Estimation of Efficiency of the Integrative Motivational Training Program (IPMT) for Patients with Schizophrenia, Undergoing Treatment in a Psychiatric Hospital, and for those living in Residential Institutions for Psychiatric Patients (PRI)

217

Abstract

Rationale. For effective reforming the system of mental health, the system of residential institutions for psychiatric patients (PRI) in the Russian Federation, the development and validation of efficiency of scientifically based methods of socializing psychiatric patients through the activation and development of their psychological resources and social competencies are of particular significance. Among the residents of PRI 46,9% have schizophrenia. Study Objective. Verification of efficiency of the original integrative motivational training program (IPMT) in two samples of patients with schizophrenia: those on inpatient treatment and those living in PRI. Materials and methods. In total, 11 training groups were carried out for the patients with schizophrenia, undergoing treatment in Psychiatric Clinical Hospital No. 4 n.a. Gannushkin (PCH) (total 45 persons, average age 44, 32 women and 13 men with different duration of the disease), and 7 training groups were conducted for the patients in PRI (total 35 persons, average age 50, 17 women and 18 men with duration of the disease over 5 years). The efficiency of the training was estimated using self-assessment instruments that the patients completed before and after the training: “Self-efficacy Diagnostics”, “Coping Strategy Indicator”, “Compliance”, “Social Avoidance and Distress Scale” (SADS), “Feedback Questionnaire”. Results. The proposed program motivational training is based on principles close to those of the recovery-oriented cognitive therapy (CT-R), cultural and historical psychology and reflection-activity approach, and contributes to positive changes in the motivational sphere of patients with schizophrenia. In the sample of patients from PCH, the indicators of social anxiety have statistically significantly reduced and there has been an increase in indicators of self-efficacy and compliance. At the level close to statistical significance, the frequency of using a problem-solving strategy has increased, the indicators of their avoidance strategy have decreased, and the indicators of a seeking social support strategy have not changed. In the sample of patients from the PRI, on the contrary, the frequency of using a constructive seeking social support strategy has statistically significantly increased. At the same time, the overall indicator of their social anxiety has reduced, and the overall indicator of their self-efficacy has increased at the level close to statistical significance. The absence of statistically significant dynamics in the variables of compliance and using a problem-solving strategy, as well as in using a destructive avoidance strategy indicates that these deficits are the most persistent and require an additional targeted work. The training participants from both samples have subjectively highly evaluated the results of the training and the changes that they have experienced. Output. There has been a preliminary conclusion made about the efficiency of IPMT for delivering on the target of increasing the resources for socializing patients with schizophrenia, both in PCH and PRI. The main differences in two samples are related to the fact that in the PRI group, in contrast to the PCH group, the indicator of a seeking social support strategy has increased, and use of dysfunctional strategies and compliance problems are more stable. The prospects for this research work consist in expanding the samples and analyzing the influence of such factors gender, age, duration of the disease and duration of stay in the residential facility.

General Information

Keywords: psychiatric residential institutions, psychosocial rehabilitation, learned helplessness, motivational training, schizophrenia, motivation deficits, violations of goal–setting, Recovery Oriented Cognitive Therapy, reflexive–activity approach

Journal rubric: Empirical Researches

Article type: scientific article

DOI: https://doi.org/10.17759/cpp.2023310102

Received: 15.06.2022

For citation: Takkueva E.V. Estimation of Efficiency of the Integrative Motivational Training Program (IPMT) for Patients with Schizophrenia, Undergoing Treatment in a Psychiatric Hospital, and for those living in Residential Institutions for Psychiatric Patients (PRI). Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2023. Vol. 31, no. 1, pp. 31–57. DOI: 10.17759/cpp.2023310102. (In Russ., аbstr. in Engl.)

References

1. Allenova O. Lyudi, vlast i PNI. Pochemu net reformy psixonevrologicheskix internatov [Elektronnyi resurs]. Kommersant. 07.12.2019. URL: https://www.kommersant.ru/doc/4180226 (Accessed 01.07.2021) 

2. Babin S.M. Psixoterapiya psixozov: prakticheskoe rukovodstvo. SPb.: SpeczLit, 2011. 335 p.

3. Bek J. Kognitivnaya terapiya. Polnoe rukovodstvo. M.: OOO «I.D. Vilyams», 2006. 400 p.

4. Vojtenko A.M. Socialnaya psixiatriya s osnovami mediko–socialnoj ekspertizy i reabilitologii: ruk–vo dlya vrachej i psixologov.  SPb.: Foliant, 2002.  255 p.

