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Features of color reflection in psychogenic pain in patients with somatoform disorders during psychotherapeutic treatment.

At the present time, in connection with a sharp deterioration in the economic and ecological conditions of life and the high emotional loads connected with this, a steady growth is being observed in neurotic and psychosomatic illnesses, a component part of which are somatoform disorders (Ishinova V. A., Svyatogor I. A., 2008 a; 2008 b). The topicality of research into these disorders is determined by its high occurrence and insufficient elaboration of the problem as a whole. Somatoform disorders (SFD) are categorised amongst other illnesses in relation to their significance to the person (Christopher Bass, et al., 2001). For people suffering these disorders, characteristic are chronic somatic complaints which are not confirmed by conducted medical research (Hamilton J, Campos R., Creed F., 1996), and are frequently accompanied by emotional disturbances which lead to a significant reduction in the level of their social functioning (Gureje O., Von Korff M., Simon G., et al, 1998). The occurrence of SFD corresponds to 30% in out-patient practice and 5.2% in inpatient practice (Clinical Psychiatry, 1998; S.A. Kulakov, 2003).

Somatoform disorders relate to 'minor' psychosomatic disorders where somatic symptoms cannot be explained by organic disorders or secondary consequences of other mental symptoms (International Classification of Diseases, 1994; Clinical Psychiatry, 1998).

According to ICD-10 (F45) the 'somatoform disorders' class relates to section (F4) 'Neurotic, associated with stress and somatoform disorders'. This section includes: somatization disorder (F45.0), undifferentiated somatoform disorder (F45.1), hypochondriac disorder (F45.2), somatoform vegetative dysfunction (F45.3), chronic somatoform pain disorder (F45.4), other somatoform disorders (F45. 8), unspecified somatoform disorder (F45.9) (International Classification of Diseases, 1994; Clinical Psychiatry, 1998).

Most often encountered are somatized disorder (F45.0), somatoform vegetative dysfunction (F45.3) and chronic somatoform pain disorder (F45.4). Relating to diagnostic criteria for somatized disorder are: the presence of many somatic symptoms presented over two or more years which have no adequate somatic explanation; constant expression of distrust in attending physicians in their attempts to convince the patient of the absence of any physical illness and refusal to follow their advice; the presence of symptoms whose consequence is disruption to social and family relations. Diagnostic criteria for somatoform vegetative dysfunction include the following symptoms: symptoms of vegetative excitation (heartbeat, blushing, and tremor having a chronic nature and causing anxiety); additional subjective symptoms relating to the body or system; concern with the given illness despite it being unconfirmed by examinations; lack of confirmation in the results of investigation into the structural or functional disturbance of the body or system (International Classification of Diseases, 1994; Clinical Psychiatry, 1998).

An important distinguishing feature of somatoform disorders is special resistance to medicamental treatment and an expressed tendency to timing (V.G. Starshenbaum, 2003). Such patients submit with great difficulty to pharmacological treatment and require psychotherapeutic treatment. However, its effectiveness in much depends on an understanding of the nature of the psychophysiological state of the patients, and their perception and experience of the pain symptoms. This process is very complicated and may be viewed in the context of other forms of mental activity, one of which is the process of color reflection in pain.

It is assumed that over the long history of human progress there have formed in the cultural tradition nonconcious associative links between color and its symbolic meaning (N.V. Serov, 1995). Sufficient attention has been devoted to the issues of using color in diagnostics and treatment (B.A. Bazima, 2001; M. Lyusher, 1996; E.I. Sokolova, 2007). At the same time, within the framework of applied methods associative links between color and the signs being studied are measured. Each color tint causes a determined shift in the psychophysiological state of the body (M. Lyusher, 1996; E.I. Sokolova, 2007). Thus, red color excites and activates, and blue calms and restrains. A classification was constructed according to the psychological action of colors on a person (G. Friling, K. Auer, 1995; L.D. Lebedeva, 2006). The authors categorised red, orange and yellow as stimulating or exciting colors. Colors from violet to blue-green--as a group of desintegrate or 'cold' colors causing processes of inhibition, removal of excitation and reduction in emotionality. Colors in the middle part of the spectrum (green, yellow-green, olive, etc.) aiding a person's immersion in his internal world were categorised as static or 'equalising'. 'Soft' or pastel tones (pale green, grey-blue, lilac, etc., that is, colors in the upper part of the spectrum) created a sensation of restraint and softness. Black and other colors with high intensity creating an oppressive impression--fear, anguish--were categorised as a group of dominating or 'oppressive' colors.

