Riga Stradins University Inara Roja USE OF COGNITIVE HYPNODRAMA IN MEDICAL HYPNOTHERAPY AND ITS CLINICAL ASPECTS Summary Riga - 2006 PREAMBLE In nowadays Europe and all over the world due to distress, psychotraumas and communication disorders the number of patients of giving-age having cognitive and psychosomatic health disorders rapidly increases - at the present moment there are 450 millions people suffering from psychic and neurological health disorders and behavioral disorders accordingly World Health Organization (WHO) data. In one of four families one of the family members has some mental problems. Analysis presented by the Health Statistics Department of the Ministry of Health of the Republic of Latvia shows that the implementation of the WHO in Latvia goes on very slowly and is not being implemented in full; and this is a very alarming indication. In accordance with the information received from the State Mental Health Agency only in 2005 the number of patients with neurotic and stress related disorders has increased for 14 per cent, but the number of patients having mood or affective disorders has increased for 2,5 per cent. Also behavioral and emotional disorders of children and adolescents have not decreased yet. Latvia still assumes one of the top positions concerning number of suicides and this is also a very alarming indication of epidemiological situation of mental and behavioral disorders in the republic. Many people don't recognize their mental and somatic health problems, many others - don't try solving their problems due to the lack of financial means, for the state doesn't provide any financial help what regards psychotherapeutic treatment. In 2006 during the scientific conference organized by the Riga Stradins University (RSU) the dominating psychic health risk factors with the inhabitants of Latvia were accentuated. Among them there are problems in people's personal relationships, consequences of having experienced emotional and physical violence, inner tension. These risk factors surround people in their work and family environment. To solve their problems people keep chronically using medicaments, alcohol, and drugs and become addicted. Following the WHO's recommendations, the Ministry of Welfare of the Republic of Latvia has worked out a draft of basic positions "Improvement of Inhabitants' Mental Health for 2006- 2010", This draft accentuates the necessity to change from stationary care to society based care, psychosomatic health promotion, prophylaxis of mental diseases and behavioral disorders, social rehabilitation of patients. In the treatment of neurotic diseases in Europe and all over the world the short term therapy, focused on mental and psychosomatic health problems of the patient, recently is being used more and more often. Medical hypnotherapy, especially cognitive hypnotherapy, is one of the options of such short term therapy. In last years cognitive hypnodrama is considered to be an effective treatment. This method allows changing in a healthy way patient's negative thinking, behavior and emotional reacting stereotypes, to decrease distress and to improve the quality of patient's life. This method has already gained international recognition. This fact is confirmed by the positive assessment of the French Hypnotherapists Association/Institute in Paris. Actuality of the Research. No scientific research works on promotion of mental and psychosomatic health in integrative medicine involving physicians - neurologists, psychiatrists, hypnotherapists, have been summarized in Latvia this far. In Latvia, unlike other European countries, there are neither a Law on Mental and Psychosomatic Health Care worked out this far. nor any Cabinet's Regulations regarding this field. This actualizes the question regarding possibilities to use the effective modern medical hypnotherapy in the treatment of patients, appliance of the research methods in such treatment and analysis of thus acquired data. Research done in this field will: o Help to monitor and to improve at the national level mental and psychosomatic health care as a part of integrated health care, including in it short-term medical hypnotherapy; o Be a significant contribution to the perfection of preventive and rehabilitation measures in this field; o Allow primary care professionals, neurologists, psychiatrists and other medicine professionals to widen their therapeutic possibilities and to help patients, when biological treatment methods are counter-indicated or are ineffective or a patient refuses to be treated with these methods. Aim and Tasks of the Research. The aim of the research is to explore possibilities to use medical hypnotherapy - cognitive hypnodrama and its efficiency in modern medicine in Latvia for both female and male blue- and white-collar workers of different age having neurotic and psychosomatic health problems, as well as to solve these problems working with individual patients, group of patients, couples, and families. For this purpose following tasks were set: 1. To assess evolution, modifications and meaning of medical hypnotherapy. 2. To choose appropriate subjective (qualitative) and objective (quantitative) methods to ensure the examining of the changes occurring in the body of the patients involved in the medical hypnotherapy in a healthy way. 3. To assess the quality of patient's life using appropriate scales, questionnaires, journals a.o. data acquiring information on hypnotic susceptibility of different patients, on their psychotraumatic influence, pain and depression manifestations, and categories of sexual dysfunctions. 4. To use cognitive hypnodrama during medical hypnotherapy seances/sessions simultaneously monitoring the activity of patient's brain, heart rate, stress and muscle tonus during hypnotherapeutic process. 5. To give recommendations and to advise some time-effective measures in the field of mental and psychosomatic health. Novelty of the Research. It is the first time the evolution of medical hypnotherapy and its meaning in the context of the WHO are being evaluated in Latvia. It is also the first time the usage of short-term medical hypnotherapy - cognitive hypnodrama - in the treatment of both female and male blue- and white-collar workers of different age having neurotic and somatoform health disturbances is being studied both in Latvia and in the world. It is the first time in Latvia when qualitative and quantitative methods, related to determination of different patients' hypnotic susceptibility, psychotraumatic influence, pain and depression manifestations, and categories of sexual dysfunctions, are being used in a scientific research work concerning usage of medical hypnotherapy in medicine. It is the first time in Latvia when clinical research methods are being used to prove functional changes in the patient's body during cognitive hypnodrama session, using for this purpose electroencephalography to control brain activity, heart rate, stress level (according to electro-conductivity of the skin) and determination of muscle tonus (according to frequency and hardness parameters) to prove the effectiveness of hypnotherapy. Hypotheses: Hypothesis 1: hypnotic susceptibility is important in medical hypnotherapy. Hypothesis 2: during medical cognitive hypnodrama the indices of subjective and objective, and experimental examination methods change. Hypothesis 3: in the assessment of patient's life quality during the process of medical cognitive hypnodrama the usage of appropriate scales, tests, questionnaires and journals is important. Hypothesis 4: medical cognitive hypnodrama is a modern effective short-term therapy in the treatment of both female and male patients of different age having mental and psychosomatic health problems. Work Basis and Activities: 1. Medical cognitive hypnodrama sessions in the treatment of neurotic and somatoform health disturbances were carried out for the time period of 7 years (from 1999 till 2006) in the Outpatient Department of the Riga lst Hospital. In total there were 1221 patients willing to receive hypnotherapy treatment. Medical hypnotherapy-cognitive hypnodrama was used for 1102 patients (925 male and female adults aged between 18 and 65 and more years, 177 children and adolescents and the young less than 18 years old). 2. According to diagnosis they were: patients having neurotic, stress-related and somatoform disorders, sexual dysfunction; adults having some personality and behavioral disorders; patients with behavioral and emotional disorders having started in their childhood; patients addicted to psychoactive substances (medicaments, alcohol, nicotine, drugs); patients in their rehabilitation period after having suffered from cerebral blood circulation disorders; patients having depressive reactions after surgeries; disabled persons having neurotic reactions after experienced head and back injuries; patients after x-ray and chemical therapy received due to some oncologic affections; patient in palliative care. 3. From 925 patients 370 were chosen which had refused taking medicaments and agreed to the medical hypnotherapy session parallel with carrying out clinical research. In most case these were patients having different pains of psychogenic origin, manifestations of mild or moderate alert and depression, posttraumatic stress syndrome, psychogenic sexual dysfunction. Practical Application of the Research. Being aware of the unfavorable epidemiologic situation in Latvia regarding mental, psychosomatic and behavioral disorders, weak legislation entry, as well as an actual necessity to find efficient means to help such patients, especially in their giving age, it is vital to give primary care professionals, neurologists, psychiatrists and other medicine professionals an opportunity to widen their therapeutic possibilities acquiring and including in the short term-treatment the hypnotherapy modality - cognitive hypnodrama. Structure of the Doctoral Work. The work consists of 26 chapters: preamble, 9 literature review chapters; 5 methodology chapters; 6 chapters describing the course of the research and results; conclusions; practical recommendations; list of literature sources; printed works on the research theme; summary; annexes. Volume of the work - 159 pages, 3 annexes on 12 pages. 