RU2786806C1 - Method for restoring the physical and psycho-emotional state of patient after suffering a coronavirus infection - Google Patents

Abstract

FIELD: preventative medicine.

SUBSTANCE: invention can be used to restore the physical and psycho-emotional state after the coronavirus infection COVID-19. The course includes 20 lessons conducted with patients in a hospital, two lessons a day. At the first lesson, information and explanatory work is carried out. On the second lesson on the first day of classes, breathing exercises with elements of full breathing are carried out. In the first half of the day on the second, fourth, sixth, eighth and tenth days a complex for physical rehabilitation is conducted, which includes the implementation of three consecutive sets of exercises at each lesson, including breathing exercises with elements of full breathing, a stretching complex, a relaxation complex. Three hours after that, only breathing exercises with elements of full breathing are carried out. On the third, fifth, seventh and ninth days in the morning exercises for psycho-emotional rehabilitation are performed based on the approach of EMCG and neuro-technics of Wingwave coaching. Three hours after that, only breathing exercises with elements of full breathing are carried out.

EFFECT: expanding the functionality of methods for restoring the physical and psycho-emotional state of patients after the coronavirus infection COVID-19 and reducing the psycho-emotional response and the number of panic attacks.

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Description

The invention relates to medicine, and more specifically to the field of improving the human body, in particular, to preventive medicine, by means of which it is possible to improve the physical and psycho-emotional state during panic attacks that occurred in patients after suffering a coronavirus infection COVID-19.

Coronavirus infection COVID-19, like any other virus, affects the functioning of many body systems and affects not only the respiratory tract and lungs, but also the central nervous system. Patients who have recovered from COVID-19, after physical recovery, experience anxiety, sleep disturbances, a sharp change in mood for a long time, in especially severe cases, depression, panic attacks may occur [Garrigues E. et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19 // Journal of Infection. - 2020. - T. 81. - No. 6. - C. e4-e6.].

Panic attacks are the most common symptom of post-COVID disorder. Compared to 2019, according to WHO experts, the number of patients with panic attacks has doubled [Shmatova Yu.E. Mental health of the population during the COVID-19 pandemic: trends, consequences, factors and risk groups // Economic and social changes: facts, trends, forecast. - 2021. - Vol. 14. - No. 2. - S. 201-224].

Panic attacks are attacks of sudden anxiety, which are accompanied by both physiological and psycho-emotional manifestations. So the symptoms from the side of physiology are manifested by a rapid heartbeat, a feeling of lack of air, tremors, sweating, a feeling of "cotton" legs, and insomnia. And the symptoms from the psycho-emotional side include a state of fear, panic, derealization of the world around. It is important to note that panic attacks do not lead to a heart attack and sudden death, but significantly impair the patient's quality of life.

Previously, panic attacks were more common among people on the background of severe stress, but now, according to experts from the Russian Society of Psychiatrists, more than 37% experience neurological disorders after suffering COVID-19, which is due to a number of reasons [https://iz.ru/1343135/2022- 06-01/psikhiatr-nazval-panicheskie-ataki-chastym-oslozhneniem-koronavirusa]: the emergence of a severe stressful situation of forced quarantine, which was characterized by self-isolation, social distancing, and the inability to control one’s life during a pandemic (when many well-known things became inaccessible), a change in social behavior at the request of the outside (restriction of contacts and movement), a collision with a virulent virus, that is, absolutely everyone is at risk, regardless of status, financial situation, lifestyle, etc.

An attack of a panic attack in time lasts on average from 5 to 20 minutes and does not pose a threat to health. But in order to avoid the transition to a chronic form, physical and psycho-emotional rehabilitation is necessary. The more often and longer the attacks become, the greater the negative imprint remains on the psycho-emotional background of a person. And yet, for the diagnosis of "panic attacks" is not enough only subjective sensations of the patient, the clinical picture must be at least 4 of the following list of symptoms, with one of them from the list 1-4; that develop suddenly and peak within a short period of time: 1) increased or increased heart rate, 2) sweating, 3) tremors and tremors, 4) dry mouth (but not from medication or dehydration); symptoms related to the body: 5) difficulty breathing, 6) feeling of suffocation, 7) pain or discomfort in the chest, 8) nausea or abdominal distress (eg, burning in the stomach, flatulence); symptoms related to the mental state: 9) feeling dizzy, unsteady or fainting, 10) feelings that objects are not real (derealization) or that one's self has become distant or "not really here", 11) fear of losing control, going crazy, 12) fear of dying; general symptoms: 13) hot flashes or chills; 14) numbness or tingling sensation; tension symptoms: 15) muscle tension or pain, 16) restlessness and inability to relax; 17) a feeling of nervousness, agitation ("on edge") or mental stress, 18) feeling of a coma in the throat or difficulty in swallowing; other non-specific symptoms: 19) increased response to small surprises or fright, 20) difficulty in concentrating or "empty mind" due to anxiety or worry. 21) constant irritability, 22) difficulty falling asleep due to anxiety. [Clinical guidelines - Generalized anxiety disorder - 2021-2022-2023 (08.16.2021) - approved by the Ministry of Health of the Russian Federation].

