Integrating Resources of M. Spivak’s Systemic Approach, Cognitive-Behavioral Therapy and Cultural-Historical Psychology in Addressing Challenges of Reforming Residential Institutions for Psychiatric Patients in Russia

2016, the Russian Federation started a reform of residential institutions for psy¬chiatric patients. An essential condition of its success is reintegration of patients into society, which implies development and implementation of effective psychosocial rehabilitation programs. Materials and Methods. In 2018, an integrated rehabilita¬tion program was developed and implemented for the first time in Psychoneurologi¬cal Residential Institution No. 22 in Moscow. The program integrated the principles and methods of M. Spivak’s systemic approach, cultural-historical psychology, and cognitive-behavioral therapy. The rehabilitation group included 12 patients with chronic mental disorders and disabilities who had resided in the institution for 3 to 16 years. The total duration of the program was 6 months. An expert assessment of the participants’ psychological and social competencies in the major life areas (housing and everyday life; work and employment; hygiene; interpersonal relations; hobbies and leisure) was carried out before and after the rehabilitation program, using Spivak’s diagnostic scales. Results. A study of the integrated rehabilitation program effectiveness showed a statistically significant improvement in the patients’ competencies in the major life areas. Follow-up of the dynamics within the follow¬ing 3 years upon the program completion revealed positive changes in their social adaptation. Output. A preliminary conclusion could be made that the proposed in¬tegrated rehabilitation program might be effective for shaping and training of social skills that increase the patients’ autonomy, as well as for overcoming self-limiting attitudes and avoidance strategies resulting from their negative experience of social “defeats” and institutional experience of learned helplessness. Each of the three in-tegrated approaches contributed to achieving the rehabilitation objectives. Further research with larger samples is needed.

1. Allenova O. Vse opasnosti seti “Internat” [All dangers of the net of the residential institution] [Elektronnyi resurs]. Kommersant Vlast = Commersant. Power, 28.10.2019. Available at: https://www.kommersant.ru/doc/4140760 (Accessed: 01.08.2021). (In Russ.).
2. Vinogradova L.N. Kontrast psikhonevrologicheskikh internatov Moskvy i Moskovskoy oblasti [Contrast of residential institutions for psychiatric patients in Moscow and in Moscow Region] [Elektronnyi resurs]. Nezavisimiy Psikhiatricheskiy Zhournal = Independent Psychiatric Journal, 2013, no 3. Available at: http://npar. ru/kontrast-psixonevrologicheskix-internatov-moskvy-i-moskovskoj-oblasti/ (Accessed: 01.08.2021). (In Russ.).
3. Vygotsky L.S. Myshlenie i rech [Thinking and speech], 5th ed., rev. Moscow: Labirint, 1999, 352 p. (In Russ.).
4. Zaretsky V.K. Stanovlenie i suschnost refleksivno-deyatelnostnogo podkhoda d okazaii konsultativnoy psikhologicheskoy pomoschi [Formation and essence of the reflexive-activity approach in providing counseling psychological help]. Konsul’tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2013, no. 2, pp. 8—37. (In Russ.).
5. Klepikova A.A. Naverno ya durak [Probably I am a fool]. St.-Petersburg: PH of the European Un-ty in St. Petersburg, 2018, 432 p. (In Russ.).
6. Kritskaya V.P., Meleshko T,K, Polyakov Y.F. Patologiya psikhicheskoy deyatelʹnosti pri shizofrenii: motivatsiya, obshchenie, poznanie [Pathology of mental activity in schizophrenia: motivation, communication, cognition]. Moscow: Meditsina, 1991, 256 p. (In Russ.).
7. Kurek N.S. Issledovanie snizheniya psikhicheskoy aktivnosti u bolnykh shizofreniey na materiale protsessov tseleobrazovaniya and tseledostizheniya. Diss. kand. psikhol. nauk [A study of the decrease in mental activity of patients with schizophrenia based on the processes of goal-formation and goal-achievement. Ph. D. (Psychology) Thesis]. Moscow, 1982, 207 p. (In Russ.).
8. Okhrana psikhicheskogo zdorovya: problem i puti ikh resheniya. Otchet o Evropeyskoy conferentsii VOZ na urovne ministrov, 2006 [Mental health: challenges and solutions. Report on the WHO European Ministerial Conference, 2006] [Elektronnyi resurs] Available at: https://apps.who.int/iris/handle/10665/328055?locale-attribute=pt& (Accessed: 16.07.2021). (In Russ.).
9. Perechen porucheniy presidenta po itogam vstrechi c predstavitelyami sotsialno orientirovannykh blagotvoritelnykh organizatsiy i volonterskogo dvizheniya 26.07.2017 [List of President’s instructions following a meeting with representatives of socially oriented charity organizations and volunteer movement 26.07.2017] [Elektronnyi resurs] Available at: http://kremlin.ru/acts/assignments/orders/55419 (Accessed: 16.07.2021). (In Russ.).
10. Protokol zasedaniya Soveta pri Pravitelstve RF po voprosam popechitelstva v sotsialnoy sfere ot 06.06.2016 [Minutes of the meeting of the Council under the Government of the Russian Federation on issues of patronage in the social sphere dated 06.06.2016] [Elektronnyi resurs]. Available at: https://www.popechitely.ru/ about/vypiska/ (Accessed: 11.07.2021). (In Russ.).
11. Protokol zasedaniya Soveta pri Pravitelstve RF po voprosam popechitelstva v sotsialnoy sfere ot 29.03.2019 [Minutes of the meeting of the Council under the Government of the Russian Federation on issues of patronage in the social sphere dated 29.03.2019] [Elektronnyi resurs]. Available at: https://www.popechitely.ru/ about/vypiska/ (Accessed: 11.07.2021). (In Russ.).
