the influence of mental factors is beyond doubt and is subject not only to indirect methods, but also to direct observation. Psychophysiological influences turn out to be more significant than living conditions, work, and nutrition. The incidence of peptic ulcers is similar in countries of Europe, Asia, and America with completely different dietary traditions. It has been shown that in people with a tendency to gastric hypersecretion (determined by the level of pepsinogen in the blood), emotional overload contributes to the appearance of peptic ulcers. The stability and repeatability of emotional reactions is so great that they are associated with serious disorders of secretion, motility, ischemia of the gastric and duodenal mucosa with a weakening of its cytoprotective properties (including against infectious agents and, in particular, Helicobacter pyloris, which has recently is given importance in the occurrence of peptic ulcer disease).

The features and conditions for the occurrence of emotional reactions in peptic ulcer disease require special consideration. In accordance with the psychosomatic hypothesis, the nature of emotional reactions is determined by certain personal characteristics. Patients with duodenal ulcer are characterized by a contradictory combination of the need for dependence, support from significant others and the desire to achieve rewards through their own active work and social achievements. Since the need for dependence contradicts the self-concept of such patients, their self-esteem, psychological defenses prevent its awareness, while the significance of success is usually realized and is often accompanied by ambition, emphasized independence of behavior and self-sufficiency. The role of such personality characteristics in the development of peptic ulcer disease is confirmed by the possibility of predicting the occurrence of peptic ulcers in “hypersecretors” using projective psychological tests.

The formation of the described personality type is associated with the characteristics of early socialization, which are characterized, in particular, by pronounced and long-lasting dependence on parents with the feeling that their love depends on potential achievements and fulfillment of duty. Intrapsychic conflict, generated by a combination of contradictory personal tendencies, underlies constant frustration and leads to an increase in emotional tension with insufficient ability to recognize emotional problems and adequately respond to emotions. According to our data, the level of frustration, dissatisfaction, and anxiety in the group of people suffering from peptic ulcer disease is significantly higher than in the control group of healthy people. The somatization of anxiety observed in these patients may play the role of a protective mechanism that helps satisfy the need for dependence and allows periodic exclusion from socially significant interactions without compromising self-esteem.

The most stressful in this form of pathology are life events in which the need for dependence or the need for achievement, or both of these needs, is frustrated. Such events (their frequency in the group suffering from peptic ulcer disease is significantly higher than in the control group) include events leading to the loss of the usual social environment (in particular, loss of loved ones, migration, dismissal from work, actual breakup of marriage, difficulties in marital relationships) . In all these cases, social support is weakened and the need for dependence is not satisfied. On the other hand, events such as the threat of dismissal, reorganization and conflicts at work, changes in the type of activity lead to frustration of the need for achievement or to the threat of such frustration. The frequency of this kind of situations, the characteristics and severity of the emotional reactions that arise differentiated the group of patients, differing in the clinical course and nature of the ulcerative defect. In particular, a large size of the ulcer corresponded to a more pronounced tendency towards self-sufficiency, independence of behavior and readiness for activities with an uncertain outcome, combined with a greater frequency of life events that prevented the implementation of these tendencies and did not allow the need for dependence to be realized.

A connection was also established between an increase in the frequency of exacerbations of peptic ulcer disease or the transition to a continuously relapsing course and the frequency of undesirable events, mainly in the family sphere, with increased emotional vulnerability and long-term persistence of negative emotions. The influence of mental factors, anxiety levels, and emotional tension on treatment results has also been shown. Scarring of the ulcer slowed down in patients who noted conflicts in the family or high work tension in an unstable work situation, and accelerated with a decrease in work tension and socially justified withdrawal from responsible responsibilities.

The importance of mental factors in the pathogenesis of bronchial asthma is evidenced by clinical observations indicating the appearance of asthmatic paroxysms and aggravation of the course of the disease in emotionally significant situations when mental stress occurs. Changes in external respiration parameters characteristic of obstructive syndrome and attacks of expiratory suffocation may be associated with emotional stress and situational factors, and the relationship between exposure to the allergen that initiates an asthmatic attack and the conditions in which this exposure occurs may be established by a conditioned reflex mechanism. In the event that the mere reproduction of these conditions (sometimes even mental) is capable of causing an asthmatic attack, the response stereotype, initially conditioned somatically, acquires a predominantly psychogenic character. Mental factors are included in a complex polyetiological pathogenetic complex, leading to changes in immunoreactivity and increased reactivity of the bronchial apparatus through mediating mechanisms. Possible changes in immunoreactivity in response to aversion (negative stimulation) and the dependence of the antigen-antibody reaction on psychophysiologically determined sensitization are discussed.