5. Vygotski L.S. Myshlenie i rech: psixologicheskie issledovaniya. Leningrad: Gos. ucheb–ped. izd–vo, 1934. 324 p.

6. Gurovich I.Ya. Psixosocial`naya i kognitivnaya terapiya i reabilitaciya psixicheski bol`ny`x: Prakticheskoe Rukovodstvo. Eds. I.Ya. Gurovich, A.B. Shmukler.  M.: Medpraktika, 2015.  418 p.

7. Dementeva N.F. Problemy soblyudeniya prav cheloveka v psixonevrologicheskix internatax i detskix domax–internatax. Prava cheloveka i psixiatriya v Rossijskoj Federacii: doklad po rezul`tatam monitoringa i tematicheskie stat`. Ed. A. Novikova. M.: Moscow Helsinki Group, 2004.  297 p.

8. Druker P.F. Praktika menedzhmenta. M.: OOO «I.D. Vil`yams», 2000. 398 p.

9. Zhukova L. Doma molchaniya. Kak reformiruyut sistemu psixonevrologicheskix internatov [Elektronny`j resurs]. RIA Novosti. 03.03.2020. URL: https://ria.ru/20170721/1498870814.html (Accessed 01.07.2021).

10. Zareczki V.K. Zona blizhajshego razvitiya: o chem ne uspel napisat` Vygotskij… Kulturno–istoricheskaya psixologiya = Cultural-Historical Psychology, 2007, № 3, pp. 96—104.

11. Zareczki V. K. Stanovlenie i sushhnost` refleksivno–deyatel`nostnogo podxoda v okazanii konsul`tativnoj psixologicheskoj pomoshhi. Konsul`tativnaya psixologiya i psixoterapiya = Counseling Psychology and Psychotherapy, 2013, № 2, pp. 8—37.

12. Zareczki V.K. Teorema L.S. Vy`gotskogo «Odin shag v obuchenii — sto shagov v razvitii»: v poiskax dokazatel`stva. Kul`turno–istoricheskaya psixologiya = Cultural-Historical Psychology, 2015, № 3, pp. 44—63.

13. Zareczki V.K., Nikolaevskaya I.A. Mnogovektornaya model` zony` blizhajshego razvitiya kak sposob analiza dinamiki razvitiya rebenka v uchebnoj deyatel`nosti. Konsul`tativnaya psixologiya i psixoterapiya = Counseling Psychology and Psychotherapy, 2019, № 2, pp. 95—113.

14. Zareczki Yu.V. Subektnaya poziciya po otnosheniyu k uchebnoj deyatel`nosti kak resurs razvitiya i predmet issledovaniya. Konsultativnaya psixologiya i psixoterapiya = Counseling Psychology and Psychotherapy, 2013, № 2, pp. 110—128. 

15. Zejgarnik B.V. Patopsixologiya: uchebnik dlya akademicheskogo bakalavriata. M.: Yurajt, 2018. 367 p.

16. Zejgarnik B.V., Kholmogorova A.B. Narushenie samoregulyacii poznavatel`noj deyatel`nosti u bol`ny`x shizofreniej. Zhurn. nevropatol. i psixiatr. im. S.S. Korsakova = Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakov,1985, № 12, pp. 1813—1819.

17. Jenner J. Direktivny`e intervencii v ostroj i social`noj psixiatrii. M.: Global`naya iniciativa v psixiatrii, 2010. 392 p.

18. Kirillova M.G., Kurek N.S. E`mocii i motivaciya bol`ny`x shizofreniej v situaciyax kooperacii i konkurencii. Psixologicheskij zhurnal= Psychological journal, 2002. T. 23, № 5, pp. 80—87.

19. Konvenciya o pravax invalidov. Prinyata rezolyuciej 61/106 General`noj Assamblei OON ot 13 dekabrya 2006 g. [Elektronny resurs] https://www.un.org/ru/documents/decl_conv/conventions/disability.shtml (accessed: 01.08.2021).

20. Kotler F., Berger R., Bikxoff N. Strategicheskij menedzhment po Kotleru. Luchshie priemy` i metody. M.: Alpina Pablisher, 2012. 144 p.

21. Kochenov M.M., Nikolaeva V.V. Motivaciya pri shizofrenii.  M.: Izd–vo MGU, 1978.  88 p.

22. Kritskaya V.P., Meleshko T.K., Polyakov Yu.F. Patologiya psixicheskoj deyatel`nosti pri shizofrenii: motivaciya, obshhenie, poznanie. M.:  MSU, 1991.  256 p.

23. Kurek N.S. Deficit psixicheskoj aktivnosti: passivnost` lichnosti i bolezn`. M.: Institut psixologii RAN, 1996.  245 p.