A known method for the treatment of patients with panic disorders [RU 2716750, IPC A61M 21/00, publ. 03/16/2020 Bull. No. 8] consisting in the fact that the patient is given a course of Ericksonian hypnosis of 8-10 sessions, once every 7-10 days, at the first session, a rapport with the patient is established, a semantic analysis of speech is carried out, a search for keywords, an assessment of representative systems for the selection of relevant metaphors and images for the purpose of using them in trance work, combining with immersion in a pleasant memory associated with a feeling of health, tranquility, harmony, comfort, good mood, healthy sleep; starting from the second session, each hypnosis session is prepared in advance, taking into account the characteristics of the patient's personality; during the second and subsequent sessions, the resource state is anchored with an olfactory stimulus by applying healing perfumes on the wrist, including essential oils based on vanilla, lavender, rosemary, lemon, bergamot, grapefruit; at the end of each session, the patient is offered homework in the form of a post-hypnotic suggestion, and namely, to draw the image that came during the session, to conduct a self-hypnosis session, causing the sensations of health, tranquility, harmony, comfort, good mood, healthy sleep formed during the session, while every day twice a day the patient independently applies healing perfumes on the wrist.

The disadvantage of this method is the lack of a physical component in the treatment, despite the fact that the manifestation of panic attacks is directly related to physiological manifestations, and therefore requires the rehabilitation of the patient's physical condition. In addition, not all patients are hypnotizable; susceptible to hypnosis, so this method cannot be widespread. The course of treatment is quite long, which is not very convenient for patients of working age.

A known method of reducing the psychological significance of negative psycho-emotional attitudes and memories [RU 2728268, IPC A61M 21/00, publ. 07/28/2020 Bull. No. 22], which includes recreating the image of a psycho-traumatic incident with its subsequent imaginary recording on a video playback device, mentally scrolling and keeping in memory the image of a psycho-traumatic incident until a subjective sensation of the moment of the culmination of a psycho-traumatic incident appears and completing the procedure by imagining the reproduction of a positive image, characterized in that a person continuously register and display on the monitor the physiological indicators of the psycho-emotional response, find out the negative graphic images and/or verbal definitions associated with the psycho-traumatic situation, store them in a memory device, then form positive graphic images and/or verbal definitions associated with constructive resolutions of the psycho-traumatic situation and save them in a memory device, then bilateral stimulation is carried out with light and / or sound and / or tactile and / or vibration and / or temperature signals with d dynamically variable parameters selected according to subjective criteria of their comfort for a person until the state of relaxation is reached, determined by physiological indicators, then, against the background of ongoing bilateral stimulation, the saved negative graphic images and / or verbal definitions are periodically presented on the monitor screen according to a given algorithm with an interval of 2 up to 10 seconds and exposure from 1 to 4 seconds until the stabilization of physiological parameters, after which, within 5-15 minutes, negative graphic images and/or verbal definitions are smoothly replaced with saved positive graphic images and/or verbal definitions.

The disadvantage of this method is the inability of patients with panic attacks that manifested after a coronavirus infection to recreate the image of a traumatic incident, since it is not clear enough due to the limited duration of panic attacks and the end of COVID-19, confirmed by PCR. In addition, we are again talking only about the psycho-emotional state of the patient without taking into account the physical.

All previously stated methods were intended for patients in whom panic attacks continued for quite a long time, being a consequence of a chronic disease. The task of the methods was to slow down the development of the underlying disease and reduce the risk of various complications.

For the treatment of panic disorders, a psychotherapeutic approach is known, which is based on the method of desensitization and processing by eye movements (EMDR). Usually, already in 5-6 sessions, it allows you to achieve a significant reduction in obsessive fears of new attacks and the cessation of advanced panic attacks (Domoratsky V.A. Psychotherapy of panic disorders. - 2016].

The DPDH method is based on the idea of bilateral stimulation, i.e. effects on both hemispheres of the brain. Such an impact can be provided in various ways: through the visual channel, when a person moves his eyes from side to side at a certain pace, following the hand of the therapist, or through the somatic channel, when the client or the therapist alternately pats the left and right knees or palms or shoulders client. Such movements and signals are produced at a certain pace and according to a certain pattern. They stimulate and balance the work of different hemispheres of the brain, causing one or the other to turn on. Such an impact has a positive effect on the emotional state of a person, reduces the level of tension, fears and worries caused by reminders of an illness. The patient follows the movement of the fingers of the neurocoach. Thus, the REM-phase (Rapid Eye Movement - rapid eye movement) is modeled - the phase of REM sleep, characterized by increased brain activity. As a result, being fully conscious, the patient gets to his unconscious. Eye movements add to the effectiveness by triggering neurological and physiological changes that facilitate the processing of traumatic memories in therapy.

