Clinical psychology

The official statistics reveal a steady growth of drug use in Russia and epidemiological estimations indicate that the real prevalence of intravenous drug users may be 4-5 times higher than the official figure. This fact highlights the importance of effective preventive programmes for young people. Each preventive programme in the field of public health should be based on the results of socio-psychological studies on a given problem (Gurvich, 1999). In this paper, we discuss the results of a two-stage study based on the ideas presented by social representations theory (Moscovici, 1961). Our purpose was to analyze the lay thinking about drugs among different groups of young Russians. A total of 257 respondents (162 males and 95 females) aged 16 to 35 participated in the study (the median age was 24 years). At the first stage, the ‘map’ of shared common views about drugs was revealed. At the second stage, different social positions (as a function of different experience with drugs) on this ‘map’ were analyzed. The reported results give support to our predictions.

Although heart surgery is one of the most effective methods in treating cardiovascular diseases, more than 50% of patients have problems in personal, social, professional adaptation after surgery (Pogosova, 1996).

According to recent studies, psychological factors contribute significantly to negative outcomes of coronary surgery. The main factors are: depression, anxiety, personal factors and character traits, social isolation, and chronic life stress (Blumental, 2003; Connerney, 2010; Contrada, 2008; Cserep, 2010, Gallagher, 2007; Hoyer, 2008; Pigney-Demaria, 2003; Rozancki, 1999; Rymaszewska, 2003; Viars, 2009, Zaitsev, 1997).

The aim of the article is to describe the association between psychological factors and the outcomes of coronary surgery. We have studied how the patient’s attitude towards forthcoming open heart surgery is associated with the outcomes.

We have picked out four types of attitude towards forthcoming heart surgery: 1) pessimistic (no belief in recovery, surgery is threatening, damaging), 2) indifferent (no belief in recovery, surgery will not change anything), 3) optimistic but not realistic (exaggerated expectations, belief in full recovery), 4) optimistic and realistic (adequate expectations, belief in improvement).

The study has shown that patients with optimistic-realistic attitudes towards forthcoming heart surgery have better outcomes, better emotional status, and shorter stays in hospital.

Moral emotions play a significant role in human behavior, and yet scholars are not unanimous in defining, differentiating, and measuring the basic moral experiences: shame and guilt. Because of this problem, the theory goes far beyond the empirical research on these emotions.

In this article we analyze the most widely accepted points of view on the difference between guilt and shame; those who espouse each point of view suggest their own assessment tools. Thus, one of the often-used methods, the Test of Self-Conscious Affect-3 (TOSCA-3) (Tangney, Dearing, Wagner, & Gramzow, 2000), is based on a theory that differentiates shame and guilt according to where the negative evaluation of the misbehavior is aimed (at one’s actions or at one’s self). Another widely used questionnaire, the Dimensions of Conscience Questionnaire (DCQ) (Johnson et al., 1987), differentiates these emotions on the basis of whether the event causing them is public or personal.

The latest studies have shown that those methods are not contradictory. In addition, both the TOSCA-3 and the DCQ have their disadvantages; for example, they do not differentiate between emotional and behavioral aspects of guilt and shame. Thus, there is a need to develop a new assessment scale that overcomes these disadvantages. One such scale is the Guilt and Shame Proneness Scale (GASP) (Cohen, Wolf, Panter, & Insko, 2011). The research conducted by its authors has established its reliability and validity, which allow us to consider the GASP as a progressive tool in assessing moral emotions, one that has great theoretical and practical value.

This work discusses certain cultural-historical concepts relating to late adoption. This term is used for the adoption of children over 2 years old. Unfortunately most people do not wish to adopt children over 2 years old. Generally they seek newborn babies, which are a rare population, probably because of birth control campaigns. The children who are available in orphanages are older children who are unwanted. This paper tries to deal with this issue emphasizing that relationships are built within a family, transforming those involved. It lays out principles for a successful adoption and illustrates this matter with a case study. Relationships should be provided so that people can interact. This interaction will lead to the transformation of all of those involved within the established relationship, which constitute the human being. We intend to demystify the difficult matter of late adoption, which is one of the key aspects concerning the return of the child to an orphanage. The adaptation of late adopted children is said to be more difficult, but when we believe that human beings can change and be modified through the relationships they establish, we see a promising possibility for late adoption. Late adoption can be successful when we view it from a relational point of view, stressing that relationships transform all the individuals involved within the group.