24. Kurek N.S. Issledovanie snizheniya psixicheskoj aktivnosti u bol`ny`x shizofreniej na materiale processov celeobrazovaniya i celedostizheniya. Diss. kand. psixol. nauk. M., 1982.  207 p.

25. Makklelland D. Motivaciya cheloveka. SPb.: Piter, 2007. 672 p.

26. Maslou A. Motivaciya i lichnost`. SPb.: Piter; 2003.  352 p.

27. Na styke dvux spektrov: narusheniya social`nogo poznaniya pri bipolyarnom i shizoaffektivnom rasstrojstvax / pod red. A.B. Kholmogorovoj. M.: Neolit, 2016. 200 p.

28. Pismo Ministerstva zdravooxraneniya RF № 14–2/I/1–4174 ot 28.10.2019 [E`lektronny`j resurs], URL: https://www.garant.ru/products/ipo/prime/doc/73436324/ (accessed 30.08.2021).

29. Protokol zasedaniya Soveta pri Pravitel`stve RF po voprosam popechitel`stva v social`noj sfere ot 29.03.2019 [Elektronny resurs]. URL: https://www.popechitely.ru/about/vypiska/ (accessed:14.08.2021).

30. Psixiatriya. Nacional`noe rukovodstvo. Kratkoe izdanie / pod red. T.B. Dmitrievoj, V.N. Krasnova, N.G. Neznanova, V.Ya. Semke, A.S. Titanova; otv. red. Yu.A. Aleksandrovskij.  M.: GE`OTAR–Media, 2012.  2009 p.

31. Seligman M. Novaya pozitivnaya psixologiya: nauchny`j vzglyad na schast`e i smy`sl zhizni.  M.: «Sofiya», 2006.  368 p.

32. Semenova N.D. Psixosocial`naya metodika dlya motivirovaniya pacientov. Social`naya i klinicheskaya psixiatriya, 2010, № 1, pp. 52—64.

33. Semenova N.D., Gurovich I.Ya. Modul` formirovaniya motivacii k reabilitacii v usloviyax mediko–reabilitacionnogo otdeleniya psixiatricheskoj bol`nicy. Social`naya i klinicheskaya psixiatriya, 2014, № 4,  pp. 31—37.

34. Sisneva M.E. Integraciya resursov sistemnogo podxoda M. Spivaka, kognitivno–bixevioral`noj terapii i kul`turno–istoricheskoj psixologii v reshenii zadach reformirovaniya psixonevrologicheskix internatov v Rossii. Konsultativnaya psixologiya i psixoterapiya = Counseling Psychology and Psychotherapy,, 2021. № 3, pp. 140—158. 

35. Sokolova E.T. Motivaciya i vospriyatie v norme i patologii. M.: MSU. 1980 128 p.

36. Speranskaya L.N. Uchenie o stoimosti B. Franklina // Vsemirnaya istoriya e`konomicheskoj my`sli: V 6 t. T.1. Ot zarozhdeniya e`konomicheskoj my`sli do pervy`x teoreticheskix sistem politicheskoj zhizni. M.: Mysl, 1987. 606 p.

37. Standarty` okazaniya pomoshhi bol`ny`m shizofreniej / pod red. V.N. Krasnova, I.Ya. Gurovicha, S.N. Mosolova, A.B. Shmuklera. M.: Moskovskij NII psixiatrii Roszdrava, 2006. 260 p.

38. Sudebny`e i normativny`e akty` RF — Polozhenie o psixonevrologicheskom internate Ministerstva social`nogo obespecheniya RSFSR, utverzhdennoe Prikazom Ministerstva social`nogo obespecheniya RF ot 27 dekabrya 1978 g. № 145 (s izmeneniyami na 12 aprelya 2007 g.). [E`lektronny`j resurs]. – URL: https://sudact. ru/law/prikazminsotsobespecheniiarsfsrot27121978n145/polozhenieopsikhonevrologicheskominternateministerstva/ (accessed 01.04.19).

39. Takkueva E.V, Sisneva M.E, Kholmogorova A.B. Vozmozhnosti vosstanovleniya konstruktivnoj aktivnosti i samoe`ffektivnosti sredstvami motivacionnogo treninga u bol`ny`x shizofreniej v usloviyax psixonevrologicheskogo internata. Sovremennaya terapiya psixicheskix rasstrojstv, 2019, № 4, pp. 38—46.

40. Takkueva E.V., Kholmogorova A.B., Palin A.V. Konsolidaciya dostizhenij organizacionnoj i klinicheskoj psixologii v reabilitacii bol`ny`x shizofreniej: integrativnaya programma motivacionnogo treninga. Sovremennaya terapiya psixicheskix rasstrojstv, 2019, № 1, pp. 38—48.