The Wingwave coaching and EMDP method is actively used and developed in business, in personal development and efficiency, in personnel management to relieve anxiety, deal with stress, fears, and help in working with post-traumatic stress disorders. Since 2006, studies have been carried out to treat patients with depressive disorders using the EMDR method. The DDG approach has been applied and successfully proved itself when used in refugee camps [Lehnung M, Shapiro E, Schreiber M, Hofmann A. (2017). Evaluating the EMDR Group Traumatic Episode Protocol With Refugees: A Field Study. Journal of EMDR, August; 129-138, Ostacoli L, Carletto S, Cavallo M, Baldomir-Gago P, Di Lorenzo G, Fernandez L, Hase M, Justo-Alonso A, Lehnung M, Migliaretti G, Oliva F, Pagani M, Recarey-Eiris S, Torta R, Tumani V, Gonzalez-Vazquez A, Hofmann A. (2018). Comparison of Eye Movement Desensitization Reprocessing and Cognitive Behavioral Therapy as Adjunctive Treatments for Recurrent Depression: The European Depression EMDR Network (EDEN) Randomized Controlled Trial. Frontiers in Psychology (9) Balance im Leistungskontext. Erding: Bachelorarbeit im Bereich Wirtschafts psychologie an der Fachhochschule fur angewandtes Management, 2013]. He successfully works with the consequences of traumatic events such as depression, anxiety, phobias, acute grief, somatic disorders and addictions, in medicine to prepare patients for dental intervention (fear is removed in a matter of minutes), medical research (for example, MRI, gastroscopy, etc.). .), operations, long-term treatment and rehabilitation. Offers individual and group support [S. Besser-Siegmund, L. Siegmund, H. Siegmund: Systemdynamisches Coaching mit der wingwave-Methode. Junfermann and Paderbom 2018].

In theory, EMDR works directly with memory networks and enhances information processing by making associations between distressed memories and more adaptive information stored in other semantic memory networks. The EMDH method is used both in individual practice and in group therapy [Lehnung M, Shapiro E, Schreiber M, Hofmann A. (2017). Evaluating the EMDR Group Traumatic Episode Protocol With Refugees: A Field Study. Journal of EMDR, August; 129-138]. In Germany, due to the difficult epidemiological situation, with the help of EMDR techniques, it is proposed to provide psychological support to clinicians who cannot cope with the influx of patients. Teaching teams on issues of psychological trauma and psychological self-defense is carried out on mental hygiene techniques [bttps://www.emdria.de/fileadmin/user_upload/emdira/PDF/Aktuell/Schutzkonzept_fuer_Kliniken.pdf].

Despite the proven efficacy of DPDH, its use in medicine is limited and no research data has been found to successfully recover patients with panic attacks after suffering a coronavirus infection. Although this technique is successfully used for employees of internal affairs bodies in emergency situations of a biomedical nature.

With COVID-19, the stressful experiences of patients associated with the circumstances of the disease are so intense and destructive that we should rather talk about mental trauma [Algorithm for detecting psychological trauma among employees of internal affairs bodies in emergency situations of a medical and biological nature (on the example of a pandemic COVID-19): educational and practical guide / E.G. Ichitovkina, Yu.V. Bogdasarov, S.V. Zhernov, A.G. Solovyov. - Domodedovo: VIPK of the Ministry of Internal Affairs of Russia", 2021. - 152 p.]. One of the most productive and economical for use in the rehabilitation process is the method of desensitization and processing of mental trauma by eye movements (EMDR F. Shapiro) [Shapiro F. Psychotherapy of emotional trauma using eye movements: Basic principles, protocols and procedures / transl. from English. A.S. Riga. - Moscow: Independent firm "Class", 1998. - 496 p.].

The transfer from the named contingent to patients with health problems is hardly possible, since we are talking primarily about recovery after mental trauma that can lead to professional burnout.

To restore the physical and psycho-emotional state of patients after suffering a coronavirus infection, these techniques were not used.