In contradistinction to G. Friling and K. Auer (1995), A.M. Lugova (2007) put forward two groups of colors according to their psychological effect on a person: 1) an invigorating range which includes red-violet, red, red-orange, yellow-orange and yellow pure colors and their lightened shades; 2) a relaxing range--yellow-green, green, blue-green, blue, blue-violet and violet pure colors and their lightened shades.

Moreover, a dependence was discovered between a preference or repugnance towards a color and the nature and intensity of the pain symptoms (G.A. Adashinskaia et al., 2003; 2005). Thus, for patients with neurogenic and somatogenic pain symptoms with high-intensity pain a preference was noted for black and grey colors, for those with mid-intensity pain--brown and red, and where there was no pain--yellow and green colors. For patients with psychogenic pain of high and medium intensity the color preferences were represented by yellow, violet and red colors; where there was no pain--by grey and green (V.I. Shchepin, 2001; G.A. Adashinskaia et al., 2003; 2005). The authors came to a conclusion about the presence of an associative link between color and pain sensation.

To reduce stress and optimise the psychophysiological condition of the patients, methods of color therapy have of late been used. The integrated effect of light of the preferred color was accomplished via a visual analyser. At the same time, contemplation of a red, orange, and yellow background was associated with warmth which created an emotional lift; green and sky blue--with a state of calm; blue and violet caused a sensation of cold, black and dark red created a sombre mood (N.V. Serov, 2002; A.M. Lugova 2007).

Apart from this, various psychotherapeutic methods are widespread based on active auto-suggestion during muscle relaxation and use of self-regulation processes (V.S. Lobzin, M.M. Reshetnikov, 1986; B.D. Karvasarsky, 1990; 2002; V.V. Kozlov, 2001; A.D. Titar, 2004). The basis of these methods is autogenic training (AT) developed by Shultz 1973. It was noted that during AT there arose spontaneous color images without any external influences in the form of inter-laced lines, 'cloudlike shadows', color spots, etc. (Karvasarsky B.D., 2002, p. 69-70). Using special exercises the patient was being learned to withstand the arising patterns and color spots emotionally and via working with them to regulate his psychophysiological state. The appearance of these images could be accompanied both by positive and also negative emotions. During autotraining the patient was trained to imagine only those images which caused positive emotions that were accompanied by optimisation of the psychophysiological condition (Karvasarsky B.D., 2002, p. 69-70). Thus, the use of psychorelaxation techniques permitted to improve the emotional and physical state.

Thus, when applying relaxation methods with the use of corresponding color ranges the emotional state improved, work capacity increased, and the physical state was restored. However, their use was limited by the conditions of the hospitals or other medical establishments, and also the capabilities of the patients themselves to master methods of autogenic relaxation.

If in the works of V.I. Shchepin (2001), N.V. Serov (2002), G.A. Adashinskaia (2003; 2005), A.M. Lugova (2007) et al. 'external' color influence on the psychophysiological state of patients was examined, then when applying relaxation methods a link was discovered between the psychoemotional state and color images (V.S. Lobzin, M.M. Reshetnikov, 1986; B.D. Karvasarsky, 1990; 2002; V.V. Kozlov, 2001; A.D. Titar, 2004).

However, neither in these, nor in other works, has a study been made of the interrelationship between pain, anxiety and color images, and also the possibility to use this link to liquidate negative symptoms. Along with that it was possible to assume that the substitution of an 'external' color influence for the 'internal' one, arising during color reflection of the pain, would allow an increase in the effectiveness of psychotherapeutic treatment.