The main purpose of the present study was to assess the role of motivation in the effective cognitive activity of elderly hypertension (HTN) patients provided with antihypertensive treatment; 25 patients with HTN took part in the study, stage 1-2; their mean age was 67.6±6.1. The psychological examination program embraced a quantitative measurement of intelligence quotient (IQ) with the Wechsler Adult Intelligence Scale, and an investigation into the qualitative features of their cognitive processes, applying a pathopsychological study procedure (Zeigarnik, 1962, 1972) and the principles of psychological syndrome analysis (Vygotsky-Luria-Zeigarnik school). The results showed that within the psychological syndrome structure of cognitive disorders in HTN patients, the leading part is played by two syndrome-generating factors: a neurodynamic factor and a motivational factor. The patients with reduced motivation would achieve poor general test results, if compared with the group of highly motivated participants. A correlation analysis of the data revealed the interconnection between frequency disturbances in motivation and the frequency in occurrence of various signs of cognitive decline, such as low efficiency in memorization and delayed recall, as well as lower IQ test results. The data provide a strong argument to support the hypothesis that motivation is of particular importance as a factor in the generation of cognitive disorders in HTN patients.

In the study, psychological and physiological features were assessed during an experimentally designed stressful situation in 85 subjects with hypertension (HTN) in the workplace, 85 patients with essential HTN, and 82 healthy individuals.

It was showed, that patients with HTN in the experimental situation were characterized by a complex of physiological and psychological features, which distinguish them from healthy participants. A reliably greater increase In systolic blood pressure (BP) was recorded in these patients in comparison with healthy individuals (on average by 14 and 3 mmHg respectively). The aspiration level (AL) of these patients was characterized by a reliably greater height, inadequacy, and instability; as for nonverbal behavior, it revealed a reliably greater amount of gestures, and frequent changes in voice tone against similar features of healthy individuals.

The group of patients with HTN at work, when compared with essential HTN patients, was characterized by a reliably greater increase of systolic BP (on the average by 16 and 4 mmHg respectively) as a reaction to emotional stress. The systolic BP increase in this group was revealed in combination with an initially reliably lower catecholamines’ level (CA), a gradual decrease of CA level in urine, and renin and angiotensin-1 in blood plasma during the experiment. This combination is an indicator of chronic stress and psychophysiological exhaustion. The patients did not manifest any increase of anxiety during the experiment; they were characterized, however, by a greater frequency of AL inadequacy and instability. The behavior of patients with HTN at work during the experiment was marked by a limited repertory of poses and gestures, but more vigorous facial expressions, and frequent pitch jumps. Obtained results lead us to confirm that the repression of emotions comes as a significant pathogenetic factor in the genesis of psychosomatic syndrome among patients with HTN at work, as opposed to patients with essential HTN.

The article analyzes certain socio-cultural and personal predispositions, which determine the modern diversity of subjective uncertainty and ambiguity manifestations. It stresses that for the creation of ‘realistic’ clinical psychology (in terms of A.R. Luria) one needs to retrace the relations between the resourceful and the psychopathological aspects of the ambiguity phenomenon and the cultural environment with its destructive ideals and mythologems, manipulative media-technologies and all-pervading idea of ‘deconstruction’. Methods for modeling the experiences of ambiguity in experimental settings, in pathopsychological examination and in projective psychological diagnostics are put in comparison. The arguments are adduced for the interpretation of deficient manifestations of subjective uncertainty as a criterion for diagnostics of the severity of personality disorder.

The article aims to demonstrate a high efficiency of the methodological means suggested by psychological syndrome analysis approach (Vygotsky-Luria school) for solving theoretical and applied issues in contemporary person-centered medicine. 

This is achieved through an example of empirical study meant to construct a psychosomatic syndrome for 290 patients with mitral valve prolapse (MVP). Analysis of all collected data was based on psychological syndrome analysis concept (Vygotsky–Luria school) and A.R. Luria’s principles for psychological factors (causes) selection, which determine the logic and structure of a neuropsychological syndrome. It demonstrated the association between characteristics of emotional experiences and clinical symptoms manifested in MVP patients. This correlation was statistically verified. The results proved that the most important syndrome-establishment factor (radical) is a specific emotionality and dysfunction of emotion regulation and emotional control in MVP patients (excessive emotional repression with insufficient reflection of emotional experiences). Features of the motivation sphere of MVP patients appear as a second psychological syndrome-establishment factor: these are domination of the motive of failure avoidance and unsatisfied self-approval need. 

We argue that psychological syndrome analysis can be used as a means to approach not only diagnostic but also prognostic tasks both in clinical psychology and medicine, as well as for the development and implementation of the person-centered integrative diagnosis model. 

