Cognitive abilities - what are they, how to develop them? Group therapy.

These early attempts, with their mixed results, were based on the premise, or at least hope that cognitive training will help change cognitive functions. But everything has changed radically with the emergence of new evidence - that cognitive exercises can help change myself . It seems almost self-evident that this should be the case.

When you exercise, not only do your athletic skills improve, but actual muscle growth occurs. In contrast, lack of exercise leads not only to a loss of athletic skills, but also to an actual decrease in muscle tissue. Or another, more important example in this regard: in a baby monkey, sensory deprivation gives rise to actual atrophy of the corresponding brain tissue.

However, decisive experimental data have only recently begun to emerge. Immersion in an enriched environment has been known to help heal brain damage in rats. Now the mechanisms behind this cure are finally becoming clear. The recovery of animals with traumatic brain injury was compared in two conditions: in a standard environment and in an environment enriched with an unusual amount of varied sensory stimulation. When comparing the brains of animals from these two groups, surprising differences were discovered. The restoration of connections between nerve cells (“dendritic branching”) was much more vigorous in the stimulated group than in the standard group. There is also some evidence that vigorous mental exercise improves due to increased growth of small blood vessels (“vascularization”). Scientists such as Arnold Scheibel are convinced that similar processes occur in human brain. Systematic cognitive activation may promote extensive dendritic arborization in victims of traumatic brain injury; this in turn facilitates the restoration of function.

This raises another question: does cognitive activation slow the progression of degenerative brain disorders such as Alzheimer's disease, Pick's disease, and Lewy body disease? These disorders are characterized by progressive brain atrophy and loss of synaptic connections. This in turn is associated with the accumulation of pathological microscopically small particles, such as “amyloid plaques” and “neurofibrillary tangles” in Alzheimer's disease.

Unlike head injury or stroke, dementias are slow, gradually progressive disorders. This means that the effectiveness of a treatment must be assessed not only by whether it reverses the course of the disease (this, at least for now, would be an unrealistic expectation) but also by whether the treatment slows the progression of the disease. There is, however, evidence that cognitive exercises can improve temporarily, even in an absolute sense. Scientists at the Max Planck Institute in Germany used positron emission tomography (PET) to study the effects of cognitive exercise and neurostimulant drugs on brain glucose metabolism in humans early stage cognitive decline. In combination, these two forms of therapy improved brain glucose metabolism. The German study examined changes in the physiology of the non-activated brain, its background state, and changes in patterns of brain activation when the brain is stimulated by a cognitive task. The development of brain neuroimaging technology is opening a window into observing the brain mechanisms of mental processes that seemed unthinkable in the past. It is now possible to directly observe what happens in the brain when a person is engaged in mental activity.

For years it has been accepted as an axiom that the brain loses its plasticity and capacity for change as we move from childhood to adulthood. Today, however, there is increasing evidence that the brain retains plasticity into adulthood and, perhaps, throughout life. Previously, it was assumed that in the adult body, dying neuronal cells are not restored. Although it had long been known that new cells could develop in birds (thanks to the work of Rockefeller University scientist Fernando Nottebohm) and rats (thanks to the work of Joseph Altman of Indiana University), this evidence was ignored on the grounds that it rather an exception than the rule. But recent work by Elizabeth Gould of Princeton University and Bruce McEwan of Rockefeller University has shown that new ones continue to appear in adult monkeys.

The growth of new neural cells has been demonstrated in the brain, a structure that plays a special role in the brain. In another study, Elizabeth Gould and her colleagues found continued growth of new neurons in the cortex of adult macaque monkeys. New ones are added to the heteromodal cortex in the prefrontal, inferior and posterior parietal regions - areas of the brain involved in the most complex aspects of information processing.

New evidence from both animals and humans opens up a whole new way of thinking about the effects of cognitive exercise. Instead of trying to form or transform specific mental processes, try to rebuild your brain itself.

Although most of us understand that mental processes are brain processes, the underlying reasoning behind different approaches to cognitive training is different. Early attempts emphasized specific functions, hoping that as a result the brain structures corresponding to that function could be somehow modified. New approach highlights the generalized, broad effects of cognitive exercise on the brain. A tennis or golf player can strive to improve by practicing daily certain technology games. This corresponds to task-specific cognitive training. Or he may hope that by training some specific aspects of technique, he will improve other aspects of technique and thereby improve the game as a whole. This corresponds to training the entire functional system. Or, finally, he may begin a training cycle with the goal of improving not so much the game itself, but the very body that plays: increasing overall strength, coordination and endurance. This corresponds to an attempt to improve brain function. The third goal is much more ambitious than the first two, but new evidence suggests it is achievable, at least in principle.

Animal studies show that increasing “brain power” through cognitive activation is no fantasy. Scientists at the renowned Salk Institute for Biological Studies in southern California tested the effects of exposure to an enriched environment on adult mice. They found that mice placed in cages equipped with wheels, tunnels and other toys developed up to 15% more nerve cells than in mice left in standard cages. The "stimulated" mice also performed better than the "unstimulated" mice on various tests of "mouse intelligence." They were able to learn mazes better and faster.

These findings are important in two respects. First, they debunk the old idea that new neurons can't develop in the adult brain—they can. Second, these findings demonstrate with dramatic clarity that cognitive stimulation can change the structure of the brain itself and improve its ability to process information. The growth of new neurons was especially noticeable in the dentate gyrus of the hippocampus, a structure on the medial surface of the temporal lobe that is thought to be especially important for memory.

The emergence of new cells (“neuronal proliferation”) in the adult brain appears to be associated with so-called neuroblasts, the precursors of neurons, which in turn develop from common cellular “half-products” called stem cells. These stem cells and neuroblasts continue to grow throughout adulthood, but they usually do not survive to become neurons. Salk Institute research suggests that cognitive stimulation increases the chances of survival for neuroblasts, allowing them to become full-fledged neurons.

Of all the uses of cognitive exercise, one that is particularly promising is its preventive role in helping people enjoy their cognitive health longer. Both anecdotal evidence and formal research have shown that education has a protective effect against dementia. Highly educated people are less likely to develop dementia. The MacArthur Foundation's Successful Aging Research Network funded a study of indicators of cognitive change in older adults. It turned out that education is the most powerful indicator of cognitive integrity in old age.

The mechanism of this connection is not entirely clear. Does an educational lifestyle protect against dementia, or are some people born with a particularly “successful” neurobiology that both makes them better candidates for higher education and protects them from dementia? It is reasonable to assume that it is the nature of the activities associated with higher education that protects against dementia rather than the education itself. Highly educated people - by the very nature of their professions - with more likely The less educated are involved in a lifetime of vigorous mental activity.

If we assume that the neurological disease that causes dementia affects both groups at equal rates, then a neurological disease of equal severity will have less of a devastating effect on a well-trained brain than on a poorly trained brain. This will happen due to the additional reserves that a well-trained brain has due to additional neural connections And blood vessels. An equal degree of structural damage will produce less functional destruction. Again, the analogy between cognitive fitness and physical fitness comes to mind. The case of Sister Mary presents this phenomenon with dramatic and remarkable clarity. She performed successfully on cognitive tests until her death at the age of 101. This was despite the fact that a post-mortem examination of her brain revealed numerous neurofibrillary tangles and amyloid plaques, hallmarks of Alzheimer's disease. It appears that Sister Mary had a healthy mind inside an Alzheimer's brain!

Sister Mary belonged to the School of Sisters of Notre Dame, a widely studied and described group of nuns from Mankato, Minnesota. Remarkable for their longevity, they are also known for their complete absence of Alzheimer's disease. This phenomenon has been unanimously attributed to a lifelong habit of being cognitively active. The nuns constantly exercised their minds with riddles, card games, discussions of current politics, and other mental activities. Moreover, college-educated nuns who taught and systematically participated in other mentally demanding activities lived longer on average than less educated nuns. These observations of the nuns' cognitive health were so compelling that a post-mortem study was planned to examine the relationship between cognitive stimulation and dendritic sprouting.

In the case of the nuns, the protective effect of cognitive brain exercises was cumulative, lasting throughout their lives. Autobiographies of nuns written between the ages of 20 and 30 were found in the archives. When the relationship between these early writings and the prevalence of dementia in later years, a striking picture emerged. Those nuns who wrote more grammatically correct and conceptually rich essays in their youth maintained their mental alertness significantly longer in life than those nuns who wrote simple factual prose when they were young.

These findings have fueled speculation in the popular press that dementia is a lifelong condition that begins to affect some people subclinically early in life, forcing them to write simpler prose. But it is just as likely that the same aspects of brain organization that make some people smarter than others also confer a protective effect on them against dementia later in life. It is also possible that the nuns, who early developed the habit of exercising their minds and apparently retained this habit, acquired the protection for their brains that proved so important in their later years.

How universal is the protective effect of cognitive stimulation on mental decline? It appears to be universal, as this effect can be demonstrated in other species as well. This was demonstrated by Del and colleagues for male Sprague-Daly rats. Animals with different tasks were less susceptible to age-related memory deficits than rats without a history of “mental exercise.”

“Use a thing or you will lose it” is an old saying. It seems to apply directly and literally to . Two scientists from Pennsylvania State University, Warner Schaie and Sherry Willis, published a paper with the intriguing title: “Can the decline of intellectual functioning in adults be reversed?” The authors studied a group of individuals aged 64 to 95 years who had suffered from cognitive decline across multiple mental functions for more than 14 years. Could a relatively short training cycle restore their thinking processes to baseline levels, compensating for 14 years of decline in spatial awareness and inductive reasoning? In many cases, the answer turned out to be “yes.” Moreover, cognitive rehabilitation was generalized; it could be demonstrated by many independent tests of various cognitive functions, and not only on those tasks that were used in training. The effect was long lasting; in many participants it could be demonstrated seven years after completion of the training cycle. The authors concluded that the training cycle reactivated cognitive skills that had begun to rust from lack of use.

If it is logical to expect therapeutic effects from cognitive exercises, then why did early attempts at cognitive rehabilitation of the effects of brain damage have had only relative success? There are various reasons for this. The first basis lies in the very difference between cognitive training of the damaged brain and cognitive exercise of the intact or nearly intact brain, between treatment and prevention. It is known that it is easier to prevent a disease than to treat it. A severely damaged brain will be less responsive to therapy than a healthy brain to prevention.

The second basis relates to the way cognitive exercises have traditionally been formulated within the “old” philosophy. In an attempt to target a specific, very narrow cognitive function, narrow cognitive exercises were used. It makes sense that the broader the cognitive training program, the more general the effects. Using an analogy with physical training, an individual who spends his entire training time repeating the same exercise cannot expect to improve his cardiovascular fitness. For this purpose, a combination of various exercises is needed.

The third basis relates to the way treatment effects are measured. By measuring the effects of one cognitive exercise by the ability to perform another cognitive task, we make assumptions about the specific nature of the therapeutic effects we are trying to measure. Failure to find an effect may, of course, be the result of an actual lack of effect. But it could just as easily be a reflection of our failure to find a measurement suitable to capture it. Because we are trying to strengthen the underlying biological processes, it would be better to measure these processes directly. Indeed, when the effects of cognitive exercises were assessed by positron emission tomography (PET), improved glucose metabolism (an important marker) was found.

The fourth basis relates to what reasonable expectations of the effects of cognitive training are. If general functions brain are enhanced as a result of such training, then the expected effect may be broad, but relatively small in any narrow area.

In any case, modern data on the proliferation of neural cells throughout life have breathed new life into the concept of cognitive exercise and given it new rationale.

Cognitive and social skills training program (CSTS) for patients with schizophrenia.

A.B. Kholmogorova, N.G. Garanyan, A.A. Dolnykova, A.B. Shmukler (Moscow Research Institute of Psychiatry)

This program was developed by the Laboratory of Clinical Psychology and Psychotherapy (headed by A.B. Kholmogorova) together with the Department of Community Psychiatry and Organization of Psychiatric Care of the Moscow Research Institute of Psychiatry of the Ministry of Health of the Russian Federation (headed by I.Ya. Gurovich), as well as the Department of the First Episode of Illness of the Moscow Research Institute of Psychiatry (headed by A. B. Shmukler).