In a study of the system of psychophysiological relationships conducted in our laboratory together with the Clinic of Therapy and Occupational Diseases of the MMA named after. I.M. Sechenov, it was shown that in the group of patients with bronchial asthma, negative stimulation associated with an increase in the number of undesirable life events (especially in the family sphere) is significantly higher than in the control group. At the same time, a high level of anxiety, frustration, and emotional tension is accompanied by a decrease in the ability to organize effective goal-directed behavior and overcome life’s difficulties without attracting the attention of others to them. Adequate response to emotional stress is complicated by disharmony of emotions and personality traits. Characteristic of this group of patients, the combination of hidden anger, “getting stuck” on negative emotions with a feeling of symbioticity, the need to be involved in the problems of other people and to involve them in their problems prevents not only the manifestation, but to a large extent the awareness of aggressive tendencies. In addition, there is a combination of a tendency to view the situation as unsatisfactory, internal rejection of social norms with anxious, psychasthenic traits that determine a high level of internal standard and the need for normative behavior. The intrapsychic conflict that arises as a result of such disharmony further intensifies anxiety, which is largely somatized and accompanied by an increase in the severity of its physiological correlates.

Factor analysis made it possible to identify bronchial asthma as the most significant (21.1% of explained variance) complex psychophysiological factor, which with the highest factor loadings includes indicators reflecting the intensity of anxiety, total frustration tension and the relationship of this tension to the level of behavioral integration. With an increase in this factor, there is a parallel increase in frustration and emotional tension, anxiety, a number of other psychological characteristics discussed above (affective rigidity, psychasthenic tendencies, insufficient integration of behavior, unsatisfied need for dependence, a tendency to view the situation as unsatisfactory) and the severity of the complex of somatic phenomena that arise when the predominance of trophotropic activation or with ergotropic activation in a situation of blockade of β-adrenergic receptors. The same factor includes IgA and IgG with a positive sign. The nature of the described factor reflects the relationship between the characteristics of the mental state, typical for patients with bronchial asthma, and changes in immunoreactivity, impaired external respiration function (ERF) of the obstructive type. Analysis of correlation dependencies also allows us to trace the influence of emotional and frustration tension and associated psychophysiological characteristics on the level of immunoglobulins in the blood, changes in respiratory function and indicators of the clinical course of bronchial asthma: frequency, duration and severity of attacks. A parallel increase in anxiety and a set of changes in respiratory function (decrease in the forced vital capacity of the lungs and volumetric output velocity), contributing to hypoventilation, appear to be specific to psychophysiological relationships in bronchial asthma, since in other cases anxiety is usually associated with hyperventilation syndrome.

Changes in psychophysiological relationships caused by emotional stress can act as one of the risk factors for diseases in the pathogenesis of which psychosomatic dependencies obviously do not play a decisive role. This applies, in particular, to such severe forms of pathology as cancer, in the origin of which psychoimmune relationships may have a certain significance.

The connection between the emotional state and the likelihood of cancer, as well as the course of the latter, was initially noted on the basis of clinical observations. With the beginning of a systematic study of this problem, a fairly clear picture began to emerge of both the life events preceding the disease, which entailed changes in the emotional state, and the predisposing personality traits of patients. Epidemiological studies, including prospective ones, suggest that feelings of despair, helplessness and hopelessness, usually caused by the loss of a significant other, are a risk factor for cancer. Cancer patients were also characterized by the presence of frustrations in childhood caused by relationships with their parents, especially with their mother. It is believed that the sensitization caused by this causes a particularly difficult experience of the situation of loss throughout later life. Specific forms of psychological defenses acquired in childhood and used by cancer patients throughout their lives that prevent the release of emotional stress were also identified.