Breathing should be considered as another treatment for panic attacks. Breathing and its control mechanisms play an important role in creating pathological anxiety, especially panic disorder [Nardi A.E., Freire RC, Zin WA Panic disorder and control of breathing // Respir Physiol Neurobiol. - 2009. - Vol. 67(1). - P. 133-143]. Therefore, the use of breathing techniques will help to cope with this condition. Breathing exercises effectively reduce the frequency and severity of panic attacks and can be effectively used in the complex treatment of panic attacks as a safe and effective non-drug method of treatment [Yakupov E.Z., Shikov A.S. Evaluation of the effectiveness of the use of breathing exercises in patients with panic attacks // Kazan medical journal. 2017. No. 2]. Paradoxically, the connection between the repetition of panic attacks and damage to the respiratory system was established at the end of the 20th century [Klein DF False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis // Arch Gen Psychiatry/ - 1993. - Vol. 50(4). - P. 306-317]. D. Klein discovered hypersensitivity to CO ₂ in patients with panic disorders.

Panic attacks can occur when the central nervous system (CNS) mistakenly reports a lack of air, causing the "alarm system" to malfunction. The sensitivity of the brain to SO ₂ as a panic stimulus can be explained by the fact that an increase in pCO ₂ (partial pressure of CO ₂ ) indicates imminent suffocation. For patients with hypoxia, which is typical after COVID-19, the appearance of panic attacks is quite understandable in the light of this theory. And, therefore, breathing exercises will be considered as one of the main means in the treatment of panic attacks.

Respiratory gymnastics as a means of promoting health and restoring lung function has been used for a long time in our country.

The most famous in our country are the respiratory techniques of K.P. Buteyko, A.N. Strelnikova, so they are most often suggested to be used when it comes to choosing techniques for stopping panic attacks.

Breathing exercises K.P. Buteyko is carried out in the following way. Sitting on a chair, relax, look slightly above the line of the eyes. We relax the diaphragm, starting to breathe so shallowly that a feeling of lack of air appears in the chest. In this state, you need to stay for 10-15 minutes. In the event that there is a need to inhale a little deeper, you need to slightly increase the depth of breathing. Breathing is performed as if by the upper part of the lungs. If everything is correct, then a feeling of warmth will definitely appear, then it will become hot, then there will be a desire to breathe in deeply. In this case, such a desire must be fought only by relaxing the diaphragm. The exit from this state is carried out without changing the depth of breathing. After training, the pause between exhalation and inhalation should be 1-2 seconds longer. All exercises are performed only through the nose, and without noise. Before and after the exercises, you need to make control measurements of the maximum pause and heart rate. The norm for an adult is from 30 to 90 seconds. So 30 seconds is fair, 60 seconds is good, and 90 seconds is great.

One of the main disadvantages of this method is the possibility of hypoxia during breath holding, which is completely unacceptable for patients after coronavirus, usually accompanied by viral pneumonia with oxygen deficiency in the blood, hypoxia. In addition, the disadvantages will be an increase in breathing and blood circulation, that is, an increase in blood pressure, the occurrence of tachycardia (heart rate more than 70 beats per minute), breathing becomes deep and frequent, the heart pumps a large volume of blood per minute than normal, which is negative affect the cardiovascular system, especially in older and elderly people. In addition, this method requires preliminary preparation (learning the theory), constant training and control by the instructor of the correct execution. Excludes self-study.

Breathing gymnastics A.N. Strelnikova was formed as a result of treatment and restoration of the singing voice. Its peculiarity is the use of a formed inhalation and the involvement of the most powerful respiratory muscle, the diaphragm, in the process of the respiratory act. The essence of the technique is an active, intense short breath, which trains all the muscles of the respiratory system. Inhalation after an active emotional inhalation occurs as if by itself (exhalation is the result of inhalation). But the role of exhalation is no less important than the role of inhalation, especially with diaphragmatic breathing, which, in principle, is not included in the work without understanding the mechanism of the diaphragm.

All gymnastics movements are performed in the tempo-rhythm of the drill step, i.e. 110-120 respiratory movements per minute, which does not allow taking into account the state of human health at a certain moment, even during individual lessons with an instructor, while increasing the so-called "rapid breathing", leading to the formation of hyperventilation syndrome and an increase in panic attacks, which has been repeatedly confirmed in various kind of research [Gorman JM, Kent JM, Sullivan GM, Coplan JD Neuroanatomical hypothesis of panic disorder, revised // Am J Psychiatry. - 2000. - Vol. 157(4). - P. 493-505]. [Gorman JM, Papp LA, Coplan JD, Martinez JM, Lennon S., Goetz RR Anxiogenic effects of CO ₂ and hyperventilation in patience with panic disorder // Am J Psychiatry. - 1994. - Vol. 151(4). - P. 547-553].

Thus, neither the breathing technique of K.P. Buteyko, nor the breathing technique of A.N. Strelnikova cannot be recommended for restoring the patient's physical condition after COVID-19.

The most effective type of breathing to restore lung function will be full breathing, which allows increasing the mobility of the lungs and chest to its anatomical volume, which is especially important when the lung lobes stick together in severe viral pneumonia.

In the “full breathing” breathing technique, there are three main types of breathing, named according to the form of execution: upper (clavicular), middle (internal thoracic), lower (diaphragmatic abdominal).