Relevance. Schizophrenia is the most expensive of all mental disorders. In the USA, treatment and care of patients costs $7 billion annually, which is 2% of the gross national product. Although the discovery of neuroleptics in the 50s greatly facilitated the treatment of schizophrenia, the problem of social adaptation and rehabilitation of these patients is still extremely acute. Today, there is no doubt that the most effective approach to rehabilitation is comprehensive psychopharmacological and psychosocial assistance. Psychosocial methods have proven to be a necessary component rehabilitation process and continue to intensively develop and improve(Gurovich, Storozhakova, 1998; Gurovich, Strozhakova, Shmukler, 2004; Kholmogorova, 1993, 2000).The proposed program is based on data from numerous scientific studies, including the most recent and reliable scientific data on the psychological mechanisms of cognitive and social dysfunction in patients with schizophrenia.

General characteristics of cognitive dysfunctions in patients with schizophrenia.As has been revealed by numerous experimental psychological studies mental functions(attention, thinking, memory) information processing in patients with schizophrenia is extremely ineffective. Metaphorically speaking, their brain and consciousness are, as it were, “inundated” with numerous stimuli from the external environment, since selection is impaired, i.e. inhibition of “unnecessary” stimuli.

Disorders of selective attention in the form of “filter breakdown” have been studied and described in the psychological “filter model” (Mc Chie, Chapman, 1961, Payn, 1966). The consequences are impaired concentration, distractibility, rapid fatigue, and in behavior - uncertainty, fearfulness, since there is no protection against overstimulation.

Attention is not only a filter, but also a readiness to perceive and process information, i.e. a kind of anticipatory behavior or readiness for reactions, coordinating protection from stimuli, maintaining concentration. In this sense, D. Zhakov ( Shakow, 1962, 1971 ) speaks of subordinate attitudes. Zhakov's set-modell model arose on the basis of the so-called “cross-over” effect, the essence of which is the reduced ability of patients to anticipate events in a probabilistic environment. Such features of the organization of attention can largely explain the well-known phenomenon of unfocused attention and behavior, i.e. difficulties in subordinating the latter to any goal. For example, preparing breakfast can become a super task for a patient, since all the preparatory steps are poorly coordinated with each other. On the other hand, patients perform tasks much worse that require flexibility and restructuring of learned schemes and patterns ( Kholmogorova, 1983 ). Rigidity is noted as the most important characteristic of the higher mental functions of patients ( Savina, 1982).

Many researchers, starting with E. Bleuler (K. Goldstein, N. Cameron, L. S. Vygotsky, S. Piro), have written about the destruction of concepts - the blurring of their boundaries, the combination of excessive specificity with excessive symbolization. This becomes an important barrier to intellectual activity and interaction with other people.

In Russian psychology, Zeigarnik and her followers made an attempt to link disturbances in thinking and other cognitive processes with disturbances in motivation in patients with schizophrenia (Zeigarnik, 1962; Kochenov, Nikolaeva, 1978; E.T.Sokolova, 1976). Impaired motivation manifests itself in a decrease in the voluntary regulation of mental functions - attention, memory, thinking, which is an important mechanism for the decrease in mental activity in these patients. Psychological mechanisms of violation of voluntary regulation (violations of mediation and goal formation, adequate reaction for success and stimulation of achievement motivation) were studied and described in detail by the team of the laboratory of the VSC PZ AMS (Kritskaya, Meleshko, Polyakov, 1991; Savina 1982, Kurek 1996).

Violations of social motivation are also expressed in a decrease in the communicative orientation of thinking, i.e. in a situation that involves taking into account the position of another person, patients experience significant difficulties; when operating with stimulus material, they often ignore this position (Kritskaya, Meleshko, Polyakov, 1991, Kholmogorova, 1983).

Despite all the debatability of any research in the field of schizophrenia, most researchers agree that disturbances in cognitive processes play a very important role and may underlie other disorders in schizophrenia. Therefore, cognitive impairment in schizophrenia is called central psychological deficit ( core psychological deficit).

From the studies described above, a very important conclusion follows about the danger of overstimulation for patients with schizophrenia, the need for very clear organization and, if possible, limitation of information and stimulation addressed to the patient. Since attention disorders manifest themselves primarily under conditions of overload, K. Neuchterlein et al. Neuchterlein et al, 1986 ) concluded that attention disorders in patients come down to disabilities information processing.

The described studies play an important role in developing the goals and general principles of organizing psychocorrectional work with patients.

General characteristics of social functioning disorders in patients with schizophrenia.

Numerous studies show that patients have impaired social skills: the adequacy of social perception, verbal communications, the ability to solve interpersonal problems and difficult life situations (see review by Kholmogorov, 2000). Thus, patients have a reduced ability to recognize the emotions of another person, adequately express their own emotions, accurately convey the verbal information they receive, and verbally express their own feelings and thoughts.

Patients with schizophrenia show increased anxiety in relation to social, emotionally significant stimuli; their activities are easily disorganized under the influence of emotional stress. They find it difficult to cope with competitive situations. The main disturbance in the emotional sphere of patients is anhedonia - a reduced ability to experience pleasure (Garanyan, 1986; Kurek, 1996). Anhedonia reduces the taste for life, impairs the ability to interact with other people, weakens positive feelings of self-esteem, reduces social motivation for achievement and interest in activities.

Modern research shows the important role of the social environment in the course of schizophrenia. Important role plays the nature of emotional communications with the immediate environment, especially with the family. Studies have shown that a high level of negative emotions in the family, an overly critical and hostile attitude towards the patient sharply worsen the course of the disease. Research has also shown increased sensitivity to criticism from other people (Voughn and Leff, 1976; Leff, 1989).

Unlike patients with other mental disorders, such as depression, patients with schizophrenia feel greater uncertainty and change after an attack, and relatives and friends are often very wary and distrustful - these patients are especially often labeled as “crazy” ( Scheff, 1973 ). Thus, these patients are especially likely to experience a lack of social support when they need it ( Brugha, 1995).

The attention deficit and difficulty processing information characteristic of patients with schizophrenia, as well as their often heightened sensitivity to emotional influences, increase the likelihood of emotional stress occurring during overstimulation or during carelessly planned, insufficiently structured activities. Such overstimulation usually leads to a deterioration in the patient's condition. The “targets” of influence during training sessions are deficits in social perception, inability to solve everyday problems, and poorly formed nonverbal behavior.

Existing approaches to compensation for cognitive and social dysfunctions.

For the first time, a program to normalize information processing functions was proposed by D. Meikhenbaum and R. Cameron ( Meichenbaum, Cameron, 1973 ). It is based on self-instructions and self-guidance, which are used by patients to focus attention, self-encouragement in difficult situations, and even reduce delusions and hallucinations. Then other more specific programs were developed.

The most common model of group work with people with schizophrenia, from the 70s to the present day, is social skills training.(Wallace et al., 1980) . American psychiatrist A. Bellak ( Bellack, 1986 ) defines social skills training as a structured training program that develops the social behavior skills necessary to create a specific network of social contacts and reduce stress that develops as a result of interpersonal conflicts and failures.

Lieberman and co-authors ( Lieberman et al., 1986) believe that the effectiveness of using social skills training is directly dependent on strict adherence to the principle individual approach. Thus, for patients who are capable of mastering strategies for solving problems related to social behavior, he recommends training aimed at optimizing the process of information processing. In accordance with the stages of information processing, three stages are distinguished in the training: 1) practicing methods of receiving information; 2) choice of response; 3) choosing the appropriate response form. At all stages, the therapist stimulates analysis of the problem situation with leading questions and gives the patient constant feedback, encouraging any correct action.

Summarizing the results of more than fifty studies conducted over the past 15 years and described in relevant reviews ( Wallace, 1984; Tarrier, 1989 ), R.P. Lieberman and T.A. Ekman ( Lieberman & Eckman, 1989 ) note that, firstly, social training is effective means optimization of social behavior in psychotic patients and, secondly, as a result of training, they are reduced clinical symptoms and the likelihood of exacerbation of the disease is reduced. Such results stimulate further active use of the social training method in modern psychotherapy schizophrenia.

One of the most important rehabilitation tasks that social skills training solves is overcoming the patient’s social isolation and including him in a wider social network.

Impaired social functioning in patients with schizophrenia is closely related to cognitive dysfunction. In part, this connection is direct and obvious. Violations of attention, memory, and thinking lead to a decrease in the performance of patients, and, ultimately, can lead to disability and social maladjustment. There is, however, a more complex dependence: the violations of social perception, communicative orientation of thinking, and attributional style described above lead to constant social distress due to general inadequacy of behavior. For example, patients with paranoid symptoms most often attribute failure in social interaction to the ill will of other people. As a result of special training in social perception in combination with cognitive training, they begin to interpret their past failures as a result of the inability to behave adequately and they become motivated to compensate for the corresponding deficits.

Impaired recognition of the emotional states of other people and the communicative orientation of thinking also leads to inappropriate social behavior and, ultimately, social disadaptation.

Thus, the idea of ​​combining cognitive function and social skills training logically follows from existing research.

It was first carried out by Swiss researchers - a group of three psychologists and one psychiatrist, employees of the university psychiatric clinics of Bern and Münsterlingen. They developed a multi-step IPT program (Integtratieves Psychologisches Terapieprogramm) - integrative psychological therapeutic program(Brenner et al.,1987), combining training of cognitive functions and social skills. The program includes 5 steps: 1) cognitive differentiation; 2) social perception 3) verbal communication 4) social skills; 5) solving interpersonal problems. This program has been tested in various clinics for 15 years.

Controlled studies have proven the effectiveness of IPT. In patients with schizophrenia who completed this program, it was noted general improvement in cognitive and social functioning. These patients differed significantly in the mentioned indicators from the control group of patients who received nonspecific maintenance therapy in the same volume.

The basic principles of the above-described integrative Swiss program formed the basis of the TCSN program. However, the goals and objectives of TCSN have been expanded and modified based on domestic research data on disorders of the voluntary regulation of cognitive functions, communicative orientation of thinking, intellectual and social anhedonia (Garanyan, 1986; Zeigarnik, Kholmogorova, 1985; Zeigarnik, Kholmogorova, Mazur, 1989; Kritskaya, Meleshko, Polyakov, 1991; Kurek, 1996;; Kholmogorova, 1983).

Cognitive and social skills training

Goals:

1) strengthening the voluntary regulation of memory and attention by teaching the use of special means (training in switching and maintaining attention, selecting information, using mnemonic techniques);

2) strengthening the communicative orientation and cognitive differentiation of thinking (operating with concepts with an orientation towards another person, joint activity in pairs and groups to achieve a common goal);

3) development of cognitive accuracy and differentiation of social perception (training in recognizing non-verbal communications - facial expressions, postures, gestures, analysis and qualification of interpersonal situations, accuracy of reproduction of the partner’s verbal behavior);

4) reduction of intellectual anhedonia (linking intellectual activity with the gaming component and success);

5) development of regulation of one’s emotional states, thinking and behavior through the development of the ability for self-observation, self-instruction and coping dialogue;

6) practicing social behavior skills (communication training on various topics in a group, modeling and acting out real life situations);

7) teaching effective strategies for solving interpersonal problems (dividing the problem into smaller ones, highlighting the stages of its solution and specific tasks, ways to solve these problems).

Principles for selection into the group:

1. patients’ awareness of relevant deficits and the presence of motivation to overcome them;

The effectiveness of work directly depends on the motivation of the participants, which consists of awareness of their problems and characteristics and interest in cognitive, intellectual, communicative activities generally.

1. Sick people close to them by age, level of intelligence and condition are selected for the group;

If the group breaks up into parts (more intact, less intact, younger - older, etc.), it is difficult for the leaders to offer tasks that are appropriate for the entire group and maintain an atmosphere of interest and pleasure from the activity. An unfavorable situation is also when there is one person in a group who differs from everyone else in some quality (for example, one woman among men).

3) group composition is 6-8 people.

