Clinical psychology

This work is dedicated to the development of L.S. Vygotsky’s ideas in clinical psychology and the clarification of some basic points of the cultural-historical concept. The paper presents a thesis about the development of man in ontogeny as the result of his interaction with the cultural environment, which transforms natural mental functions into higher mental functions. This process can be attended by a whole range of psychopathologies. The issues discussed include voluntary regulation of higher mental functions, determination of the involuntariness and “post-voluntariness” of functions, the internalization of actions, the differentiation of affect and emotion (including as higher mental functions), the “cultural” socialization of non-mental functions (sex, sleep, excretion), and the discord between natural and “cultural” entities in a person. The basis for the ontological development of man is the genesis of “subjectness”, like all the forms of higher activity that emerge when encountering cultural restrictions and requirements causing specific mental disorders. The supposition is made that there are no significant restrictions to explaining either mental or non-mental functions with the cultural-historical approach. Recommendations for further research are suggested.

The vocational activities of doctors and their social status do not ensure their health. And, falling ill, doctors don’t identify themselves with ordinary patients as they have a deep knowledge of medicine. Thus, the internal picture of a doctor’s illness is both a research and a practical problem: the problem of the psychoprevention of doctors’ illnesses at all stages of their professionalization. The purpose of the research was to study the phenomenological features of the internal picture of doctors’ illnesses using the structural approach. The total number of participants was 132. The experimental group consisted of 66 sick doctors, differentiated according to their stage of professionalization: vocational training (students), professional adaptation (interns), full professionalization (doctors). The control group consisted of 66 people who did not have any medical education. All the control subjects were hospitalized with chronic diseases during the study period. The organization of the research was carried out with the use of clinical-psychological and diagnostic methods, the methods of descriptive statistics, and comparative, multidimensional, and structural analysis. The research revealed the following phenomenological features of the internal picture of doctors’ illnesses: the prevalence of some anxiety in the doctors and high awareness of their health; the doctors’ altruistic orientation; their willingness to work despite difficulties; and their ability to achieve high results in different activities. The structural features of the doctors’ image of their own diseases on the cognitive level were the following: qualitative heterogeneity during in-service activities; a high degree of image integration during in-service activities; and stereotyped perceptions of the disease. The emotional level revealed the emotional distance between doctors and their patients, and the behavioral level revealed doctors’ disregard for the symptoms of the disease. The structural-phenomenological features of the formation of the internal picture of doctors’ illnesses are specific to the circumstances of their origin. For the purpose of the psychoprevention of doctors’ own diseases it is necessary to include these features in the special courses on medical psychology at the stages of vocational training (students) and professional adaptation (interns), as well as in the “psychology in practical medicine” project for doctors.

Fear of disease progression is one of the most common sources of psychological distress in patients suffering from chronic diseases. Fear of disease progression is a situationspecific and fully discernible (reportable) emotion based on personal experience of a life-threatening disease. This article presents the results of a study of cancer patients’ coping behavior according to the levels of fear of disease progression experienced. The presence of pronounced fear of disease progression reflects a negative cognitive-affective response to one’s expectations for one’s own future; this response is related to a decrease in adaptive capacity. To determine the particular characteristics of coping strategies and coping resources in women with reproductive-system cancers according to the level of fear of disease progression. A total of 177 women with reproductive-system cancers were examined, among them 59 with breast cancer and 118 with gynecological cancers. Women with reproductive-system cancers have varying sets of coping strategies and coping resources according to their level of fear of disease progression. For each of the differentiated groups, specific characteristics of the strategies of coping with difficult life situations are described, along with cognitive self-regulation strategies specific to the illness and to coping resources. The women exhibiting moderate fear of disease progression significantly more often adhered to problem-oriented strategies of coping with difficult life situations and illness and had an internal locus of control regarding treatment. Patients with a low level of fear of disease progression tended to use strategies of positive reinterpretation of difficult life situations and illness; an external locus of control regarding treatment prevailed in this group. Patients found to have a dysfunctional level of fear of disease progression displayed significantly higher rates of using cognitive-regulation strategies focused on negative aspects of illness, as well as strategies for avoiding difficult life situations. Fear of disease progression is a psychological problem in women with reproductive-system cancers. Higher levels of fear of disease progression are associated with a decrease in the psychosocial adaptation of women suffering from reproductivesystem cancers.

