Сведения об авторах: САГАЛАКОВА Ольга Анатольевна, кандидат психологических наук, доцент кафедры клинической психологии Алтайского государственного университета (Барнаул, Россия).
The paper examines the problem of the use of modern AVATAR therapy for auditory hallucinations (AH). There is a traditional asymmetry of the focus of interest in the study of AH with a bias towards the study of the final result of perception at the expense of comprehension of the process of AH development. The methodology of the cultural-activity approach and study of the patterns of the genesis of the “voices” in pathopsychology provide an adequate basis for understanding the nature of AH. Current intervention in psychosis is based on recognizing the role of psychological factors. АН are amplified in the state of anxiety, or in case of disturbed interpersonal relationships. AVATAR therapy provides the patient with psychological means of restoring deliberate mental activity, gaining control over one’s mental activity through its objectification, making the “voice” less malevolent and managing negative experiences. The method is based on a dialogue with an avatar, a visual digital image of the “voice”. It is designed in a virtual environment evoking a presence effect, which allows directed interaction with it in order to increase assertiveness. The experiments showed encouraging, but still debatable, results of the effectiveness of AVATAR therapy.
An analytical review of the directions for auditory hallucinations (AH) interventions in the context of the development of ideas about the phenomenon of “voices” is presented. The transformation of methodological approaches evolves from the conceptualization of hallucinations as “perceptions without an object” and “production of sick brain” to an acknowledgment of the connection with the stimulus and the significance of the subject's activity; from the concept of AH as a symptom to the analysis of perception as a mediated activity, the differentiation of AH cognitive and perceptual models. Changes in conceptualization determine the contemporary goals of the intervention. In the cultural-activity approach methods are used to improve the psychological state based on the comprehension of the systemic nature of the defect in mental activity. The limitations of comparing the effectiveness of pharmacological treatment and psychotherapy are shown. In the development of evidence-based intervention strategies the integration of cultural-activity approach thesis and cognitive-behavioral therapy (CBT) models is productive. Within the framework of the “third wave” CBT and therapy based on social relations the leading techniques for adapting to “voices” are presented. Conceptualization the mechanisms of AH allows to move from the goal of intervention related to adaptation in defect – to distress reduction, increase the controllability of AH, to overcoming the consequences of psychosis.
Представлен аналитический обзор подходов к изучению когнитивных факторов нарушений психической деятельности при обсессивно-компульсивном расстройстве (ОКР). Обозначен историко-методологический путь осмысления механизмов ОКР: от ранних когнитивных теорий, через описание системы дисфункциональных убеждений и изучение протекания мыслительной деятельности посредством анализа руминаций к выявлению особенностей фокусировки внимания при ОКР и социальном тревожном расстройстве, нейрокогнитивному подходу в изучении ОКР во взаимосвязи с социальной тревогой, позволяющему интегрировать имеющийся экспериментальный опыт и определить вероятный трансдиагностический нейронный коррелят тревоги-ERN. Ключевые слова: обсессивно-компульсивное расстройство (ОКР); дисфункциональные убеждения; руминации; искажение внимания; нейрокогнитивные исследования; социальное тревожное расстройство (СТР); ERN; самофокусировка внимания.
The article is devoted to the analysis of the prospects for research on neurocognitive mechanisms of anxiety disorders. In response to limitations and contradictions in the logic of the categorical method of classification of mental disorders, the popularity of the dimensional approach, in which the emphasis shifts to the assessment of the severity of symptoms. The National Institute of Mental Health has developed the promising approach based on the search for systemic neurobiological foundations of mental disorders. Based on the project RDoC (Research Domain Criteria) the search for trans-diagnostic mechanisms of mental disorders has been updated. The logic of RDoC echoes the position of Russian pathopsychology, in which the syndrome of mental activity disorders is considered in dynamics, the mechanisms of the functioning of the psyche are qualified as identical in norm and pathology. In the study of anxiety-related disorders, the obvious commonality of the spectrum of manifestations that acquire nosological clarification against the background of the escalation of the severity of symptoms and secondary compensatory processes has repeatedly been put forward in the center of research attention. The aim of the article is a theoretical and methodological analysis of the neurocognitive basis of the errors monitoring system, characteristic of normal and excessively expressed in anxiety disorders, including ERP component error related negativity (ERN). As a result, it is shown that this neurocogitive marker, experimentally modeled in conflict tasks (e.g., Eriksens flanker task), is expected to be a probable transdiagnostic basis for anxiety-related disorders (social anxiety disorder, obsessive-compulsive disorder). The increase in the amplitude of ERN in internalization, uniting anxiety-depressive symptoms, is explained by individual differences in the readiness to detect error and sensitivity to incorrect decisions. At the moment, the study of ERN retains the tempted of simplified interpretations, the arbitrary establishment of direct causal connections between the neural basis and mental phenomena.
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