12. Psikhosocialnaya i kognitivnaya terapiya i reabilitatsiya psikhicheski bolnykh. Prakticheskoye rukovodstvo [Psychosocial and cognitive therapy and rehabilitation of the psychiatric patients. Practical guide]. In Gurovich I.Y., Shmukler A.B. (ed.). Moscow: PH Medpraktika-M, 2015, 420 p. (In Russ.).
13. Serebriyskaya L.Y. Psikhologicheskiye factory stigmatizatsii psikhicheski bolnykh. Diss. kand. psikhol. nauk [Psychological factors of stigmatization of the psychiatric patients. Ph. D. (Psychology) Thesis]. Moscow, 2005, 177 p. (In Russ.).
14. Takkueva E.V, Sisneva M.E., Kholmogorova A.B. Vozmozhnosti vosstanovleniya konstruktivnoy aktivnosti i samoeffectivnosti sredstvami motivatsionnogo treninga u bolnykh shizofreniey v usloviyakh PNI [Restorative possibilities of constructive activity and self-efficacies by means of motivational training of those who suffers from schizophrenia in conditions of psychoneurological boarding schools]. Sovremennaya terapiya psikhicheskikh rasstroystv = Current Therapy of Mental Disorders, 2019, no. 4, pp. 38—46. (In Russ., abstr. in Engl.).
15. Kholmogorova A.B. Narusheniya refleksivnoy regulyatsii poznavatelnoy deyatelnosti pri shizofrenii. Diss. kand. psikhol. nauk [Disorders of the reflexive regulation of cognitive activity in schizophrenia. Ph. D. (Psychology) Thesis]. Moscow, 1983, 219 p. (In Russ.).
16. Kholmogorova A.B.. Rychkova O.V. Narusheniya sotsialnogo poznaniya. Novaya praradigma v issledovaniyah tsentralnogo psikhologicheskogo defitsita pri shizofrenii [Disorders of social cognition. A new paradigm in research on the key psychological deficits in schizophrenia.]. Moscow: FORUM, 2016, 288 p. (In Russ.).
17. Beck A.T., Finkel M.R., Beck J.S. The Theory of Modes: Applications to Schizophrenia and Other Psychological Conditions. Cognit Ther Res., 2021, no. 45, pp. 391—400.
18. Beck A.T., Rector N.A. Cognitive therapy of schizophrenia: a new therapy for the new millennium. Am. J. Psychother., 2000, no. 54(3), pp. 291—300.
19. Beck A.T., Rector N.A. Cognitive approaches to schizophrenia: theory and therapy. Ann. Rev. Clin. Psychol., 2005, no. 1, pp. 577—606.
20. Bradshaw W. Integrating cognitive-behavioral psychotherapy for persons with schizophrenia into a psychiatric rehabilitation program: results of a three-year trial. Community Ment Health J., 2000, no. 36(5), pp. 491—500.
21. Carozza P. Principi di riabilitazione psichiatrica. Per un sistema di servizi orientato alla guarigione / Franco Angeli editore. Libro Universitario, 2006, pp. 500.
22. Corrigan P.W. Mental health stigma as social attribution: implications for research methods and attitude change. Clin Psychol Sci Pract., 2000, no. 7(1), pp. 48—67.
23. Corrigan P.W. Penn D.L. Lessons from social psychology on discrediting psychiatric stigma, Am Psychol., 1999, no. 54, pp. 765—776.
24. Corrigan P.W., Watson A.C. Understanding the impact of stigma on people with mental illness. World Psychiatry, 2002, no. 1(1), pp. 16—20.
25. Malik N., et al. Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months. J Clin Psychiatry, 2009, no. 70(2), pp. 201—207.
26. Granholm E., et al. Enhancing assertive community treatment with cognitive behavioral social skills, training for schizophrenia. Trials, 2015, no. 16, p. 438.
27. Grant P.M., Bredemeier K., Beck A.T. Six-Month Follow-Up of Recovery-Oriented Cognitive Therapy for Low-Functioning Individuals with Schizophrenia. Psychiatr Serv, 2017, no. 68(10), pp. 997—1002.
28. Link B.G. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev., 1987, no. 52, pp. 96—112.
29. Link B.G., et al. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav., 1997, no. 38, pp. 177—190.
30. Curcio J., et al. Patterns assistenziali ed esiti (outcome) psicosociali. Uno studio osservazionale-longitudinale prospettico: suggerimenti per un buon funzionamento dei servizi di riabilitazione. Psicologia Calabria, 2012. No. 1—2, pp. 9—16.
31. Grant P.M., et al. Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy. Psychol Med., 2018. Vol. 48(2), pp. 261—268.
32. Spivak M. Introduzione alla riabilitazione sociale, teoria, tecnologia e modelli d’intervento. Riv. Sperim. Freniatria, 1987. Vol. CXI, pp. 522—574.
33. Grant P.M., et al. Successfully breaking a 20-year cycle of hospitalizations with recovery-oriented cognitive therapy for schizophrenia. Psychol Serv., 2014. Vol. 11(2), pp. 125—133.
34. Langer L.I., et al. The effect of a mindfulness-based intervention in cognitive functions and psychological well-being applied as an early intervention in schizophrenia and high-risk mental state in a Chilean sample: study protocol for a randomized controlled trial. Trials, 2017. Vol. 18(1), p. 233.
35. Turkington D., Kingdon D., Weiden P.J. Cognitive behavior therapy for schizophrenia. Am J Psychiatry, 2006. Vol. 16, pp. 365—373.