Today in Russia and all over the world significant efforts are invested in building biobanks—specialized facilities for storing biological materials for research and medical purposes. The successful functioning of biobanks depends directly on people’s willingness to donate their biological materials. No previous studies of people’s attitudes toward donations to biobanks have been undertaken in Russia. The goal of this study was to measure attitudes toward biobank donation among young Russians and to evaluate potential sociodemographic and personality factors that play a role in a person’s readiness to become a donor. Data from 542 students at Saint Petersburg State University were collected from group-administered paper-and-pencil questionnaires. Only one-fifth of the students knew about the existence of biobanks, while roughly the same number believed they might have heard something about them but were not absolutely certain. However, the students indicated a relatively high level of readiness to become biobank donors (74%). Willingness to be a biobank donor was correlated significantly with studying biology and was just modestly correlated with students’ values. In addition, we found gender-specific differences in the biobank characteristics that students felt were important in making a decision about whether to donate. The study demonstrated that today the attitudes of the general population (at least, those of the subgroup studied, students) do not pose a problem for the further development of biobanking in Russia.

The study described in this article investigated contemporary young people’s perceptions of drugs and psychoactive substances (PAS). In the course of the research the following hypothesis was tested: in young people’s perceptions about drugs and PAS there are differences in emotional coloring, coherence, and tolerance. J.-C. Abric’s structural approach was used as the basic methodology. The free-associations method provided the bulk of the empirical material. The results obtained were processed via prototypic analysis (by P. Vergès’s method), indexing of emotional associations (by E.E. Pronina’s method), and frequency and content analysis. 

As a result the core and the periphery of the perceptions of youth about drugs and PAS were described, and generalized notional categories that synthesize the structural elements of the perceptions were identified. The study revealed that the perceptions of young people about drugs and PAS do differ in coherence, tolerance, and emotional coloring. Perceptions of drugs are firm, consistent, and negative, while perceptions of PAS are less coherent but dynamic and have an ambivalent emotional coloration. The results are of prognostic importance for understanding young people’s attitudes toward drugs and PAS and can be used to design programs and measures directed to the prevention of PAS and drug abuse.

This study investigated the level of conceptual and metacognitive abilities and their interaction in adolescents with different forms of dysontogenesis. The total sample (N= 173) included four groups of young adolescents (11-12 years old): with normal development, with infantile cerebral palsy (CP), with attention deficit hyperactivity disorder (ADHD), and with delayed intellectual development (DID). We measured the adolescents’ performance on tests of conceptual abilities (the use of categories at different grades of generalization, the discovery of abstract meaning and implicit connections between concepts) and metacognitive abilities (attention selectivity, as measured by Mtinsterberg’s test and the understanding of hidden pictures, and attention organization, as measured by indices of cognitive styles). The results showed, first, that in comparison with normal adolescents, the adolescents with CP and ADHD had a deficit of metacognitive abilities, but they did not differ in rates of conceptual abilities. As for adolescents with DID, even though they had lower rates of conceptual abilities and attention selectivity, they did not differ from the “norm” group on some indices of attention organization. Second, a tendency for the disintegration of conceptual and metacognitive abilities (as measured by correlation and factor analysis) was most clearly seen in the adolescents with ADHD and DID. The adolescents with CP and ADHD had conceptual (categorial and generative) abilities as a mental resource, and the adolescents with DID had metacognitive abilities as a mental resource. The resource function of conceptual and metacognitive abilities was determined not only by their level but also by the extent of their interaction (integration).    

