Tarabrina N in post-traumatic stress integrative approach. Head of the Psychological Editorial Office

Relevance. Currently, the integration of the achievements of domestic clinical psychology with the most significant areas of world, mainly Western, psychology is a priority task for a wide range of specialists.

Acute and pressing problems of modern psychiatry and clinical psychology, the solution of which necessarily involves such integration, are associated with the study of the psychological consequences of the impact of high-intensity psychotraumatic stressors on a person who has become a participant or witness to catastrophic situations (Bekhterev, 1915; Gapnushkip, 1927; Aleksandrovsky et al. , 1991; Lptsyferova, 1994; Molyako, 1992; Idrisov, Krasnov, 2004; Ababkov, Perret, 2004; Bodrov, 2006; Smirnov, 1999; Tarabripa, Lazebnaya, 1992; Tarabrina, 2001, 2004, 2007; Krystal, 196 8, 1978 ; Pitman, Orr, 1987; Van der Kolk et al., 1996; ICeane, 1988).

The likelihood of any person getting into a traumatic situation in the modern world is constantly increasing, and this poses the challenge for specialists of various profiles to develop adequate methods for diagnosing and treating emerging pathological consequences.

Despite the fact that the number of studies devoted to the study of the psychological consequences of a person’s stay in a traumatic situation has been rapidly increasing over the past decades, many theoretical and methodological aspects of this problem remain either unresolved or debatable.

In Russian psychology and psychiatry, interest in research in this area has increased due to the introduction of the category of post-traumatic stress disorder (PTSD) into scientific discourse. In the 80s of the last century, PTSD (post-traumatic stress disorder - PTSD) was included as an independent nosological unit in the American Classification of Mental Disorders, and in the mid-90s PTSD was included in the International Classification of Mental and Behavioral Disorders (ICD-10) . 5

This has caused an avalanche-like growth in the number of clinical, psychological, socio-psychological, cultural studies carried out within the framework of a new scientific and practical direction - “traumatic stress”, which is currently being intensively developed.

The inclusion of PTSD in classifiers has been controversial among different clinicians in different countries; Along with the noticeable progress of research in this area, the debatability of the problems associated with them is increasing. This is especially true for the semantic field of traumatic stress, the problems of the dose-response model, the inclusion of guilt in the register of post-traumatic symptoms, the possible influence of brain disorders, the effect of stress hormones, memory distortions when diagnosing PTSD resulting from sexual abuse in early childhood, the influence of the socio-political situation in society on the diagnosis of PTSD, etc. (Krystal, 1978; Pitman, Orr, 1993; Breslau, Davis, 1992; McFarlain, 1988; Everly, Horowitz, 1989). The number of countries using the diagnosis of PTSD in clinical practice increased between 1983 and 1987, and from 1998 to 2002 from 7 to 39 (Figueira et.al., 2007). The identified trend of growth in research in the field of PTSD is primarily associated with the growth of international terrorist activity.

Most of the work on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD. Research is carried out on a wide variety of coptingites: combatants, victims of violence and torture, man-made and man-made disasters, patients with life-threatening diseases, refugees, firefighters, rescuers, etc.

The main concepts used by researchers working in this area are “trauma,” “traumatic stress,” “traumatic stressors,” “traumatic situations,” and “post-traumatic stress disorder.”

However, as many researchers point out, the consequences of a person’s exposure to traumatic situations are not limited to the development of acute stress disorder (ASD) or PTSD (which, as a rule, is comorbid with depression, panic disorder and substance dependence); The range of clinical manifestations of the consequences of super-extreme exposure to the human psyche is, of course, thyrsus and still requires further comprehensive and interdisciplinary research.

The relevance of this study is due, firstly, to the high socio-economic significance of the problem in modern society; secondly, the need for a holistic theoretical and methodological analysis and integration of various directions in the field of studying the psychological consequences of a person’s stay in traumatic situations and a differentiated approach to understanding this phenomenon; thirdly, the need to develop a scientifically based classification of post-traumatic cognitive-psychological-personal changes in the human psyche, which is especially important when choosing targets for psychocorrection and psychotherapeutic work.

The purpose of the study is to develop an integrative approach to the study of the psychological aspects of post-traumatic stress, which includes: a comprehensive theoretical and empirical study of the phenomenon of post-traumatic stress (PTS); theoretical and methodological justification for the integration of the achievements of domestic clinical psychology with existing foreign approaches to the study of post-traumatic stress disorder; correlation of semantic fields of the concepts “stress”, “post-traumatic stress”, “post-traumatic stress disorder”; separating the concept of “post-traumatic stress” into an independent category; determining the place of this category in the structure of psychological knowledge.

The object of the study is the psychological consequences of exposure to high-intensity psychotraumatic stressors on a person (combatants, participants in the liquidation of a nuclear power plant accident, refugees, patients with breast cancer (BC), children with traumatic experience, firefighters, rescuers, military personnel of the Ministry of Internal Affairs), manifested as a continuum , consisting of various types of mental maladjustment, one of which is post-traumatic stress.