When studying the pathogenetic links of the chain: emotional reaction - integrative structures of the brain (on the basis of which it is formed) - oncogenic process, the main attention was paid to the hypothalamus-pituitary-adrenal cortex system and immunosuppressive effects. Clinically and experimentally, the dependence of the production of glucocorticoids on the severity of negative emotions, the depth of depressive states and the influence of glucocorticoids on the state and function of the thymus, which is associated with the T-system of immunity and, in particular, antitumor immunity, has been shown. Thus, numerous studies indicate that neuroendocrine changes are associated with stressful exposure that causes a strong affective reaction and the inability of the individual to cope with it, which can have an immunosuppressive effect and, thereby, contribute to the oncogenic disease. It is obvious that the described psychophysiological constellations represent only one of the factors in the complex pathogenesis of oncological conditions.

Treatment of diseases in the genesis and clinical picture of which psychosomatic dependencies play an important role requires specialist training in the field of clinical psychology, sufficient experience in assessing emotional situations, in the diagnosis and treatment of mental disorders of the neurotic range and personality disorders. Such preparation makes it possible to integrate all the information received, form a holistic picture of the patient and use it to conduct adequate therapy. Treatment of psychosomatic disorders caused by emotional stress should take into account to the maximum extent the described stereotype of psychosomatic disorders and the advisability of influencing the psychophysiological regulation system at all its levels. This involves measures aimed at reducing the number and intensity of individually significant frustrating situations by correcting the social environment and restructuring the patient’s perception of his relationship with this environment, reducing the level of anxiety, correcting neurotic disorders and personal inadequacy, restoring emotional and vegetative-humoral balance. Finally, therapeutic measures should include means and methods aimed at eliminating somatic pathology at the level of the organs or systems concerned. In our laboratory, such complex treatment, including preliminary personal diagnosis, orientational psychotherapy, psychopharmacological agents (with individual choice of drugs and doses), agents that normalize the peripheral response to autonomic stimulation, was effective in diseases such as the cardiac variant of neurocirculatory dystonia (vegetative-endocrine cardiopathy), paroxysmal heart rhythm disturbances, essential hypertension, peptic ulcer, sometimes even in cases previously resistant to therapy.

The stated treatment goals presuppose an appropriate diagnosis. The latter, in addition to the examination methods adopted in somatic medicine, is aimed at identifying stressful situations, emotionally significant problems, assessing the current mental state and personality traits of the patient. It should be borne in mind that the information received from the patient (and his environment) should be assessed taking into account the emotionally determined selectivity of its selection, the likelihood of underestimating or, conversely, emphasizing certain facts due to their emotional processing. A frequent effect of psychological defenses is the transformation of the patient’s initial attitudes and values ​​(sometimes to the exact opposite). Familiarity with the patterns of such transformations and the mechanisms of psychological defenses helps to identify the source of emotional stress, which may not be recognized by the patient himself. Accordingly, to assess the pathogenetic role of stressful situations for the purpose of their correction (sociotherapy), what is important is not the objective characteristics of the external environment in themselves, but the extent to which they disrupt the balance of the relationship between the patient and his environment and interfere with the satisfaction of his actual needs.

To select adequate treatment methods and determine optimal therapeutic tactics, it is necessary, as already mentioned, to have the most complete understanding of the patient’s mental state, the characteristics of his personality, and the prevailing stereotypes of his personal response. The possibilities of obtaining such an understanding are significantly expanded if, along with clinical research, standardized methods of psychological diagnostics are used. The high value of such methods in the study of patients with psychosomatic disorders is confirmed by many years of experience in our laboratory.

The place of psychotherapy in the treatment of psychosomatic disorders is determined by the fact that eliminating the state of emotional stress, reducing the level of frustration and anxiety, reorienting the patient in the environment in order to change his attitude towards pathogenetically significant situations, correcting inadequate behavioral stereotypes and personal reactions are the essential goals of a pathogenetically oriented system of therapeutic events. In this case, a whole variety of psychotherapeutic methods can be used, of which only a few will be considered in this article.