The number of participants is determined by the need to ensure group interaction and, at the same time, keep all participants in the field of attention; it should not cause much stress for people with communication problems, and provide each of them with the time necessary to complete all the exercises. While the limitations of the upper limit of participants in schizophrenia groups seem quite obvious, the limitations of the lower limit need to be noted. Many exercises are “technically” impossible to do in a group of less than 4 people. In a group that is too small, it is more difficult for the subject to choose a partner to perform the exercise and it is more difficult for the leader to guide this choice. Finally, all positive group effects disappear.

Setting.

The training includes two stages – 1) intensive in a closed group; 2) supporting in the so-called slow open (partially open) group. Intensive training is carried out during a stay in the clinic or in a day hospital with a frequency of at least 2 times a week. The duration of each lesson is no more than 60 minutes. Longer sessions are tiring for patients. It is important to strictly observe the start and end times of the lesson. The lesson starts on time, even if not all participants are present. This emphasizes the importance of setting time limits and encourages participants to stop being late. The system of “fines” is aimed at this - a late participant must complete an exercise intended only for him.

The total number of classes at the intensive training stage is 16-20. The maintenance stage is aimed at maintaining and consolidating the cognitive and social skills developed during the intensive stage, as well as strengthening social connections and providing social support. So that patients after discharge, as well as those who have found a job, can participate in it, it is held in the evening, once a week, the duration of each lesson is 60-90 minutes. At the maintenance stage, the group may include a larger number of people from different groups (10-14) who have completed the intensive training stage. The total duration of both stages is at least six months. Individual variations are possible.

An important factor influencing the effectiveness of classes in a closed group is the constancy of the group composition or regularity of attendance. New participants can join the group no later than the second lesson (subject to an individual conversation with the leader about the group and its rules). Intermittent attendance makes it impossible to clearly plan a lesson, reduces the effectiveness of group interaction, reduces the motivation of other participants and makes the group deliberately heterogeneous - because a person who misses classes does not know and cannot do something that other participants can do. In addition, missing a lesson means missing some stage of interaction between group members. The necessary gradual rapprochement and experience of communication with other group members is interrupted, while the remaining group members find themselves at a different stage of group interaction.

Lesson structure

Classes begin and end with the same procedure. Each participant says two words about his mood at the moment and the exercise that he remembers most from the last lesson (at the beginning of the lesson) or from the lesson that just ended (at the end of the lesson). At the end of the lesson, you can also perform some kind of movement ritual to end the lesson. One of the presenters is the first to answer these questions, thereby setting a model for these statements. This ritual gives the presenters information about the emotional state of the participants and its dynamics, forces the participants to once again remember all the exercises done. Then, as a rule, a short exercise is carried out aimed at activating, “getting into work.” This could be a “repetition of the past” - consolidation of an already worked stage. Then follow more labor-intensive exercises that continue what was started or introduce a new training subroutine. The results of these exercises are usually discussed. Often after such discussions, when ways are identified that can improve the execution of the exercise, the exercise is repeated again (in the same or modified form) to master and consolidate these methods. Longer, more focused exercises are alternated with short, often movement exercises. At the end of the lesson, a short exercise is carried out, which should maintain a positive emotional atmosphere, create a feeling of success and pleasure. After each lesson, participants are asked to complete homework. It can in some form repeat what was done in the lesson or, conversely, prepare material for the next lesson. Homework saves time in class and forces participants to be active between classes.

The sequence in which participants perform the exercise may vary. As a rule, exercises are performed in a circle or, in a more complex version, the turn is determined by throwing an object (ball, soft toy) to each other. Many exercises are performed in pairs.

At the first lesson, the presenters once again inform the participants all the necessary information about the training, including listing its goals, emphasize the importance of complex treatment, which includes drug treatment and psychological training, and list the rules for the group. Participants are given a memo with a brief listing of the training objectives, the rules of the group (with a small commentary) and, if necessary, a class schedule.

TCSN subroutines.

The intensive training stage includes 6 subprograms:

1. memory and attention training;
2. training of communicative thinking and ability to cooperate;
3. development of accuracy of social perception;
4. development of verbal communication;
5. practicing social skills;
6. development of problem solving skills.

Principles of the group:

1) clear, structured teaching style - all classes are clearly planned, conducted in a strictly certain days and hours, the duration of one lesson is fixed, should not exceed 60 minutes, all instructions for the exercises are extremely clearly formulated;

2) avoiding emotional and information overload;

3) a gradual transition from rigid structure with task orientation to increasing spontaneity in intergroup interaction;

4) a gradual transition from a more directive style to a less directive style;

5) a gradual transition from emotionally neutral material to emotionally loaded material;

6) gradual introduction of new material and transition to more complex goals and objectives;

7) constant repetition and development of previous steps;

8) clear feedback from the presenters when performing exercises in terms of correct execution;

9) a ban on criticism - mistakes are recorded calmly, as an obligatory and inevitable element of training, in the most friendly manner;

10) saturation of the lesson positive emotions– exercises are carried out in a playful way, everything is celebrated, even small achievements and successes;

11) exchange of feelings, observations and experiences at all stages of work (the key question after each exercise is “What helped, what hindered? What techniques did you use?”);

12) activation and unloading by alternating mental and physical exercises;

13) the group is conducted by two trained cotherapists, which allows you to use the principle of modeling, monitor the implementation of exercises and emotional condition each participant, give the most complete feedback..

In the process of training social skills, well-known principles of social learning are also used, which have proven to be effective when working with this population: 1) instructing how to behave in a given situation; 2) feedback – analysis and reinforcement of certain types of behavior; 3) modeling – reproduction of a behavior model, live (with the participation of a therapist) or symbolic (using film or video); 4) role-playing; 5) social reinforcement - the use of praise when desired behavior is observed; 6) homework to practice desired behavior ( Corey, 1986).

Principles of interaction between cotherapists.It is assumed that functions will be divided between the main presenter and co-presenter. The main facilitator gives instructions for the exercises and directs the overall sequence of work. The co-host helps the presenter demonstrate exercises; in situations where modeling is necessary, he distributes gaming material and task cards to patients. Both facilitators monitor the performance of the exercises and the dynamics of the emotional state of the participants, and give the necessary feedback to the group members. Both cotherapists constantly keep a diary of classes, recording transitions to new subprograms, the goals of each lesson and exercise, the reactions and dynamics of achievements of group members. Cotherapists jointly discuss each session: to what extent the goals of the session have been achieved, what the individual dynamics of its participants are, how the exercises were performed, how successful their interaction was. Each subsequent lesson is carefully planned based on the program strategy and analysis of the previous lesson. It is recommended to conduct testing on the main functions and abilities that the training is aimed at developing before and after it.

Testing should be carried out before the start and after the end of the training.

1st block (self-assessment of dysfunctions and symptoms):

1. Self-assessment of cognitive and social dysfunctions (Kholmogorova’s cognitive deficit questionnaire, Goldstein’s social skills questionnaire adapted by Khlomov, Baklushinsky);
2. Psychopathological symptoms (SCL-90 Derogatis symptom questionnaire);
3. Emotional disturbances (Beck Anxiety and Depression Inventory);

2nd block (cognitive functions):

1. Attention (counting with switching by Platonov, word search by Savina);
2. Memory (10 words);
3. Formal intelligence (Raven's progressive matrices);
4. Predisposition - latent signs (comparison of concepts, version of Polyakov’s laboratory);
5. Communicative orientation of thinking (definition of concepts by Kholmogorova, Cowell-Meleshko technique);

3rd block (social functioning):

1. Social perception (Kurek's emotion recognition);
2. Self-esteem (Dembo - Rubinstein option);
3. Level of activity, adequacy of goal setting (level of Kurek’s claims);
4. Self-requirements, quality standards, features of processing socially significant information (perfectionism questionnaire Garanyan, Kholmogorova);
5. Social functioning (short version of the Moscow Integrative Social Network Questionnaire, Sommer, Fudrik Social Support Questionnaire)

Description of training subprograms.

Subroutine 1. Memory and attention training

Objectives: 1) motivation, problematization, introduction; 2) creating a safe atmosphere and positive attitude, 3) introduction of elements of group interaction; 4) practicing on game models mnemonic techniques (reliance on semantic connections) and methods of concentration (performing exercises that require monitoring the process, readiness for a quick response), information selection (for example, respond only to certain stimuli, do not name “black and white” etc.) and organizing information (drawing up a hierarchy of concepts and characteristics of concepts, building a meaningless set of sentences into a story, etc.); 5) discussion of difficulties, as well as developed techniques and ways to overcome them.

Subroutine 2. Development of communicative thinking and ability to cooperate(2-3 lessons are the main one).

Objectives: 1) introducing interaction in pairs based on the material from past classes (joint memorization, assistance in maintaining attention); 2) working with concepts (defining given concepts for another, guessing the intended concepts, jointly identifying the most informative features of concepts, receiving feedback about the difficulties encountered by partners); 3) interaction in pairs with the goal of jointly achieving a certain result (joint drawing of figures, overcoming obstacles, etc.); 4) discussion of difficulties and means of overcoming them.

Subroutine 3. Social perception(2-3 lessons are the main one).

Objectives: 1) training in the interpretation of nonverbal expression - recognition of emotions, expression of various emotions, recognition of the emotional state by facial expressions and gestures; 2) training in the analysis of social situations using pictures and slides - collecting information about the emotional state of the characters, the situation and other details; 3) training in interpreting the collected information; 4) training in classification and qualification of various interpersonal situations; 5) discussion of difficulties and ways to overcome them.

Subroutine 4. Verbal communications(2-3 lessons are the main one).

Objectives: 1) training in the accuracy of reproducing received verbal information, for example, a small fragment of a test or a short story; 2) training in drawing up proposals, questions and answers on a given topic; 3) joint interviewing of one or two group members on a given topic; 4) free communication on a given topic; 5) discussion of difficulties and ways to overcome them.

Subroutine 5. Social skills(2-3 lessons are the main one).

Objectives: 1) identifying difficulties in everyday life and self-care; 2) developing independence skills (for example, planning to get ready before going out; planning what to do when going to the store, planning how to prepare breakfast, etc.); 3) identifying and discussing real interpersonal situations that cause difficulty; 4) discussion possible options behavior and dialogue in these situations; 5) conducting a role-playing game (initially, a cotherapist can act as a model);

6) discussion of the results of the role-playing game, identifying ways to overcome difficulties.

(completes the intensive training phase).

Objectives: 1) development of self-observation skills using a diary to record situations and associated emotions and thoughts (three-column technique); 2) identifying the reasons that influence mood - provoking situations (for example, the need to leave the house), negative thoughts (for example, “I won’t succeed,” “people look unkindly,” etc.), dysfunctional beliefs (for example, “everything must be done well or not at all”, “people are unfriendly”, etc.); 3) development of skills of alternative thinking and coping dialogue; 4) identification of typical problem situations, their specification and division into smaller ones (for example, getting a job); 5) identifying stages and discussing possible ways to solve them.

Examples of activities for training subprograms.

Subroutine 1. Memory and attention training

Sample lesson plan.

1 Exercise “Black and white”.

2..Exercise “10 words”.

3.. Option “10 words” - memorization with strong and weak associations. Discussion.

4. Exercise “Meticulous investigator”.

5. Exercise “Dog-dog”.

Homework – come up with questions for the exercise “Black and White”

Exercise 1. “Getting to know each other”

The first memory exercise, which is also the beginning of contact between group members, is remembering the names of the participants and calling them by name. First, all participants in a circle identify themselves. Then the presenter introduces himself again, followed by one of the group members and throws the ball to him. And so on until all the names are called quickly and confidently.

You can also get to know each other using the extended memorization procedure (when each subsequent participant repeats the names of everyone sitting in a circle before him and adds his own name), but this is a much more difficult procedure, it puts the participants in an unequal position.

The acquaintance procedure is carried out, as a rule, not only at the first, but also at the second lesson. Participants must not only remember names, but also gain the skill of calling each other by name: throwing a ball with the words “Your name is Masha,” “Your name is Sasha,” etc.

Exercise 2. “Two texts”

The exercise is addressed to a greater extent to attention (the ability to select information), and to a lesser extent to memory. It is used to problematize. With its help it is very easy to show that it is impossible to perceive and remember two texts at the same time and that there are ways to facilitate perception and memorization

It requires four texts of approximately equal complexity.