Within the framework of the present work the study is proposed of the link between color images and the pain of patients with somatoform disorders during psychotherapeutic treatment using empatho-techniques based on synaesthetic mechanisms. In the given work we study synaesthesia between color images and pain. At the same time the patient in a condition of 'empathy' (concentration) in zones of pain localisation established a link between the pain and its color reflection. When concentrating attention on color images, their transformation was noted, accompanied by a decrease in the intensity of psychogenic pain up to its complete disappearance.

The purpose of the present work consisted in the study of the interrelationship of color images and psychogenic pain of patients with somatoform disorders during psychotherapeutic treatment.

Hypothesis:

1) a state of concentration ('empathy') on zones of pain, sensitivity is reflected in color images;

2) during psychotherapeutic treatment positive transformation occurs of color images which is connected with a reduction of pain symptoms and an improvement of the psychophysiological state.

Method

Participants

Research was carried out for 39 people with somatoform disorders (9 men and 30 woman aged from 20 to 60 years old, with an average age of 40 years) (Group 1). The criteria for selecting patients were their complaints, typical for the given disorders and diagnosis of the attending physician. Amongst them 20 people had higher education (51%), 19 patients (49%) had post-secondary education. 32 patients (82%) were married, 2 patients (5%) divorced, and 5 people (13%) had not been married.

The main complaints of the patients under study were cephalagia, spinal pains, and heart pain, etc. Also noted was discomfort in the area of the digestive tract, dyspepsia, irritable bowel syndrome, Da Costa's syndrome, etc. Vegetative disturbances were manifested by headaches, coldness in the extremities, and sweatiness. At the same time, a lasting or labile increase in arterial pressure was observed, an acceleration in the number of cardiac contractions, disturbances in breathing rhythms, a sensation of heaviness, and muscular tension. The indicated symptoms presented, as a rule, in combination with emotional conflict or psychosocial problems. Those pains experienced had no physical basis and were not confirmed by medical examinations.

As a control group, 30 healthy people (20 women and 10 men aged from 18 to 60 years old, with an average age of 39 years) were taken (Group 2). Amongst them 85% of those studied were married and 15% had never married. Amongst the healthy subjects 68% had higher education, and 32% post-secondary education.

Apparatus/materials

Empatho-techniques were used as a psychotherapeutic method of treatment which allowed certain conditions to be achieved and created for the use of self-regulation processes (V.A. Ishinova et al., 2003; 2004; 2005; 2007). The method being used was applied to discover and study the dynamics of visual images when concentrating on pain. In the beginning the patient was asked to adopt a position comfortable to him (sitting or lying with eyes closed) and to concentrate on places of localised pain or physical discomfort. Under these conditions color spots spontaneously arose which were a color reflection of the physical sensation of pain. In the condition of 'empathy' there occurred the establishment of a link between physical sensations and color images. Empatho-techniques were used as a psychotherapeutic method which allowed the eradication of pain and the normalisation of the psychophysiological condition of the patients (Ishinova et al., 2003; 2004; 2005; 2007). The role of the psychotherapist came down to training the patient from session to session in the methods of 'empathy' in pain zones and the tracking of corresponding color images.

Empatho-techniques consisted in the following. Initially the patient was asked to adopt a comfortable position (sitting or lying with eyes closed) and to concentrate on the places of localised pain or physical discomfort. Under these conditions the patients noted the spontaneous appearance of color images which were a color reflection of the physical pain sensation. In other words, in a state of 'empathy' a link was established between physical sensations and color images. According to the patients' self-reports, color images were noted in the form of achromatic, chromatic colors and their combinations.

The color images received could appear in the form of achromatic ('a'), to which all shades from white to black were categorised; chromatic colors, which included: 1) red, orange and yellow, relating to the longwave part of the spectrum and designated by us with the letter 'l'; 2) yellow-green, green, and blue-green, relating to the mediumwave part of the spectrum and designated with the letter 'm'; 3) blue and violet colors relating to the shortwave part of the spectrum ('s'). Moreover, mixed chromatic and achromatic colors in various combinations ('al', 'als', 'alm', etc.) were assessed.