An important circumstance that complicates psychotherapy for psychosomatic disorders and prevents the establishment of the necessary cooperation between the patient and the therapist (“formation of a therapeutic alliance”) is that, although emotional disorders, the inability to cope with emotional problems, are an important link in the occurrence and course of psychosomatic disorders, they, as a rule, are not sufficiently realized and are often denied by the patient himself, which determines his orientation towards biological methods of therapy. Psychotherapeutic methods that are directly aimed at changing somatic functions are usually more favorably perceived by patients.

Such methods include relaxation, which as a psychotherapeutic procedure is widely used in psychosomatic medicine. It is usually carried out in two ways: according to Jacobson, when the patient is taught to feel his muscle tone and then relax the muscles, and according to Schultz, when the patient, mobilizing his imagination, evokes sensations (warmth, heaviness, etc.) that accompany muscle relaxation , resulting in it actually happening. The last method in the form of a specific system is called autogenic training. Meditation techniques can also be used to achieve relaxation. General relaxation is an effective anxiolytic (anti-anxiety) remedy, since anxiety syndrome always contains a component of muscle hypertension (especially in the muscles of the shoulder girdle and neck). In addition, against the background of relaxation and a decrease in the level of wakefulness during psychogenic training, it is easier for patients to learn to control certain autonomic functions. Good results are obtained for this purpose by using biofeedback, i.e. visualization using technical means of the effects of controlling physiological functions, which gives patients the opportunity to control their changes. Depending on the nature of the feedback, this control extends to the frequency and rhythm of heart contractions, blood pressure levels, smooth muscle tone, and gastric secretion. The successful use of this method for vegetative-vascular dystonia, hypertension, heart rhythm disturbances, peptic ulcer, and bronchial asthma has been reported.

The use of deep (psychodynamic) therapy becomes appropriate if the source of an inadequate emotional response is far away in time (for example, in early childhood) or is not recognized by the patient under the influence of psychological defenses due to incompatibility with the self-concept. Bringing emotional problems into the sphere of consciousness makes it possible to adequately resolve them, which can help eliminate somatic symptoms that have developed on the basis of emotional stress.

Awareness of one's emotional reactions in situations involving intractable problems can be achieved through non-directive psychotherapy. The principle of such therapy is that the patient is assisted in self-analysis through directed questions and paraphrasing the patient’s answers in such a way that he can realize and formulate his attitude to the problem and find ways to resolve it.

The formation of a stable connection between thought patterns, emotions and somatic functions may have pathogenetic significance. This pathogenetic chain: unfounded judgment - emotion - somatic symptom - can be broken with the help of cognitive therapy, which is especially indicated for patients capable of introspection and self-analysis. In this case, the patient identifies his judgments, recognizes their unfoundedness, replaces inadequate judgments with realistic ones, and checks the correctness of this replacement. Correction of inadequate cognitive constructs can be achieved by introducing new elements into these constructs, which makes it possible to influence the hierarchy of needs and behavioral stereotypes (guidance psychotherapy) and, accordingly, cope with emotional problems reflected in somatic symptoms.

Treatment of emotiogenic disorders of interpersonal relationships is sometimes successfully carried out through discussion and (or) modeling of relevant situations in small groups of patients (group psychotherapy), which as a means of treating emotionally caused somatic disorders can be quite effective. This is also due to the fact that in the process of group interaction socially acceptable forms of responding to emotional stress are worked out.

Hypnotherapy is sometimes successfully used to relieve functionally fixed psychosomatic monosymptoms. It is also used to achieve general relaxation (especially non-directive, “soft” hypnosis according to M. Erickson).

Psychopharmacological therapy for psychosomatic disorders is used to reduce anxiety and emotional stress (including physiological correlates of anxiety) and to transform persistent maladaptive forms of response with which psychosomatic phenomena are associated. At the same time, the basic principles of psychopharmacological therapy are observed, which involve the choice of a drug in accordance with the specific mental state and personality characteristics, a slow and gradual increase in doses, starting from minimal ones (which is associated with pronounced individual differences in the pharmacokinetics and pharmacodynamics of drugs and the presence of a “therapeutic window”, in within which the psychopharmacological effect is maximum), a gradual reduction in doses upon completion of therapy in order to avoid “withdrawal syndrome”.