The subject of the study is post-traumatic stress, understood as a symptom-comilex, the content of which represents a set of interrelated psychological characteristics such as anxiety, emotional instability, de-resistance, basic beliefs and a number of psychopathological parameters. Research objectives:

1. Theoretical and methodological analysis of various areas of research on post-traumatic stress in the context of the development of clinical concepts of post-traumatic stress disorder.

2. Analysis of the interrelations and relationships of the concepts “stress”, “trauma”, post-traumatic stress disorder”, “traumatic and post-traumatic stress” and determination of the grounds for identifying “post-traumatic stress” as an independent category.

3. Analysis and systematization of modern empirical research into the psychological consequences of experienced traumatic stress, highlighting the main promising directions and approaches in this area of ​​psychological science.

4. Development of a set of psychodiagnostic methods aimed at determining the psychological characteristics of G1TS.

5. Empirical study of age, demographic, individual psychological, emotional, cognitive and personal characteristics, as well as the study and comparison of the characteristics of the life perspective of persons who have experienced various types of traumatic stress.

6. Empirical study of the dependence of the level of PTS on the probability of risk of traumatic exposure, as well as on a complex of social, age, individual psychological and cognitive-personal factors.

7. Establishment of individual psychological and personal characteristics, level of professional preparedness as factors hindering the development of P"GSR

8. Study of the relationships between psychological characteristics of a person (anxiety, extraversion/introversion, neuroticism), signs of post-traumatic stress, previous traumatic experience with the intensity of experiencing a terrorist threat.

The theoretical and methodological basis of the study was made up of the provisions of the subject-tensional (Rubinshtein, Brushlinsky, Znakov, Sergienko), systemic (Lomov, Zavalishina, Ponomarev, Barabanshchikov.) and syndromic-psychological approaches (Vygotsky, Luria, Polyakov); the principles of personality integrity developed in Russian psychology (Abulkhanova-Slavskaya, Ananyev, Myasishchev, Karvasarsky), the biopsychosocial approach to mental pathology (Perret, Kholmogorova); ideas of domestic scientists about the internal picture of the disease and the impact of severe somatic diseases on the human psyche (Luria, Nikolaeva, Tkhostov, Sokolova, etc.); ideas of cognitive psychology about the formation of mental pathology and PTSD (Beck, Ellis, Janoff-Bulman, Piaget); the concept of stress (Selye, Lazarus, Bodrov, Ababkov), as well as principles and approaches to the development of problems of post-traumatic stress (Pitman, Van der Kolk, Derogatis, Keane, etc.), theoretical ideas and practical achievements of the psycho-oncological direction and ideas about the multifactorial determination of etiology and the course of oncological diseases (Greer, Celia, Holland, etc.).

Research methods:

In terms of theoretical and methodological analysis, the work used nomothetic and ideographic research methods, systemic, subject-activity and biopsychosocial approaches. Since domestic psychology lacked adequate psychological instruments suitable for measuring the parameters of post-traumatic stress, part of this work consisted of translating and adapting existing and well-proven foreign methods, as well as developing original methods. The methodological complex used in this work includes the following blocks:

1) Methods aimed at measuring the signs and level of G1TS: Structured clinical interview - SKID (SCID: Structured Clinical Interview for DSM-1I1-R); Scale for clinical diagnosis of P "GSR (CAPS: Clinical - Administered PTSD Scale); Scale for subjective assessment of the severity of the impact of a traumatic event, SHOVTS (Impact of event scale - revised, IOES-R); Mississippi scale - military and civilian version (MS, Mississippi Scale); Life Experience Questionnaire (LEQ).

2) Methods aimed at studying psychopathological characteristics: Questionnaire of the severity of psychopathological symptoms (SCL-90-R, Symptom Check List); Beck Depression Inventory (BDI).

3) Methods for studying personal and cognitive parameters: Personality Questionnaire (adapted version of Eysenck’s technique) (Eysenk Personality Inventory, EPI); Basic Beliefs Scale, WAS (World Assumption Scale, WAS); Spielberger-Hanin Situational and Personal Anxiety Questionnaire (LT, CT); Questionnaire for experiencing a terrorist threat - OPTU (Questionnaire developed by N.V. Tarabrina in collaboration with Yu.V. Bykhovets).

3) Methods for studying PTS in children: A semi-structured interview to identify signs of traumatic stress in children - PIVPPSD was developed (by Shchepina and Makarchuk); Questionnaire of the structure of temperament V.M. Rusalova (OST); Raven's Progressive Matrices Technique (PRM); Children's version of the Rosenzweig Picture Frustration Test (PF-study); Bass-Darkie Questionnaire (BD); Kondash Anxiety Scale (CT); Modified Dembo-Rubinstein Self-Esteem Test (MTS); Family drawing (IJC).

Statistical data processing was carried out using the SPSS-10 software package and included analysis of the significance of differences and correlation analysis.

An integrative approach to the study of clinical-psychological, cognitive-emotional and personal phenomena in different social contexts made it possible to combine modern psychometric diagnostics, qualitative analysis of observation materials, surveys, expert assessments, and taking into account external criteria.