At the same time, as attention was shifted from the pain to the color images, their transformation was noted, which was accompanied by a decrease in the intensity of the pain symptom and an improvement in the patient's condition. That is, as the pain intensity decreased, a transformation occurred in the color images: colors in the longwave part of the spectrum were replaced by colors in the mediumwave and shortwave parts of the spectrum that was typical for healthy people. During psychotherapeutic treatment the intensity of pain was assessed on the 'pain' scale from the SF-36 quality of life questionnaire. Also, each patient indicated which color corresponded to the pain he experienced. A change in color images was assessed according to the self-reports of each patient and the obtained data recorded in the research reports.

Before beginning the sessions each patient was acquainted with the basis of the method and detailed instructions given on the procedure for the research. Additional methods of treatment were not used. The role of the psychotherapist amounted to training the patient from session to session in the methods of 'empathy' with zones of pain, and the ability to relate physical sensation with its color reflection and emotional condition. At the same time, as the removal of concentration of his attention from the intensity of the pain to color images progressed there was a transformation in them which was accompanied by a reduction in the expressiveness of the pain symptom and an improvement in emotional state. In other words, along with the transformation of color images there occurred also a transformation in the intensity of pain symptoms up to their complete disappearance.

For assessment of the psychological status at the beginning and end of the course, the levels were determined of trait and state anxiety (TA and SA) using the self-assessment scales of Spielberg-Hanin (I.F. Dyakonov, 2005), and also quality of life using questionnaire MOS SF-36 (Medical Outcomes Study-Short Form) (A.A. Novik, T.I. Ionova, 2002). Special attention was paid to the pain measure which was determined according to the 'Pain' scale of the same survey. According to the authors of the method, the less the intensity of pain, the higher the measure on the 'Pain' scale, as with other measures in the MOS SF-36 questionnaire (A.A. Novik, T.I. Ionova, 2002). A summary assessment of the pain consisted of quantitative (intensity) and qualitative characteristics. To assess the intensity a scale was used where: 0--no pain; 1--very weak pain; 2--weak pain; 3--medium pain; 4--strong pain; 5--very strong pain. The qualitative characteristics were determined according to the degree of the pain's influence on role functionality: 1--did not hinder at all; 2--a little; 3 moderate; 4--strongly; 5--very strongly. Also studied were the dynamics of change in the physical, emotional, mental and social functioning whilst receiving psychological help according to the scales: physical functioning (PF), role physical functioning (RFF), general health (GH), vitality (V), social functioning (SF), role emotional functioning (REF) and mental health (MH).

To assess the functional state of the central nervous system (CNS) an examination was carried out of the bioelectrical activity (BEA) of the brain. A record of the EEG was made on a 'Mitsar' 21-channel electroencephalograph in a state of calm wakefulness and during empathetic contact. Electrodes were placed according to the 10x20 international scheme. Assessment of the bioelectrical activity was performed visually according to the I.A. Svyatogor (2001) classification and using mathematical analysis.

Statistical processing of the data obtained was carried out using the STATISTICA v 5.5 computer program for non-parametric parameters. At the same time, the Wilkinson (T) and Mann-Whitney (U) criteria were used, and also the Fisher precision method for a fourfold table (V.S. Genes, 1967).

Research procedure

The research was conducted in three stages. At the first stage in the beginning of the course of psychotherapeutic treatment acquaintance was made with the patient's problem, his life and medical history, and psychodiagnostics performed. Also analysed was the patient's environment with the purpose of recording possible genetically conditioned illnesses. In this case, if the obtention of information was difficult, for example, due to age or the patient's state of health, conversations were held with his relatives and available records from clinics or hospitals studied.

Also conducted at this stage was psychological testing of patients with SFD with the aim of discovering the level of anxiety, quality of life, and presence of pain symptoms. Apart from this, the functional condition of the central nervous system (CNS) was studied, assessed according to background and reactive patterns of brain BEA according to the classification developed by I.A. Svyatogor (2000; 2004), and also according to the spectra of power, amplitudes, and indexes of the main EEG components (delta, theta, alpha and beta ranges).

Studied at the second stage in the psychotherapy process were the color images occurring when concentrating attention on pain. At the second stage in the psychotherapy process empatho-techniques were used to remove pain symptoms in patients with somatoform disorders. With a decrease in the intensity of pain changes were noted in the color images. All information obtained was recorded in the research reports.