Fear of childbirth (FOC) is an important psychological problem that is studied worldwide because it affects the well-being of pregnant women. However, in Russia, this problem does not receive adequate attention among researchers. The purpose of the present study was to investigate the conditionality of fear of childbirth (FOC) in pregnant women by external and internal factors, which we assumed were the reasons for this fear. As external factors, we considered socio-demographic indicators (e.g., age, marital status, level of education, housing, and the attitude of relatives towards pregnancy) as well as indicators of gynecological history (e.g., the term of pregnancy, the outcome of previous pregnancies, and pregnancy complications). As internal (psychological) factors of the fear of childbirth, we considered personal anxiety as well as general inclination towards and negative consequences of different fears (20 types of fears and phobias were examined). The study was conducted with a Russian sample of 76 women at different stages of pregnancy and with different socio-demographic indicators and gynecological histories. The analysis of the results showed the absence of significant differences between women who were pregnant with FOC and those without this fear in terms of the external factors considered in this study. According to the study’s data, a general inclination of women to fear is associated with fear of childbirth. However, the findings for the women with FOC did not indicate significant positive correlations between the level of this fear and exposure to any of the 20 types of fear and phobias measured in the study. Furthermore, the results did not detect relationships between the FOC level and women’s personal anxiety. The results allow us to conclude that FOC is a separate phenomenon that is not dependent on other phobias and fears. Fear of childbirth has a subjective and highly individual genesis. It is not a direct consequence of objective factors, and it cannot be predicted based on women’s personal characteristics (in particular, anxiety). For further study of this problem, we suggest that researchers identify different types of FOC and describe their content as a way to help develop practical methods of providing psychological assistance for women during pregnancy.

This article presents research on the most effective measures in rehabilitation programs for people with chemical addictions and research on the personal characteristics that influence the complete cessation of drug and alcohol consumption. Building a model of an effective rehabilitation process is one of the most significant problems in organizing aid for drug and alcohol addicts. Analysis of the results of previous research revealed a number of factors that influence the stability of remission: individual biological factors (general state of health, presence of co-existing diseases); individual psychological factors (coping strategies, shifting of attention, self-control, aggressiveness); rehabilitation program factors (duration of programs, rehabilitation measures, form of rehabilitation, conditions for admission to a rehabilitation center); social factors (family support, rehabilitation with children, availability of communities with no drug addictions); spiritual factors (call to a divine power for help). We have researched the most effective measures of rehabilitation programs for people with chemical addictions, as well as personal characteristics that influence the full cease in drug and alcohol consumption.

In our research we studied people undergoing rehabilitation in different programs (nonstate 12-step, confessional, and state). Five groups of respondents participated in the research; the total number of respondents was 945.

The purpose of our research was to investigate the factors of stable remission for drug addicts in different rehabilitation programs. Our conclusion is that there are outer (social) and inner (personal) factors of stable remission.

Our research revealed that during positive remission (abstinence from taking drugs) addicts had fewer social and psychological problems, and their social and psychological personal characteristics improved; it also revealed those measures that furthered the development of remission. Respondents considered the following the most effective measures: small groups, lectures on addiction, written tasks connected with the analysis of feelings (diaries, self-analysis etc.), individual and group psychological classes, sport, introduction to faith, prayer, labour, communication with graduates of rehabilitation programs. The received data demonstrates the necessity of complex approach to rehabilitation, with regards to biological, psychological, social and spiritual components of addiction.

A major risk factor for late-onset Alzheimer’s type dementia (DAT) is the carriage of the ε4 allele of the apolipoprotein E (ApoE) gene. Identifying cognitive deficits in healthy ApoE-ε4 carriers is valuable in order to develop interventions to prevent them from developing DAT. Existing evidence about cognitive deficits in the domains of episodic memory and cognitive control specific to ApoE-ε4 is contradictory.