Two presenters read each of their texts out loud at the same time. First, participants are instructed to listen to both texts and then reproduce them. Then the group is divided in half, each half listening to only one text while reading both at the same time.

It is discussed how much the second text interferes with concentration and perception of “one’s own”, what is perceived from each text.

Exercise 3. “Text and counting”

If there is only one leader in the group, a modification of the previous exercise can serve the purpose of problematization, when the leader reads the text, and the participants must listen and at the same time count in their minds (or come up with words for one letter of the alphabet).

Exercise 4. “Black and white”

The exercise requires attention, but to a greater extent it is aimed at creating a fun atmosphere and a playful mood.

It is a child's game. The presenter asks questions, the participants must answer them, observing the condition: “don’t name black and white, don’t say “yes” and “no.” As a complicating condition, you can introduce the requirement not to tell lies.

For this exercise, you need to have a pre-prepared list of provocative questions (for example, what color is the zebra’s stripes, has the lesson started yet).

This exercise, after completing it in class, can be used as one of the first homework assignments. Participants are asked to come up with suitable questions to ask each other in the next session.

Exercise 5. “Male-female names”

Participants must name names - the first and second are male, the third is female, the fourth is again male, etc. Required to call full names. The exercise can be repeated and the complexity varied by asking other concepts (two animals - one plant, etc.) In this exercise, it is important that the participants understand the full breadth of the task proposed to them and do not narrow it (you can name foreign names, exotic plants). After the exercise, we discuss how you can make this task easier for yourself. For example, introduce your relatives, movie characters, or the zoo.

Exercise 6. “Four-legged”

An attention exercise, quite easy, introducing elements of movement.

The presenter tells a story. Participants must react in a certain way to a given type of concept - clap if the story mentions something on four supports (a dog, a bus) and stomp when an emotion is mentioned.

Exercise 7. "Electricity"

The exercise requires motor coordination. It can be performed if the facilitator is sure that the participants do not have specific problems with tactile contact and the first stage of entering into psychological contact has already been completed.

Participants sit in a close circle, put their hands on the knees of their neighbors (the left hand is on the right knee of the neighbor on the right, the right hand is on the left knee of the neighbor on the left) and begin to clap their hand on the knee, so that the sequence of knees is observed, along which “electric current” is transmitted. . It is complicated by the acceleration of movement and a change in the direction of the “current”.

Exercise 8. “Clap-top”

A kind of “Electric Current” that does not require tactile contact with other people, but requires more concentration. Each participant places their hands on their laps. Consistently, as if transmitting a current, the participant slaps himself on the knee right hand, then stomps his left foot. Then the next one slaps himself on the knee, etc. The exercise becomes difficult when changing directions and sides - clapping with your left hand, stomping with your right foot.

Exercise 9. “Typewriter”

This common exercise is aimed at training attention and creating a fun gaming atmosphere. The letters from which the pre-prepared phrase is composed are distributed among the participants (2,3,4 letters each). The phrase is posted or written on the board. The rules require participants to clap their hands one after another, as if someone is pressing keys and typing letter by letter. Clap – hit the corresponding letter). The end of a word is marked by stomping, the period by standing. Composing or selecting phrases can become homework.

Exercise 10. “Anti-time”

Exercise from the book by N. Tseng and A. Pakhomov “Psychotechnical games in sports”

Talk about something in reverse order, as if replaying a film (for example, how I spent the day, how I came here, a fairy tale familiar to everyone). The exercise is not as simple as it might seem at first glance. For example, even telling such a simple fairy tale as “The Turnip” in reverse order requires a certain concentration and can be fraught with mistakes.

Exercise 11. “Meticulous investigator”

The participant is asked to describe in detail the part of the room located behind him, which he cannot currently see. The exercise requires a certain technical organization so that everyone has their own “invisible” area. It must be applied to the specific conditions of the room where the lesson is being held. To give this exercise a game element, you can set game instructions, for example, “detective”, as if the investigator were describing in detail the scene of the crime

Exercise 12. "Description of the picture"

The presenter shows the participants a picture with a sufficient number of different objects on it for a short time, then the picture is removed, each participant must write a list of all the objects depicted in the picture.

Exercise 13. “Witness to an accident”

Similar to “Meticulous Investigator”, but makes much greater demands on the adequacy of interaction and contact between participants. In the presence of such adequacy, it promotes contact between participants and group cohesion. Can only be carried out in a group where there are no participants with severe communication and social perception disorders.

Participants are given instructions, facing away from each other, to write down a description of the clothing of all group members, without using evaluative categories.

Exercise 14. “Cold-hot”

Along with memory and attention, the exercise is also aimed at the ability to interact, to decenter, and the ability to focus on instructions.

One of the participants leaves the room, the rest must agree and change the position of a predetermined number of objects (3-5) in the room. The one who left returns and his task is to find all the changes. The rest of the participants help him, accompanying his actions with the words “cold”, “warmer”, “hot”, etc.

In this exercise, it can be important to encourage those remaining in the room to help the person seeking change.

Exercise 15. “Dog-dog”

This exercise is effective for relaxation and raising energy levels. Each participant names an animal. Everyone must remember who named which animal. The first one simultaneously claps his hands twice and names “his” animal twice, then slaps his knees twice and calls “someone else’s” animal twice. The one whose animal was named goes through the same procedure and names someone else. Gradually the speed of clapping and naming should increase.

Exercise 16. “Memorizing the pose”

One of the participants takes a certain pose, while the others turn away or close their eyes. Then everyone looks at this pose for a few seconds, after which the pose changes and everyone except the “author” must repeat as accurately as possible the position of the body, limbs, facial expressions, and finger positions. This exercise can be effectively increased in difficulty to develop social awareness. You need to depict some emotion with a pose, and those who look at and repeat the pose need to guess this emotion.

Exercise 17. “10 words”

You can ask participants to memorize 10 one- and two-syllable words, then also memorize 10 words each, but in different versions - using strong and weak associations, emotionally charged and neutral words, using mnemonics (for example, mentally hanging words on an imaginary street). By comparing the results obtained and discussing them, the participant can see which conditions improve his ability to remember.

Exercise 18. “Memorizing words with condition”

Participants take turns coming up with words (in a circle or with a ball) that correspond to a certain condition (on a certain topic, starting with the same letter, etc.). In a more complex version, he comes up with a second word in response to the first (opposite in meaning, starting with the last letter of the previous word, associated associatively with the first) or a phrase using the first word and with some other condition. For example, the phrase must include the word specified by the previous participant and the word denoting color. You can ask participants to come up with phrases that would make up a story. After this, participants are asked to remember and write down all the named words. During the discussion, it is revealed what helps, what hinders memorization, and how this information can be used for memorization in everyday life.

Exercise 19. “Memorizing two-digit numbers”

First, subjects must memorize 10 one- and two-digit numbers that do not carry obvious associative connotations, then the presenter suggests memorizing numbers that have certain cultural associations (31 - New Year, 18 - age of majority, etc.) and names these associations. Then it is discussed how it is easier to remember, what associations everyone can come up with. This exercise is convenient to use to demonstrate “egocentric thinking” - which associations are understandable to all people belonging to this culture, which are understandable only to a certain group, and which are understandable only to the author who came up with the association. To do this, in the list of numbers that have obvious associations, you can enter a number that is significant for group members, for example, the number of the room where classes are held, the number of the bus that goes to the place of classes, etc.

Subprogram 2. Development of communicative thinking and ability to cooperate.

Sample lesson plan.

1. Exercise “Memorizing with a condition.”

2. Exercise “Definition of a concept.” Discussion. Selection of the most successful definitions.

4. Description of the picture. Discussion. Selection of significant features.

3. Exercise “Unmanned aircraft”. Discussion.

5. Exercise “Electric current”

Homework is to prepare descriptions and definitions for the exercise “Depending on who.”

Possible exercise options.

Exercise 1. “Definition of concepts”

The exercise is addressed to the communicative component of thinking.

Each participant defines and describes the concept given to him by the leader so that all other participants guess as quickly and accurately as possible what he is describing. If a concept has remained unclear for a long time, it is important to discuss why this happened and whether there are any ways to describe it differently.

As a variation of this exercise, you can do the exercise"Identification by picture."To do this, you need a picture with a sufficient number of similar objects (for example, an interior with different objects furniture) or several similar pictures. The presenter names the signs of the object he has envisioned until the participants guess what the object is. Then it is discussed what features distinguish this item from others. Participants can also act as a presenter.

Exercise 2. “Strong and weak signs”

To illustrate the idea of ​​significant and insignificant characteristics, the presenter can describe to the participants the concepts according to the most significant, “strong” characteristics and according to “weak”, insignificant ones. You can count how many signs were needed to guess what was going on in the first case and in the second. You can give examples of signs that are significant for some people and incomprehensible to others. After this, the subjects come up with definitions of concepts given by the presenter or invented by themselves. You can set a topic, for example, describe a concept related to autumn.

Exercise 3. "Description of a Half"

Participants are given similar pictures cut in half; everyone must describe the half they received so that the owner of the other half guesses the missing half in the description.

Exercise 4. “Automatic”

The exercise is a well-known game. One of the participants (“the automaton”) comes up with a concept, the others ask him questions to which he can only answer “yes” or “no.” We have introduced a third option - “I can’t answer” for those cases when it is impossible to clearly agree or reject the question. Comparison with a machine helps the respondent not to get confused by detailed answers. Questioners are penalized with one minute of silence if they ask a question that requires an answer greater than "yes" or "no" and for making a specific guess that turns out to be incorrect. It is discussed what questions and why help you reach your goal faster, what answers were inaccurate and confused those asking.

Exercise 5. “What can’t happen without?”

It is necessary to highlight the main features of certain concepts proposed by the presenter, without which they cannot be accurately defined. For example, there is no school without a teacher and students.

As a result of performing these exercises, one way or another related to the identification of essential features of concepts, a list of significant features of concepts is compiled.

Exercise 6. “Depending on who”

The exercise requires decentration, the ability to look at the situation from the perspective of another. When highlighting the essential features of concepts, it is important to emphasize that they can change depending on the specific interaction partner. Participants are given the task of explaining the same thing to different people. For example, explain the way to a visitor or local resident. A variation of this exercise is the exercise"Cat Bird" . It is necessary to describe the room from two positions - a bird that flew in and a cat that wandered in.

Exercise 7. “Circus”

The exercise is directly aimed at decentration. First, participants come up with associations that evoke in them some well-known and “culturally unambiguous” concept, for example, a circus. And then they have to figure out what associations the circus evokes in them. different people(and not only people) - a child, a parent, a director, a veterinarian, a trainer, a tiger.

Exercise 8. "Unmanned aircraft."

Participants pair up. Each pair receives a piece of paper on which 2 “bases” and “obstacles” are drawn. One participant takes on the role of “dispatcher”, the other – “aircraft”. “Airplane” puts the handle on one “base” and closes his eyes. The controller gives commands to guide the “plane” to the second “base” without hitting the “obstacles”. The “airplane” moves the pen along the sheet in accordance with the instructions of the “dispatcher”. Then the participants change roles. It is discussed which role was easier, why, what feelings they experienced, and whether the “planes” were able to completely trust the “controllers.”

Exercise 9. "The Blind and the Guide"

A common exercise. It is similar to the previous one, but places greater demands on interaction. The exercise is done in pairs. One of the participants closes his eyes, “obstacles” are placed around the room (chairs, other large, but not dangerous objects). The second partner (“guide”) uses words to direct the actions of the “blind” person so that he avoids all obstacles and reaches the “goal.” Then the partners change roles. As a variation of this exercise, we used the exercise"Shunting locomotive."Participants stand in a chain, holding each other by the waist. The “dispatcher” gives commands to the first in the chain – the “steam locomotive”. It is important to discuss what the “cars” were more oriented towards - the commands of the “dispatcher” or the movement of the previous “car”.

Exercise 10. "Drawing in parts"

Participants are asked to draw a picture, for example, of a man. Each person draws only part of the person, starting with the head and the top of the piece of paper, then wraps the paper so that only the very bottom part of the drawing is visible to the next participant, and passes it on. The next participant must guess which parts of the man he should continue drawing. Then the drawing is passed on to the next one. This simple task can turn out to be unexpectedly difficult if the first participant does not leave “tails” for the second to add parts of, or if the second does not think about what the first has already drawn (in other words, if the participant is not oriented towards the partner).