At the third stage at the end of the course a second study was carried out of the psychophysiological characteristics of the patients under examination.

The number of sessions was determined by the nature of the change in psychophysiological measures, decrease in complaints, and improvement in wellbeing. The whole course of psychotherapy was performed in a period from one to two months with 1-2 sessions conducted per week, which corresponded on average to 12 sessions each with a duration of 45 minutes.

Results and discussion

At the beginning of the course patients with SFD had an average pain measure on the 'Pain' scale significantly (p < 0.05) lower (60.5 [+ or -] 9.2) than in the group of healthy subjects (82.15 [+ or -] 8.1) (Diag. 1; Table 1). Patients assessed their pain as having 'moderate' and 'strong' levels of intensity which 'a little' or 'moderately' limited their functioning in society (Diag. 1; Table 1). Distinct from patients with SFD, the healthy subjects on the 'Pain' scale either marked it as completely absent or as 'very weak pain' which related to physical discomfort not having a significant influence on their quality of life (Table 1; Diag. 1).

Moreover, for the patients under study a high TA level was discovered (48.2 [+ or -] 3.3), which significantly (p < 0,05) distinguished them in comparison with the healthy subjects (35,67 [+ or -] 1,9) and a moderate SA level--32.5 [+ or -] 3.1 (the lower SA level for healthy subjects was 22.4 [+ or -] 1,8) (Diag. 2).

An increased level of anxiety for patients with SFD against a background of expressed pain symptoms was accompanied by a low level of role functioning. So in comparison with the healthy subjects, patients with SFD had significantly lower (p < 0.001) values for role physical (48.5 [+ or -] 11.7) and emotional (50.1 [+ or -] 11.1) functioning, general health (58.3 [+ or -] 5.0) and vitality (47.9 [+ or -] 6.4). It can be assumed that the obtained deviations from normal values are a consequence of the patients' psychophysiological state which is characterised by sleep disruption, increased sensitivity, and the presence of pain symptoms and strong emotional stress that had a significant influence on physical functioning (83.8 [+ or -] 6.0), mental health (53.3 [+ or -] 6.8) and social functioning (73.4 [+ or -] 8.5) (Diag. 1; Table 1).

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Thus, patients with SFD assessed their quality of life significantly lower than healthy subjects.

Anamnestic data from survey patients showed the presence of such personal traits as extreme affect resistance, tendency to fears, suspiciousness, anxiety, continually increased background mood in combination with a hunger for work, high activity, optimism and conflict in some, and sensitivity to offence, suspicion and vulnerability in others. At the same time, characteristic for them was the withdrawal from conflicts and tendency to social deprivation which was reflected in low measures on the 'social functioning' scale.

Anamnestic data and results of psychological tests allow the assumption that the characteristics discovered are not only the consequence of illness but also of the personal traits of patients with SFD.

During the use of empatho-techniques based on synaesthesia mechanisms, the character of the psychogenic pain's color reflection was studied in patients with SFD. Fifty seven sample observations were conducted during which a link was established between color images and psychogenic pain. At the same time, both 'pure' chromatic ('l', 'm', and 's') and 'pure' achromatic (from light-grey to black--'a') colors were detected, as also were combinations of these colors ('mixed' color images 'als', 'alm', 'lm', 'ls', etc).

For this 57 sample observations were conducted during which an interrelationship was established between color images and psychogenic pain. At the same time, both 'pure' chromatic colors were detected ('l', 'm' and 's') and 'pure' achromatic (from white to black- 'a'), and also all possible combinations of these colors ('mixed' color images 'als', 'alm', 'lm', 'ls', etc.). In all, 15 variations of color images were identified. In all, 15 variants of color images were identified: variant 'a' was observed in 6 cases, 'l' in five cases, 1 case of variant 'm', 5-'s', 6-'al', 2-'am', 4 'as', 1-'lm', 5-'ls', 6-'alm', 3-'ams', 1-'lsm', 3 'lsam', and 3 'ms'. However, according to Fisher's Precision Method (FPM) at the beginning of the course where there were pain symptoms there were only 7-'a', l, s, al, ls, alm, als (Table 2)--significantly (p < 0.05) appearing color images. So for patients with SFD psychogenic pain was reflected in the following manner: red, orange, yellow (longwave part of the spectrum part of the spectrum), blue and violet (shortwave part of the spectrum), various shades from black to white (achromatic colors), combinations of red, orange and yellow with blue and violet (mixed colors in the longwave and shortwave parts of the spectrum), red, orange and yellow in combination with green and black-and-white (mixed colors in the longwave and shortwave parts of the spectrum and achromatic colors). From Table 2 it is clear that colors in the mediumwave part of the spectrum (green--'m') were not characteristic for patients SFD where there was psychogenic pain (Table 2).