During upper breathing, during inhalation, the ribs, shoulders and collarbones are raised, i.e. only the upper parts of the lungs are involved, the air flow is weak, and a lot of energy is wasted. Medium breathing is more effective, since the abdominal region is involved in the process and air penetrates into the middle of the lungs. Lower breathing due to the participation of the diaphragm allows you to use the lower lobes of the lungs, improving lymphatic drainage from certain parts of the lungs, the abdominal organs are massaged, improving the functions of digestion, metabolism, the muscles of the abdominal wall are toned, while less load falls on the heart. These three types allow you to use all parts of the lungs in the act of breathing, which improves respiratory function, frees the bronchial system from sputum and reduces the likelihood of complications due to deep ventilation of the lungs. This is especially true for patients who have had a coronavirus infection.

The use of full breathing, despite all its effectiveness, is quite limited due to the difficulty of mastering difficult coordination movements, therefore we suggest performing breathing exercises in a lightweight version: we consider full breathing not as a single exercise, but as a strict sequence of exercises with one type of breathing (upper , middle, lower, etc.), calling this complex "Respiratory gymnastics with elements of full breathing."

Considering the methods of treating panic attacks, we did not find comprehensive recommendations for restoring not only the psycho-emotional, but also the physical condition of patients. These categories are considered, as a rule, separately from each other.

Known complex way to restore and improve human health [RU 2730979, IPC A61M 21/00, A61H 1/00, publ. 08/26/2020 Bull. No. 24] including the interaction of bodily, psychological and spiritual practices, creating a positive emotional mood and fixing it in physical sensations, in which they initially teach correct posture and maintaining a sense of self-respect and dignity as a permanent skill, while performing a complex of adaptive physical gymnastics for the joints and spine with diaphragmatic breathing and psychological accompaniment to ergotropic music; perform a set of exercises for training the organs of vision, consisting of physical exercises for the oculomotor muscles and the subsequent implementation of psychological practices for training and stimulating the visual analyzer; carry out training of the sensory systems of the body - the sense organs to establish a biofeedback of the peripheral nervous system with the central nervous system, for which they take a meditative posture sitting on a chair, close their eyes and mentally represent visual, tactile, auditory, gustatory and olfactory sensations of heat and cold sequentially; work on the formation of a positive emotional mood corresponding to the state of youth, strength and health, keep this image in memory and use it in further work with the body, enhancing the capabilities of a person, thereby forming the skill of constantly maintaining psychological and physical health; perform a complex of emotional and socially oriented psychological practices, including the formation of a feeling of love for oneself, for people and the world around, forgiving people and situations that have a negative impact on the inner emotional world of a person, eliminating excessive psychological and social stress, forming new relationships in the family, team , society.

Paying tribute to the integrated approach to the impact on the human body, namely: bodily, mental and spiritual, it should be noted that this method is designed to maintain the physical and psycho-emotional state of a person in the absence of health problems.

A known method of improving the physical and psychological state [EN 2691847, IPC A61N 39/00, A61N 7/00, publ. 06/18/2019 Bull. No. 17] including the conduct of complex therapy in the following stages: questioning the patient, including such issues as age, occupation, daily routine, complaints; determination of the psycho-emotional state: anxiety, mental attacks, chronic stress; determination of height, weight, blood pressure, pulse; after that, complex therapy is carried out, which includes the following stages: for 30 minutes, indoors, they perform Qigong breathing exercises in combination with elements of Taijiquan gymnastics, while the exercises are performed with musical accompaniment with a predominance of stringed, percussion or wind instruments, as well as with conducting aromatherapy through the use of an aroma lamp, the air temperature in the room is 20-25 ° C; after performing the exercises for 1-3 minutes, the following biologically active points (BAP) are exposed with acupressure: RP-2 "Da-du", V-60 "Kun-lun", C-7 "Shen-men" and GI-11 "Tsui-Chi"; after acupressure, herbal medicine is carried out by taking 100-200 ml of green or herbal tea; after that, a thermal effect is carried out by visiting a bath or sauna; while carrying out from 3 to 7 procedures per month.

Qigong breathing exercises are characterized by breathing with the lower half of the abdomen, which allows you to activate blood pressure and venous circulation. When performed correctly, this technique is also beneficial for the spine and joints, improves the flow of oxygen-rich blood and eliminates stagnation in the articular tissues, as well as weight loss, but does not accelerate the return of the lungs to anatomical volume. This assumes a rather in-depth multi-complex approach to exercises both in Qigong breathing gymnastics and Taijiquan gymnastics, which includes not only meditative practices, but also knowledge of one’s philosophy as a whole, and this can be negatively perceived by many people with already formed foundations, principles and beliefs. Consequently, the application of Eastern practices from this point of view will be very limited. In addition, not all medical institutions have specialists who know the named oriental practices, including, among other things, work with biologically active points, not to mention the presence of a sauna or bath, a phytobar.