Characteristics of the examined groups. The study was organized and conducted at the following bases: Moscow Regional Research Institute named after. M.F. Vladimirsky, Institute of Radiology of the Russian Academy of Medical Sciences, Moscow City Clinic No. 220, All-Russian Institute of Fire Defense, Moscow Secondary School No. 1, “Boarding House for Family Education” (non-state educational institution - NOU), Center for Temporary Isolation of Juvenile Offenders (TSVIMP), Department of Laryngeal Reconstructive Surgery and trachea of ​​the children's hospital named after. St. Vladimir, Center for Medical and Social Rehabilitation of the Federal Migration Service, North Caucasus Military District, SOBR GUOP and OMON of Moscow, Central Airmobile Detachment (Zhukovsky) of the Ministry of Emergency Situations of the Russian Federation, Department of Oncology and Radiation Therapy of the Moscow State Medical and Dental University.

The total number of subjects and their number in groups are given in table. No. 1.

Table No. 1.

The number of subjects in the examined groups and the list of techniques used in each group

Groups examined N Methods

Military Veterans in 123 SCID; CAPS; LOES-R; MS; MMPI;

Afghanistan STAI; BDI; SCL-90-R

Liquidators 138 SCID; CAPS; 10ES-R; MS; STAI; BDI; SCL-90-R; MMPI

Refugees 60 CAPS; IOES-R; MS; STAI; BDI; SCL-90-R

Cancer patients - breast cancer 75 CAPS; IOES-R; MS; STAI; BDI; SCL-90-R; LEQ; W.A.S.

Firefighters 115 IOES-R; MS; STAI; BDI; SCL-90-R

Rescuers 47 MS; STAI; BDI; SCL-90-R; EPI; LSI;

Employees of the Ministry of Internal Affairs 34 IOES-R; MS; STAI; BDI; SCL-90-R

Young adolescents 161 PIVPSD; MTS; LUT; OCT; PMR; PC; PF-study

Residents of Moscow 288 MS; STAI; SCL-90-R ;LEQ; EPI; OPTU

Residents of the Republic of Ichkeria 73 MS; STAI; SCL-90-R ;LEQ; EPI; OPTU

Residents of Transbaikalia 131 MS; STAI; SCL-90-R; LEQ; EPI; OPTU

Note. The “methodology” column contains the accepted abbreviation of the methodology, which is presented in the “Research Methods” section.

The personal participation of the author of the dissertation was in the development of methodological principles of the study, in justifying the adequacy of the approaches used to the problem of the psychology of post-traumatic stress, in organizing and conducting cycles of empirical research, in adapting clinical-psychological interviews and psychodiagnostic methods for a Russian-speaking sample, statistical, psychological analysis, interpretation of results and their generalization.

General theoretical hypotheses of the study:

1. At the present stage of development of psychological science, an effective study of the phenomenon of post-traumatic stress as one of the psychological consequences of exposure to high-intensity stressors on a person involves the integration of knowledge accumulated in different traditions of domestic clinical psychology with various foreign concepts and directions in the study of mental trauma and its consequences; The existing different approaches to this problem do not contradict each other, but reflect individual aspects of this phenomenon.

2. The psychological consequences of exposure to extreme traumatic stressors of a high level of intensity on a person are a continuum representing various types of mental maladjustment, one of which is post-traumatic stress.

3. The main differential diagnostic parameter characterizing 1GGSD at the psychological level is the emotional and personal changes of a person, which reflect a violation of the integrity of the individual. This disorder is determined by the fact that under conditions of exposure to high-intensity stressors, a person as a subject loses the ability to effectively perform his integrating functions.

Empirical hypotheses:

1. The complex of psychodiagnostic methods developed and tested in the study represents a reliable and valid psychological toolkit that makes it possible to differentially measure the intensity of existing post-traumatic stress, to identify on this basis individuals (or groups of individuals) with a high level of PTS and to determine the targets of psychocorrectional and psychotherapeutic work with them.

2. The level of post-traumatic stress, determined using a developed set of psychodiagnostic methods, is determined by socio-demographic, personal, emotional-cognitive and psychopathological characteristics.

3. The pattern of relationships between psychological characteristics, determined using the developed set of methods, can be considered as an empirical model (symptom complex) of post-traumatic stress.

4. A high level of PTS (MS), associated with personal and situational anxiety (STAI), with a number of psychopathological characteristics (SCL-90-R) and the severity of signs of depression (BDI), corresponds with the clinical picture of PTSD.

5. A low PTS indicator, which does not have such connections, characterizes individuals who are resistant (resilient) to the psychotraumatic effects of high-intensity stressors.

Scientific novelty. An integrative approach, implemented through a theoretical and methodological analysis of the achievements of domestic clinical psychology and foreign approaches to the study of mental trauma and its consequences, carried out in the context of the development of clinical concepts of post-traumatic stress disorder, in combination with a comprehensive empirical study of the psychological characteristics of post-traumatic stress, allowed us to develop a new scientific direction - psychology of post-traumatic stress.

For the first time, an analysis of the interrelations and relationships of the content of the concepts “stress”, “post-traumatic stress”, “post-traumatic stress disorder” was carried out, on the basis of which “post-traumatic stress” was singled out as an independent category and its place in the structure of psychological knowledge was determined.