Since the main types of psychopharmacological effects and classes of drugs have already been discussed in the previous article1, it is advisable here to dwell only on some points that are essential in the treatment of psychosomatic disorders.

It should be borne in mind that in cases where anxiety and emotional stress determine the mental state, and the physiological correlates of anxiety determine the main somatic symptoms, psychopharmacological therapy may be limited to the use of psychotropic drugs, the effect of which is manifested by a rapidly developing tranquilizing effect (mainly benzodiazepine tranquilizers). However, since psychosomatic disorders are usually based on quite persistent and non-adaptive stereotypes of mental response, in most cases, along with tranquilizers, drugs are used that have not only a rapid tranquilizing effect, but also a slow antipsychotic one (tranquilizers). If this stereotype is characterized by depressive forms of response, including those expressed as masked depression, drugs are used that combine a tranquilizing effect with an antidepressant one (tranquilizing antidepressants). In this case, it is necessary to take into account the fact that the effect of tranquilizers on autonomic-humoral regulation is realized indirectly through a decrease in the level of anxiety and emotional stress and, accordingly, helps to eliminate shifts that have arisen in connection with emotional stress, regardless of their initial sympathoadrenal or vagoinsular orientation. In particular, the initial increase in secretion and increase in the intensity of synthesis of catecholamines under the influence of tranquilizers decrease. In the same case, if initially the secretion of catecholamines was reduced and their metabolism was slowed down, under the influence of tranquilizers the opposite effect is observed.

When using drugs with slow effects, their direct effect on autonomic-humoral regulation, associated with both the main effect (for antipsychotics - mainly adrenolytic, for antidepressants - mainly adrenomimetic), and with the effect usually considered as a side effect, should be taken into account. (in particular the anticholinergic effect of many neuroleptics and antidepressants). It is important that people suffering from psychosomatic disorders tend to exaggerate the side effects of drugs due to increased attention to their physical sensations. The significance of such a negative attitude of the patient is confirmed by the occurrence of adverse somatic events while taking placebo. A positive placebo effect, or the occurrence of deterioration when taking a placebo, reflects the patient’s attitude towards treatment and can be used to assess this attitude, regardless of whether the patient himself is aware of it.

In psychosomatic disorders, some effects of psychopharmacological drugs, usually regarded as side effects, may be desirable. Thus, the muscle relaxant effect of tranquilizers - derivatives of benzodiazepine and propanediol - is useful for muscle “tensions” and various spastic conditions. The anticholinergic properties of a number of antipsychotics and antidepressants may be desirable where their antispasmodic, antiemetic and antacid effects are needed.

We can note drugs whose effect on vegetative symptoms is so pronounced that their effect can be considered as vegetative-stabilizing. Such drugs include among antidepressants, in particular, opipramol (Insidon), among neuroleptics - sulpiride (Eglonil), which are purposefully used for certain psychosomatic disorders, for example, peptic ulcers, migraines. Vestibulo- and vegetostabilizing properties are also expressed in etaparazine.

Drugs that act on peripheral mediator processes (for example, β-blockers) are not only effective at the level of autonomic regulation, eliminating autonomic correlates of anxiety, but, thanks to the feedback mechanism, often reduce emotional stress.

It is important to consider the interaction between psychotherapy and psychopharmacological treatment, since the use of psychopharmacological agents cannot be considered as a purely biological therapy. Behavior modification under the influence of these drugs can lead to a decrease in the patient’s active role in resolving his conflicts and emotional problems, without which it is impossible to achieve a lasting therapeutic effect. Directed psychotherapeutic influence can prevent such a development of the situation. At the same time, the use of psychopharmacological drugs creates a more favorable background for psychotherapy, reducing the level of anxiety and promoting the transformation of psychological defenses, weakening emotionally caused distortions in perception and assessment of the environment and one’s own reactions, improving the integration of behavior and social interaction. In addition, reducing anxiety and vigilance makes the interaction between therapist and patient more productive.

LITERATURE

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Psycho-emotional stress is a difficult condition that can cause dangerous diseases: in some cases it provokes a cerebral vascular attack. Psycho-emotional stress can be overcome, the main thing is to learn how to do it. There are many different techniques you can try to avoid stressful situations.

A change of scenery would be a good option.