62 images and 4 tables are given to make the compiled and analyzed information more demonstrative, 203 literature sources are quoted in the work. On the theme of this doctoral work have been published or are submitted for publishing: 20 works in scientific magazines and collected articles, including internationally quotable ones; 40 works - in scientifically practical editions; 3 works -in books and brochures. On research results it has been reported in 18 conferences, including 11 international. In the first part of the work, basing on literature sources, theoretical aspects of the research are described: Mental and psychosomatic health as a part of society health; importance of medical hypnotherapy for multimodal integrative therapy; process of medical hypnotherapy; history of medical hypnotherapy; essence of hypnosis; modifications of medical hypnotherapy and structure of hypnotherapy séance/session; meaning of brain in hypnotherapy; clinical (experimental) verification of medical hypnotherapy; hypnotic induction and hypnotic susceptibility. In the second part of the work research methods are described: questionnaire and interviews of patients; methods to identify hypnotic susceptibility; methods to identify psycho-traumatic influence, pain and depression manifestations; cognitive hypnodrama - therapy/method; experimental methods to identify clinical manifestations during hypnotherapy sessions. In the third part of the work research results are described and analysis is given. Analysis is based on practical experience in using cognitive hypnodrama in the short-term treatment, clinical measurement data of patients having neurotic and psychosomatic health disorders and therapeutic strategy of using cognitive hypnodrama for the patients representing this category. Supervisor: Habilitated Doctor of Medicine Science, Professor Janis Zalkalns Riga Stradins University, Department of Rehabilitation. Research Consultants: Doctor of Medicine Science, Professor Raisa Andrezina, Riga Stradins University Department of Psychiatry and Narcology; Doctor of Medicine Science, Professor Marcel Bertholds, Honorary Member of the Latvian Academy of Science, Ascona Mental Health Center of Switzerland. Process of the Research: The research was worked out in the Outpatient Department of the Riga 1st Hospital in the time period from 1999 till 2006 with following international human rights and standards of physicians' ethics. LITERATURE REVIEW Mental and Psychosomatic Health as an Integral Part of Society's Health. Scientific research of psychosomatic health and unhealthiness began in 19th century, when psychiatrists, neurologists and psychotherapists made some discoveries after they had started to consider the development of human personality and had tried to solve some health problems in a psychodynamic way. Mental and psychosomatic medicine is the branch of medicine dealing with interaction of psychic and somatic processes in a human being, connection between human body and environment, treatment of mental and psychosomatic health disorders. Several conditions are being assessed in mental and psychosomatic medicine: 1) interaction of inherited factors and emotional conflicts; 2) dysfunctional thinking and behavior models. Nowadays mental unhealthiness, psychosomatic diseases, neuroses and behavioral disorders are assessed in accordance with the International Classification of Diseases (ICD-10). In the work with patients are applied mental state assessment, pain and depression tests, neuropsychological, neurophysiologic tests a. o. Hypnotherapy is a special communication between the hypnotherapist and an individual or a couple, or a group of patients, another time - among two hypnotherapists and an individual or a group. Nowadays in the treatment of neurotic and psychosomatic patients, especially in their giving age, short-term therapy methods are applied more and more often. For this reason in the treatment and care of the patients a short-term therapy modality - medical hypnotherapy is included. In Latvia this work can do by physician-hypnotherapist (Cabinet's Regulations in 2005 approved the speciality - hypnotherapist). Meaning of Medical Hypnotherapy in Multimodal Integrative Therapy. In the Encyclopedia of Psychiatry issued in 1995 in the USA psychic and somatic recovery of the patient during hypnotherapeutic sessions is described. Medical hypnotherapy is a highly specialized therapy and at the same times also a diagnostic, scientific method to explore and to treat psychic and somatic disorders of a human being. Authors of modern multimodal integrative therapy call hypnotherapy process a psychodynamic dialog, verbal and non-verbal communication between a hypnotherapist and a neurotic, psychosomatic patient. Unlike other medicine disciplines in the hypnotherapeutic process important is a connection between the illness of human body and this person's personality traits and manifestations of person's emotions. Every hypnotherapeutic communication has a goal: to solve patient's conflict, to prevent functionaries disorders of the patient, to make this functionaries effective. During therapeutic process a work alliance is created between the hypnotherapist and the patient. Emphatic interfaces, maintenance of confidentiality are necessary. During the medical hypnotherapy session there are actually created such circumstances in which the information can freely move through the patient's body using different ways between patient's psyche and body. The aim is to process this information in a healthy way and thus a positive result could be achieved. During every hypnotherapy séance the information works in the patient's brain at the level of bio-currents, hormones and many other levels, among which there are no strict delimitations. Both during traditional - classic and new - medical hypnotherapy, during self-hypnosis, autogenously training the individual shows his/her readiness to make some experiments with healthy possibilities opening before him/her, and at the same time the individual maintains also personal assessment of the life. During the hypnotherapy person's negative attitude and reacting structure are being altered and his/her unhealthy reaction stereotypes are deleted. Medical hypnotherapy helps changing the mode of individual's behavior, social communication. Cognitive judgments are changed (Weitzenhoffer, 1982). Shortly about evolution of Medical Hypnotherapy. Foundations of medical hypnotherapy as a science were laid in 1843 by experiments of the Scotch surgeon James Braid, who started using the term hypnosis and pointed out that this is a normal, natural bodily state of a human being (Braid, 1843). In this time also his book "Neurohypnology" was published. At the beginning of the 19th century already several hypnologists' schools were founded, there were established also several famous neurology and psychiatry clinics, laboratories, where medical hypnotherapy was practiced. In Paris Salpetriere Hospital the famous neuropathologist Jean-Martin Charcot (Charcot, 1882) found out, when treating his patients, that there exist three significant states of medical hypnosis: catalepsy, lethargy and somnambulism. Hospital of the Paris Nancy Faculty of Medicine changes in the physiological reaction of human body during medical hypnotherapy were proved (there changed blood content, peristalsis of the stomach, milk producing, heart rate, sleep processes). The professor of the Nancy Hospital Hippolyte Bernheim (Bernheim, 1891) was the first one in the history of the scientific research of hypnosis to turn the attention to the fact, that the patient can acquire the results of hypnotherapy also being awake or during self-hypnosis. In 1936 the scientist Alfred Lee Loomis (Loomis, 1936), when writing down the electroencephalogram (EEG) of the patient first in the state of active hypnosis and then - in a natural sleep, proved that bioelectric activity of the brain during the trance corresponds to the state of wakefulness and not to the state of sleep. The neurologist of Jena Johannes Heinrich Schultz (Schultz, 1932) discovered that the manifestations of hypnotherapy are self-hypnosis and autogenously training (AT). In 1958, thanks to the science and praxis of the psychiatrist and hypnotherapist Milton Erickson, the Commission of the American Medical Association passed a resolution, in accordance with which: medical hypnotherapy may be practiced only by a person having a physician's education; hypnotherapy is one of the treatment and scientific research methods of a practitioner; a prospective hypnotherapist requires knowledge of psychiatry, neurology and medical psychology. Milton Erickson started a new hypnotherapy era (Erickson, 1979). Today his work is continued in America by Ernest Rossi, Michael Nash a. o. (Nash, 1979). In today's France already for many years in the field of psychodynamic and psychoanalytic hypnotherapy there have been working Jean Becchio, Charles Joussellin, Lelongue a. o. (Becchio, 1994). In England there continues to develop the cognitive hypnotherapy of E. Thomas Dowd (Dowd, 1997) and clinical hypnotherapy of John Hartland (Hartland, 1996). In Russia there work such world-famous medical hypnotherapy professionals as Grimak, Krol and Kandiba jomā (Гримак, Кроль, Кандыба, 2000). In Latvia since 1963, just the same as in other countries, the first physicians having started to research and to use medical hypnotherapy in their work in hospitals, where neurologists, psychiatrists, surgeons and oncologists. In the 1970ties the Nervous and Psychic Diseases Department of the Riga Medical Institute started to train under the leadership of the professor A. Penciks and the assistant professor S. Lisica prospective neurologists and psychiatrists teaching them practical appliance of hypnotherapy in hospitals (Roja, 2000). At the same time traditional medical hypnotherapy in Latvia started to apply the Head of the rehabilitation club "Panaceja", surgeon and oncologist J. Zalitis (Zālītis, 2001). In 1997 under the leadership of J. Zalitis the Latvia Tranceologic Psychotherepy Association was founded. Medical hypnotherapy in Latvia was used actively in his praxis of clinical surgeon by P. Gerke (Gerke, 1989). Since 1999 under the leadership of the neurologist, hypnotherapist Inara Roja there was developed and has been successfully applied the method of cognitive hypnodrama in the treatment of neurotic and psychosomatic patients. This method bases on the traditions of the new hypnosis of M. Erickson, psychodynamic hypnosis of J. Becchio, cognitive clinical hypnosis of E.T. Dowd and hypnodrama of J. L. Moreno and is approved by the French Hypnotherapists Association/Institute. Under the leadership of J. Zalitis there work the Latvian Tranceologic Psychotherapy Society (LTPS) unifying both medical and non-medical persons. Under the leadership of I. Roja there work only physicians unified under the Society of Physicians Hypnotherapists and Sexologists, Sexopathologists (SPHSS). I. Roja heads also the certification of the physicians-hypnotherapists of both mentioned societies in Latvia. Latvian hypnotherapists have participated with their scientific reports in the World Congress of Latvian Physicians, international conferences, congresses and seminars. Modalities of Medical Hypnotherapy. In the communication with a patient or a group of patients the hypnotherapist uses in a way safe for one's health different techniques in order to gain with a therapeutic design selective attention, psychic and selective relaxation, activation of imagination of the person involved in the hypnotic process. Hypnotherapist performs the deepening of the trance state and brings the patient in and out of the state of trance. There is also self- hypnotherapy possible. Classical Hypnotherapy. Classical hypnotherapy relates the trance state of a person to be hypnotized to narrowing of this person's conscious mind caused by the suggested word or touch of the hypnotherapist made with the intention to fixate the attention of the individual, or to create a transfer from the state of wakefulness to the state of calmness or sleep. During the classical hypnotherapy session the tonus of the cortex is weakened and delayed, while at the same time, when the hypnotherapist addresses the patient, the state of wakefulness occurs in the region of the brain's auditory analyzer. According to the modern model of classical hypnotherapy it is necessary to achieve a complete relaxation of patient's skeletal muscles and the feeling of heaviness and warmth in patient's body. Nowadays classical hypnotherapy is used in the treatment of patients both individually and in group. Hypnotherapist may record his/her suggestion on the audio- or videotape. Classical hypnotherapy is being widely used as an option of medical sleep and harmonic relaxation, for example, when treating