Exercise 11. “Joint drawing”

Participants are given the theme of the drawing or some detail of it. The exercise can be done in pairs, in which case it is important to guide and discuss the distribution of roles. You can complicate it by requiring silence.

The second option, if it is impossible to divide the group into pairs, is performed in a circle. In this option, it is interesting to set not only a theme, or not to set a theme at all, but to set a part of the picture (for example, a circle). The first participant must somehow play with this detail, and the rest must only develop the idea laid down by the first. But for this, the first one must leave them sufficient space.

Subprogram 3. Social perception

Sample lesson plan.

1. Exercise “10 words” with memorizing two lists - neutral and emotionally charged words. Participants are asked to determine what the difference is between the lists.

2. Exercise “Who is experiencing what.” Discussion.

3. Making a list “How do we know about the emotional state of another person?”

4. Exercise “Dumb Secretary”. Discussion

Homework is to come up with a pose that expresses some feeling.

Possible exercise options.

Exercise 1. “List of Emotions”

When starting this routine, it can be helpful to make a list of emotions. It can be used over several sessions. Participants name all the emotions that come to mind, and a general list is compiled and posted for everyone to see.

If it turns out that participants remember overwhelmingly negative emotions, and begin to explain this by their global dominance in the world, you can do an exercise"Exotic fruits" Participants are asked to write down fruits and vegetables they know within a fairly short period of time. As a rule, it turns out that common species they write more than exotic ones. A parallel can be drawn with the fact that the feelings that prevail at the moment are remembered more easily, just like the fruits that we eat and see more often. But this does not mean that we are not familiar with other fruits. Just like at other moments in life, we can experience more positive feelings.

Exercise 2. “Who is worried about what?”

What is known to everyone is selected piece of art(as a rule, these are fairy tales or cartoons), for example, “The Tale of the Fisherman and the Fish,” “Cinderella,” and the participants name the emotions that the characters can feel. Particular attention is paid to moments where the hero can feel different feelings at the same time or says one thing but actually feels something else.

Exercise 3. "Stupid secretary."

A situation is given: visitors to the boss’s reception really want to know what mood he’s in, but the secretary cannot name a single emotional state (“she doesn’t know Russian well”), she can only answer questions about external manifestations emotions. Participants ask questions that can be used to guess the emotional state of another person. A list of signs is compiled by which we judge a person’s emotional state (words, facial expressions, gestures, physiological manifestations of emotions, movements).

Exercise 4. “Drawing Emotions”

Participants are asked to draw on paper the face or figure of a person experiencing a particular feeling. Then these pieces of paper are passed around, and everyone signs what feeling they see in this drawing and wraps up their inscription so that others cannot see it. It is discussed whether the audience's perceptions coincided with each other and with the feeling intended by the author, what contributed and what hindered this coincidence.

Exercise 5. "Broken Phone Pose"

One participant conceives and depicts some kind of emotion in posture and facial expressions - shows it to the next (the rest have their eyes closed), the next one must guess what kind of emotion is intended and show the same pose to the next participant. Then they compare what happened at the beginning and what happened at the end, everyone names the emotion that the pose expressed.

Exercise 6. "The emotion of the picture"

The presenter shows the participants several reproductions and asks them to determine what feelings each of them is associated with. Another option is to select the appropriate picture for the named leading emotions. This allows you to realize how the feelings caused by the same stimulus may coincide or diverge, and discuss how this manifests itself in real life and what types of behavior follow from this.

Subprogram 4. Verbal communications

Sample lesson plan.

1. Inventing associations. Participants come up with associations or all of them - for one concept given by the leader, or in a circle, for the previous concept. At the end of the idea, you need to remember all the associations.

2. Exercise “Detective”. Discussion of difficulties. Coming up with different endings for stories.

3. Exercise “Clap-top”.

4. Exercise “Bird-Cat” with instructions to come up with a monologue on behalf of the heroine.

4. Exercise “Emotion of a picture.”

Homework – exercise “Renaming”

Possible exercise options.

Exercise 1. “Detective”

Compiling a story from pictures - each participant chooses a certain number of pictures and uses them to come up with a “detective” - a complete story with some kind of “detective” plot.

Exercise 2. "Different Definitions"

The concept comes up. Participants take turns defining this concept so that the next participant understands what they are talking about. Each participant must whisper define the same concept for the next one, but be sure to give a different definition than the one he heard. Then all the definitions are pronounced out loud, they discuss which ones were closest to the concept, what helped and what hindered guessing.

Exercise 3. "Making a Story"

Participants are presented with a list of words that contains words that are not too closely related to each other. You need to write a short story using all these words. You can set the theme of the story. In this case, one participant can come up with a whole story or take turns - everyone comes up with a sentence for a common story.

Exercise 4. "Renaming"

Give new names to well-known works (books, films) that would reflect their essence and be understandable to others. How other participants perceive these names is discussed, and the “author” explains his reasons for the new name. It is important that these works are truly familiar to everyone. At first, the presenter can propose a list for renaming, then the participants themselves can rename the works they have conceived, and the rest can guess the original name.

Subroutine 5. Social skills

Sample lesson plan.

1. Conditional Memory exercise with a social interaction topic (for example, a meeting).
2. Exercise “Why did you move?” Discussion.
3. Exercise "Foreigner". Discussion of the difficulties encountered.
4. Exercise “Why was I late?”

Homework - exercise "Getting ready for the trip."

Possible exercise options.

Exercise 1. “Getting ready for the trip”

Several situations are given, real or unreal travel, participants make lists of things that need to be taken with them on each trip, they discuss what needs to be taken on this particular trip, how the equipment differs for each trip and why. At the end, the presenter names important forgotten items (for example, they took all the equipment, but did not take any of the clothes).

Exercise 2. “What happened?”

The presenter tells the origin and end of some situation and asks to come up with what could have happened in the interval, the motives for the hero’s actions. The presenter can offer some not very obvious motive for the hero’s behavior (for example, one person rudely pushes another from the tram - maybe this other person himself attacked someone). The possibility of guessing the motives of another person's actions, standard and non-standard connections between motives and behavior are discussed.

Exercise 3. “Why did you move?”

A situation is set - a person gets on the bus, sits in an empty seat, and at that moment his neighbor moves away from him - why did the neighbor move? We need to come up with as many reasons as possible, and it is important to highlight the reasons that are not related to the passenger who just boarded.

Variation of this exercise“Why were you late?” -name 10 possible reasons for being late for class.

Exercise 4. “Foreigner”

An exercise on nonverbal communication skills - you need to communicate with your partner without words. Depending on the state of the group as a whole and each patient individually, you can make the task more or less difficult. Participants can do it in pairs, in teams, all together. You can set one task (for example, to find out the time) or several (someone finds out the time, and someone asks to give up their seat). In the latter case, you need to specify a certain situation (trolleybus ride).

Exercise 5. “Sympathize with a friend”

A well-known unpleasant situation is set (for example, “Angry traffic cop”). You can choose a situation that is significant for the participants, but in this case it should not be an actual severe psychotraumatic situation (loss of a loved one, etc.). One takes on the role of the unfortunate person who finds himself in this unpleasant situation. Everyone else should express sympathy for him, and he gives feedback - whether this sympathy helped him and how.

Subprogram 6. Emotional self-regulation and problem solving

Sample lesson plan.

1. Compiling and discussing a list of difficult situations. Choosing a situation for a role-playing game.

2. Role-playing game “Difficult situation”. Discussion.

3. Memorizing the sculptural pose (a “theme” of the pose is set, reflecting something that happened in the role-playing game).

Homework – “Help yourself” exercise.

Possible exercise options.

Exercise 1. Role-playing game “Difficult situation”

It turns out what social situations are difficult and unpleasant for the participants. A situation is chosen that is significant to the majority and can be played out. Such a situation could be an ordinary everyday situation. For most people, this turns out to be situations of communication with sellers and cashiers. The presenter plays the role of a negative character or the one who creates this complexity. Participants interact with him. Typical ways of behavior and assessment of this situation are analyzed and played out. The presenter can play an internal monologue of a negative character, from which the reasons for his impoliteness, rudeness, etc. become clear. It is important to emphasize those reasons that are not related to customers or clients. Then a constructive way or several responses to this situation are chosen. The same situation plays out in a “constructive manner”.

Exercise 2. “Help yourself”

May be a result of the previous exercise or separate exercise. It begins in the same way as the previous exercise, but a situation of failure is considered, when it is impossible to resolve the situation in a constructive way, when there is no way to influence the source of unpleasant experiences. A phrase is invented that the participant can use to help himself, even if he is unable to change the situation (“I’m right,” “I can do this,” “I behave with dignity”).

Exercise 3. “Stigma”

In an effectively working group, in which trusting relationships and a high level of mutual understanding have developed between participants, a situation of stigmatization can be played out. To analyze whether the participants are afraid that others will find out about their mental illness, what exactly they are afraid of, how they can react to such a situation.

Exercise 4. “Shipwreck”

The exercise is aimed at increasing self-esteem and self-awareness. Everyone must name their strengths, thanks to which they can be useful, valuable, and worthy of attention in some situation. The situation is, to a certain extent, critical. You can start not by naming the qualities, but by mentioning specific useful actions that the participant can perform in this situation.

Exercise 5. “Compliment”

The exercise is aimed at increasing self-esteem. Each participant draws his own self-portrait and writes a quality that he values ​​in himself, a good wish to himself. This piece of paper is passed from one participant to another, and everyone writes something positive to the author - a good wish, notes some positive quality, what exactly was pleasant in communicating with this person. This exercise can complete the group.

Cognitive games

Cognitive exercises are aimed at developing:

Body diagrams,

Orientation in space,

Quasi-spatial representations,

Visual, auditory and kinesthetic perceptions.

"Organization of the workplace" (formation of the ability to follow the rules, control one’s activities, transfer the method of action from one situation to another).

"Listen to the silence" (formation of voluntary regulation of one’s own activity, development of auditory gnosis). Starting position - lying on your back. Close your eyes and consistently listen to the sounds on the street outside the window, then in the room, your breathing, your heartbeat

"Organizing paper space" (formation of spatial representations). Starting position - sitting on the floor. It is necessary to show children how to place drawings on a landscape sheet and scan the lines: they should start working from the top left corner, from left to right, from top to bottom. At the first stages of work, you can line album sheet on stripes and cells, show with arrows the directions of eye movement. Work should be done strictly inside the cage or strip.

Cognitive exercise “Noisy boxes” (formation of auditory memory). Starting position - sitting on the floor. The instructor needs to prepare several identical sets of boxes filled with various materials (sand, cereal, paper clips, paper balls, etc.), which create different noises when shaken. Children with eyes closed They listen to the noise of one of the boxes, which is being shaken by the instructor, then they sort through their boxes and find a similar one.

"Cup of Kindness"(emotional development). The instructor explains: “Sit comfortably, close your eyes. Imagine your favorite cup in front of you. Mentally fill it to the brim with your kindness. Imagine another, someone else’s cup next to you, it’s empty. Pour your cup of kindness into it. Next to it is another empty cup, another and another. Pour kindness from your cup into empty ones. Don't be sorry! Now look into your cup. Is it empty, full? Add your kindness to it. You can share your kindness with others, but your cup will always remain full. Open your eyes. Calmly and confidently say: “It’s me! I have such a cup of kindness!”

"My hand, your hand" (formation of spatial representations). Children are divided into pairs and, sitting facing each other, first determine their left hand, left shoulder, right knee, etc., then their partner’s.

“Formation of quasi-spatial representations” . Starting position - sitting on the floor. The instructor teaches the children the following concepts: “before”, “after”, “earlier”, “later”, “between”. He invites children to structure the sequence of time of day, year, days of the week, months of the year. Then you can develop skills in orienting and analyzing time on the dial of a clock.

"Cold-hot" . The instructor hides an object in the room and then uses commands to guide the player to the goal. Commands can be: “one step to the right, two steps forward, three to the left, etc.” If the child is well oriented in space, then you can use a plan diagram.