A known method of psychophysical correction of the body "Kia-do" [RU 2375032 C2, IPC A61H 1/00, publ. 10.12.2009 Bull. No. 34], which allows non-drug healing of people of different ages with the help of psychophysical warm-up, psychotherapy, basic stances and techniques of martial arts aikido.

This method does not take into account the patient's condition after suffering a coronavirus infection, and therefore cannot be used for residual effects with the respiratory, cardiovascular and nervous systems. It is more intended to maintain the physical and psycho-emotional shape of a person in the absence of health problems. In addition, the use of aikido techniques requires a certain level of physical fitness, including coordination capabilities, which is not always possible for weakened patients after coronavirus.

A known method of improving human health [RU 2264799 C1, IPC A61H 1/00, A63B 21/00, publ. 27.11.2005 Bull. No. 33], which consists in restoring the work of the muscle tissue of various organs, psychological rehabilitation of deep destructive processes in the central nervous system, leading to an increase in the level of protective functions of the body at the subconscious level. This patent is taken as a prototype.

Despite the integrity of the ongoing rehabilitation measures that combine the movements of the mind and muscles of the human body, the method is intended to maintain the physical and psycho-emotional shape of a person in the absence of health problems.

All of the above patents also have one common drawback, they cannot be used by persons with poor health as a result of a coronavirus infection. The considered methods are more intended for recreational purposes for people who do not have chronic diseases.

The closest analogues in previously published inventions have not been found.

Thus, the main methods of treating a panic attack should be breathing relaxing practices and cognitive-behavioral therapy, combining effects on both the physical and psycho-emotional components of the patient's condition. But when choosing means from these methods, it is necessary to take into account the following - that the goal of rehabilitation methods will be not only the eradication of panic attacks, but also the restoration of lung function by strengthening the respiratory muscles, increasing the mobility of the lungs and chest to its anatomical volume.

The task of the method for restoring the physical and psycho-emotional state of patients after a coronavirus infection is to eliminate the complications that have arisen after a coronavirus infection, which are reversible.

The technical result consists in expanding the functionality of methods for restoring the physical and psycho-emotional state of patients after the coronavirus infection COVID-19 and reducing the psycho-emotional response and the number of panic attacks.

The technical result is achieved due to the fact that in the method of restoring the physical and psycho-emotional state of patients after suffering a coronavirus infection COVID-19 based on complaints of the appearance of panic attacks 1.5-2.0 months ago after suffering COVID-19 with the results of the examination: saturation is not less than 94%, negative PCR test, confirmed diagnosis of "panic attacks" patients are prescribed and carried out a rehabilitation course to restore the physical and psycho-emotional state of patients, including 20 sessions with patients for 10 days in a hospital, two sessions a day, with the first the lesson is held in the first half of the day, and the second after 3 hours. At the first lesson, information and explanatory work is carried out, organized according to the principle "School of the patient" in a group mode, including the formation of maintaining the patient's motivational readiness for responsible and conscious inclusion in the rehabilitation process due to awareness of the means and methods used in the classes, the terms of rehabilitation, the expected results, as well as behavior during panic attacks and the use of aromatherapy as one of the new directions in the treatment of panic attacks.

Then, behavioral skills are practiced during panic attacks in order to relieve an attack, for this, the patient, at the beginning of practicing the skill, tries to slow down the rhythm of breathing, breathes less deeply, paying attention to inhalation and exhalation, while inhaling is short, holding the breath is slightly longer than inhalation and slowly exhaling, then he conducts grounding, resting his feet on the floor, or on the ground, after which any objects in his field of vision are listed by color or shape. At the second lesson on the first day of classes, breathing exercises are performed with elements of full breathing, which includes 20 consecutive exercises performed in the initial position “sitting on a chair”: the back is straight, pressed against the back of the chair, to reduce physical stress on the spine, while each exercise of the first complex is performed 6-8 times.

Then in the first half of the day on the second, fourth, sixth, eighth and tenth days, a complex for physical rehabilitation, exercise therapy is carried out, which includes the performance of three consecutive sets of exercises at each lesson, including: breathing exercises with elements of full breathing, a stretching complex that relieves physical stress , a relaxation complex that relieves neuro-emotional stress, while first performing the first complex of physical rehabilitation - a respiratory gymnastics complex with elements of full breathing, which repeats the complex performed in the second lesson of the first day. Then they proceed to the second complex of physical rehabilitation - a stretching complex, which includes 10 exercises performed at a slow pace in pairs in the initial “standing” position, in addition, pairs are selected in such a way that the height, weight and strength of the participants are approximately equal , while each exercise in the complex is performed a total of 10 times. After that, they begin to perform the third complex of physical rehabilitation - a relaxation complex, which includes 15 consecutive exercises performed in the initial position "sitting on a chair", while the repetition of each exercise in the complex for calming and relaxing for 5 sessions is the same, except for this , in each static position are delayed for 30 seconds.