patients having alert neurosis. It can be combined with musical therapy, narcohypnosis and hypnotic electrosleep (Volpert, 1972). Erickson's New Hypnotherapy. The new, psychodynamic hypnotherapy of M. Erickson bases, unlike classical, traditional hypnotherapy, on interpersonal multilevel communication between hypnotherapist and his/her patient during a psychodynamic, hypnotic dialogue. In the therapy of Erickson in the patient's psyche there occur dissociation of the conscious and unconscious processes, there manifests plasticity of the space and time. Modern neuroscience call the changes, occurring during Erickson's hypnotherapy, the floating trance: the level or "deepness" of the trance is determined by relationships between processing of information in conscious and unconscious mind of the patient. During light trance in there occur in the patient both conscious and unconscious processing of the information; in the dissociated state of mind during the trance the subject has completely passed to the unconscious processing of the information (Gordon, 1981). Psychodynamic Hypnotherapy of Rossi, Becchio and Joussellin. Scholars and further developers of modern psychodynamic hypnotherapy as E. Rossi (the USA); J. Becchio and Ch. Joussellin (France) accentuate in their scientific research that hypnotherapy is a multimodal process, where the activity of the structures of the psyche (unconsciousness) manifest apart from the conscious mind of the patient (Becchio, 2002; Rossi, 1986). This process is called a dissociated processing of informative material in the human psyche. Every psychiatry seance gives the patient an opportunity to turn his/her negative self-hypnosis into positive self-hypnosis. The method of J. Becchio speaks of the usage of healthy resources of patient's unconscious mind; and joining natural self-influence abilities of the patient. Old-age Regression and Old-age Progression. During the old-age regression the patient returns to his/her early years of life and meets in his/her imagination with the events and experiences of that time, with memories on a traumatic experience repressed in the unconscious mind this far. This is an adaptive hypnotherapy method, a technical method of hetero-hypnotic and self-hypnotic communication (Lynn, 1991). Sublimation Hypnotherapy. Freud accentuated the importance of self-sublimation period in the latent stage of psychosexual development, when there is no distinct activity of sex hormones yet. In 1998 J. Zalitis expanded Freud's sublimation theory introducing in the hypnotherapy upbringing sublimation and supersublimation (Vikmanis, 1998). It has to be noted that during the supersublimation therapy, the patient very often gets into the state of somnambulism or ecstasy (for example, starts screaming, pulls his/her hair and so on), what can make a negative influence on the treatment of, e.g., patients having psychotic manifestations. Self-hypnosis. Self-hypnosis or autohypnosis is a hypnotic state initiated by the subject of himself/herself. Self-hypnosis can be both positive and negative (Benson, 1975). In self-hypnosis, just the same as in hypnotherapy, capacity of human body manifests in harmonic neuromuscular relaxation comprising also autonomous nervous system, perceptions, cognitions, emotions, and psyche. Autogenous Training. Autogenous training (AT) is an activating psychotherapeutic and psycho- preventive method. According to the latest opinions AT is classified as a modification of hypnotherapy, in the framework of which self-hypnosis is used. AT is not only relaxation of muscles: it means deep changes in central nervous system, synchronization of ganglioneural activity. Self-regulation process of the body takes place when AT is practiced. Homeostasis and dynamic balance of the inner environment of the body, which were disturbed due to different stessors, are renewed. AT method consists of basic and higher levels. Classic AT method is the method of Schultz and its modification - Jacobson's progressive relaxation (Jacobson, 1928). In the East AT method has been developed by several schools of yoga which offers different bodily postures and facial expressions for the training, accentuating a direct connection among tonus of muscles, mimics and mood. Hypnotic Imagination. During hypnotherapy it is possible to induce a dream solving patient's problem. This process is called hypnotic imagination (Farr, 1990). The scene offered by the hypnotherapist corresponds to patient's problematic: existential, pacificator, regressive, meditative, affective a. o. Imagination can be initiated: by a word (verbal therapy); by suggestion proposing the patient to remember or to imagine during hypnosis a visual event; by communication with the patient using during the séance the tone of hypnotherapist's voice or music, appropriate sounds and scents. Meditation. When meditating, the person uses imagination as a tool for self-programming. Modern examinations during meditation, using positron emission tomography (PET), show that in this process audile and visual perception zones, kinesthetic and feeling zones in the brain are activated (Lou, 1999). Hypnodrama. Hypnodrama is a modification of group therapy. The method of hypnodrama combines elements of scenic hypnosis and psychodrama. For the first time hypnodrama method was described by Moreno and Enneis in 1950 when they treated neurotic patients with a manifest hypnotic susceptibility (Moreno, 1950). Hypnodrama seance for one patient is usually led by two hypnotherapists. Other patients from the group are spectators sitting in the therapy hall; they watch and simultaneously experience hypnodramatic content. Thus hypnodrama group participants comprehend themselves. After the session hypnodrama is discussed in the group. Cognitive Hypnotherapy. With cognitive hypnotherapy patients with thinking and behavioral disorders are treated. This therapy is based on discoveries made by two Americans - A. Ellis and A. Beck on the subject of the idea that human consciousness is not a passive organ intended to acquire surrounding environment, but (Ellis, 1997) an active constructing organ. During cognitive hypnotherapy patient's negative thoughts are processed, his/her emotional behavior changes. Cognitive hypnotherapy sessions usually last for 4-8 weeks. Couple, Family and Group Hypnotherapy. Hypnotherapy can be used also when treating a couple, a family or a group and trying to solve some psychosomatic health problems and problems in relationships. During this therapeutic process healthy relationships among persons taking part in hypnotic communication are created. Patients sit in chairs or lie on couches. The hypnotherapist uses classic or psychodynamic hypnotherapy method. Dream Hypnotherapy. The method of dream therapy or oneirotherapy was developed basing on th 20 century's neurophysiology discoveries on activity of the brain and psychodynamic changes during the sleep in the phase of dreams, on the meaning of paradox dream phase in ensuring homeostasis of human body. Modern neurovisualization methods state that during an induced hypnotic dream, as well as during a self-induced dream (Crick, 1984). Music and Smell Hypnotherapy. Usage of music and smells in the medical trance has had in the development of mankind psychotherapeutic meaning, stimulating fantasy and creative activity. Music is used in the treatment of mentally ill, neurotic persons, patients with psychogenic pain and sleep disorders. In the medical hypnotherapy music helps to relax. This therapy helps working with the memories related to some songs or dances. Correspondent songs or music can be used in the hypnotherapy to process conflict-situations in the individual or in the couple, or to solve psychosomatic health problems successfully. Automatic Letter in Hypnotherapy. During hypnotherapy automatic letter allows to find out true facts related to psychotrauma experience by the patient: if the person doesn't want to tell or due to psychotraumatic experiences can't verbalize the experienced events, the patient may choose whether to draw the experience or to interpret the developments symbolically. Narcohypnosis. Pharmacological Hypnotherapy. Narcohypnosis is used very seldom nowadays. In the past narcohypnosis was used as a suggestive therapy (narcopsychotherapy) in the treatment of alcoholics and drug addicts. Narcohypnosis allows the patient to relax more quickly. When narcohypnosis is used, the doctor has to study pharmaco-dynamic features of the relevant medicament; one should be very careful with potential overdose of the relevant narcotic preparation: if the dose is too large, the patient may sink into a too deep sleep and not to receive suggestions of the hypnotherapist: this can be proved by the EEG recording when the patient passes from the theta state of trance to the delta state of sleep (Kirsch, 1997). Meaning of the Brain and Central Nervous System (CNS) in the Hypnotherapy. Patient's brain is the leading organ in hypnotherapy. In the hypnotherapy the word said by the hypnotherapist communicates with different brain centers of the patient: audial, visual, kinesthetic, sensual, olfactory, taste a. o. centers and through the nervous system works on the patient's body. Thus in the course of therapy the patient experiences physiological, kinesthetic, emotional, vegetative reactions in the body, patient's behavior and thinking change. Neuroscience studies and discoveries on manifestation of the hypnosis phenomenon in a living organism proved the tight connection and dependency of hypnosis on CNS. Nowadays CNS is evaluated as a neuronal network, in the anatomic systemformations of which there occurs modulation of nerve impulse - code. The person has a chance to go in his thoughts back in time (in the psyche level it occurs in the process of memories, for example: in hypnotherapy during old-age regression). The person has also a possibility to go ahead in time (prognosticating thinking, in hypnotherapy: old age progression). The brain in total is a carrier of memories starting from the smallest units - nerve cells. The latest neuroscience discoveries regarding research of emotions and cognitive processes accentuate (Fromm, 1970): o affects are created in the neurophysiologic substrate of the brain (in the locus ceruleus region), where appropriate chemical substances are produced; they can be corrected using appropriate psychopharmacological preparations as well as using psychodynamic hypnotherapy; o psychotropic medicaments can eliminate the affect, however, they can't correct the content of patient's thoughts, to free the patient from his/her thinking and behavior stereotypes. This can be achieved via medical hypnotherapy. Clinical Research Approval of Medical Hypnotherapy. Nowadays changes in human body during medical hypnotherapy are being studied using different methods. Among leading methods aimed to record psychophysiological processes in the medical hypnotherapy there are electrophysiological and other physical and chemical methods. For example, electric activities of the skin (galvanometry) can be recorded, electrocardiogram can be taken, brain activity can be measured (electroencephalography, magnetic resonance, positron emission tomography), biochemical analysis can be carried out. Electroencephalography. Electroencephalography (EEG) is the leading method, which allows recording precisely physiological processes of the brain, bioelectric activity and in nowadays it is widely used in hypnotherapy (Larry, 2003). Unlike ideas of the scientists of previous years regarding