"Labyrinth"(formation of spatial representations). The child should go around the chairs moving forward: to the right, to the left of the chair, above, under the chair. A prerequisite is to speak out loud your spatial actions.

"Find the figure"(formation of tactile memory). Starting position - sitting on the floor. Children take turns, with their eyes closed, touching a number of figures with different surface textures: smooth, rough, prickly, slippery, velvety, etc. Then, without opening their eyes, they must find objects with the same surface and arrange them in a given order. The number of figures must be increased gradually. First one hand is involved in the work, then the other, both together.

"Pose"(formation of tactile memory). Children sitting with their eyes closed are given a pose in turn (a more complicated version - 2-3 poses in succession). The child must feel and remember them, and then reproduce them in the required sequence.

"Movement". (formation of motor memory). The instructor offers children several sequential movements (dance, gymnastics, etc.). Children must repeat them as accurately as possible and in the same sequence.

"Rhythm"(sitting on the floor). The instructor sets the rhythm by tapping it with one hand, for example, “2-2-3” (at the beginning of mastering, visual reinforcement is given - children see the instructor’s hands, and in the process of mastering they gradually move on to auditory perception only, i.e. with their eyes closed). Then the children are asked to repeat the rhythmic pattern with their right, left hand, two hands simultaneously (claps or blows in front of them), in combination (for example, “2” with the right hand, “2” with the left hand, “3” with both hands at the same time). After mastering the first part of the exercise, children are asked to reproduce the same rhythmic pattern with their feet.

"Invisible hat" (formation of visual memory). Starting position - sitting on the floor. Within 20 seconds, children are asked to memorize objects lying on the table, which the instructor covers with a hat. Then the children are asked to remember and list all the objects. To complicate the exercise, remember the order of the objects, which the instructor can change.

"Superfluous word"(development of speech sound discrimination). Starting position - sitting on the floor. Children are asked to exclude from a number of words the one that does not fit the rest of the words. For example, in the word series “squirrel, squirrel, bleach, white,” the word “squirrel” is excluded. Children need to explain why they excluded this particular word.

"Octopussy"(formation of visual and spatial memory). Children position themselves in a certain way around the perimeter of the room (in the corner by the window near the ball, etc.) and remember their place. The instructor plays a piece of music during which the children run freely around the room. During the pause, they must return to their place as quickly as possible. Complicating the exercise - children must take a place one position forward while moving clockwise.

"Shop"(development of auditory-verbal memory). Starting position - sitting on the floor. The instructor invites the children to “go to the store” and lists the items that need to be purchased. The number of items must be gradually increased from one to seven. You can change roles (salesperson, mother, child) and stores (Milk, Toys, Bakery, etc.). The “seller” first listens to the “buyer’s” order, then selects the “product”. The “buyer” checks and takes the “product” home, where the “mother” checks that the purchase is correct.

"Forbidden Sound" (development of speech sound discrimination). Starting position - sitting on the floor. The instructor invites the children to answer the question without using a particular sound or replacing it with clapping. For example, the sound “m” is excluded. Then to the question: “What berries grow in the forest?” You can't call raspberries and strawberries. Using cotton, the answer to the question will be: “(cotton)-Alina, ze-(cotton)-lyanika.”

"Fish, Bird, Beast" (formation of auditory-verbal memory). Starting position - sitting on the floor. The instructor points to each child and says: “Fish, bird, beast, fish, bird, beast.” The player on whom the counting stops must quickly name any animal. If the answer is correct, the instructor continues the game; if the answer is incorrect, the child drops out of the game. The game can be played in different ways.

"Say the word backwards" . (formation of speech sound discrimination). Children are asked to take turns saying the sentence from the end by the instructor. You need to start with short words(cat, house), gradually moving to longer ones.

"Color Visualization". Starting position - sitting on the floor. Children are asked to “fill” their brain with a color (red, blue, green) of their choice. The focus needs to be on keeping the color clear and clean. You can focus on the similarities or differences between the colors. For each color, you can choose a bodily pose that will help you visualize the color.

"Encrypted Proposal" (formation of auditory-verbal memory). Starting position - sitting on the floor. For memorization, short sentences are given, for example: “The children were playing in the yard.” It is proposed to encrypt the sentence by adding an “hwe” insertion after each syllable: “De(hwe)ti(hwe) ig(hwe)-ra(hwe)li(hwe) vo(hwe) dvo(hve)re(hwe).”

"Rhythm in a circle."Children sit in a semicircle. The instructor taps out a rhythm. Children listen carefully and, at the instructor’s command, repeat it (separately or all together). When the rhythm is mastered, the children receive the command: “Let's clap this rhythm as follows. Each person takes turns beating one clap from a given rhythm. From left to right. When the rhythm ends, the next one in the circle waits a short pause and starts over. Anyone who is late with his clap, who fails to pause, or who makes an extra clap receives a penalty point or is eliminated from the game.” Possible ways complicating the task: lengthening and complicating the rhythm, tapping the rhythm by each player with both hands in turn, etc. Children can also be offered to play sounds of different volumes within a rhythmic pattern (for example: quiet and loud).

“My cap is triangular” .(ancient game). Children sit in a circle. Everyone takes turns, starting with the leader, and says one word from the phrase: “My cap is triangular, my cap is triangular. And if it’s not triangular, then it’s not my cap.” Then the phrase is repeated, but the children who get to say the word “cap” replace it with a gesture (light clap on the head with the palm of their hand). Then the phrase is repeated again, but at the same time two words are replaced with gestures: “cap” (light clap on the head with your palm) and “mine” (point with your hand at yourself). When repeating the phrase for the third time, three words are replaced with gestures: “cap”, “mine” and “triangular” (the triangle is depicted with hands).

"Human Visualization" (sitting on the floor). Children are asked to visualize a familiar person (someone present). To do this, you need to concentrate on his face and carefully study every detail. Then mentally approach the person, move away, look at him from the right, left, behind and in front

.“I know five”(development of nominative processes). Starting position - sitting on the floor. Children are asked to name five names of boys, girls, plants, animals, etc., while hitting the ball.

"Visualization of a three-dimensional object." Children are asked to mark any three-dimensional object (ball, chair, globe) in front of them and study each part of the object, then imagine it as a whole. Then you need to change the size, shape, color.

"Mirror Movements" (body development). The instructor stands with his back to the children and performs movements with his arms, legs, and body. Children repeat all the movements of the instructor. The complication of the exercise is that the instructor faces the children, who must repeat his movements.

"Tuh-tibi-duh"(emotional development). There is a comical paradox in this ritual. Children cast a spell against bad mood, grievances and disappointments. Without talking, they move chaotically around the room and, stopping opposite one of the participants, must angrily say Magic word"Tuh-tibi-duh." The other participant can remain silent or say the magic word “Tuh-tibi-duh” three times. After this, continue moving around the room, stopping from time to time in front of someone and angrily pronouncing the magic word. It is important to say it not into emptiness, but to a certain person standing opposite. After a while, the children will not be able to help but laugh.

"Gold fish"(formation of voluntary regulation and self-control). Starting position - sitting on the floor. Each participant is asked to describe a well-known plot, for example, “The Tale of the Fisherman and the Fish,” from the perspective of some character: an old man, an old woman, a fish, the sea, etc. At the same time, the other participants must carefully ensure that the story sounds exactly as it should be. what this character actually took part in, and ask provocative questions: “How did you feel?”, “How do you know this, because you weren’t there?”

"Visualization of a large object" . Children are asked to visualize a house, apartment, street. To do this, you need to imagine yourself opening the door and entering the apartment. Children can concentrate on the details of fittings, curtains, paintings, etc. Then you need to go back and carefully examine appearance building.

"Wax figure" (formation of voluntary regulation and self-control). Participants with their eyes closed “sculpt” each other into the same sculpture. After which everyone returns to the pose previously given to him and maintains it until the last copy is completed. Then the children open their eyes, compare the resulting figures and discuss the result.

"Events in order" (development of cause-and-effect relationships). Starting position - sitting on the floor. The instructor asks the children to put events in order: I go to bed, I have lunch, I watch TV, I brush my teeth, I play football, etc. Another option: in a year, the day before yesterday, today, tomorrow, a month ago, the day after tomorrow, etc.

"Encrypted Proposal" (formation of auditory-verbal memory). Starting position - sitting on the floor. To remember, short sentences are given, for example: “My name is Hera.” Children are asked to encrypt the sentence by adding a “fi” insert before each syllable: “(fi)Me(fi)nya (fi)-zo(fi)vut (fi) Ge(fi)ra.”

"Time and Antitime" (development of cause-and-effect relationships). Starting position sitting on the floor. Each participant is asked to describe some event (excursion, movie, story, etc.) first correctly, and then from end to beginning.

"Visualization of geometric shapes" . Children are asked to imagine a circle (square, triangle, etc.), then mentally change its size, color, shape, rotate it around its axis, zoom out and bring the figure closer.

"Ranging"(development of a hierarchy of concepts). Starting position - sitting on the floor. The instructor explains what ranking is and suggests ranking the following words-concepts according to a certain principle: peas - apricot - watermelon - orange - cherry; baby - youth - man - old man - boy; be silent - speak - shout - whisper; snowflake - icicle - iceberg - ice floe - snowdrift; city ​​- apartment - country - Earth - street.

"Photo"(emotional development). The instructor shows the children a photograph of a person with a certain mood. One of the participants must reproduce the phrase given to him with an intonation corresponding to the emotion in the photo. It is necessary to accompany the statement with appropriate facial expressions and gestures. The rest of the children must evaluate the correctness of the task.

"Visualization of movements" . Children are encouraged to imagine themselves anywhere globe. To do this, you need to feel yourself floating easily above the Earth, the warmth of the sun's rays and the breeze, notice the smells and sounds...

"Visualization of a Wizard." Starting position - sitting on the floor. Children are asked to imagine a kind and wise person to whom they can ask any questions. You must listen carefully to the answers of this wizard. He can tell an extraordinary story about himself.

"Visualization of the Magic Eight." Starting position - sitting on the floor. Children are asked to imagine a lying figure eight, which is located inside the head and stretches from ear to ear. It is necessary to mentally follow the trajectory of the figure eight with your eyes.

"Superfluous word".Starting position - sitting on the floor. The instructor invites children from a group of words (can be on cards) to choose the odd one that does not fit the meaning: plate, cup, table, teapot; red, blue, beautiful, yellow, gray; a lot, purely, little, half; yesterday, today, in the morning , the day after tomorrow; comma, dot, dash, union; old, tall, young, elderly, young.

regional state budgetary institution

social services

"Spassky boarding house for elderly disabled people»

Developed by: psychologist

Alieva Asiya Asifovna

Spassk-Dalniy

Training program to strengthen

cognitive and social skills.

Relevance of the program:

Old age is the strongest and most independent risk factor for the development of disorders of higher brain (cognitive) functions. As the number of elderly people increases, the number of patients with cognitive disorders increases. Advances in the pathophysiology and neurochemistry of cognitive impairment, as well as new neuropharmacological data, now allow us to consider cognitive impairment as a partially curable condition. Therefore, timely diagnosis and the earliest possible initiation of treatment for cognitive impairment in older people seem extremely important, since when diagnosed late, these disorders often reach the level of dementia

Assessment of the state of cognitive functions and syndromes of their impairments
Cognitive (synonyms - higher cerebral, higher mental, higher cortical, cognitive) functions are among the most complex functions of the brain, with the help of which the process of rational cognition of the world is carried out and targeted interaction with it is ensured.

Cognitive functions include:

• gnosis - perception of information, the ability to combine elementary sensory sensations into holistic images; violation of gnosis - agnosia or, with a lesser severity of violations, dysgnosis; a patient with agnosia sees an object, can describe it, but does not recognize it, despite the absence of primary sensory disorders;
• memory - the ability to imprint, store and repeatedly reproduce received information; memory impairment - amnesia or, with less severe impairment, dysmnesia;
• intelligence - the ability to analyze information, identify similarities and differences, general and particular, main and secondary, the ability to abstract, solve problems, build logical conclusions;
• speech - the ability to understand spoken speech and express one’s thoughts verbally; speech disorders - aphasia or, with less severity of disorders, dysphasia;
• praxis - the ability to acquire and retain a variety of motor skills, which are based on automated series of movements; violations of prakis - apraxia or, with less severity of violations, dyspraxia; a patient with apraxia cannot perform one or another action due to the loss of a skill (“forgot how” to perform certain actions), despite the absence of paresis, coordination disorders and other primary movement disorders.