We maintained that this approach, applied in theoretical and practical fields of clinical psychology and mental health care is highly efficient at the current stage of the science evolution due to prospects revealed by s new methodological context of postnonclassical model of rationality and a comprehensive character of the cultural-historical concept regarding an individual and his mind as a self-developing open systems.

The article has discussed the Leningrad Siege (1941-1944), focusing on the individual and collective memories of survivors who had lived through that trauma during their childhood. Thus far there has been no psychological investigation of the feelings of extreme deprivation caused by that Siege, despite the reams of material published on Leningrad under siege. To deal with this shortfall, the critique has considered the effect of that experience on the future lives of the people concerned. The basic methodology, the paper maintains, combined quantitative and qualitative approaches and involved a comparison of two equal-sized groups: the experimental group, comprising 60 war survivors who lived through the Siege; and the control group, comprising 60 war survivors who were evacuated from Leningrad during the Siege and consequently did not experience the trauma. The review related that the groups were matched by age and by gender distribution. Data for the Interpretative Phenomenological Analysis-based qualitative analysis (QA) were collected according to psychometric measures (containing scales for depression, general satisfaction with life, and stress) applied in semi-structured interviews. The QA, for its part, used methods such as correlation, factor- and cluster-analysis to measure data segments. The nature of the suffering and the persistence of the human threat (past and present) were reconstructed within the framework of the psychological experiences (under extreme conditions) faced by the experimental group. The report, in conclusion, has stated that these experiences were evaluated via psychoanalytic tools dealing with child development, mourning and symbolization of traumatic events. These enabled it to identify psychological phenomena such as child grief and the impact of trauma on the adult life of the former Siege victims.

This article considers the potential for applying contemporary philosophical theories (which distinguish classical, nonclassical, and postnonclassical types of scientific rationality) to the specification of theoretical methodological principles in the study of clinical psychology. We prove that psychological syndrome analysis (developed by the Vygotsky–Luria–Zeigarnik school), taken as a system of principles for organizing research as well as for interpreting its results, conforms to the epistemological complexity of the object of study in clinical psychology, which is understood in the postnonclassical scientific view as a self-developing system. We present an example of the formation of a psychosomatic syndrome in 290 patients with mitral-valve prolapse, applying methods of qualitative and statistical data analysis in a longitudinal clinical-psychological study. We prove that the syndrome is system-defined and has a multilevel character, and that its structure is determined by several factors: the motivational factor (with the domination of the failure-avoidance motive and the unsatisfied self-approval need); the factor of the emotional-regulation disorders, represented by both excessive emotional repression and lack of emotional control; and a psychophysiological factor. We argue that a psychosomatic syndrome can be used as a means for approaching not only diagnostic but also prognostic tasks both in clinical psychology and in medicine. We conclude that the results of our empirical study, conducted within the framework of postnonclassical philosophy and using the methods of psychological syndrome analysis, not only expand the scientific background on the nature of a particular disease (mitral-valve prolapse) but also pose further questions whose investigation will broaden our view of the psychological mechanisms of psychosomatic- syndrome genesis.

The theoretical model of the establishment of the syndrome of early infantile autism is elaborated including all the stages of this establishment. According to Vygotsky and his ideas about the hierarchical organization of pathological syndromes, there is the definition of the difference between the structure and the function of the primary (biological) and secondary (sociological) phenomena of the syndrome of early infantile autism.

The psychology of corporeality is a new and intensively elaborated branch of science. The theoretical foundations of its subject differ significantly from those of medical psychosomatics. In a given article some new concepts of this approaching discipline are introduced and the role of symbolic mediation in genesis of different psychosomatic diseases is discussed.

The author analyzes in brief the historical development of psychiatry, psychology and psychotherapy in Soviet Union and pots-Soviet Russia. He expresses his view on modern state of affairs between state and private practice and gives a detailed account of the formation of modern Russian psychoanalytic community and its entry into the international community.

Basing on the theoretical analysis and personal longstanding research, the author offers general characteristics of narcissism, delineates the relations between the disturbances of identity structure, regulatory mechanisms, cognitive styles and modes of interpersonal cognition, which allows predicting a wide range of psychic and behavioral disorders. It is shown that the phenomenon of narcissism has a bio-psycho-social causation, and that the contemporary technological glut as well as the expansion of consumerist values give new stimuli for the development of narcissistic and perfectionist personality trends.

The author discusses the controversial issues of formation and functioning of psychological defense mechanisms in ontogenesis and in personality disorders as they are represented in classical and contemporary psychoanalysis, in cognitivism and communication theory. The paper emphasizes the role of cognitive organization (style), sign-symbolic mediation, representative system of object relations and attachments in individual typological variability of the level organization of defense mechanisms, in efficiency of personal and social adaptation, in maturity and mental health of personality.