For the first time, based on theoretical analysis and generalization of the results of empirical research, it has been shown that the psychological consequences of a person’s exposure to extreme, traumatic external and internal factors of a high level of intensity manifest themselves in a continuum, representing different types and degrees of mental maladaptation, one of which is post-traumatic stress.

For the first time, the assumption has been put forward and confirmed that at the psychological level, the symptoms of post-traumatic stress disorder are represented by a set of interrelated psychological characteristics - a symptom complex included in the semantic field of the concept of “post-traumatic stress”.

For the first time in Russian psychology, within the framework of a Russian-American cross-cultural project, a comprehensive study was conducted aimed at determining PTS in combatants in Afghanistan.

For the first time, it has been shown that traumatic experiences are internalized at different hierarchical levels of the human psyche depending on the type of stressors: “event” and “invisible”. “Event” stress is caused by the direct perception of a stressor; “invisible” stress is caused by a subjective-emotional response to the knowledge a given person has about the threat to life to which he is exposed (for example, the radiation threat).

For the first time, the psychological consequences of experiencing the stress of a radiation threat among participants in the liquidation of the Chernobyl accident have been studied.

For the first time, based on the results of an empirical study, it has been shown that the level and characteristics of post-traumatic stress in people who have experienced a traumatic situation associated with an immediate threat to life (combatants in Afghanistan, participants in the liquidation of the Chernobyl accident, refugees and patients with breast cancer) are significantly higher than similar ones parameters obtained during examination of persons whose professional activities are associated with an increased risk of getting into traumatic situations (firefighters and military personnel of the Ministry of Internal Affairs).

For the first time in Russian psychology, empirical confirmation has been obtained from foreign research data that the diagnosis of cancer is one of the extreme psychotraumatic stressors, as a result of which some patients develop PTS; a high level of PTS corresponds to the clinical picture of PTSD.

For the first time, the manifestations of post-traumatic stress in children aged 11-13 years who have experienced various traumatic situations have been studied; the specificity of the development of post-traumatic stress in them, due to age, gender and individual psychological characteristics, has been shown.

Theoretical significance. The theoretical and empirical justification for a new scientific direction in clinical psychology is presented - the psychology of post-traumatic stress, which has its own subject of study, structure and system of concepts, its own boundaries and areas of research, methodological foundations and methodological means of research. The problem of post-traumatic stress is considered and analyzed from the perspective of integrating the achievements of domestic clinical psychology and various foreign approaches to the study of mental trauma and its consequences. The work was carried out in the context of the development of clinical concepts of post-traumatic stress disorder in combination with a comprehensive empirical study of the psychological characteristics of post-traumatic stress.

The integrative approach implemented in the study made it possible to consider post-traumatic stress as a symptom complex reflecting the impaired integrity of a person as a result of the traumatic impact of high-intensity stressors, causing such a level of emotional-cognitive and personal changes that make the integrative-regulatory function of a person as a subject difficult.

Practical significance of the study. The results obtained in this work make it possible to use methods of quantitative and qualitative analysis of signs of post-traumatic stress in both adults and children. The results of the study are of interest for psychological, pedagogical, psychotherapeutic practice and social work, and are widely used in creating training courses and workshops for students of psychological, practical and clinical psychological specialties.

The data obtained in this study are important for the development of individual psychological rehabilitation programs for various populations exposed to high-intensity stressors, for the timely identification of a group at risk for developing post-stress conditions and the determination of psychotherapeutic strategies for working with them. The developed complex of clinical, psychological and psychodiagnostic methods is valuable for researchers, making it possible to include them in a set of psychodiagnostic tools for working with people who have experienced traumatic stress. The results of the study are implemented:

Into the practice of the Moscow Psychological Service, the practice of the Center for Social and Psychological Rehabilitation of Combatants in Nizhnevartovsk, and the practice of the clinics of the Moscow Research Institute of Psychiatry of the Russian Health Service. The results of the study are used in the educational process of the Faculty of Psychology of the State Institute of Humanities, the Faculty of Psychology of Moscow State University. M.V. Lomonosov, Transbaikal State Humanitarian Pedagogical University, Faculty of Psychology of St. Petersburg State University, Department of Pedagogy and Psychology of Chechen State University, Moscow Medical and Dental University.

The reliability and validity of the research results is ensured by the consistent implementation of methodological positions, theoretical and methodological elaboration of the problem; using complementary research methods; meaningful comparative analysis of the phenomenology of the phenomenon and connections identified on an extensive representative sample (r = 2000 when adapting methods and n = 1245 in empirical research).

The validity of the data is determined by the adequacy of measurements, careful statistical processing of the material; re-checking individual doubtful results; correlation of quantitative and qualitative data, reproducibility of a number of results obtained by foreign and domestic researchers.

Provisions submitted for defense. The defense is presented on the theoretical and empirical basis of a new scientific direction in medical psychology - “psychology of post-traumatic stress: an integrative approach.”

1. In this study, the integrative approach is implemented by considering post-traumatic stress as a symptom complex that reflects the impaired integrity of a person as a result of the traumatic impact of high-intensity stressors, causing such a level of emotional, cognitive and personal changes in which a person as a subject loses the ability to perform the main integrative function. The psychological consequences of exposure to extreme psychotraumatic factors of a high level of intensity on a person are represented by a continuum consisting of various types of mental maladjustment, one of which is post-traumatic stress.