Monofunctional cognitive impairment, i.e. isolated aphasia, agnosia, amnesia or apraxia, usually occur with local lesions of certain parts of the cerebral cortex as a result of stroke, traumatic brain injury, tumor and other causes. At the same time, in old age, most chronic progressive brain diseases of a neurodegenerative or vascular nature are accompanied by multifunctional cognitive disorders, when there is simultaneous depression of several (or all) cognitive functions.

To establish a nosological diagnosis, choose patient management tactics and determine prognosis, it is important not only to establish the nature of cognitive impairment, but also their severity. According to the classification of Academician of the Russian Academy of Medical Sciences N.N. Yakhno (2005), distinguish between severe, moderate and mild cognitive impairment.

Severe cognitive impairment (SCI) refers to mono- or multifunctional disorders of cognitive functions that lead to a complete or partial loss of independence and self-sufficiency of the patient, i.e. cause professional, social and (or) everyday disadaptation. SCI includes, in particular, dementia of a degenerative or vascular nature. According to epidemiological data, at least 5% of people over 65-70 years old suffer from dementia. The presence of dementia or other types of SBO indicates significant brain damage, which usually develops as a result of a long-term pathological process. The prognosis in most cases is unfavorable, since SBO is most often progressive, less often stationary.

Moderate cognitive impairment (MCI) is a mono- or multifunctional disorder of cognitive functions that goes beyond the average age norm, but do not cause maladjustment, although they can lead to difficulties in difficult and unusual situations for the patient. UKN are marked on initial stages cerebral pathology. In older adults, the prevalence of MCI is 11–17%. The prognosis depends on the nature of the underlying pathological process and patient management. Over 5 years of observation, in 50% of patients MCI transforms into severe, in the rest they can remain stable or regress.

Mild cognitive impairment (MCI) is defined as a decrease in 1 or more cognitive functions compared to baseline. high level(individual norm); MCI does not affect everyday, professional and social activities, including its most complex forms. MCI can be caused by the physiological process of aging or occurs in the earliest stages organic disease brain. In most cases, adequate therapy can reduce the severity of MCI.

Age itself can only cause mild and non-progressive cognitive impairment. In the presence of moderate or severe impairments, as well as a noticeable progression of cognitive impairment over a short period, we are talking about an ongoing brain disease. In such cases, it is necessary to establish an accurate nosological diagnosis, which is based on the clinical and psychological characteristics of the existing disorders, data from laboratory and instrumental research methods.

Purpose of the program:

1) strengthening the voluntary regulation of memory and attention by teaching the use of special means (training in switching and maintaining attention, selecting information, using mnemonic techniques);

2) strengthening the communicative orientation and cognitive differentiation of thinking (operating with concepts with an orientation towards another person, joint activity in pairs and groups to achieve a common goal);

3) development of cognitive accuracy and differentiation of social perception (training in recognizing non-verbal communications - facial expressions, postures, gestures, analysis and qualification of interpersonal situations, accuracy of reproduction of a partner’s verbal behavior);

4) reduction of intellectual anhedonia (linking intellectual activity with the gaming component and success);

5) development of regulation of one’s emotional states, thinking and behavior through the development of the ability for self-observation, self-instruction and coping dialogue;

6) practicing social behavior skills (communication training on various topics in a group, modeling and acting out real life situations);

7) teaching effective strategies for solving interpersonal problems (dividing the problem into smaller ones, highlighting the stages of its solution and specific tasks, ways to solve these problems).

Tasks:

— development of mental abilities;

- help to become socially significant,

— creating a favorable climate in the group

Lesson structure.

Classes begin and end with the same procedure. Each participant says two words about his mood at the moment and the exercise that he remembers most from the last lesson (at the beginning of the lesson) or from the lesson that just ended (at the end of the lesson). At the end of the lesson, you can also perform some kind of movement ritual to end the lesson. One of the presenters is the first to answer these questions, thereby setting a model for these statements. This ritual gives the presenters information about the emotional state of the participants and its dynamics, forces the participants to once again remember all the exercises done. Then, as a rule, a short exercise is carried out aimed at activating, “getting into work.” This could be a “repetition of the past” - consolidation of an already worked stage. Then follow more labor-intensive exercises that continue what was started or introduce a new training subroutine. The results of these exercises are usually discussed. Often after such discussions, when ways are identified that can improve the execution of the exercise, the exercise is repeated again (in the same or modified form) to master and consolidate these methods. Longer, more focused exercises are alternated with short, often movement exercises. At the end of the lesson, a short exercise is carried out, which should maintain a positive emotional atmosphere, create a feeling of success and pleasure. After each lesson, participants are asked to complete homework. It can in some form repeat what was done in the lesson or, conversely, prepare material for the next lesson. Homework saves time in class and forces participants to be active between classes.

The sequence in which participants perform the exercise may vary. As a rule, exercises are performed in a circle or, in a more complex version, the turn is determined by throwing an object (ball, soft toy) to each other. Many exercises are performed in pairs.

At the first lesson, the presenters once again inform the participants all the necessary information about the training, including listing its goals, emphasize the importance of complex treatment, which includes drug treatment and psychological training, and list the rules for the group. Participants are given a memo with a brief listing of the training objectives, the rules of the group (with a small commentary) and, if necessary, a class schedule.

Activities within the program:

This program involves classes with clients of “DIPI Spassk” in within three months, one lesson per week. The duration of each lesson is 1 hour. Composition of the group (mixed): men and women similar in age, level of intelligence and condition, group of 6-8 people. To work, you need a spacious room with furniture that can be easily moved (chairs, tables).

Methods and techniques: role-playing games, dramatizations, short theatrical miniatures on a given topic, discussions, lectures and mini-lectures, psychological exercises of various directions.

Description of training subprograms.

Subroutine 1. Memory and attention training

Tasks:

1) motivation, problematization, acquaintance;

2) creating a safe atmosphere and positive attitude,

3) introduction of elements of group interaction

4) practicing on game models mnemonic techniques (reliance on semantic connections) and methods of concentration (performing exercises that require monitoring the process, readiness for a quick response), information selection (for example, respond only to certain stimuli, do not name “black and white” etc.) and organizing information (drawing up a hierarchy of concepts and characteristics of concepts, building a meaningless set of sentences into a story, etc.);

5) discussion of difficulties, as well as developed techniques and ways to overcome them.

Subroutine 2. Development of communicative thinking and ability to cooperate (2-3 lessons are the main one).

Tasks:

1) introduction of interaction in pairs based on material from past classes (joint memorization, assistance in maintaining attention);

2) working with concepts (defining given concepts for another, guessing the intended concepts, jointly identifying the most informative features of concepts, receiving feedback about the difficulties encountered by partners);

3) interaction in pairs with the goal of jointly achieving a certain result (joint drawing of figures, overcoming obstacles, etc.);

4) discussion of difficulties and means of overcoming them.

Subroutine 3. Social perception (2-3 lessons are the main one).

Tasks:

1) training in the interpretation of non-verbal expression - recognition of emotions, expression of various emotions, recognition of the emotional state by facial expressions and gestures;

2) training in the analysis of social situations using pictures and slides - collecting information about the emotional state of the characters, the situation and other details;

3) training in interpreting the collected information;

4) training in classification and qualification of various interpersonal situations;

Subroutine 4. Verbal communications (2-3 lessons are the main one).

Tasks:

1) training in accurately reproducing received verbal information, for example, a small fragment of a test or a short story;

2) training in drawing up proposals, questions and answers on a given topic;

3) joint interviewing of one or two group members on a given topic;

4) free communication on a given topic;

5) discussion of difficulties and ways to overcome them.

Subroutine 5. Social skills (2-3 lessons are the main one).

Tasks:

1) identifying difficulties in everyday life and self-care;

2) developing independence skills (for example, planning to get ready before going out; planning what to do when going to the store, planning how to prepare breakfast, etc.);

3) identification and discussion of real interpersonal situations that cause difficulty;

4) discussion of possible options for behavior and dialogue in these situations;

5) conducting a role-playing game (at first the presenter can act as a model);

6) discussion of the results of the role-playing game, identifying ways to overcome difficulties.

Subprogram 6. Emotional self-regulation and problem solving (completes the intensive training phase) .

Tasks:

1) development of self-observation skills using a diary to record situations and associated emotions and thoughts (the “three columns” technique);

2) identifying the reasons that influence mood - provoking situations (for example, the need to leave the house), negative thoughts (for example, “I won’t succeed,” “people look unkindly,” etc.), dysfunctional beliefs (for example, “everything must be done well or not at all”, “people are unfriendly”, etc.);

3) development of skills of alternative thinking and coping dialogue;

4) identification of typical problem situations, their specification and division into smaller ones (for example, getting a job);

5) identifying stages and discussing possible ways to solve them.

Lesson No. 1.

Exercise No. 1."Acquaintance".

A memory exercise that is also the beginning of contact between group members.

Exercise No. 2."Black White".

An attention exercise aimed at creating a fun atmosphere and a playful mood.

Exercise 3. “Clap - stomp.”

A kind of “Electric Current” that does not require tactile contact with other people, but requires more concentration.

Exercise 4. “Anti-time.”

A story about something in reverse order.

1. Reflection. Feedback.

Homework: come up with questions for the exercise “Black - White”.

Lesson No. 2

Exercise 2. “Text and counting.”

The presenter reads the text, and the participants must listen and at the same time count in their heads (or come up with words for one letter of the alphabet).

Exercise 3. “Male - female names.”

Participants must name names - the first and second are male, the third is female, the fourth is male again, etc. In this exercise, it is important that the participants understand the full breadth of the task proposed to them and do not narrow it down (you can name foreign names, exotic plants).

Exercise 4. “Typewriter.”

The exercise is aimed at training attention and creating a fun gaming atmosphere.

Exercise 5."Description of the picture."

The presenter shows the participants a picture with a sufficient number of different objects on it for a short time, then the picture is removed, each participant must write a list of all the objects depicted in the picture.

1. Reflection.

Homework: choose words and phrases for the Typewriter exercise.

Lesson No. 3

Exercise 1. “Greetings.”

Each participant in turn finishes the phrase “Hello, my name is…..I came (went) here in order to…..”

Exercise2. “Memorizing the pose.”

One of the participants takes a certain pose, while the others turn away or close their eyes. Then everyone looks at this pose for a few seconds, after which the pose changes and everyone except the “author” must repeat as accurately as possible the position of the body, limbs, facial expressions, and finger positions.

Exercise 3."Memorizing two-digit numbers."

First, subjects must memorize 10 one- and two-digit numbers that do not carry obvious associative connotations, then the presenter suggests memorizing numbers that have certain cultural associations (31 - New Year, 18 - age of majority, etc.) and names these associations. Then it is discussed how it is easier to remember, what associations everyone can come up with.

Exercise 4.“Memorizing words with a condition.”

Participants take turns coming up with words (in a circle or with a ball) that correspond to a certain condition (on a certain topic, starting with the same letter, etc.).

Exercise 5. “Farewell - wish.”

1. Reflection.

Lesson No. 4

Exercise 1. “I can do it, and it’s great!”

Each of the participants in turn greets the group according to the proposed pattern: “Hello, I am ………, I can do it, and that’s great!” Exercise2. “Definition of concepts.”

Exercise3. “What can’t happen without?”

It is necessary to highlight the main features of certain concepts proposed by the presenter, without which they cannot be accurately defined.

Exercise4. "Circus".

The exercise is directly aimed at decentration. Participants come up with associations that evoke in them some well-known and “culturally unambiguous” concept.

1. Reflection.

Participants take turns giving each other an imaginary gift. It could be anything because... fictitious gift.

Lesson No. 5

Exercise 1. “I came here to...”

Each participant greets the group using the suggested greeting template: “Hello, I…….. I came here to…….”