The objective of our research was to assess episodic memory and cognitive control in healthy ApoE-ε4 carriers.

Cognitively healthy ApoE-ε4 carriers (13 ε4/ε4 heterozygotes) and noncarriers (22 ε3/ε3 homozygotes), who were matched on age and family history of DAT, were compared on episodic-memory and cognitive-control tasks. Episodic-memory tasks were verbal and visual recognition tasks with a systematic variation of distractor-to-target similarity. Executive functions were assessed by a task for updating working memory, an inhibition task, and a switching task. Working-memory capacity was also assessed.

The results showed that executive functions were generally not impaired in the carriers, but carriers showed a specific increase in accuracy-related switch costs. Workingmemory capacity was not reduced in the carriers. In the domain of episodic memory, the carriers were found to make more errors with phonetic distractors in the verbal episodicmemory task. They also tended to make more errors with visually dissimilar distractors in the visual episodic-memory task.

The results are indicative of an episodic-memory deficit specific to the carriage of ApoE-ε4. This deficit may be driven either by deficits in storage or by deficits in the encoding of the to-be-remembered material. Contradictory results concerning the presence of an episodic-memory deficit obtained in previous studies may stem from small effect sizes, the use of specific materials, and the employment of attention-intensive encoding strategies. The carriers also showed a switching deficit that possibly is related to difficulty in retrieving task rules from episodic memory. Existing empirical contradictions concerning the presence of an executive deficit in carriers may in part depend on the extent to which tasks used to assess an executive deficit draw on the switching function. In this study, there was no general executive deficit in the carriers of ApoE-ε4.

An in vitro fertilization (IVF) pregnancy is stressful both financially and emotionally. Patients undergoing an IVF procedure often have already had infertility and reproductive losses. Pregnancy through IVF involves the increased risk of various medical complications. Experts around the world are actively engaged in studying the specifics of the mental state of participants in IVF programs during pregnancy. Of critical importance is the issue of providing psychological support for couples who are preparing for and who have received an IVF pregnancy. 

The aim of our research was to investigate the mental state of women participating in an IVF program. The study involved 224 pregnant women in the second and third trimesters: 62 women with an IVF pregnancy and 162 women who conceived naturally. The study took place at the Kulakov Scientific Center for Obstetrics, Gynecology, and Perinatology in Moscow, Russia. All the study participants had encountered medical complications during their pregnancy. No significant differences were identified in mental well-being in the two groups; this finding suggests that somatic complications during pregnancy are a general source of anxiety regardless of the reason for their occurrence. The second and third trimesters of pregnancy register increased anxiety levels associated with experiences of reproductive loss and the presence of physical problems. The main resources of a woman’s personality that contribute to her self-confidence and mental stability are her professional employment and flexible behavior.

The study aimed to investigate the basic aspects of quality of life and relation to disease in patients with malignant or premalignant bone tumors. Study participants (N=82) were aged 18 to 67 years (average age 34 ± 2 years). They were separated into three groups depending on diagnosis: patients with osteosarcoma, patients with giant cell tumor and patients with chondrosarcoma. The SF-36 Health Status Survey and the Quality of Life Questionnaire - Core 30 with Bone Metastasis (BM22) Module were used to assess patient quality of life. The type of relation to disease method (TOBOL) was used to determine the relation to disease of the patients.

According to the results of the quality of life study, patients with giant cell tumor exhibited the highest degree of limiting physical activity and reduced social functioning, the greatest financial difficulties and more pain sites than either patients with osteosarcoma or patients with chondrosarcoma. The study of relation to disease revealed that all studied groups of patients were susceptible to ergopathic and sensitive types of relation to disease. Moreover, patients with giant cell tumor experienced increased levels of tension and irritability with respect to relation to disease and treatment, while patients with chondrosarcoma were more susceptible to anxiety and hypochondria with respect to relation to disease.

