Процедуры групповой АМТ-терапии 


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Процедуры групповой АМТ-терапии



 

Основные техники АМТ также подходят для групповой терапии и могут проводиться в группах от 6 до 8 человек. При этом в технику предполагается внести некоторые изменения.

Во-первых, увеличивается время занятий. Занятия организуются таким образом, чтобы самый слабый пациент сумел получить необходимые навыки. Например, если он не сумел приобрести навык достижения релаксации, переход ко второму занятию теряет всякий смысл.

Поскольку сцены релаксации должны быть созданы для всех клиентов, это совершенно естественно увеличивает время каждого занятия. В целом продолжительность первого занятия увеличивается до 75 минут. Для обеспечения формирования навыка релаксации у всех участников группы первое занятие можно повторить.

Правило удлинения времени и повторы занятий при необходимости также распространяются на все последующие занятия техники АМТ. Следовательно, на занятие, посвященное формированию ситуации тревоги уровня интенсивности 60, также должно быть отведено 75 минут (занятие 2 по индивидуальной технике АМТ). То же относится к формированию ситуации тревоги с уровнем интенсивности 90 (занятие 4 по индивидуальной технике АМТ).

Занятия для стандартной группы в 6–8 человек могут быть организованы следующим образом:

Занятие 1 – объяснение, идентификация сцены релаксации и тренинг релаксации.

Занятие 2 – повторение занятия 1.

Занятие 3 – идентификация ситуации тревоги (уровень интенсивности 60), инструкция по релаксации, а также инструкция по активации тревоги с последующим контролем релаксации даются терапевтом.

Занятие 4 – самостоятельная релаксация, инициируемая пациентами, активация тревоги с последующим релаксационным контролем – внимание к ранним сигналам тревоги.

Занятие 5 – повторение занятия 4.

Занятие 6 – идентификация ситуации тревоги (уровень интенсивности 90), самостоятельная релаксация, осуществляемая пациентами, ситуация активации тревоги, самостоятельно прекращаемая ими, и самостоятельная инициация контроля релаксации: чередование сцен активации тревоги с уровнями 60 и 90.

Занятие 7 – повторение занятия 6.

Занятие 8 до завершения курса – самостоятельная релаксация, активация тревоги с последующей самостоятельно инициированной пациентом релаксацией при сохранении в сознании ситуации тревоги; чередование ситуаций тревоги с уровнем интенсивности 60 и 90.

Ситуации релаксации и тревоги записываются. В технике индивидуальной терапии АМТ при инициации ситуаций тревоги и релаксации терапевт описывает детали окружающей обстановки и детали, стимулирующие активацию тревоги. В связи с тем что у каждого пациента в группе детали ситуации тревоги отличаются, устная инструкция для группы становится невозможной. Вместо этого с каждым пациентом проводится индивидуальное собеседование с целью определения индивидуальных особенностей ситуации тревоги. Затем предлагается записать сформированную ситуацию тревоги на карточке. В данном случае, когда терапевт дает пациентам инструкцию переключиться на ситуацию тревоги, каждый из них понимает, что инструкция относится к ситуации тревоги, записанной на его индивидуальной карточке.

Сигнализация рукой имеет особое значение для получения важной информации. Например, если пациент не дает сигнала об активации тревоги, терапевт может сказать: «Если Вы смогли испытать переживание активации тревоги уровня интенсивности 60 во время визуализации последней сцены тревоги, дайте мне знак об этом поднятием правой руки». Сигнализация такого рода обеспечивает терапевту важность контролировать успешность каждого во время занятия.

В заключении необходимо отметить, что использование техники АМТ в больших группах неэффективно.

 

 

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[1]DSM – Диагностическое и статистическое руководство по психическим заболеваниям (Diagnostic and Statistical Manual of Mental Disorders) Американской Ассоциации Психиатров (APA).DSM – III – R (1987); DSM – IV (1994); ICD – 10-я версия Международной Классификации болезней.

 

[2]Сопутствующий патологический процесс (термин обычно используется в эпидемиологии для обозначения одновременного существования двух и более нарушений).

 

[3]Тестовая тревожность – тревога, которую испытывают дети в ситуации оценки их возможностей, результатов деятельности и т. д.

 

[4]Carter F. Anxiety in childhood and adolescence: encouraging self-help through relaxation training. New York, 1988.

 

[5]Дополнительную информацию по указанному вопросу, включая описание практических случаев и руководство по обучению навыкам контроля можно найти в издании: Suinn R. Anxiety management training (AMT): A behavior the rapy. New York, Plenum, 1990.

 



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