participation of the right hemisphere in negative emotional experiences, modern science proves that during hypnotherapy seance negative emotional events are revived in patient's memory with the involvement of the speech centers of the left hemisphere (DePascalis, 1998). EEG examinations are very important tool of the hypnotherapist, when working with the patients both ambulatory and in the hospital. For the patient, whose EEG recording shows symptoms of brain damages or epileptic paroxysmal activity, hypnotherapy is contraindicated. Magnetoencephalography. Magnetoencephalography (MEG) is a new technology allowing studying a very weak magnetic field during brain activity (Nishiike, 2000). This magnetic field induced by the patient is stated, using a specific supraconductivity quantum interference device. Thus it is possible to determine magnetic activity of individual regions of the brain, similarly as it is when using positron emission tomography, with the only difference that in case of PET radioactivity of the individual regions is being established. Positron Emission Tomography. Positron emission tomography (PET) nowadays is a modern approach of image diagnostics used in the medicine when determining, for example, the initial source of malicious tumors and their localization in the brain, cause of pain etc. In the last years PET is successfully used also to control physiological effects of hypnotherapy. In different brain regions responsible for emotions, realization of thinking and behavior plans, imagination (midbrain, forehead, temple, occipital lobe) of the person being in hypnotic state, when imagination and fantasy are working, there go on active processes (Lou, 1999). Magnetic Resonance. Magnetic resonance (MR) is a branch of radiology where, unlike computer-tomography, x-rays are not used, but it combines the effect of the magnetic field, caused by a large magnet, and radiofrequency waves. MR records physiological changes, attracting them to physiological solution, including, changes of water concentration in cells and neurons. Also this method gives indicates activity of individual brain regions during hypnotherapy (Woodruff, 1994). Heart Rate Monitoring. During hypnotherapy heart rate can change; this, in its turn, influences blood pressure (Lobzin, 1974). When a person goes through negative emotional experiences, the tension of the muscles increases, pathological postures, mimic, gestures are created, and there suffers the activity of the viscera, blood pressure changes. This means that the sensory nerve impulse information keeps due to tensed muscles also emotional centres of nervous system in an increased tension. Electrogastroscopy. During medical hypnotherapy it is possible to measure also physiological functions of the human which, for example, are related to the functioning of the stomach (Lobzin, 1974). For instance, for the patients, suffering from stomach disorders, both medical hypnotherapy and electrogastroscopy (EG) were applied simultaneously; electrogastrogram (EGG) of the stomach were recorded. The EGG acquired during medical hypnotherapy showed a positive influence on the smooth musculature. Stress Monitoring. Physiological changes in the body in stress situations - mental tension, as well as physical muscle tension (for example, when someone sticks or pinches) - can be stated measuring changes of electrochemical reactions occurring in the pores of the skin (Forbes, 1993). It is known that stress stimulates discharge of sweat, thus, measuring electric resistance, relevant changes can be stated. The most often for this purpose devices with sensitive electrodes (sensors) are used. The recording of the signals (sounds which frequency depends on stress level) is analyzed using appropriate computer program. Electromyography and Myotonometry. To state muscle tension and relaxation (relief) electromyography and electromyotonometry methods are used. Recently in medicine the myotonometry method which registers muscle tonus (Vain, 2000) is used. With this method frequency of contractions (Hz) and muscle tension (firmness or hardness) (N/m) are stated. Myotonometry can be used during hypnosis when it is necessary, for example, to control contractions or tension of arm muscles (clenching of one's fist) during the seance. Biochemical Changes of the Body during Hypnotherapy. It has been proved that during hypnosis the temperature of the body changes, the temperature of the skin decreases (electrodermal activity), the tonus of muscles (self-frequency of contraction) decreases as well. This can be stated, using electromyography methods. Hypnosis damps sympathetic nervous system, leading to the decrease of the amount of chemical substances of adrenaline group in medulla, which can be stated analytically (Maiolo, 1969). According to immunochemical research, serotoninergical catecholamines (glutamates, glycines) has a delaying meaning and their concentration increases during the sleep cycle, similarly as it happens when opiate receptors are activated in the brain during hypnosis and neuropeptides are produced (encephalines, endorphines, vasopressin, tachikinines). Adrenocorticotrophic hormone is activated (Sachar, 1964). Hypnotic induction and Hypnotic Susceptibility. Nowadays the several hypnotic susceptibility scales are used: Stanford Hypnotic Susceptibility Scale (SHSS) and Harvard Group Scale (HGS) (Shor, 1962). RESEARCH METHODS There exist several methods that can be used in hypnotherapy. They can be qualitative (they are used in preparing hypnotic seance, in the process - they are based on the inquiry of the patients, self-appraisal of the patients and the objective assessment of the hypnotherapist) and quantitative (objective when using appropriate analytical methods, devices a. o. equipment functional changes of patient's body are stated during hypnotherapy). For this research-work the following methods were applied: 1) Qualitative methods basing on the questionnaires and interviews of the patients, observation and objective assessment of the hypnotherapist: a) questionnaires and interviews of the patients; b) methods of determining of hypnotic susceptibility; c) methods to state the impact of psychotraumas, manifestations of pain, sexual dysfunctions. 2)Cognitive hypnodrama - therapy and method; 3)Quantitative methods used during hypnotherapy: a) brain activity monitoring; b) heart rate monitoring; c) stress monitoring; d) monitoring of the muscle tonus. 1. Questionnaires and Interviews of Patients. Using questionnaires, it is possible to find out the opinion of the patients regarding their own health, symptoms that should be eliminated during hypnotherapy, conformity with physiological and psychological abilities a. o. Thus questionnaires and interviews allow finding out patient's complaints etc. These questionnaires comprise questions regarding: 1) working hours; 2) content of the work; 3) relationships in the work; 4) relationships in the family; 5) necessity to see the doctor or to be treated; 6) psychotraumas experienced in the family; 7) wishes and aims regarding one's health; 8) effect of psychosocial work and family environment factors. 2. Methods to determine one's Hypnotic Susceptibility. In the work there were used: Stanford Hypnotic Susceptibility Scale (answers within 13 points system on the subject of manifestations before and during hypnotherapy; manifestations after hypnotherapy); Harvard Hypnotic Susceptibility Scale (answers within 25 points system on the subject of the deepness of trance and hypnoidal state; insusceptibility; hypnoidal state; light trance; medium trance; deep trance); Sunnen Trance Scale Scoring Form For Hypnosis, Self- Hypnosis, and Meditation (answers on 13 questions helping to determine hypnotic susceptibility of the patient, as well as abilities to further self-hypnosis or meditation). 3. Methods to determine Effects of Psychotraumas, Pain and Depression Manifestations. In the work there were used: Davidson Psychotrauma Scale (according to this scale there are analyzed: psychotraumatic event and the frequency of the experiences related with this event during the last week; McGill Short-Term Pain Questionnaire (intensity of psychogenic pain is determined); Montgomery-Asberg Depression Rating Scale (evaluated: outer appearance; complaints about sadness; inner tension; sleep disorders; decreased appetite; difficulty to concentrate; apathy; weariness; inability to feel; pessimistic thoughts; thoughts of suicide). 4. Cognitive Hypnodrama - Therapy/Method. This therapy bases on the new hypnosis of M. Erickson, psychodynamic hypnosis of J. Becchio, cognitive clinical hypnosis of E.T. Dowd and hypnodrama of J. L. Moreno and I. Roja's 30 year experience in neurology and medical hypnotherapy. During cognitive hypnodrama: psychodynamic processes are activated aimed to work on different brain activity manifestation levels: psychic, cognitive and behavioral level; changes in one of these levels cause changes also in all other levels; there occur cognitive reconstruction, metaphoric refraining, activation of paradox, humorous and other alternative processes; techniques of behavioral changes are used together with creation of emotional self- expression, self-control; in this process there are used: visualization, active imagination, fantasy, induced dreams, appliance of different stories with the aim to create in the patient ability to experience new quality of thoughts and actions; sensor stimulation, emotional self-revelation, elastic transformation are being facilitated; during post-hypnotic suggestion the vital "Ego" power of the patient is strengthened. Cognitive hypnodrama is a highly structured and systematic medical hypnotherapy modality consisting of several phases: inlro phase - trance phase - hypnodrama phase -final phase - exit- from-trance phase. To be sure of changes in patient's health, in case of necessity, pain, depression and stress scales are used. The acquired results are assessed together with the patient. The patient, according to his/her wishes, keeps diary, draws or displays his/her new self-image in other creative way. 5. Brain Activity Monitoring fEiectroencenhaloeranhv). For the EEG digital device EEG „AELIANCE" (Nicolet, Biomedic, USA) is used. In this work EEG is used with the aim to establish brain activity during hypnodrama session, as well as to determine the relevant brain regions, which activity occurs due to social events (during dominating emotions, aggressions, pain, positive and negative experiences). EEG is used also to exclude from further therapy the patients, whose EEG recordings show brain damage symptoms or epileptic paroxysmal activity. 6. Heart Rate Monitoring. Heart rate monitoring (HRM) was performed using the device Polar S810i Heart Rate Monitor, consisting of a belt with a sensitive sensor and monitor. With the help of the sensor heart rate is stated (beats/min). The monitor, which is constructed as a clock-computer with radio frequency diapason, performs input and processing of the data. For the processing of the data a special software Polar is used. 7. Stress Monitoring. Stress monitoring during hypnotherapy sessions was carried out with the device-sensor "Biofeedback" (see Fig.l). With the fingers placed on the electrodes the devices states electric resistance of the skin, which is then transformed into sound signals (the sound frequency changes according to electric resistance). The recording of the signals (sounds with the frequency depending on stress level) is analyzed using appropriate software. Fig.l. Device Calmlink Biofeedback GSR2 intended to measure stress level and diagram of sound frequency showing the stress level during the hypnotherapy. 