41. Хekxauzen X. Motivaciya i deyatel`nost`. SPb.: Piter, 2003. 860 p.

42. Kholmogorova A.B. Dve konfliktuyushhie metodologii v issledovaniyax psixoterapii i ee e`ffektivnosti: poisk tret`ego puti (chast` II). Konsultativnaya psixologiya i psixoterapiya = Counseling Psychology and Psychotherapy. 2010, № 1, pp. 14—37.

43. Kholmogorova A.B. Narusheniya refleksivnoj regulyacii poznavatel`noj deyatel`nosti pri shizofrenii. Diss. kand. psixol. nauk. M., 1983. 219 p.

44. Kholmogorova A.B., Garanyan N.G., Dolny`kova A.A., Shmukler A.B. Programma treninga kognitivny`x i social`ny`x navy`kov (TKSN) u bol`ny`x shizofreniej. Social`naya i klinicheskaya psixiatriya, 2007,  № 4, pp. 67—77.

45. Kholmogorova A.B., Rychkova O.V. Narusheniya social`nogo poznaniya – novaya paradigma v issledovaniyax central`nogo psixologicheskogo deficita pri shizofrenii. M.: Forum, 2016. 288 p.

46. Kholmogorova A.B., Rychkova O.V., Pugovkina O.D., Moskacheva M.A. Misheni i metody` psixologicheskoj pomoshhi pacientam s rasstrojstvami shizofrenicheskogo i affektivnogo spektrov. M.: Neolit, 2016. 96 p.

47. Kholmogorova A.B., Zareczki V.K. Mozhet li kul`turno–istoricheskaya koncepciya L. S. Vy`gotskogo pomoch` nam luchshe ponyat`, chto my` delaem kak psixoterapevty`? Kulturno–istoricheskaya psixologiya = Cultural-Historical Psychology, 2011, № 1, pp. 108—118.

48. Cirin D.A. Psixologiya vy`uchennoj bespomoshhnosti: uchebnoe posobie. M.: Akademiya, 2005. 120 p.

49. Shmukler A.B., Gurovich I.Ya., Kostyuk G.P. Stacionarnaya psixiatricheskaya pomoshh`: deinstitucionalizaciya i ee posledstviya v stranax Severnoj Ameriki i Evropy`. Social`naya i klinicheskaya psixiatriya, 2016, № 4, p. 109.

50. Beck A.T., Finkel M.R., Beck, J.S. The Theory of Modes: Applications to Schizophrenia and Other Psychological Conditions. Cogn Ther Res, 2021, № 45, pp. 391—400.

51. Grant P.M., Beck A.T., Inverso E., Brinen A.P., Perivoliotis D. Recovery–Oriented Cognitive Therapy for Serious Mental Health Conditions. NY: Guilford Press, 2020.  274 p.

52. Grant P.M., Beck A.T. Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophr Bull, 2009, № 35(4), pp. 798—806. 

53. Grant P.M., Beck A.T. Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Res, 2010, № 15, pp. 65—70. 

54. 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, № 68(10), pp. 997—1002. 

55. Grant P.M., Huh G.A., Perivoliotis D., Stolar N.M., Beck A.T. Randomized trial to evaluate the efficacy of cognitive therapy for low–functioning patients with schizophrenia // Arch Gen Psychiatry, 2012, № 69(2), pp. 121—127.

56. Grant P.M., Perivoliotis D., Luther L., Bredemeier K., Beck A.T. Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery–oriented cognitive therapy. Psychol Med, 2018, № 48(2), pp. 261—268. 

57. Grant P.M., Reisweber J., Luther L., Brinen A.P., Beck A.T. Successfully breaking a 20–year cycle of hospitalizations with recovery–oriented cognitive therapy for schizophrenia. Psychol Serv, 2014, № 11(2), pp. 125—133. 

58. Seligman M.E.P. Helplessness: On depression, development, and death. San Francisco: Freeman, 1975. 256 p.

59. Vita A., Barlati S. Recovery from schizophrenia: is it possible? Curr Opin Psychiatry, 2018, № 31(3), pp. 246—255.

Information About the Authors

Elena V. Takkueva, Head of the psychological department, Autonomous non–commercial organization «Home of amazing people 77», Moscow, Russia, ORCID: https://orcid.org/0000-0002-5690-6464, e-mail: takkueva@mail.ru

Metrics

Views

Total: 404
Previous month: 27
Current month: 25

Downloads

Total: 217
Previous month: 6
Current month: 14