In modern medicine there are many ways to help cope with this condition.

You can resort to meditation, yoga, relaxation, you can get rid of accumulated negative energy with the help of ordinary valerian, mint is a good sedative.

The harmful effects of stress

When a person experiences such conditions, a certain amount of adrenaline and norepinephrine is released. In large quantities, these hormones are harmful to the body. They contribute to increased blood pressure; as a result of their effects, adrenaline and norepinephrine can damage the vascular wall and cause vasospasm. After stress, dangerous illnesses such as heart attack and stroke can develop. With frequent experiences of negative emotions, a person may develop hypertension, which causes significant harm to health.

Adrenaline and norepinephrine increase muscle tone, moreover, they help increase blood sugar levels. If a person has any problems related to the activity of the cardiovascular system, or has a tendency to high blood pressure, stress will have a stronger effect than on a healthy person. If a person has heart problems, vascular spasms can be very dangerous. This mental state can be caused by various negative factors, for example, everyday difficulties; often a person experiences stress while at work. Every person needs to learn how to cope with stress.

In some cases, people experience pain accompanied by increased fatigue: in this case, insomnia and migraine appear. Worth knowing: frequent stress can significantly weaken the protective properties of the immune system.

A condition such as chronic stress poses a health threat: it can cause hypertension, which causes frequent increases in blood pressure. Chronic stress negatively affects the state of the cardiovascular system and blood vessels. In this case, there is a considerable risk of the appearance of sclerotic plaques (especially if the level of cholesterol in the blood is elevated). A bad mood and a depressed state can easily develop into psycho-emotional stress. These conditions can lead to disruption of the functioning of organs and all body systems. If a person is sick, the body will spend energy fighting stress and be distracted by restoring mental functions, thus the fight against the disease will be reduced to zero.

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Methods for dealing with anxiety

To alleviate the symptoms of stress, psychologists advise keeping a diary or speaking your thoughts into a voice recorder. It is important to ensure that a person is able to explain, characterize, and analyze his own mood. You can reduce your stress level by writing down your thoughts on paper: in order not to get lost in your thoughts, try to talk it out, a person dear to you can listen to your problems. After this, your mood will change for the better, you will be half free from disturbing thoughts. There are many ways to provide prevention against this mental illness. The most radical option is to leave civilization.

Pet owners claim that it is the latter that help cope with stress. When a person strokes a dog or cat, his well-being improves to a large extent. As a result of research, the positive effects of pets have been proven. If a person has a pet at home and often strokes it, the psyche becomes stronger, the person himself becomes more restrained, moreover, his blood pressure normalizes. Pets not only give joy, they can reduce hypertensive crises. To avoid daily stress, you need to try to change external circumstances, for example, change your place of work and even your place of residence. Not everyone decides to take such important steps, so you can change your attitude towards a specific irritating factor.

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Exercise and heart-to-heart conversations

Some people prefer to remain silent when experiencing stress, others try to speak out. To gradually get out of a tense state, it is recommended to start physical training. By doing exercises, you can calm down and overcome moderate depression; exercise significantly strengthens the cardiovascular system, it normalizes blood pressure and lowers cholesterol levels. Regular exercise helps strengthen the immune system and combat stress every time. After an intense half-hour workout, the mood will significantly improve: a person’s anxiety state will decrease by one quarter; in addition to these features, physical exercise promotes favorable mental activity. Walking will also help relieve stress: it is recommended to walk for half an hour at a brisk pace.

As mentioned above, talking and writing down thoughts on paper helps overcome stress. Try to find a person with whom you can discuss your problems, he should listen to you and understand how you feel. To relax and distract yourself from negative thoughts, you can lie on your bed with your eyes closed and imagine that you are relaxing on a sunny beach, breathing in crystal clear air. Try to come up with a picture that will be suitable for you. It is important to tune in to a positive wave, while turning on your own imagination. Similar exercises can be done for 30 minutes a day.

To avoid stressful situations, you can resort to a technique called progressive relaxation. It is necessary for a person to understand the difference between when his muscles are in a calm state and when they are in a tense state. The sensations of such a contrast are easy to understand when you feel relaxed. You need to realize that a state of relaxation can be achieved almost whenever you need it.