When concentrating on color images reflecting psychogenic pain their transformation was noted, which was accompanied by a reduction in the intensity of the pain right up to its complete disappearance. In conditions of no pain in all 10 color images variants were noted: 22-'a', 3-'l', 5-'m', 12-'s', 1-'al', 3-'am', 3-'as', 2 'lm', 3-'ls', 3-'ms'.

During psychotherapeutic treatment a reduction was noted in pain symptoms up to their complete disappearance which was accompanied by a transformation of color images. Where there was a significant lack of psychogenic pain (p < 0.05) there were only three variants of color images (achromatic, mediumwave and shortwave colors) (Table 2). Longwave colors were not detected either in pure form or in combination with other colors (Table 2).

Thus, the results obtained illustrated the interrelationship of color images with psychogenic pain which, as a rule, is accompanied by negative emotions (anxiety, irritation, etc.). It may be assumed that by influencing the transformation of color images and changing them in the optimal direction it is possible to reduce psychoemotional tension and optimise the psychophysiological state of patients.

Distinct from patients with SFD, healthy subjects experiencing physical discomfort (30 sample observations) there were noted (p < 0.05) only two variants of color images--'a' and 'as' (achromatic--from black to white and a combination of achromatic with shortwave--from black to white with blue and violet colors). Where there was no physical discomfort, 'pure' achromatic and shortwave colors were noted, and also mixed--mediumwave with shortwave (green with blue and violet colors) (Table 3).

When studying brain BEA it transpired that 12% did not exhibit deviations, 46% registered a reduction in the intensity of alpha and a strengthening of the intensity of pathological theta and beta components, and for 42% the absence of an alpha-component and the domination of a desynchronised EEG was noted.

At the end of the course of psychotherapeutic treatment the psychophysiological state of patients had improved. So, for patients with SFD the intensity of pain symptoms significantly declined, which was reliably confirmed (p <0.001) by an improvement in the 'Pain' scale measure (80.4 [+ or -] 7.2) which approached the value for healthy subjects (82.15 [+ or -] 8.1) (Fig. 1; Tables 1 and 4). There was also a significant (p < 0.001) reduction in the level of TA and SA (Fig. 2).

The improvement in the psychophysiological state of patients with SFD was reflected in the measures for their quality of life. The average value of the measures for all scales of the QL questionnaire at the end of the course had significantly improved (p < 0,001) in comparison with the initial values and approached the measures for healthy subjects (Fig. 1; Table 1 and 4). Also, there were no significant differences noted for the TA and SA measures which may bear testimony to the restoration of the psychophysiological state of patients in this group and in connection with this an improvement in role functioning.

A significant improvement in psychological measures during psychotherapeutic treatment not always coincided with the normalisation of EEG patterns. Thus, with initial normal measures for BEA (12%) no changes were discovered. For subjects with moderate BEA deviations, in 73% there was noted a significant (p <0.05) increase in the intensity of the alpha-component against the background of a reduction in the intensity of theta- and beta-components, at the same time as for subjects with a desynchronised EEG the increase in intensity of the alpha-component was only noted in 40% of those studied. These data illustrated that despite the significant improvement in the psychological status of patients with SFD, normalisation of the functional state of the CNS according to brain BEA parameters was only observed in 73% and 40% of subjects with an initially changed FS CNS, and FS CNS was not changed where there were initial normal corticosubcortical interrelationships.