2. At the psychological level, the symptoms of post-traumatic stress disorder represent a set of interrelated characteristics - a symptom complex -■ included in the semantic field of the category “post-traumatic stress”. A set of psychodiagnostic methods developed and tested in the study makes it possible to determine various aspects of this symptom complex and establish targets for psychotherapeutic assistance.

3. Internalization of traumatic effects occurs at different hierarchical levels of the human psyche, depending on the type of stressors: “event” and “invisible”. “Event” stress is caused by experiencing a directly perceived stressor through the senses; “invisible” stress is caused by a subjective-emotional response to the knowledge a given person has about the threat to life to which he is exposed (for example, the radiation threat).

4. The psychological picture of post-traumatic stress under the influence of different types of stressors - “event” and “invisible” - is different.

4.1. A high level of post-traumatic stress caused by participation in combat (“event” stress) manifests itself in the form of a symptom complex of interrelated psychological characteristics (high anxiety, depression, a number of psychopathological symptoms), corresponding to the clinical picture of PTSD, as well as alcohol dependence. The combination of these signs is not observed in the group of veterans without PTSD. The main parameters of the psychological state of participants in combat operations in Afghanistan, identified in this work, are generally similar to the results of American studies of veterans of the Vietnam War.

4.2. PTSD, which arose under the influence of “invisible stress” of radiation damage among participants in the liquidation of the consequences of the Chernobyl nuclear power plant accident, differs from PTSD, which develops under the influence of “event” stressors (war stress, disasters, etc.). The consequences of exposure to a stressor that is not perceived by the senses (“invisible” stressor) are largely mediated by individual personal characteristics and are characterized by a high level of symptoms of physiological excitability. At the same time, the semantics of symptoms is predominantly associated with anxiety about the future.

4.3. Differences in the psychological picture of post-traumatic stress under the influence of different types of stressors (“event” and “invisible”) are especially manifested in the phenomenon of a shortened life perspective. Experiencing war trauma most of all deforms the emotional component of the future perspective, while the ability to plan for the future is generally preserved. Experiencing the stress of the radiation threat does not cause significant differences in this parameter in connection with the diagnosis of PTSD: planning for the future includes possible trauma associated with a threat to health or life in both cases. When assessing the emotional component of their life prospects, “liquidators” with signs of PTSD experience the prospect of living alone more acutely and are more dependent on their health status. 5. Currently, the register of traumatic stressors includes the terrorist threat, which is formed under the influence of information about terrorist attacks in the media and other means of communication. It has been established that high intensity of experience of a terrorist threat is associated with signs of PTS.

6. Extreme psychotraumatic stressors also include the diagnosis of cancer, which leads to the development of PTSD in some patients. It has been shown that in patients with breast cancer (BC) a high level of post-traumatic stress corresponds to the clinical picture of PTSD.

6.1. The psychological characteristics of PTS caused by life-threatening diseases are associated with certain cognitive-personal characteristics - basic beliefs. The level of education is negatively associated with the intensity of PTS, and the number of previous life stresses and the intensity of their impact on a person’s life correlate with the severity of PTS that occurs in response to the diagnosis of cancer.

6.2. Differentiation of breast cancer patients according to the intensity of PTS allows us to identify a risk group, which is characterized by the level of PTS corresponding to the clinical picture of PTSD, and to develop methods of individualized psychological assistance for these patients.

7. The psychological picture of post-traumatic stress and its intensity is determined by socio-demographic, cognitive-personal and emotional characteristics.

7.1 Groups with high, average and low rates of post-traumatic stress differ significantly in all measured parameters: quantitative indicators of socio-demographic and psychological characteristics, as well as the specificity of the relationships between them obtained by the correlation method. Emotionally unstable, introverted individuals, prone to experiencing negative emotions, suffering from various manifestations of psychopathological symptoms, are more susceptible to intense experiences of traumatic effects.

7.2. The severity of post-traumatic stress in people who survived an immediate threat to life - participants in combat operations in Afghanistan, participants in the liquidation of the Chernobyl accident, refugees and patients with breast cancer (the “traumatized” group) - is significantly higher than similar parameters obtained from examining people whose professional activities is associated with an increased risk of getting into traumatic situations - firefighters and military personnel of the Ministry of Internal Affairs (“at-risk groups”).

7.3. Post-traumatic stress in children who have experienced various traumatic situations is characterized by the presence of stable relationships (patterns) between individual psychological characteristics and the level of PTS of high and medium intensity. These patterns include: the level of intellectual development, a number of temperamental characteristics (social pace, social desirability, plasticity), various types of response to a frustrating situation. Factors contributing to the development of PTS are: low level of intellectual development, increased anxiety, low level of family support, disrupted family structure, gender - PTSD occurs more often in girls than in boys.

8. The development of a holistic psychological concept of post-traumatic stress involves the integration of the achievements of domestic clinical psychology with approaches developed in Western psychology to the study of post-traumatic stress disorder as one of the most severe consequences of mental trauma. Different directions in PTSD research do not contradict each other, they are complementary - they present individual aspects of this phenomenon.