Three hours after the complex for physical rehabilitation in patients, on each of these days, only breathing exercises with elements of full breathing are performed.

On the third, fifth, seventh and ninth days in the first half of the day, they perform psycho-emotional rehabilitation exercises based on the approaches of EMDR and Wingwave-coaching neurotechnics, and including 4 exercises performed, each of which is performed on a specific day, while:

on the third day of classes, an exercise is performed, which is the “Butterfly” technique, carried out in three stages, where at the first stage tactile bilateral stimulation is performed, at the second stage visual bilateral stimulation is performed, and at the third stage the neurocoaching technique is implemented;

on the fifth day of classes, they perform an exercise representing the “Working with the Elements” technique, carried out in six stages with a neuro-coach, while the duration of work in each element is 10 minutes;

on the seventh day of classes, they perform an exercise, which is a neurotechnics "Refuge", carried out with a neurocoach, in which the patient closes his eyes and mentally creates a refuge for himself - a real or fictional place where he feels completely safe, calm and comfortable, and at the same time a refuge anything can be - a cozy little house, an uninhabited island, the most ordinary room, a deserted beach, then the neurocoach pronounces the words necessary to complete the exercise, while the duration of the exercise is 20 minutes;

on the ninth day of classes, they perform an exercise, which is a “Safe Place” neurotechnics, performed with a neuro-coach who pronounces important points, the group listens and presents, each of which is important and close to him, without saying out loud. The exercise includes the implementation of 5 stages, at the same time: at the first stage, a visual image is created, at the second stage, a voice sound track is created, at the third stage, kinesthetic sensations are formed, at the fourth stage, the “Smell” technique is performed, at the fifth stage, the “Implementation” technique is performed. ”, while the duration of the exercise is 30 minutes.

Three hours after the patient completes the exercise for psycho-emotional rehabilitation, on each of these days, only breathing exercises with elements of full breathing are performed.

Before each session and after, the patient undergoes a current monitoring of the physical condition, measurement of blood pressure and pulse, in addition, after the second complex of physical rehabilitation of the complex for stretching (as the most difficult) and pulse.

To assess the physical condition of patients, before the start of the rehabilitation course and at the end of it, an assessment of the respiratory system is carried out (pulse oximetry (SO ₂ saturation), assessment of forced vital capacity (FVC), lying respiratory rate (RR), cardiovascular system (test 6 -minute walk (TSW), assess the neurological status (level of depression, anxiety), severity and frequency of panic attacks before and after the rehabilitation course according to the Spielberger-Khanin questionnaire and the Hamilton Depression Scale (HRDS).

The invention is carried out as follows.

In patients after coronavirus infection COVID-19, age, occupation are detected, a study of the respiratory system is carried out (pulse oximetry (SO ₂ saturation), assessment of forced vital capacity (FVC), respiratory rate lying down (RR), cardiovascular system (test 6-minute walk (TSW), evaluate the neurological status (level of depression, anxiety), severity and frequency of panic attacks before and after the study using the Spielberger-Khanin questionnaire and the Hamilton Depression Scale (HRDS), analyze the results of computed tomography (CT) of the lungs and blood pressure (BP) corresponding to the beginning and end of the disease, analyze the polymerase chain reaction (PCR) test for no more than 48 hours, detect the presence or absence of complications requiring hospitalization, and based on complaints of panic attacks after suffering COVID-19 1.5-2.0 months ago referred to a neurologist to confirm the diagnosis of panic disorder (PD) or an anxiety disorder (the diagnosis of "panic attacks" is confirmed using a questionnaire approved by the Ministry of Health of the Russian Federation at the initial appointment with a neurologist).

With the results: saturation of at least 94%, a negative PCR test, a confirmed diagnosis of "panic attacks", patients are prescribed and carried out a rehabilitation course to restore the physical and psycho-emotional state of patients after a coronavirus infection (according to the claimed invention), given in a hospital.

The rehabilitation course includes classes with patients for 10 days in a hospital, 20 lessons, two lessons a day, while the first lesson is held in the morning, and the second after 3 hours.

On the first day (in the first half of the day), at the first lesson, the “working” pulse and blood pressure (BP) are measured in patients, with the normal value for a particular patient, they are allowed to take classes. After that, information and explanatory work is carried out, organized according to the “School of the Patient” principle in a group mode, including the formation of maintaining the patient’s motivational readiness for responsible and conscious inclusion in the rehabilitation process due to awareness of the means and methods used in the classroom, the terms of rehabilitation, the expected results. , as well as behavior during panic attacks (informational messages "Behavior during panic attacks") and the use of aromatherapy as one of the new directions in the treatment of panic attacks.