8. Muscle Tonus Monitoring. To determine the tension and relaxation of the muscles the myotonometer MYOTON-3 was used, see Fig. 2 (Vain, 2000). Myotonometry was used during hypnotherapy when it was necessary to control, for example, contractions (Hz) or tension (N/m) of the patient's arm muscles (clinching the fist) during the seance. Fig. 2. Miotonometer and a computer diagram 9. Statistical Processing of the Data. Results acquired in the framework of the work were input into the computer; they were processed using Excel and statistical data processing software SPSS. 11 according to overall accepted descriptive statistical methods. In the statistical processing of the heart rate monitoring results the reliability of the tests or data was assessed using the Pearson Correlation Coefficient r (if the coefficient lies in the interval between 0,95÷0,99, the reliability is excellent; 0,90÷0,94 - good; 0,80÷0,89 - acceptable; 0,70÷0,79 - bad; 0,60÷0,69 - questionable). Inter-rater reliability was measures, using Cohen's kappa coefficient (k). This coefficient determines relation among experimental data, the number of patients and proportion or a relation, showing the agreement among the participants to experimental data. (Landis, 1997). If the patients quantity exceeded 20 the ANOVA (Analysis of Variance) were used. In this analysis the Fisher criteria F and parameter η2 which take into consideration the uncontrolled factors was used. ACQUIRED RESULTS AND THEIR ANALYSIS Practical Experience in Usage of Cognitive Hypnodrama in the Treatment In the time period of 7 years (1999-2006) medical hypnotherapy (cognitive hypnodrama) was used in the treatment of the patients of the Outpatient department of the Riga 1st Hospital. The possibilities of its usage in the treatment of neurotic and psychosomatic patients, as well as individuals having personality and behavioral disorders, and addicted patients were studied. In total there were 1221 patients willing to receive hypnotherapy treatment. After receiving their anamnesis and having acquainted with objective examination results of these patients - 119 patients were denied to start hypnotherapy due to following reasons: acute coronary blood circulation crises experienced one month ago; oncologic disease with metastases; endogenous depression; generalized epilepsy; schizophrenia. Thus medical hypnotherapy - cognitive hypnodrama - was used for 1102 patients (925 male and female adults aged between 18 and 65 and more years, 177 children and adolescents and the young less than 18 years old). Subdivision of the Patients according to the manifestations of their disease and diagnoses. There were patients: 1)with neurotic, stress related and somatoform disorders (n=258); 2)with behavioral syndromes related to physiological disorders and somatic factors (n=161); 3)with mood (affective) disorders (n=91); 4)personality and behavioral disorders of adults (n=l 17); 5)behavioral, emotional disorders, having started in one's childhood and adolescence (n=177); 6)psychic and behavioral disorders caused due to taking of psychoactive substances (n=59); 7)with phantom pain; after experienced mastectomy, uterine surgeries; after trauma of burning; patients in their rehabilitation period after experienced cerebral blood circulation with paresis; after arm or leg amputation; after head and back traumas; after ray and chemical therapy due to oncologic diseases; palliative care patients; patients in combined therapy (hypnotherapy & medicine); couple, family therapy; sociopath patients (n=239). Hypnotherapy was denied for 101 patients: they were sent to additional examinations in order to particularize diagnosis and to receive therapy by the psychiatrist or general practitioner: they, already during the 3-4 cognitive hypnodrama seance had psychosomatic reactions, spasms, spastic shortness of breath. Hypnotherapy was refused for 13 patients; they were sent to additional examinations in order to particularize diagnosis and to receive therapy by the psychiatrist or pediatrician - neurologist already after the 3-4 cognitive hypnodrama seance. During the therapy they had paroxysms, mixed behavioral and emotional disorders (adventurism with depression/ alert), social functioning disorders increased; 14 male and 17 female adolescents changed their homosexual orientation to heterosexual orientation during cognitive hypnodrama sessions: catamnesis data of these patients in the time period of two years show the maintaining of these health changes. In one year 51 patients were willing to repeat the cognitive hypnodrama course and received an abridged cognitive hypnodrama course (5-7 sessions). 17 patients repeated their cognitive hypnodrama course after two years after having experienced a new psychotrauma. Patients having participated in the medical cognitive hypnodrama session and clinical research. 370 adult patients took part in the clinical research (male and female, aged between 18 to 65 and more years, both blue and white collar workers). The experience gained in these observations and clinical researches showed that cognitive hypnodrama simultaneously is a therapy and the method of analysis and diagnostics. The main results of using cognitive hypnodrama: for 197 patients with neurosis, phobias and manifestations of depressions, posttraumatic stress syndrome, somatoform disorders, neurasthenia and syndrome of weariness during medical cognitive hypnodrama session (first 2 or 4 sessions) there could be observed only physiological reactions caused by emotional stimuli (sweating, high color, breathing rhythm, change of bodily expressions), however, no subjective emotional experience was developed for these patients. For these patients there manifested itself blindness of feeling or alexetimia: the process of the development of the emotional experiences or feelings in the brain was disturbed. Usage of several different scenarios in the framework of cognitive hypnodrama, as well as creation of an opportunity for the patient to develop his/her own, personal, desirable scenarios was considered as an approach to influence these patients’: feeling development centers; emotional experience centers. Catamnesis data after one year proved constant and positive health changes for 111 patients. As the result of dissociation processes in the psyche after 3-4 cognitive hypnodrama séances for 19 patients there manifested: in 3 cases: mania without psychotic symptoms; in 2 cases: mania with psychotic symptoms; in 2 cases: attack of epilepsy with the pass-out; in 1 case - a distinct depression; 3 adult patients having sexual identity disorders informed after the 3-4 cognitive hypnodrama séance/session that now they have a certain inner conviction to undergo operative and hormonal therapy to change their sex in order not to be forced to refuse from their sexual choice and behavior; in 8 cases patients in the 4-5 séance/session had a vocal or kinesthetic twitch. In 3 cases the EEG of the patients, representing this group, displayed focal activity and in subsequent clinical observations/examinations epilepsy was confirmed. In patients, for whom also the EEG recording was done during cognitive hypnodrama sessions in some cases there were activity of the prefrontal region of the left hemisphere was displayed during positive emotions. In other patients in the old-age regression phase, when events involving strong positive or negative emotions were recalled in their memories, the negative emotional experience increased the activity in the prefrontal cortex of the right hemisphere, but in case of positive experiences - in the left hemisphere. Negative experience for 12 patients suffering from stammer or logoneurosis caused an increased activity in the left hemisphere. This is in line with scientific literature data on asymmetric changes of the electric activity of the prefrontal cortex during hypnotherapy using memories of different emotional shades and different involvement of the speech center of the left hemisphere during negative emotional experiences (DePascalis, 1998). The sexual dysfunction of female patients, suffering from psychogenic vaginism, and patients, suffering from the loss of sexual desire, was caused by sexual violence, incest, experienced in their childhood. Due to successful cognitive hypnodrama these women experienced a qualitative sexual intercourse and got free from the influence of the psychotraumatic events. Also men having erectile dysfunction experienced during the hypnodrama session a possibility to construct successful sexual life scenarios in their imagination causing subsequent loss of the sexual dysfunction. According to catamnesis data they continued to experience positive sexual life quality also one year after the conclusion of the treatment course. Patients, for whom biological therapy of taking medicaments was necessary (antidepressants, assuagements, hormones a.o. preparations), the simultaneous use of cognitive hypnodrama allowed decreasing the dose of the medicament and to shorten the biological therapy course. Some results of the practical use of cognitive hypnodrama in the medical hypnotherapy, the so called, combined therapy are displayed in Table 1. Table 1 Comparison of cognitive hypnodrama practical usage (statistical analyze of hypnotherapy results done if patients value increase 20) Most positive results were obtained, when: treating patients with neurotic and somatoform disorders (psychogenic pain, neurasthenia), with neurotic and somatoform disorders (psychogenic pain, neurasthenia); treating patients with behavioural, emotional disorders, having started in one's childhood and adolescence (logoneurosis etc), palliative care patients, patients participated in cognitive hypnodrama couple therapy, patients in combined therapy (hypnotherapy & medicine). It was shown that in some cases medical hypnotherapy have better results than short term psychodynamic psychotherapy. Results are given in Table 2. Table 2 Comparison of gained positive results (effectiveness) in medical hypnotherapy - cognitive hypnodrama (CH) with effectiveness of psychotherapy (according to literature) Effectiveness of medical hypnotherapy - cognitive hypnodrama expressed oneself already during 3 - 6 session, only sometimes the 9-12 session was needed. According literature the positive result of psychotherapy treatment was to see after 8 sessions in 50% cases, after 20 - 26 sessions in 75% cases. Analysis of the Results for the Patients having taken part in the Clinical Research During cognitive hypnodrama (before the therapy and at the conclusion of the therapy) questionnaires, hypnotic susceptibility tests, psychotraumatic influence, pain, depression and sexual dysfunction tests and clinical experiments were applied. They were patients who agreed to medical hypnotherapy together with carrying out of clinical research and had categorically refused from medicamentous therapy. Among them there were patients having: o different localization pain of psychogenic origin, conventional denotation - PS, and affective or mood disorders (light,medium and heavy depression episodes),conventional denotation- D; o sexual dysfunctions of psychogenic origin (for male - erectile disorders, conventional denotation - ED; for female - loss of sexual desire, conventional denotation - STZ); posttraumatic stress syndrome, conventional denotation -PTSS. According to their professional work, patients could be subdivided as follows: male 