Approbation of the study. The main provisions and results of the work were presented by the author at the I International Conference on Traumatic Stress (Kyiv, 1992); at nine Annual Conferences of the International Society for Traumatic Stress Study (ISTSS) in 1993 - 1998, 2000, 2004, USA; at a scientific and theoretical seminar for social workers of rehabilitation centers of the Committee for the Affairs of Soldiers-Internationalists of the CIS (Moscow, IP RAS, 1993); at the conference of representatives of the Committees for the Affairs of Soldiers-Internationalists of the CIS (Moscow, 1994); at a seminar on the problems of post-traumatic stress disorders (Ryazan, 1994); at the 4th European Conference on Traumatic Stress (Paris, 1995); at the All-Russian Conference “Radioecological, medical and socio-economic consequences of the Chernobyl accident” (Moscow, Golitsyno, 1995); at the workshop “Radiation Risk, Risk Perception and Social Structure” (Oslo, Norway, 1995); at the World Congress on Traumatic Stress (Jerusalem, 1996); at the scientific and practical conference “Results and tasks of medical monitoring of the health status of participants in the liquidation of the consequences of the disaster at the Chernobyl nuclear power plant in the long-term period” (Moscow, 1998); at the conference “New approaches to the diagnosis and treatment of affective disorders” (Moscow, 1998); at the Russian-American meeting “Emergencies and Mental Health” (St. Petersburg, 2000); at the All-Russian Meeting of Psychologists

Ministry of Internal Affairs (Moscow, 2000); at the round table: “Comprehensive rehabilitation for disabled people and combat veterans” (Ruza, Moscow region, 2000); at the International Conference “Psychology and Human Ecology: Psychological Factors in the Culture of Peace and Nonviolence in Modern Russia” (Moscow, 2001); at the anniversary scientific conference of IP RAS (30th anniversary of IP RAS) (Moscow, 2002); at the Russia-NATO symposium “Social and psychological consequences of biological, chemical and radiation terrorism” (Brussels, 2002); at the scientific conference “Psychology: modern directions of interdisciplinary research” (Moscow, 2002); at the seminar “Organization and implementation of a complex of socio-pedagogical and psychological-correctional measures aimed at the rehabilitation of employees of internal affairs bodies - participants in combat operations and anti-terrorist operations” (Nizhnevartovsk, 2002); at the working meeting of the Expert Council on the social and psychological consequences of terrorism, Russia-NATO (St. Petersburg, 2003); at the Russian conference “Affective and schizoaffective disorders” (Moscow, 2003); at the International Conference “World Community against Globalization, Crime and Terrorism” (Moscow, 2004); at the 2nd All-Russian Conference “Humanitarian Strategies of Anti-Terrorism. Psychology of fanaticism, fear and hatred" (St. Petersburg, 2005); at the NATO workshop “Social and psychological factors in the origin of terror” (Italy, 2005); at the XIV Congress of Russian Psychiatrists (Moscow, 2005); at the All-Russian conference “Modern principles of therapy and rehabilitation of mentally ill patients” (Moscow, 2006); at the 8th World Congress on Psycho-Oncology (Venice, 2006); at the regional scientific and practical conference of the Southern Federal District “Mental health of the population in conditions of a long # emergency situation” (Grozny, 2007).

1. A new scientific direction has been developed - the psychology of post-traumatic stress, which is based on the integration of the tradition existing in domestic clinical psychology of constructing a psychological picture of the clinical symptoms of a mental disorder and the main approaches to the study of mental trauma and its consequences developed in Western psychology. Different directions in the study of post-traumatic stress disorder do not contradict each other, but are complementary and represent separate aspects of this phenomenon.

1.2. At the psychological level, the symptoms of post-traumatic stress disorder represent a set of interrelated characteristics (symptom complex), included in the semantic field of the category “post-traumatic stress”. The developed complex of psychodiagnostic methods allows us to identify various aspects of this symptom complex, differentiate individuals and groups according to the level of post-traumatic stress and determine the targets of psychocorrectional and psychotherapeutic work with them.

1.3 The level of PTS is associated with personal and situational anxiety, psychopathological parameters, the severity of signs of depression and socio-demographic characteristics. A high level of post-traumatic stress corresponds to the clinical picture of PTSD.

2. The integrative approach is implemented at the level of considering post-traumatic stress as a symptom complex, the characteristics of which reflect, first of all, a violation of the integrity of the individual as a result of the psychotraumatic effects of high-intensity stressors. In this case, emotional-cognitive personal changes can reach such a level at which a person as a subject loses the ability to cope with his integrating function.

3. The psychological consequences of human exposure to extreme psychotraumatic factors of a high level of intensity are manifested by a continuum, representing various types of mental maladjustment, one of which is PTSD.

4. It has been established that the internalization of traumatic effects occurs at different hierarchical levels of the human psyche, depending on the type of stressors: “event” and “invisible”. “Event” stress is caused by experiencing a directly perceived stressor through the senses; “invisible” stress is caused by a subjective-emotional response to the knowledge a given person has about the threat to life to which he is exposed (for example, the radiation threat).