Exercise 2. "Unmanned aircraft."

Participants pair up. Each pair receives a piece of paper on which 2 “bases” and “obstacles” are drawn. One participant takes on the role of “dispatcher”, the other – “aircraft”. Then the participants change roles.

Exercise 3. "Drawing in parts."

Participants are asked to draw a picture, for example, of a man. Each person draws only part of the person, starting with the head and the top of the piece of paper, then wraps the paper so that only the very bottom part of the drawing is visible to the next participant, and passes it on. The next participant must guess which parts of the man he should continue drawing.

Exercise4. "Automatic".

One of the participants comes up with a concept, the others ask him questions to which he can only answer “yes” or “no”.

1. Reflection.

Exercise 6. “Farewell - wish.”

Each of the participants in turn finishes the phrase: “I wish you today that.....”

Lesson No. 6

Exercise 2 "The Blind and the Guide"

Places great demands on interaction. The exercise is done in pairs. One of the participants closes his eyes, “obstacles” are placed around the room (chairs, other large, but not dangerous objects). The second partner (“guide”) uses words to direct the actions of the “blind” person so that he avoids all obstacles and reaches the “goal.”

Exercise 3. “Joint drawing.”

Participants are given the theme of the drawing or some detail of it. The exercise can be done in pairs, in which case it is important to guide and discuss the distribution of roles. You can complicate it by requiring silence.

Exercise 4 “Identification by picture.”

A picture is offered with a sufficient number of similar objects (for example, an interior with different pieces of furniture) or several similar pictures. The presenter names the signs of the object he has envisioned until the participants guess what the object is.

Exercise 5. "Description of a Half".

Participants are given similar pictures cut in half; everyone must describe the half they received so that the owner of the other half guesses the missing half in the description.

Reflection.

Exercise 6. “Farewell is good advice.”

Each of the participants, saying goodbye, gives some kind advice to the whole group.

Lesson No. 7

Exercise 1. “I rejoice when...”

Each participant greets the group according to the pattern suggested by the leader: “Hello! My name is……..I rejoice when…….”

Exercise 2. “List of emotions.”

Participants name all the emotions that come to mind, and a general list is compiled and posted for everyone to see.

Exercise 3. “Who is worried about what?”

A well-known work of art is selected (as a rule, these are fairy tales or cartoons), for example, “The Tale of the Fisherman and the Fish,” “Cinderella,” and the participants name the emotions that the characters can feel.

Exercise4. “Drawing emotions.”

Participants are asked to draw on paper the face or figure of a person experiencing a particular feeling. Then these pieces of paper are passed around, and everyone signs what feeling they see in this drawing and wraps up their inscription so that others cannot see it.

Reflection.

Participants, saying goodbye until the next lesson, shake hands.

Lesson No. 8

Exercise 1. “I am proud of myself if...”

Each of the participants greets the group by saying their name and continuing the pre-suggested phrase: “Hello, I…….. I am proud of myself if……….”

Exercise 2. "Stupid secretary."

A situation is given: visitors to the boss’s reception really want to know what mood he’s in, but the secretary cannot name a single emotional state (“she doesn’t know Russian well”) and can only answer questions about external manifestations of emotions. Participants ask questions that can be used to guess the emotional state of another person.

Exercise 3. "Broken pose phone."

One participant conceives and depicts some kind of emotion in posture and facial expressions - shows it to the next (the rest have their eyes closed), the next one must guess what kind of emotion is intended and show the same pose to the next participant.

Exercise 4. "The emotion of the picture."

The presenter shows the participants several reproductions and asks them to determine what feelings each of them is associated with.

Reflection.

Exercise “I am a brave man!”

Each of the participants in turn addresses the group and repeats the phrase “I am a brave and confident person, I am great, and I am proud of myself!” And all the other participants answer: “Yes, (name)! You are a brave and confident person and we are proud of you!”

Lesson No. 9

Exercise 1. “What is my mood like?”

This exercise allows participants to realize their emotional state “here and now” and express it in a figurative, symbolic form.

Exercise 2. "Making a Story"

Exercise 3. "Renaming".

Assignment: give new names to well-known works (books, films) that would reflect their essence and be understandable to others.

Fairy tale “Turnip”;

The Tale of the Fisherman and the Fish";

Fairy tale “Ryaba Hen” and others.

Exercise 4. "Circus".

The exercise is aimed at decentration. First, participants come up with associations that evoke in them some well-known and “culturally unambiguous” concept, for example, a circus. And then they have to figure out what associations the circus evokes in different people.

Reflection.

Exercise 5. “Without words”

Participants say goodbye without words, using only gestures, facial expressions, etc.

Lesson No. 10

Exercise 1 “Hello, world!”

Participants take turns finishing the phrase: “My name is………Hello, World!”

Exercise2. “Definition of concepts.”

The exercise is addressed to the communicative component of thinking.

Each participant defines and describes the concept given to him by the leader so that all other participants guess as quickly and accurately as possible what he is describing.

Discussion on a given topic.

Parable. Rabbi and God.

Discuss what you read, express your opinion and justify it.

Exercise 3. “Clap-top.”

Each participant places their hands on their laps. Consistently, as if transmitting a current, the participant slaps himself on the knee with his right hand, then stomps with his left foot. Then the next one slaps himself on the knee, etc.

Reflection.

Exercise 4. “Wish for the day.”

Each of the participants, saying goodbye, makes some kind of good wish to the whole group.

Lesson No. 11

Exercise 1.”I came to class to...”

Each participant greets the group according to the pattern suggested by the leader: “Hello! My name is……..I came to class to…….”

Exercise 2. “Getting ready for the trip.”

Several situations are given, real or unreal travel, participants make lists of things that need to be taken with them on each trip, they discuss what needs to be taken on this particular trip, how the equipment differs for each trip and why

Exercise 3. “Why did you move?”

A situation is set - a person gets on the bus, sits in an empty seat, and at that moment his neighbor moves away from him - why did the neighbor move? We need to come up with as many reasons as possible, and it is important to highlight the reasons that are not related to the passenger who just boarded.

Exercise4. “Composing a story.”

Participants are presented with a list of words that contains words that are not too closely related to each other. You need to write a short story using all these words.

Exercise 5. “Good advice.”

Each participant, saying goodbye to the group, gives others some good advice.

Lesson No. 12

Exercise 1. “I am a gift to humanity because…..(or “since I…..”).”

Each of the participants greets the group by saying their name and continuing the pre-suggested phrase: “Hello, I…….. I am a gift to humanity because I……….”

Exercise 2. “What happened?”

The presenter tells the origin and end of some situation and asks to come up with what could have happened in the interval, the motives for the hero’s actions.

Exercise 3. “Sympathize with your friend.”

A well-known unpleasant situation is set (for example, “Angry traffic cop”). You can choose a situation that is meaningful to the participants.

Exercise 4. “Why was I late?”

Consider a situation where a person is late for class. You need to list 10 possible reasons for being late.

Exercise 5. “Foreigner.”

An exercise on nonverbal communication skills - you need to communicate with your partner without words.

Exercise 6. “Today I learned for myself that...”

Each participant, saying goodbye to the group, finishes the phrase: “Today I learned for myself that...”

Lesson No. 13

Exercise 1. “I rejoice when I hear...”

Each of the participants greets the group by saying their name and continuing the pre-suggested phrase: “Hello, I…….I am happy when I hear……….”

Exercise 2. Role-playing game “Difficult situation”.

It turns out what social situations are difficult and unpleasant for the participants. A situation is chosen that is significant to the majority and can be played out.

Exercise 3. “Help yourself.”

A situation of failure is considered when it is impossible to resolve the situation in a constructive way, when there is no way to influence the source of unpleasant experiences.

Exercise4. “Stigma.”

A situation of stigmatization is played out between the participants. Find out whether participants are afraid that others will find out about their illness.

Exercise 5. “Let’s shake hands.”

Each participant, saying goodbye to the group, shakes hands with other participants in the training.

Lesson No. 14

Exercise 1. “I like it when they call me...”

Each of the participants greets the group by saying their name and continuing the pre-suggested phrase: “Hello, I……..I like to be called ……….”

Exercise2. “Shipwreck.”

The exercise is aimed at increasing self-esteem and self-awareness. Everyone must name their strengths, thanks to which they can be useful, valuable, and worthy of attention in some situation.

Exercise 3. “Similarities between us.”

Group members are encouraged to identify what unites them, despite their many differences. Characteristics and qualities can be written down on a piece of paper. For example, they are kind, pleasant to talk to, we like to listen to music, etc.

Exercise4. "Compliment."

The exercise is aimed at increasing self-esteem. Each participant draws his own self-portrait and writes a quality that he values ​​in himself, a good wish to himself.

Exercise 5. “Imaginary gift.”

Participants take turns giving each other an imaginary gift. It can be anything, because... fictitious gift.

Our brain is an amazing system that constantly performs interesting tricks. Are you familiar with the “red car” effect? A man buys a red car and suddenly starts seeing red cars on the street all the time. This distortion is called the “frequency illusion” or “Baader-Meinhof phenomenon” and occurs due to the brain’s selective attention and tendency to always confirm its point of view (confirmation bias).

The brain is not only susceptible to cognitive illusions, but is also able to respond flexibly to external stimuli. Is it possible, in this case, to “pump up the mind” by exerting a stimulating effect on it? A University of California meta-analysis found that short-term cognitive training leads to benefits in important cognitive functions measured by laboratory tests.

Working memory is capable of storing and accessing information in the short term. This is a narrow “intelligence bottleneck” that affects cognitive processes more high order, including controlled attention and reasoning.

An analysis of 20 scientific studies showed that working memory is not only trained, but also affects fluid intelligence.

Fluid intelligence is the ability to think logically, analyze and solve problems regardless of previous experience. Fluid intelligence does not depend on previously accumulated knowledge.

Just three weeks of regular cognitive exercise significantly increases the number of neural connections. This leads to an acceleration of the exchange of information between different parts of the brain, improves the ability to remember new information, develops logical thinking, the ability to compare facts and quickly make the right decisions.

There are a lot of cognitive training options. We have collected several that are distinguished by their simplicity, small volume and quick results (at least you can immediately assess at what level your working memory is now).

Long-term memory test

Vikium

Vikium suggests first taking a test and determining the quality of your thinking. Based on the test results, you receive a training program. The course consists of daily 15-minute lessons.

The service operates on a freemium model: users can purchase access to all courses, specialized tasks, and the opportunity to compete with other participants. A premium account costs 1,990 rubles per year.

The project website states that solving the proposed problems will help you stop being distracted by external interference and irritants, and will teach you how to quickly switch between different types activities, concentrate on tasks and work more productively. The company even has games that work with a device that reads the electrical activity of the brain (alpha rhythm and beta rhythm) - you need to work with them with full concentration and in absolute calm.

Brain Metrix

But this is a real game, but it was created “according to the precepts” of neuroscientists. The one who can well predict the exact place where the ball will go will be able to show a high result.
When playing, try not to focus on where the ball is, but try to predict where it might end up.

You will find others on the website free games against the computer, which will help your brain better operate working memory. In some cases, they will immediately tell you the number of points, after which you do not need to continue the game - you have already achieved perfection.

Eidetic

Eiedtic uses spaced repetition to help you remember everything from important phone numbers to Wikipedia facts. The method consists of repeating memorized educational material at certain, ever-increasing intervals. Spaced repetition does not involve rote learning.
Works only on iOS.

Fit Brains

The service works with the brain in six areas: focus, memory, speed, logic, visualization and language. Fit Brains is the only brain training program that includes emotional intelligence (EQ) training in addition to cognitive skills exercises. There are both paid subscriptions and free courses.

Brain training includes many types of training: memory tests, IQ tests, fluid intelligence, reflexive actions and creativity. Combining a variety of games with a planned training schedule will stimulate all the major memory areas of the brain and strengthen your skills.

As we get older, we need to train our minds more to maintain and sharpen skills. Even puzzles, riddles, crosswords, card games, and perhaps some computer games can help stimulate the part of the brain associated with cognitive abilities. logical solution problems, memory storage and other mental abilities.

UPD. The Vikium project has been added.

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