67 blue collar workers, 123 white collar workers; female: 59 blue collar workers, 121 white collar wokers. Test of Hypnotic Induction and Effectiveness of Hypnotic Susceptibility. At the beginning and conclusion of cognitive hypnodrama seances hypnotic susceptibility of the patients was determined (Stanford, Harvard and Sunnen scales). Simultaneously analysis of psychotraumatic event, pain and depression intensity, erection quality was carried out (Davidson Trauma scale, McGill Short-Term Pain Questionnaire, Montgomery - Asberg Depression Rating Scale, erectile quality test included in the questionnaires for the male patients). The summary of the acquired results are shown in Tables 3 and 4. Table 3 Comparison of hypnotic susceptibility of the patients (male and female) according to Stanford, Harvard and Sunnen scales before medical cognitive hypnotherapy course was started Hypnotic Stanford Scale Harvard Scale Sunnen Scale Susceptibility Male K Fern. K Male K Fern. K Male K Fern. K 0 - immunity 6 0,88 5 0,87 4 0,78 3 - 1 2 - 1 - light trance 59 0.75 60 0,70 55 0,68 51 0,87 58 0,88 57 0,66 II - medium trance 27 0,67 31 0,80 31 0,80 38 0,79 39 0,89 31 0,53 III — distinct trance 7 0,50 2 - 8 0,68 5 0,45 1 - 6 0,70 IV — very distinct 1 - 2 - 2 - 3 - 1 4 - Comparison of hypnotic susceptibility of the patients (male and female) according to Stanford, Harvard and Sunnen scales at the conclusion of the medical cognitive hvpnotherapy course It was stated that hypnotic susceptibility depends on psychological characteristics, thinking and reasoning (cognitions) of the individual, and events occurring in the therapeutic process of cognitive hypnodrama, which transform patient's initial thinking and emotional reactions. During hypnotic susceptibility tests several patients had psychotic reactions and paroxysmal states. For these patients cognitive hypnodrama was not started - they were sent to additional examination in order to particularize their diagnosis. Analysis of Psychotraumatic Effects, Pain and Depression Manifestations, Sexual Dysfunctions. For 112 patients after experienced stress situation in 6 month time the mental and psychosomatic health disorders are developed and objective examination of these patients didn't detect any organic diseases. Percentual division of the patients (male and female), having posttraumatic stress syndrome (PTSS), according to the Davidson Trauma Scale, depending on the structure of the work to perform is displayed in Fig. 3. Fig. 3. Percentual division of the patients (male and female), having posttraumatic stress syndrome (PTSS), according to the Davidson Trauma Scale, depending on the structure of the work to perform. Before and after hypnotherapy course 102 patients (47 male and 55 female) were assessed according to McGill Short-Term Pain Questionnaire. These patients were included in the cognitive hypnotherapy and clinical research group and had had psychogenic pains of different localization and intensity (PS) in their back or head and depression manifestations (D) already for 6 months. Psychosocial pain perception factors were assessed: experience of past pains, somatization, depressiveness, alert and helplessness or belief in controlling powers of pain. Patients with psychogenic pain had also depression, which was assessed according to the Montgomery - Äsberg Depression Rating Scale. Results are shown in Fig. 4. Fig.4. Division of the patients (male and female), having depression manifestations, according to the Montgomery -Asberg Depression Rating Scale before (A) and after (B) hypnotherapy course depending on the structure of the work to perform Characteristic Clinical Manifestations of the Patients during Cognitive Hypnodrama. During clinical research, performing brain activity monitoring (BAM) with electroencephalography (EEG), heart rate monitoring (HRM), stress monitoring (SM) and muscle tonus monitoring (MTM), activities were stated and summary of characteristic manifestations are shown in Table 5. Division of the patients into categories (I-II) according to myotonometry data is displayed in Fig. 5 and 6. Table 5 Statistical data of clinical investigations Fig. 5. Characteristic muscle tonus parameters - frequency of the contractions of the muscle m. flexor carpi radialis (Hz) and hardness/tension (N/m) during hypnodrama episodes for the I category patients (at the conclusion of the session parameters decrease). Fig. 6. Characteristic muscle tonus parameters - frequency of the contractions of the muscle m. flexor carpi radialis (Hz) and hardness/tension (N/m) during hypnodrama episodes for the II category patients (at the conclusion parameters remain actually the same). These images show that the greatest correspondence of the clinical research data during cognitive hypnodrama episodes (connection with definite excitement/stress moments) can be stated in the heart rate (88 %) and stress level (84 %). A lesser correspondence is to observe in the changes of muscle tonus and this was mainly related with the clinching of the fist or moving fingers. These manifestations appeared only for 70% of patients, including those, for who arm levitation was to be observed (35 from 50 individuals having taken part in the clinical research). COGNITIVE HYPNODRAMA SEANCE An Example of Hypnodrama Seance, Characterizing Interaction between the Hypnotherapist and his Patient 1. Patient with phobic alert The patient R. (19 years old) complained about a sudden, spastic alert 3-4 times a week, during which he had strong palpitation of the heart, feeling of having a lump in his throat, headaches, sweating, and inner tension, his hands were shaking when talking with representatives of opposite sex (girls, women), high color, being afraid of inquiring looks of other persons, unsuccessful attempts to develop intimate relationships with a girl he likes. Anamnesis: up to 15 years R. was very active in learning and sports and didn't have any problems to communicate with his contemporaries or adults. When he was 15, R. experienced a psychotrauma - sexual violence from an elder friend. Since then R. started experiencing the aforementioned problems. When talking with his female doctor, he avoided looking in her face, his voice, mimics and posture displayed uniformity. For a month R. had taken anti-alert medicament Xanax, prescribed by his general practitioner, however - spastic states hadn't decreased. R. hadn't had any treatment by neurologist psychiatrist or psychotherapist. The patient didn't want to use medicaments anymore. Following his general practitioners recommendations, he had decided to consult hypnotherapist. Diagnosis: phobic alert (F40), posttraumatic stress syndrome (F43.1). The patient R. was wiling to receive medical hypnotherapy and underwent a 7 session (séance) course. 2. Patient with psychogenic logoneurosis. The patient L. (35 years old), mother of three children, complained about having sudden attacks of stammering with shortness of breath, headaches. Stammering occurs at crowded places, during moments of intimacy with her beloved person. She had never had stammering attacks before; this problem has developed after a psychotrauma experienced in her family. The patient was treated by the psychotherapist, who has prescribed her medicaments, bet she has denied such therapy, for in her adolescence, according to the patient; she had had allergic skin reactions when taking pills. Objective examination was done (EKG, EEG, and CT for the head): examination data didn't show any organic pathology. Diagnosis: Dissociated (conversion) disorders (F40) with hysteric logoneurosis, diffuse emotional experiences. The patient L. was wiling to receive medical hypnotherapy and underwent a 9 session (séance) course. Simultaneously also electroencephalography, heart rate monitoring, stress monitoring and muscle tonus monitoring were done for these patients. The acquired data were compared with the data of control group patients without neurotic and psychosomatic health disorders, for which cognitive hypnodrama sessions were performed and clinical measurements were done. For the patient having phobic alert cognitive hypnodrama course (7 séances (sessions)) was recommended: medical séance - once a week, intended to activate psychic, cognitive and behavioral level of the patient, as well as to achieve cognitive and emotional restructuring. Cognitive and emotional psyche structures related to fears and alerts were changed. The examples of clinical investigations recordings are shown in Figures 7-10 (Explanation: I - Intro phase; 11- Trance phase; III - Hypnodrama phase; IV- Final phase (exit -from-trance phase). 1 -Overture (foreplay); 2- Continuation of the Scenario-Bound Solution; 3 - Self-Revelation; 4 - Strengthening of the Scenario; 5 - Acquiring of Symbols). Fig. 7. Heart rate monitoring of the patient with phobic alert during the 1 st cognitive hypnodrama session acquired by computer software . Fig. 8. Characteristic phases of the EEG recording of the patient with phobic alert during the 1 st cognitive hypnodrama performance/session. Fig. 9. Changes of sound frequency corresponding with electric resistance of the skin of patient's fingers characterizing stress level during the 1st cognitive hypnodrama session (A) and end session (B) for the patient with phobic alert. Fig. 10. Frequency of the contractions (Hz) of the m. flexor carpi radialis characterizing arm muscle tension during the 1st cognitive hypnodrama session (A) and end session (B) for the patient with phobic alert. Physiological measurements data for the control group patient without any neurotic and psychosomatic problems during cognitive hypnodrama Physiological measurement results for the individuals without neurotic and psychosomatic problems during cognitive hypnodrama are displayed in Fig. 11, which shows that during hypnotherapy heart rate and stress level of these patients actually don't change. Fig. 11. Heart rate and stress level (changes of sound frequency) of the individuals without neurotic and psychosomatic problems phobic alert during the cognitive hypnodrama session acquired by computer software. Physiologic measurement data for the patient having psychogenic logoneurosis, which prove changes in the stress level and brain activity during emotional experiences experienced during hypnotherapy Stress level monitoring data demonstrate the connection between the increase of the stress level and negative emotional experiences during the 3r session. During the 9" session the stress level decreases (self-relaxation is already acquired, stammering attacks have disappeared, psycho- traumatizing experiences are processed, the patient has experienced the possibility to model her behavior, the way of reacting, to use the healthy symbols, images of self-revelation and self- hypnosis acquired during hypnodrama in her real life). Also EEG data show that at the conclusion of the course of séances activity of the brain, which is related to negative experiences, has decreased in both brain hemispheres and is not so distinct. EEG data of the patient, having psychogenic logoneurosis, are shown in Image 12. Image 12. EEG activity of the left and right hemisphere of the brain during cognitive hypnodrama session for the patient, having psychogenic logoneurosis. Hypnodrama Strategy in the Treatment of Neuroses and Psychosomatic Diseases Treatment of Neurosis. Treatment strategy bases on the fact that alert, fears and inner tension can't exist inside a human simultaneously with the state of calmness and relaxation. For the patients with fears and alerts during