4.1 Differences in the psychological picture of post-traumatic stress under the influence of different types of stressors (“event” and “invisible”) are convincingly proven by the results of studying the characteristics of the phenomenon of a shortened life perspective (this is one of the symptoms of PTSD, which is more common, the higher the values ​​of post-traumatic symptoms).

4.2. The presence of mental trauma is closely related to cognitive-emotional changes in the perception of life perspective. Experiencing war trauma most of all deforms the emotional component of the future perspective, while the ability to plan for the future is generally preserved. Experiencing the stress of the radiation threat does not cause significant differences in this parameter in connection with the diagnosis of PTSD: planning for the future includes possible trauma associated with a threat to health or life in both cases. When assessing the emotional component of their life prospects, “liquidators” with signs of PTSD experience the prospect of a lonely life more acutely and are more dependent on their health.

5. A high level of post-traumatic stress caused by participation in combat (“event” stress) manifests itself in the form of a symptom complex of interrelated psychological characteristics (high anxiety, depression, a number of psychopathological symptoms) corresponding to the clinical picture of PTSD. as well as alcohol addiction. The combination of these signs is not observed in the group of veterans without PTSD.

6. Features of psychophysiological reactivity are most pronounced in Afghan veterans with a high intensity of clinical symptoms of the disorder. The main parameters of the psychological state of participants in combat operations in Afghanistan are generally similar to published results obtained in American studies of Vietnam veterans.

7. It has been established that the consequences of exposure to a stressor that is not perceived by the senses (“invisible” stressor) are mediated by individual personal characteristics; The PTSD that occurs in this case differs from PTSD that is formed under the influence of “event” stressors (war stress, disasters, etc.). A feature of PTSD that occurs under the influence of “invisible stress” is a high percentage of symptoms of physiological excitability, and the semantics of the symptoms are, for the most part, associated with future life.

8. The experience of a terrorist threat, formed mainly under the influence of information about terrorist acts in the media and other means of communication, is associated in a vulnerable (emotionally unstable part of the population) with a high level of PTS symptoms, which allows us to classify the phenomenon of a terrorist threat as a traumatic stressor . It is also accompanied by negative emotions, high levels of anxiety, increased vigilance, decreased adaptive capabilities of behavior, somatic discomfort with vegetative manifestations, etc.

9. The risk of PTS (and, accordingly, PTSD) is associated with the likelihood of experiencing traumatic stress; The level of post-traumatic stress in people who have experienced a traumatic situation associated with an immediate threat to life - participants in combat operations in Afghanistan, participants in the liquidation of the Chernobyl accident, refugees and cancer patients (breast cancer) - is significantly higher than in people whose professional activities are related to increased risk of getting into traumatic situations - firefighters and military personnel of the Ministry of Internal Affairs.

10. Different levels of PTS (high, medium and low) correspond to different symptom complexes of psychological characteristics. They differ significantly: in socio-demographic parameters, quantitative indicators of psychological characteristics, as well as the specifics of the relationships between them obtained by the correlation method.

11. Published data from foreign studies have been confirmed that the diagnosis of cancer is one of the extreme traumatic stressors, as a result of which some patients develop post-traumatic stress of varying severity.

12. Psychological characteristics of PTS in patients with breast cancer are associated with certain cognitive-personal characteristics - basic beliefs. The level of education is negatively associated with the intensity of PTS, and the number of previous life stresses and the degree of their influence on a person’s life correlate with the severity of PTS. Differentiation of breast cancer patients according to the intensity of PTS allows us to identify a group at risk for developing PTSD and determine the targets of psychotherapeutic work with these patients.

13. The study of post-traumatic stress in children who have experienced various traumatic situations, determining its level and the specifics of its occurrence makes it possible to predict the further emotional and personal development of the child.

13.1. The presence of stable relationships (patterns) between individual psychological characteristics and high and average levels of PTS in children has been shown. These patterns include: the level of intellectual development, a number of temperamental characteristics - social tempo, social desirability, plasticity, various types of response to a frustrating situation.

13.2. Factors contributing to the development of high levels of post-traumatic stress in children have been identified: low level of intellectual development, increased anxiety, low level of family support, disrupted family structure, gender PTSD occurs more often in girls than in boys.

Conclusion

The range of problems that arise during the interaction of the medical and psychological systems tends to expand and change, which is due to both scientific achievements and demands from society. One of the “new” (the dramatic consequences of catastrophic situations on the human psyche have been known since ancient times) problems in domestic clinical psychology in recent decades has become the need to include in its subject field research into the psychological consequences of exposure to high-intensity stressors on humans.

Traditionally, these problems have mainly been studied by specialists in the field of psychological stress, who included critical life events in the list of stressors. V.A. Bodrov (2006) defines psychological stress “as a functional state of the body and psyche, which is characterized by significant disturbances in the biochemical, physiological, mental status of a person and his behavior as a result of exposure to extreme factors of a psychogenic nature (threat, danger, complexity or harmfulness of living conditions and activities)” (p. 21).