Thus it can be assumed that the psychotherapeutic effect mechanism is based on the synaesthetic link between spontaneously transforming color images and pain during psychotherapeutic treatment. According to direction of the transformation it is possible preliminarily to assess the degree of influence of negative factors on the psyche of the subject, his reaction to the experienced state, and attitude to his condition. At the same time, a positive transformation may be observed which represents a process of change in color images in the optimal direction (colors in the longwave part of the spectrum reflecting pain and anxiety transform into colors in the medium- and shortwave parts of the spectrum and achromatic ones). The transformation process of color images is associated with the formation of patients' ability for self-regulation, which is accompanied by a reduction in psychoemotional tension and the disappearance of a feeling of discomfort at the somatic and emotional levels.

Conclusions

1. The psychological state of patients with somatoform disorders, by which we understand in the present study the levels of state and trait anxiety, and the intensity of psychogenic pain and variants of color reflection corresponding to it, significantly differ from those in healthy subjects.

2. Measures of bioelectrical activity for patients with SFD in 88% of cases differed from normal values.

3. Discovered deviations in the psychophysiological state of patients with SFD coincided with a low level of quality of life.

4. The psychotherapeutic treatment (empatho-techniques) method we used led to a reliable improvement in the psychological measures being studied.

5. Results of electrophysiological study showed that despite a significant improvement in the psychological status of patients with SFD, normalisation of the functional state of the CNS according to electroencephalography parameters was only observed in 73% of subjects with moderate changes in brain BEA and in 40% of subjects with expressed changes in brain BEA, and did not change where there were initially normal corticosubcortical interrelationships.

6. For the first time data was obtained bearing testimony to color reflection of psychogenic pain in patients with SFD and where there was physical discomfort in healthy subjects. Results of research in healthy people are presented for comparison with the data of patients with SFD on page 11 and in Table 3 and Diagrams 1 and 2. Seven variants of color reflection were reliably identified where there were pain symptoms inpatients with SFD. In contradistinction to this, only two variants of color reflection were identified in healthy subjects, corresponding to physical discomfort.

7. The psychotherapy course conducted led to a significant improvement in all psychophysiological measures and quality of life.

8. The results obtained may be used as diagnostic and prognostic criteria when studying the psychophysiological state and as a control measure of the effectiveness of psychotherapy.

Received April 4, 2008

Revision received May 12, 2009

Accepted May 22, 2009

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Vera A. Ishinova (1), Irina A. Svyatogor (2) and Tatiana N. Reznikova (3)

(1) Wallenberg Institute of Special Education and Special Psychology

(2) Pavlov Institute of Physiology, Russian Academy of Sciences

(3) Institute of the Human Brain, Russian Academy of Sciences (Russia)

Correspondence concerning this article should be addressed to V.A. Ishinova, Saint Petersburg, 195256, Ul. Butlerova, d. 13, kv. 687 (Russia). E-mail: vaishinova687@yandex.ru
Table 1
Average values of quality of life (QL) measures in scores
for patients (n = 39) with somatoform disorders before and
after psychotherapeutic treatment

     QL         Mean value       Before         After         p<
Questionnaire     (M) and       psycho-        psycho-
   Scales        standard     therapeutic    therapeutic
                 deviation      therapy        therapy
                   (SD)

     PF              M            83.8           94.4
                    SD            6.0            2.8         0.001

     RPF             M            48.5           87.8
                    SD            11.7           6.9         0.001

      P              M            60.5           80.4
                    SD            9.2            7.2         0.001

     GH              M            58.3           72.6
                    SD            5.0            4.7         0.001

      V              M            47.9           69.7
                    SD            6.4            5.8         0.001

     SF              M            73.4           90.4
                    SD            8.5            4.1         0.001

     REF             M            50.1           78.6
                    SD            11.1           9.5         0.001

     MH              M            53.3           75.6
                    SD            6.8            4.4         0.001

p<--level of significance according to Wilkinson criteria;
M--mean value; SD--standard deviation; n--sample size.
PF--physical functioning; RPF--role physical functioning;
P--pain; GH--general health; V--vitality; SF--social
functioning; REF -role emotional functioning; MH--mental
health.