cognitive hypnodrama relaxation with a gradual desensitization of the psychotraumatic event is developed (this approach lets to "delete" the alert); in the old-age regression phase the possibility is created for the patient to meet in his/her imagination with his/her psychotrauma (probably, the scary event), to process it analytically; a positive way of reacting is developed (it has an effect of "conditioned reflex", which hereinafter manifests itself as an automatic self-relaxation). During cognitive hypnotherapy session depression patients experience - with the help of metaphors - active, dynamic developments, during which their "ego" and self-image are strengthened. In combined therapy this can be used together with psychopharmacological means, starting already from the first day of treatment. Treatment of Psychosomatic Manifestations and Behavioral Disorders. In the treatment of patients, having psychogenic pain, patient's feelings must be verbalized; his/her thinking and behavior stereotypes, emotional way of reacting must be changed. When treating a patient with phantom pain, new cognitive and emotional perception images are created (patient has a chance to experience in his/her imagination "the meeting with the amputated arm or leg, to tell it about his/her problems, to say good-buy"). For the patients, having bulimia nervosa or eating disorders, during cognitive hypnodrama unhealthy thinking and reaction stereotypes are changed, using the methods of minimizing and changing of content. For the patients with obsessive compulsive disorders (obsessive thoughts or compulsive actions) stories are used, in which the patient is confronted with the psychotraumatic event, but in this case the patient plays the role of the director and has a task to invent and to apply new ways of reacting and is being emotionally trained to experience humorous, extraordinary situations, for example, the patient sees his/her "nervous washing oh hands" in a witty cartoon or image. For the patient, having paralysis and anesthesia, speech disorders of psychogenic origin, similar methods of cognitive psychodrama are used (in different scenarios patient experiences physical and sensor activity: engages in sports, dances, sings or recites, saves people, takes part in a mythical developments acting as a muscleman with burning hands etc.). For the patients with non-organic sleeplessness (difficulties to fall asleep, early wake-up, excessive sleepiness during the day-time) the image of an "inner clock" is created in the cognitive hypnodrama. In case of patients with sexual choice disorders during cognitive hypnodrama a new scenario to strengthen a healthy sexual choice is created and unhealthy desires are being processed. Treatment of Personality Disorders. These are patients having negative personal experiences and lack of social connections in their anamnesis. For example, a paranoid personality can not forget offences, such a personality is always suspicious etc. This is considered during cognitive hypnodrama and thematic directions are offered for these patents to be able to develop scenarios of the behavior: "to step out and watch as a looker-on". Treatment of Oncologic Patients. Oncologic patients suffer from alert, depressions, frustrating reactions, pain and sleep disorders. They may have manifestations of by-effects of the chemical therapy and ray-therapy (sickness, vomiting, and loss of hair). In the treatment of these patients as an efficient method such cognitive hypnodrama is recognized, during which the patient is offered to control his/her emotions experiencing different scenarios; to co-ordinate the existing health with positive manifestations of his/her power before the illness set in. Treatment of Posttraumatic Stress Syndrome. In this case patients, having a delayed response to psychotraumatizing event, a reoccurring, obsessive revival of the psychotraumatizing event in the memory, dreams, and nightmares are treated. These patients have anhedonia. They avoid situations resembling psychotrauma and at the same time suffer from social isolation. Cognitive hypnodramam offers a chance for these patients: they can meet fearlessly with the scary past events; to experience emotional catharsis; to experience a dream without scary events and nightmares; old-age progression used during cognitive hypnodrama allows these patients to meet with themselves in positive situations of their lives. Treatment of Addictions (nicotine, drugs, alcohol, gambling, computers). During cognitive hypnodrama patient's thinking and action stereotypes are changed; situations are created, in which the patient experiences the feeling of comfort without "alcohol", "steeling ritual" etc.; in the further life the patient practices self-hypnosis, autogenous training, Treatment of Sexual Identity Disorders Caused in one's Childhood, Enuresis, Twitch, Logoneurosis and Hyperkinetic Disorders. For the patients with inorganic enuresis the image of "enuresis alarm" is developed and strengthened during sessions - when this alarm sounds, the patient wakes up and goes to the bathroom to empty his/her urinary bladder. In case of children- patients special therapeutic metaphors and fairytales are used, in which children act as protagonists, may experience possibilities to transform different scary images, to make sure of their courage and heroism. For the patients with psychogenic twitch relaxation and development of calmness, inducing of sleep are being accentuated during cognitive hypnodrama, thus regulating cerebral cortex and subcortex processes. For the patients with twitch, blepharospasm, as a very efficient is considered to be the focused hypnotherapeutic activity. To eliminate manifestations of psychogenic logoneurosis or stammering the patient - with help of imagination scenarios - experiences in the cognitive hypnodrama session fluent speech, successful public appearance a. o. Work with a Couple, Family in the Medical Hypnotherapy. In the work with a couple during cognitive hypnodrama erotic fantasies are induced; the possibility is created to experience those models of one's sexual and family life they haven't dared to develop in their real life; the couple learns to solve and to eliminate the existing problems and conflict situations. Medical Hypnotherapy in Group. Medical hypnotherapy in group is recommended in the work with addiction patients, sociopaths, and patients having sleep disorders. Medical Hypnotherapy for the Individuals in their Rehabilitation Period, after Surgeries. During cognitive hypnotherapy a possibility is created for the patients "to move an immobile arm", "to move freely", "to experience oneself without paralysis", positively influencing recovery period of the patient. Medical Hypnotherapy in Palliative Care (Tanatotherapy). This is a work with patients, having an unfavorable prognosis of the development of their diseases and are informed about this prognosis. During this therapy metaphoric processes are activated, in which images of different seasons, natural landscapes etc. are applied. In the sessions music chosen by the patient can be used. CONCLUSIONS 1. Modality of medical hypnotherapy - cognitive hypnodrama - is an effective modern short-term therapy used both for male and female patients of different age having neurotic and psychosomatic health problems, and it can be applied only by physicians with a special medical hypnotherapy education (advisably - neurologists or psychiatrists). 2. Cognitive hypnodrama helps to change in a healthy way the mode of thinking, behavior and social reaction, to acquire healthy self-impact, int. al autogenously training, as well as to promote the harmonious relations of family. 3. The results of investigation based on statistical analysis of the data prove the stated hypothesis that hypnotic susceptibility tests must be performed for each patient before starting cognitive hypnotherapy course, as well as the necessity of electroencephalography in order to detect patients having paroxysmal states. 4. The necessity to perform patient's examinations, subjective tests of depression, pain manifestation and clinical examinations (electroencephalography, heart rate, stress and muscle tonus monitoring) in order to state the effectiveness of the treatment in hypnotherapeutic process has been proved. 5. Effectiveness of the combined therapy (cognitive hypnodrama and medicaments) for the patient, starting from the first day of treatment, has been proved. Thus it is possible to shorten the course of medicamentous therapy, as well as to cure the patients from chronic medicamentous addiction. PRACTICAL RECOMMENDATIONS 1. To be able to help in the most effective way the patients in their giving age having psychosomatic and mental health problems, the Ministry of Health of the Republic of Latvia should settle the matters regarding inclusion of short-term medical hypnotherapy - cognitive hypnodrama in the list of state-paid medical services. 2. Short-term hypnotherapy should be included in the rehabilitation and palliative care of the patients. 3. Cognitive hypnodrama should be included in the consolidated programs of treatment, research and training with the actual aim - to promote the mental and somatic health care accomplishment at the state level and more qualitative education of new physicians. 4. Primary care physicians, neurologists, psychiatrists, internist and other medical professionals should extend their therapeutic possibilities, acquiring special knowledge of short-time hypnotherapy. 5. Cognitive hypnodrama or autogenously training should be included in the treatment of the patient, if biological treatment methods are contraindicated or the patient disclaims these methods. 6. During cognitive hypnodrama medical course electroencephalography, heart rate and stress monitoring should be performed for the patient in order to exclude from the further hypnotherapy patients having paroxysmal states (epileptic activity etc.) APPROBATION OF THE DOCTORAL WORK Approbation of the doctoral work took place on 3 October 2006 during the joint doctorate session of the Neurology Department and Department of Psychiatry and Narcology at the Geronologic clinical base of the Rehabilitation institute, Riga Stradins University. REPORTS ON RES ARCH RESULTS 1. Rīgas Stradiņa universitātes (RSU) 5. zinātniskā konference. 2006.g. marts: 1)”Augu valsts preparātu, uztura bagātinātāju un pašrelaksācijas paņēmienu pielietošana seksuālo problēmu risināšanā vīriešiem pēc 65 gadu vecuma"; 2) „Effect of using Vardenafil, Andriol testocaps and short - term Psychodynamic Psychotherapy: Hypnosis, self - hypnosis in the combined medical and psychosexual therapy for erectile dysfunction in aging male". 2. Starptautiskā konference „Atstumtība un nedrošība - riski un risinājumi", RSU ESF, Rīga, 2006.g. 5. maijs: „ Stress un psiholoģiskā vardarbība darbā - sabiedrības sociāla un psiholoģiska problēma Latvijā ". 3. 5 th Baltic Congress of neurology. Riga, 2006, June 1-3: „An integrative therapy in case of neurotic depression with alert, sleep disorders and decreased sexual inclination ". 4. 8th Congress of the European Federation of Sexology, June 4-8. 2006, Praque, Czech Republic: „Treatment of aging patients with hypoactive sexual desire usingpsychodynamic hypnosis and medicine ". 5. Starptautiska konference "Psiholoģiska palīdzība bērniem un psihoterapija". Austrumeiropas eksistenciālās psihoterapijas asociācija un Krīzes centrs ģimenēm ar bērniem. Ventspils, 2006, 6.