Most authors tend to consider psychological stress as a transactional process that reflects a person’s interaction with the outside world (Ababkov, Perret, 2004). The definition of psychological stress as a state and as a process is legitimate and justified, however, questions remain, which primarily relate to the need to develop differentiating criteria for the consequences of exposure to stressors, which are very different both in their intensity and in phenomenology.

As shown in the first part of this work, it was the consequences of exposure to high-intensity stressors, primarily combat stress, that served as the impetus for their consistent study, which ultimately led to the identification of PTSD as a separate nosological unit. This in turn has stimulated clinicians and psychologists to develop clinical and psychological methods for diagnosing PTSD, as well as to search for effective treatments for the disorder. A new interdisciplinary branch of science has emerged - traumatic stress, or, as some researchers believe, psychotraumatology.

The introduction of PTSD in ICD-10, on the one hand, the high social significance of the problem of the consequences of experienced traumatic stress, on the other, contribute to the intensive development of research in domestic psychology and psychiatry, which naturally relies on approaches and directions already available in foreign science.

An analysis of foreign research in this area has shown that most of the work on PTSD is devoted to the epidemiology, etiology, dynamics, diagnosis and treatment of PTSD. The semantic field of the concept “traumatic stress” includes such concepts as “trauma”, “traumatic stress”, “post-traumatic stress”, “traumatic stressors”, “traumatic situations” and “post-traumatic stress disorder”, which are contextually dependent.

Many studies have shown that the consequences of a person's exposure to traumatic situations are not limited to the development of acute stress disorder (ASD) or PTSD. Typically, PTSD is comorbid with depression, panic disorder, and substance abuse; the range of clinical manifestations of the consequences of super-extreme exposure to the human psyche is, of course, wider, and the psychological picture of the symptoms of the disorder has not been specifically studied.

One of the main achievements in domestic clinical psychology is, in our opinion, the construction of a psychological picture of a separate mental disorder, based on a theoretical and empirical study of its clinical manifestations.

In Russian psychology, a syndromic-psychological approach has been developed (based on local brain pathology), which has successfully proven its effectiveness in both theoretical and practical work (Vygotsky, 1982; Luria, 1978). Discussing the problems of clinical psychology, V.F. Polyakov, as one of its main tasks, raises the question of extending this approach to the field of clinical-psychological studies of mental disorders, proposing to consider a psychological syndrome as a “new formation” that affects a person’s life and complicates his socio-psychological adaptation (Polyakov, 1996).

In different areas of psychology, concepts such as “formation”, “pattern”, “complex”, “totality”, etc. are used to denote empirically determined interrelated psychological characteristics. One of the main tasks in clinical psychological research is to determine the psychological specificity of individual diseases, and consideration of the totality of identified psychological parameters as a “psychological syndrome” seems both legitimate and promising.

In this paper, an attempt is made to apply these approaches to the analysis of empirical studies of post-traumatic stress.

One of the most fundamental questions in all studies of post-traumatic stress in victims of various traumatic events is why some people experience post-traumatic stress reactions while others do not, i.e. how to explain the causes of this disorder, what factors predispose or contribute to its development? It is very difficult to answer this question, since the effect of many variables cannot be controlled in one study. We tried to answer this question by analyzing the relationship of the studied signs of post-traumatic stress with socio-demographic, cognitive-personal and clinical characteristics, presumably capable of influencing the processes of coping with trauma.

13 work presents the results of an empirical study of the psychological consequences of exposure to traumatic stressors, carried out on different groups of subjects. The main results of these studies include the demonstration of the differential diagnostic capabilities of the developed psychodiagnostic complex for determining the severity of post-traumatic stress, which made it possible to differentiate survivors of traumatic stress into groups with high, medium and low levels of PTS. It has been shown that only a high level of PTS corresponds with the clinical picture of PTSD.

At the same time, the PTS symptom complex also includes psychological characteristics that reflect the cognitive-personal and emotional changes of a person caused by exposure to a traumatic experience. Thus, the study presents data on the distortion of the perception of life perspective in patients with signs of PTS. The intensity of post-traumatic stress reactions is associated with the qualitative characteristics of a person’s ideas about himself, his own life and the world around him.

There are many authors who develop their own concepts of mental trauma as the destruction of cognitive-emotional circuits. Despite the lack of terminological consistency, the meaning of these concepts is that such schemes explain reality, serve as a source of trust in the world and in oneself, make the world predictable and create the preconditions for orientation to the future. Cognitive schemes are assigned a priori and a posteriori functions. In the case when the schemes are violated, a person cannot anticipate the future and make plans, since he simply has nothing to rely on, which is accompanied by an acute state of emotional distress. While cognitive-emotional schemas are deep structures, at the conscious level the perspective is represented in the form of goals, plans and life activities of the individual.

Shortened life perspective is one of the symptoms of PTSD; at the psychological level, for a person, a life perspective means the possibility of drawing up some kind of probabilistic forecast of life, a forecast of personal development. The work shows, firstly, that the shortening of life perspective is a very complex psychological phenomenon that reveals itself in both behavioral, cognitive, emotional, and personal aspects. Thus, we can consider this phenomenon not from the point of view of some deficiency or inferiority, i.e. not only from the point of view of clinical psychology, but from the point of view of a broader psychological context.

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