The purpose of the research was to study the patterns of using proactive coping and adherences to it’s different types in patients with chronic non-specific lung diseases. Participants of the study (N=180) were 30 to 60 years old. The Proactive Coping Inventory was used to assess the patients’ psychological status. According to the results of the study patients with chronic non-specific lung diseases use different types of proactive coping behavior while solving problematic and stressful situations. The research revealed that patients with bronchial asthma don’t have the skills of independent decision making, definition of objectives, considering of options in solving conflicts or other inconvenient situations sufficiently developed. Patients with chronic obstructive pulmonary disease are less satisfied with the emotional support that they receive from their relatives and closest people, it’s harder for them to reveal their feelings and emotions than for those who suffer from bronchial asthma and healthy ones. The results of the study may be useful in developing educational systems of proactive coping behavior skills for patients with chronic non-specific lung diseases for their health and well-being support.

The Influence of genetic and environmental factors on liability to depression in Russian teenage sample was investigated. 196 twin pairs aged 13 to 17 (M=15,2) from Moscow, Izhevsk and Bishkek took part in the survey. We have found out that genetic factors had an effect on individual difference in depressiveness among Russian teenagers: more than 50% of variance was explained by additive genetic factors which correspond to international results. The biggest genetic influence was obtained for such scales as negative emotions, negative self esteem and externalization which are the most replicable factor scales in CDI structure worldwide.

Suicide is a controversial phenomenon that people of different cultures and even of different epochs have had difficulty naming. It used to be an enduring theme of many medical, psychological, philosophical, and moralistic discussions. It is a paradoxical act of ultimate self-destruction, a flight from life to death. To commit suicide is to overcome the fear of personal death and to make a step into nothingness. Such a desperately brave deed requires an abandonment of one's sense of immortality, which we all have, a change of values and worldviews. But if one's suicide attempt proves unsuccessful, the question becomes how to explain to oneself and others one's recent act of self-violence. To discover these explanations, we conducted a study of 319 people, ranging in age from 18 to 25; they were all either students (n = 156) or patients in an emergency toxicology ward (people who had attempted to poison themselves, n = 163). This article summarizes theories of suicidal behavior and of the fear of death together with the ideas of cultural anthropologist E. Becker on these matters and puts suicide into the terror-management perspective. The suicidal act is viewed as a mortality salience, and the hypothesis is that people who deny their recent suicide attempt (n = 33) and who have one (n = 95) or several (n = 35) suicide attempts in their personal history exhibit different terror-management patterns in comparison with each other and with the control group. They fall back on different resources with various degrees of effectiveness. Implications of these results for understanding suicidal and postsuicidal behavior are discussed and suggestions for rehabilitation are made.

The article describes the development of an integrative bio-psycho-social model of personality disorders. This model is based on the interconnection of intellect, self-regulation, self-identity, and social relationships. The prognostic value of the category of “affective-cognitive style” is estimated on the grounds of a meta-analysis of various empirical studies and theoretical models. The article discusses the results of clinical and experimental studies that specify the functions of cognitive differentiation and integrity and of symbolic mediation and reflection in the regulation of the content, emotional valence, temporal stability, and spatial organization of intrapsychic representations of self and interpersonal relationships, as well as the systemic organization of defense and coping operations.

Modern approaches to the psychological diagnostics of children are based on need analysis and the systematization of existing trends in domestic and foreign children’s neuropsychological diagnoses. This article highlights the strengths and weaknesses of each approach, as well as identifying possible areas of integration. One of the most acute problems is the development of experimental psychological methods to determine the quantitative and expressed characteristics of the mental development of children by flexibly combining qualitative and quantitative approaches, with a view to putting into practice foreign neuroscience principles and standards of evidence. An analysis of contemporary publications on neuropsychological diagnosis reveals the need to consider the standardization of neuropsychological research in the context of current approaches, requirements, and psychodiagnostic criteria. In the domestic neuropsychological literature, these issues are need attention: standardized procedures for presenting stimuli are not, as a rule, described; basic psychometric assessment of the results of the tests is lacking; no investigation of their clinical and psychometric validity is carried out. An analysis was made of the nature of the psychometric approach in foreign child neuropsychology, which relies on mathematical procedures of processing qualitative (ordinal) data converted into quantitative indicators. We examined separately the mathematical software for clinical trials (based on the principles of «evidencebased medicine»), which relies on the «abnormal» nature of the distribution of clinical phenomena.