Patients with different types of bone tumors have different experiences with respect to their physical and mental health, their social functioning and their general health. The results of the study may be useful in developing individualized psychological aid programs for patients with malignant and premalignant bone tumors.

Any psychological paradigm needs a psychopathological system that helps professionals to describe and explain the behavioral expressions that deviate from “normal” (whether this term is used with the semantic property of statistical or ideal adaptations). In this work, I seek to present the system that I have been developing since 1998 among the psychologists at the Instituto Vegotsky de Lisboa (Vygotsky Institute of Lisbon), Portugal, to understand psychopathology with regard to the vygotskian approach. It was conceived and designed according to the work of Rita Mendes Leal and her contribution to socioemotional development theory, AR Luria’s systemic and dynamic theory of the human brain, the theory of Activity (dyatel’nost) of AN Leont’ev, and the psychopathological German school of E Kraepelin, presented and disseminated in Portugal in the early twentieth century by Professor Sobral Cid. It is intended to be a proposal to colleagues who are interested in postnonclassical psychology and a request for arguments.

Oncologic disease should be considered one of modern society’s dominant pathologies because of its chronicity. Estimates of a patient’s adaptation to chronicity shapes the information given to the patient, which is a powerful strategy for changing the patient’s social representation from a mere clinical case to a psychosocial being. In this article, the patient’s persona, when captured in the social processes and relations involved in therapeutic acts, is conceptualized as the main actor on the stages and sets of hospitals. The informative act, in which information is given to a patient in a hospital, allows identification of the psychosocial profile inherent in the patient’s role; this profile describes some relevant categories, among which the “informed patient” and the “uninformed patient” stand out.

The purpose of the study was to investigate the dynamics of the psychological features and clinical symptoms in mitral valve prolapse (MVP) patients receiving long-term integrative psychotherapy for anxiety disorders (AD) and to investigate the psychological factors of their improvement in mental health as a result of psychotherapy. Thirty-two MVP patients with AD attended long-term integrative psychotherapy. Psychological and clinical examinations of the patients were made before and after the therapy courses and in a follow-up study after 2, 5, and 10 years. Data from the study show that 78.1% of the patients who attended psychotherapy sessions demonstrated valid improvements in self-rated psychological well-being and a reduction in their anxiety levels. Analysis of emotion-regulation strategies showed that psychotherapy encouraged the use of strategies effective for solving adaptive tasks. Positive dynamics in the development of personality reflection, the recognition of one’s emotional experiences, improved skills of self-regulation, and growing awareness of actual needs, individual purposes, and personality resources—all were associated with the reduction of MVP clinical symptoms. The psychiatrist who interviewed the patients reported that most of them were in sustained remission.

Aging can be viewed as a continuation of development and an active interaction with the environment during which regressive changes are combined with progressive new formations. It is believed that the self-determining nature of subjectivity in the elderly mediates self-awareness and favors self-acceptance as an active agent that determines the outcomes of one’s own life at this age as an autonomous self-regulating subject of one’s own activity. A formative experience proved the efficiency of using art therapy as a method for mobilizing personal resources during aging.

According to Lev Vygotsky’s theory, every bodily deficiency not only changes a person’s attitude to the world but also entails social consequences, which makes its social and psychological rehabilitation so important. The way in which problems of deformity compensation and supercompensation are solved, is largely determined by a patient`s motivation. The paper deals with stuttering (logoneurosis) as an extreme form of broken communication; it analyses the peculiarities of stutteres and their families, and the specific features of treating this defect; it also dwells on issues involving family co-participation in social rehabilitation. The multilayered system of family group logo psychotherapy - treatment of stuttering children, teenagers and adults - is based on Yu.B. Nekrasova’s method of group logopsychotherapy. It also employs non-traditional techniques: Nekrasova’s dynamic psycho-therapeutic diagnostics and biblio-, kinesi-, symbol-, video- and cinema therapies.