-7. jūlijs: „Pašrelaksācijas metožu psihoterapeitiska pielietošana skolas vecuma bērniem", 6. Latvijas primārās aprūpes ārstu un arodveselības ārstu konference 2006.gada 25. maijā Rīgā: „Kognitīvās hipnodrāmas pielietošana medicīnā ". 7. 8th Congress of the European Societv for Sexual Medicine. Copenhagen, Denmark, 2005, 4-7 December: „Using psychodynamic hypnotherapy and Levitra in male patients ". 8. European association for psychotherapy (EAP) - 13th Congress of psychotherapy. Vilnius, Lithuania, 2005, July 7- 10: „ Use of psychodynamic Hypnosis and antidepressant Pram in the complex treatment of depressive patients. An integrative therapeutic plan in case of depression". 9. 4 th International Baltie Congress on Sport Medicine, 2005, 1l.-12.nov: „ Use of AT in sport - school boys after psychotrauma". 10.4th International Sympozium „Quality in Occupational Health, Tartu, Feb., 2004: „Prevention of occupational psychogenic pain. Training of occupational health in Latvia". 11. Pasaules latviešu ārstu 4.kongress. Rīga, 2001 g. 20-22. jūnijs: 1) „Hipnoze vaginisma ārstēšanā"; 2)"Organisma ceturtais stāvoklis ". 12.Latvijas ārstu neirologu konference Rīgā, 2003.gada decembrī: „Psihodinamiskā hipnoterapija un tās pielietošanas iespējas neiroloģisko slimību ārstēšana". 13.Rīgas Stradiņa universitātes Medicīnas nozares zinātniskā konference 2004.gadā: „Potentation of the efficacy of Levitra by trance ". 14.Teorētiski - praktisks seminārs. Latvijas Zinātņu akadēmijā, 2004.g. 3. decembris: „Psihosociālie un organizatoriskie darba riska faktori. Autogēnais treniņš". 15.Starptautiskā transoloģiskās psihoterapijas konference. Rīgā, 2003. g. 30. maijs: „Psihodinamiskā un analītiskā hipnoterapija XXI gadsimta integratīvajā psihoterapijā ". 16.Starptautiskais hipnozes kongress, Rīga, 2004.gada 4. - 6. jūnijs: „ Psiho dinamiskās hipnoterapijas - kognitīvās hipnodrāmas pielietošana pacientu ārstēšanā ". 17.Ārstu neirologu un psihiatru teorētiski| - praktisks seminārs, Rīga, 1972.g. novembris: „Гипноз в клинике нервных болезней ". 18.Студенческая научная конференция РМИ. Министерство здравохранения Латвийской ССР. Рижский Медицинский институт, 1970: „Гипнотерапия при комплексном лечении больных диенцефалитом в неврологическом стационаре " LIST OF SCIENTIFIC PUBLICATIONS Scientific issues: 1. Roja I., Roja Z. Treatment of aging patients with hypoactive sexual desire using psychodynamic hypnosis and medicine. European Journal of Sexual health, 2006: 15: 81-82, 2. Roja I. Cognitive hypnodrama in case of chronic pain. European Journal of Clinical hypnosis, 2006 (under redaction). 3. Roja I., Zalkalns J. Experience Regarding phitopreparations and fhe use of cognitive hypnodrama for the male patients at the period of involution. The Journal of European Society of Hypnosis in psychotherapy and psychosomatic medicine, 2006 (under redaction). 4. Roja I. An integrative therapy in case of neurotic depression with alert, sleep disorders and decreased sexual inclination. 5 th Baltie Congress of neurology. Riga, June 1-3, 2006: 27-28, 5. Roja I-, Roja Z. Use of psychodynamic Hvpnosis and antidepressant Pram in the complex treatment of depressive patients. An integrative therapeutic plan in case of depression. European Association for Psychotherapy (EAP) -13th Congress of Psychotherapy, Vilnius, Lithuania, July 7, 2005: 25-26. 6. Roja I. Use of AT in sport - school boys after psychotrauma. 4 th International Baltic Congress on Sport Medicine), 11-12 Nov., 2005: 40-41. 7. Roja I., Roja Z. Prevention of oecupationa! psychogenic pain. 4 l International Symposium "Quality in Occupational Health", Tartu, 5-6 Feb., 2004: 30-32. 8. Zalkalns J., Roja I., Šķesters A. Augu valsts preparātu, uztura bagātinātāju un pašrelaksācijas paņēmienu pielietošana seksuālo problēmu risināšanā vīriešiem pēc 65 gadu vecuma. Rīgas Stradiņa universitātes (RSU) 5. zinātniskā konference. 2006. g. 3.03: 28. (Raksts pieņemts publicēšanai RSU Zinātnisko rakstu krājumā). 9. Roja I, Zalitis J., Tula-Rijkure A. Potentation of the efficacy of Levitra by trance. Rīgas Stradiņa universitātes Medicīnas nozares zinātniskā konference, 2004:64-65. 10. Roja I., Šauriņš A., Roja Ţ., Poţarskis A., Rubene D. Levitras un psihodinamiskās hipnozes pielietošana pacientiem ar erektilo disfunkciju kombinētā terapijā. Ţurn.primārās aprūpes ārstiem „Medicine", 2004,4,12 -13. 11.Roja I. Sāpju terapija. Latvijas Sāpju izpētes un ārstēšanas asociācija. Rīga, 2001: 78-84. 12.Vikmanis U., Zālītis P., Purkalne T., Tula-Rijkure A., Roja I. u.c. Bioloģiskās terapijas potencēšana ar hipnozi onkoloģijā. Pasaules latviešu ārstu 4.kongress. Tēţu krājums, Rīga, 2001: 98-99. 13.Roja I., Birzniece L.B., Spote S-, Koļesņikova L., Kreitiņš U., Vaišļa J., Zālītis J. Daţi perversiju cēloņi un to terapijas iespējas transoloģijā. Pašsublimācijas izraisīšana. Transoloģijas almanahs, 2001: 27-29. 14.Roja 1.. Hipnoze vaginisma ārstēšanā. Pasaules latviešu ārstu 4.kongress. Tēţu krājums, Rīga, 2001: 152-153. 15.Tula - Rijkure A., Zālītis P., Dombrovskis A., Ozola V., Tereško B., Kokarēviča A., Bērziņa L., Roja I.. 50 gadu jubileja jaunam uzskatam par transu (hipnozi) Latvijā. Transoloģijas almanahs, Rīga, izd. AJ, 2003: 5-7. 16.Roja L. Psihodinamiskā un analītiskā hipnoze 21.gadsimta integratīvā multimodālā psihoterapijā. Transoloģijas almanahs, Rīga, izd. AJ, 2003:3. 17.Roja L. Vīriešu seksuālā disfunkcija. Transoloģijas almanahs, Rīga, izd. AJ, 2003:56-59. 18.Roja I., Tula - Rijkure A., Kalnietis G., Demenčuka V., Purkalne L.T. Cipraleksa lietošana kompleksā terapijā. Transoloģijas almanahs, Rīga, izd. AJ, 2003:64, 19.Roja I. Šeit un tagad. Transoloģijas almanahs, Medicīnas preses apgāds. Rīga, 2001: 2. 20.Roja. I., Roja Ţ., Kaļķis H., Šulca Z., Lūsis R. Stress un psiholoģiskā vardarbība darbā - sabiedrības sociāla un psiholoģiska problēma Latvijā. Starptautiskās konferences „Atstumtība un nedrošība - riski un risinājumi", RSU ESF, Rīga, 2006, rakstu krājums (iesniegts publicēšanai). 21.Роя И. Гипнотерапия при комплексном лечении больных диенцефалитом в неврологическом стационаре. Студенческая научная конференция РМИ. Министерство здравохранения Латвийской ССР. Рижский Медицинский институт, 1970: 22-24. Brochures: 1. Roja I., Zalkalns J., Bertholds M. Autogēnais treniņš. Rīga, 2006, 32 lpp. 2. Roja I. Kognitīvā hipnodrāma ārstnieciskā hipnoterapijā, Rīga, 2006, 50 lpp, 3. Roja I., Roja Ţ., Ka|ķis H. Stress un vardarbība darbā, Rīga, 2006, 46 lpp. Scientific-practical issues: 1. Roja I., Zalkalns J., Roja Ţ.. Psihodinamiskās īstermiņa psihoterapijas, neiroprotektora, fitopreparāta pielietošanas efektivitāte kompleksā terapijā pacientiem pēc 60 gadu vecuma. Ţurnāls primārās aprūpes ārstiem un darbiniekiem "Medicine", 2006,4: 36-38. 2. Roja I.. Zālītis P., Tula-Rijkure A., Lilienfelde N., Podniece V., Kaina A. Organisma ceturtais stāvoklis. Pasaules latviešu ārstu kongresa tēţu krājums. Rīga, 2001:152-53. 3. Roja I., Kalnietis G., Purkalne T.L. Citaloprāma lietošana pacientu kompleksajā ārstēšanā. Ţurnāls "Latvijas ārsts", 2004/3:51-52. 4. Zālītis J, Tula-Rijkure A., Roja I., Zālītis P. Antidepresantu nozīme atkarību ārstēšanā ar transu (hipnozi). Latvijas ārstu ţurnāls, 2002/6: 22-24. 5. Roja I.. Hipnoze sāpju gadījumā. Latvijas ārstu ţurnāls, 2002,1: 34-36. 6. Roja I.. Putnu dienas. Atziņas par Alcheimera slimību Latvijas Neirologu asociācijas rīkotā semināra. Latvijas ārstu ţurnāls, 2000, 2: 56-57. 7. Roja I. Hipnotiskā saskarsme. Latvijas ārstu ţurnāls, 1997,7: 44-47. 8. Roja I. Par bērnu un pusaudţu garīgo veselību. Latvijas ārstu ţurnāls, 2001,10: 37-41. 9. Roja I. Hipnoze vaginisma ārstēšanā. Ţurnāls „Dzemdniecība un ginekoloģija", 2001,4: 32-34. 10.Roja L. Anna Freida un bērnu psihoanalīze. Latvijas ārstu ţurnāls, 2002, 9: 41-44. 11.Roja L. Seminārs pārjauno psihodinamisko hipnoterapiju. Latvijas ārstu ţurnāls, 2001, 4: 51. 12.Roja L. Otrais hipnoterapeitu un seksopatologu izlaidums. Latvijas ārstu ţurnāls,2001,3: 53. 13.Roja Ţ., Roja I. Stress un vardarbība darbā. Ţurnāls "Latvijas ārsts", 2004, 13: 32-35. 14.Zālītis J., Vikmanis U., Tula - Rijkure A., Purkalne T., Roja I., Zālītis P. 168, kas varēja vest pasaulē Latviju. Psihodinamiskā transoloģiskā onkoloģija. Latvijas ārstu ţurnāls, 2002, 9: 30-36. 15.Roja L. Hipnoterapeita fenomens. Ţurnāls "Mistērija", 2003: 23. 16.Roja L. Sapņu analīze. Ţurnāls "Apelsīns", Rīga, 2006, 2:38-40. 17.Roja L, Tula - Rijkure A. Pozitīvā geju psihoterapija. Latvijas ārstu ţurnāls, 2003, 2: 49. 18.Tula - Rijkure A., Zālītis P., Roja I., Zālītis J. Nelaimīgi "mīlošo", t.i., atkarīgo terapija sublimējot. Latvijas ārstu ţurnāls, 2001, 10:41-43. _ 19.Roja I. Tantriskais sekss. Ţurnāls primārās aprūpes ārstiem un darbiniekiem "Medicine", 2005, 5:37-39. 20.Roja I. Vēlreiz par depresiju. Latvijas ārstu ţurnāls, 2000, 11: 39-45. 21.Roja L, Zaļkalns J. Kā palīdzēt vīrietim involūcijas periodā? Ţurnāls "Doctus", 2006, 5:35-37. 22.Roja I. Dinamisks seminārs (par LU Medicīniskās pēcdiploma izglītības institūta un starptautiskās firmas Aventis - Pharma rīkoto semināru sensibilizācijas, sāpju un cilvēka biopsihosociālās eksistences modeļa izpētē). Latvijas ārstu ţurnāls, 2000, 5: 59-60. 23.Roja I. Hormoni un galvassāpes sievietei. Ţumāls "Dzemdniecība un Ginekoloģija", 2000, 1: 32-34. 24.Roja I. Ārstējošs miegs (intervija ţurnālistei). Laikraksts "Diena", 1999, 20.05; 25.Roja I. Trauksmes daţādās sejas, Latvijas ārstu ţurnāls, 2000, 12, 38-50; 26.Roja I. Latvijas Transoloģiskās psihoterapijas asociācija un Latvijas Seksologu - seksopatologu asociācija, ţurnāls "Latvijas ārsts", 2001, 6: 41; 27.Roja I. Kombinētās terapijas pielietošanas iespējas vīriešiem andropauze (hipnoterapija un medikamenti). Ţurnāls primārās aprūpes ārstiem un darbiniekiem "Medicine", 2005, 11: 35-37. 28.Roja I. Vai vīrietim mēdz būt klimakss? Ţurnāls " Medicine", 2005, 7: 33. 29.Roja L, Roja Ţ., Poţarskis A. Cerebroprotektora Tanacan un psihodinamiskās hipnoterapijas izmantošana pacientiem andropauze un menopauzē. Ţurnāls " Medicine", 2004, 11: 34-35. 30.Roja L. Eiropas seksuālās medicīnas biedrības kongress. Latvijas ārstu ţurnāls, 2006/4: 27. 31.Roja I. Psihoterapijas pasaulē: gatavība tuvoties otram. Ţurnāls " Latvijas ārsts", 2004, 5: 57-58. 32.Roja L. Neiroze un personības izaugsme. Ţurnāls " Latvijas ārsts", 2003/10: 50-52. 33.Roja I. Seminārs psihoanalīzē. Ţurnāls " Latvijas ārsts", 2002, 9: 50-51. 34.Roja L, A. Sauriņš, Ţ. Roja, A. Poţarskis, D. Rubene. Levitras un psihodinamiskās hipnozes pielietošana pacientiem ar erektīlo disfunkciju kombinētā terapijā. Ţurnāls „Medicine", 2004, 4: 12-13. 35.Roja L. Mums raksta - mēs atbildam (par ārstniecisko hipnoterapiju: atbilde medicīnas ţurnāla lasītājiem). 36.Roja I. Hipnoze vaginisma ārstēšanā. Pasaules latviešu ārstu 4.kongress. Tēţu krājums, Rīga, 2001 g. 20.-22. jūnijs, 152-153. 37.Roja L Psihodinamiskā un analītiskā hipnoze 21.gadsimta integratīvā multimodālā psihoterapijā. Latvijā. Transoloģijas almanahs, Rīga, izd. AI 2003:3. 38.Roja I. Vīriešu seksuālā disfunkcija. Ţurnāls "Jums, kolēģi" tematiskais pielikums, Rīga, 2003: 31-43. 39.Roja L, Zaļkalns I, Bertholds M. Sievietes un seksuālās neirozes. Ţurnāls "Doctus", 2006,10: 22-27. ACKNOWLEDGEMENTS Heartfelt thanks for the academic and collegial support provided by professors Janis Zalkalns, Raisa Andrezina, Marsel Berthold, Philip Zindel, Mintauts Caune, Egils Vitols. and Juris Berzins. My sincere gratitude goes to neurologist EEG specialist Mara Gintere. Special thanks to professor Valdis Kalkis for his support of statistical data analyses and my colleagues from Riga 1 sl Hospital Outpatient Department. My sincere gratitude goes also to my family for countenance.
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