Table 2
Reliable (p<0.05 according to FPM) frequency of occurrence
of color patterns in % of patients with SFD where there is
psychogenic pain and where it is absent (n = 57)

                        Reliable occurrence
Variants of            of variants of color
color                    reflection where
reflection               pain is present

                    %      Mean        SD
                          error %
                         ([+ or -])

Achromatic (a)      10       4        4-22
Longwave (l)        9        4        3-10
Mediumwave (m)      --       --        --
Shortwave (s)       9        4        3-10
Achromatic +
  longwave (al)     10       4        4-22
Longwave +
  shortwave (ls)    9        4        3-10
Achromatic +
  longwave +
  shortwave (als)   10       4        4-22
Achromatic +
  longwave +
  mediumwave
 (alm)
Achromatic +
  longwave +
  mediumwave
  (alm)             10       4        4-22

                        Reliable occurrence
Variants of             of variants of color
color                    reflection where
reflection                 pain is absent

                    %      Mean        SD
                          error %
                         ([+ or -])

Achromatic (a)      38       6        27-53
Longwave (l)        --       --        --
Mediumwave (m)      9        4         3-10
Shortwave (s)       21       5        11-34
Achromatic +
  longwave (al)     --       --        --
Longwave +
  shortwave (ls)    --       --        --
Achromatic +
  longwave +
  shortwave (als)   --       --        --
Achromatic +
  longwave +
  mediumwave
 (alm)
Achromatic +
  longwave +
  mediumwave
  (alm)             --       --        --

%--number of observations of the given color from the total
number of observations; [+ or -]--mean error; SD (standard
deviation)--indicates in which limits it is possible to
expect reliable occurrence of the said attribute.

Table 3
Reliable (p<0.05 according to FPM) frequency of occurrence
of color patterns in % of healthy subjects with physical
discomfort and where it is absent (n = 30)

                           Reliable occurrence
                           of variants of color
Variants                        reflection
of color                      where pain is
reflection                        present

                                Mean
                               error
                     %      % ([degrees])      SD
                     e
Achromatic (a)      33            9           17-53
Longwave (l)        --           --            --
Shortwave (s)       --           --            --
Mediumwave +
  shortwave (ms)    --           --            --
Achromatic +
  shortwave (as)    20            7           8-39

                   Reliable occurrence
                   of variants of
Variants           color reflection
of color           where pain is absent
reflection
                                Mean
                                error
                     %      % ([degrees])      SD

Achromatic (a)      30            9          15-49
Longwave (l)        --            -            -
Shortwave (s)       27            8          12-46
Mediumwave +
  shortwave (ms)    17            7           6-35
Achromatic +
  shortwave (as)    --            -            -

%--number of observations of the given color from the total
number of observations; [+ or -]--mean error; SD (standard
deviation) indicates in which limits it is possible to
expect reliable occurrence of the said attribute.

Table 4
Average values of measures of quality of life (QL) scales in
scores for patients with somatoform disorders after
psychotherapeutic treatment and for healthy subjects

                                             Groups studied

QL              Mean value (M)     Patients with     Healthy
Questionnaire    and standard       SFD (after       subjects
Scales          deviation (SD)   psychotherapeutic
                                    treatment)

PF                    M                94.4            94.8
                      SD                2.8            2.9

RPF                   M                87.8            85.6
                      SD                6.9            8.8

P                     M                80.6            82.2
                      SD                7.0            8.1

GH                    M                72.6            72.4
                      SD                4.7            5.1

V                     M                69.7            71.3
                      SD                5.8            6.3

SF                    M                90.4            88.7
                      SD                4.1            5.7

REF                   M                78.6            79.5
                      SD                9.5            10.8

MH                    M                75.6            73.6
                      SD                4.4            5.1

Reliability determined by Mann-Whitney criteria (U) was not
discovered. M--mean value; SD--standard deviation;
n--sample size. PF--physical functioning; RPF--role physical
functioning; P--pain; GH--general health; V--vitality;
SF--social functioning; REF -role emotional functioning;
MH--mental health.
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Author:Ishinova, Vera A.; Svyatogor, Irina A.; Reznikova, Tatiana N.
Publication:Spanish Journal of Psychology
Article Type:Report
Date:Nov 1, 2009
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