This system may serve as a model for forming motivational involvement and intragenic activity by patients and their relatives in social rehabilitation processes. The paper describes the levels and psychological structure of motivational involvement and mechanisms of its formation in logopsychotherapeutic processes. Motivational involvement is understood as a source of a subject’s intragenic (inner) activity, the paper maps out strategies to form intragenic activity. The family group logopsychotherapeutic techniques may also help optimize communication between parent and child, doctor and patient, teacher and pupil, professor and student.

Based on the analysis of psychosocial models of alcoholism and depression the general and specific factors of occurrence and course of illness are identified in the present study. The authors put forward hypotheses regarding the mechanisms of activation of psychological addiction to alcohol as an ineffective coping strategy. The necessity of empirical research needed to refine the techniques and targets of patient care within the psychiatric and psychological care is justified. The results of the pilot study show that depressed patients who are subject to alcohol dependence feature marked distress in interpersonal relations, coupled with hostility and aim at gaining profit and pleasure by manipulating other people. These patients are hostile to others, while in interpersonal relationships personal safety is important to them, so they may be more likely to resort to manipulation. In their attitudes with respect to health the communication of these patients is characterized by hedonistic tendencies and histrionic traits in interpersonal contacts.

The psychological aspect of treating HIV-infected substance users entails changing their behaviour, as their behaviour is what leads to the risk of them transmitting and spreading HIV. Psychological treatment must facilitate their adaptation so that they may be otherwise treated for substance abuse and HIV. We propose establishing the psychological objective of helping patients overcome substance addiction by addressing their internal representation of the disease (IRD), value-sense and motivational sphere, as well as their relationships with their physician, as this is the main person who interacts with the patient in the clinic. An IRD study of patients with an opioid dependency, complicated with infectious diseases, showed that the IPD emotional level of opioid patients, as interconditional for other levels, can be an indicator of the status and impact of the main objective. A comparative study of substance users who received psychotherapy with those not receiving psychotherapy showed that the value-sense and motivational sphere is also an important target for preventive action. A study of the physician’s image of drug treatment clinics’ patients revealed that increases in the communicative competence of drug treatment facilities’ personnel represents a third course of preventing the transmission of HIV among substance dependent patients.

Statistical data about Internet users indicates that Russia ranks first in Europe in terms of its number of Internet users. Young people prevail among Russia’s Internet users. Internet dependence behaviour is given a definition. The behavioural peculiarities of Internet addicts are considered. Time perception is a background for psychical processes. The time focus of the human psyche reveals itself in the speed and duration of perception, impression, memory, thought and emotions peculiar to people with a certain temperament and of a certain age, sex and group. Time perception is an integral part of our mental processes. A human being is inclined to consider all events and processes taking place around him as a process which takes time. The time perception of every person is always specific, and it is reflected in his or her thought and behaviour. The results of studying higher mental functions and time perception in internet-addicted teenagers are given. The obtained results have revealed distraction at the end of the study due to the high exhaustiveness of the neuro-dynamic component of mental activity, as well as the poorer ability of Internet addicts to be conscious of themselves in time. Given the absence of a clear pattern of their roles in real life, Internet addicts may often find that their addiction results in mental conflicts and self-aggression. In turn, it may result in impulsion, confusion, certain problems with explaining personal actions, wishes and motives. Internetaddicted teenagers have a more pessimistic attitude towards their time and life activity. When running into hardship, their behavioural performance and incentives to overcome barriers may be limited.

The article presents an empirical study of sense of humor disorders in patients with schizophrenia and affective disorders. Several parameters of analysis are distinguished: humor recognition, humor preferences and the level of laughing activity. It is showed that patients with schizophrenia are characterized by inability to recognize humor. As soon as patients with schizotypal disorder do recognize humor, this may be used as a diagnostic criterion in clinical practice. Sense of humor in patients with schizophrenia and affective disorders acquires peculiarities which are defined here as preferences of certain cognitive mechanisms and topics of jokes.