Aromapsychology allows you to get rid of negative blocks and harmonize the psycho-emotional state with the help of essential oils. Information about aromatherapy is educational and informative and does not imply their use at the stationary stage, as they can cause an allergic reaction in others. Patients are advised to use 8 essential oils (lavender, ylang-ylang, orange, frankincense, valerian, sandalwood, bergamot and mint) to relax and relieve nervous tension.

A panic attack is a physiologically safe, but psychologically depressing condition. The more often and longer they become, the greater the negative imprint they leave on the psycho-emotional background of a person. Therefore, it is important to have information on how to cope with a panic attack without waiting for the results of participation in the study, which will give patients confidence in their abilities and ensure the effectiveness of the rehabilitation course.

Essential oils are best used in a diffuser. With this use (inhalation of oils), aroma molecules are identified by olfactory receptors, which, in turn, send a signal to the brain, where a response is formed to the inhalation of a particular oil. The limbic system is responsible for emotions.

After informing the patient, they practice behavioral skills during panic attacks with the aim of relieving an attack.

To do this, the patient first tries to slow down the rhythm of breathing, breathes less deeply, paying attention to inhalation and exhalation, while inhaling is short, holding the breath is slightly longer than inhalation and slowly exhaling. For example, 1-2-3 inhale, 1-2-3-4-5 hold your breath, 1-2-3-4-5-6-7 exhale. This approach will reduce hyperventilation, restore the balance of oxygen and carbon dioxide in the blood, and, by the principle of biofeedback, reduce heart rate and panic.

Then he conducts grounding, emphasis with his feet on the floor / ground. For example, if the patient is sitting, then it is necessary to try, in addition to the feet, to use the buttocks and back, with force resting them on the seat and back of the chair / chair. If the patient is standing and there is no way to sit down, in addition to the feet, it is also recommended to try with an open palm to lean on something nearby: a tree, a wall, a piece of furniture and be sure to pay attention to the surface structure under the palm, smooth or rough, its temperature, other available features. This forced switching of the brain to other sensations turns on cognitive areas that suppress emotional ones.

After that, any items are listed by color or shape. For example, 5 round objects or 8 black ones.

It is possible to use the technique of waiting for a panic attack using a fitness bracelet to monitor the pulse and saturation, provided that a panic attack always begins in a certain situation. The desire to record your feelings and control them, as a rule, excludes a panic attack.

All these simple actions will significantly reduce the level of unpleasant sensations and experiences.

After the end of 1 session, the patient is measured blood pressure and pulse

At the second lesson on the first day, 3 hours after the 1st lesson, a complex of respiratory gymnastics with elements of complete breathing is carried out. Group breathing exercises with elements of full breathing, held after 3 hours, are mandatory for inpatients who have no contraindications who have undergone COVID-19, since experience shows that at least 15 breathing exercises are needed to fully restore the functions of the respiratory system with elements of complete breathing. Patients with panic attacks were not concentrated in any ward, in any of the 5 departments of the Center, this allowed them to be socialized to a greater extent, new acquaintances appeared, the “obsession” with their problems went away, since the ward neighbors have a fairly diverse list of diseases , and general physical therapy classes contributed to the consolidation of friendly ties, which could not but affect the positive emotional mood.

The complex of respiratory gymnastics with elements of complete breathing includes 20 exercises, and is performed in the initial position "sitting on a chair": the back is straight, pressed against the back of the chair, to reduce the physical load on the spine, while:

in the first exercise, the hands are placed on the knees, the head is thrown back, the gaze is upwards, a slow breath is taken through the mouth, the head is tilted forward, touching the cervical fossa with the chin, the gaze is lowered, the breath is slowly exhaled through the nose;

in the second exercise, the hands hang freely, raise the shoulders up, stretch the diaphragm as much as possible, perform a slow breath through the nose, then quickly lower the shoulders, relaxing them, perform a quick exhalation through the mouth;

in the third exercise, the fingers are clasped on the stomach into a “lock”, they draw in the stomach, pressing on it with their hands, perform a slow breath through the nose, then sharply push the hands out of the stomach, perform a quick exhalation through the mouth;

in the fourth exercise, the fingers are clasped on the stomach in a “lock”, inflate the stomach, bending in the lower back, perform a slow breath through the nose, then slowly deflate the stomach with the help of the hands, return the lower back to the back of the chair, perform a slow exhalation through the mouth;

in the fifth exercise, the fingers are clasped in a "lock" on the stomach, turn the palms outward and stretch forward, the fingers remain in the "lock", the elbows are straightened, the head is tilted forward, the arms are at shoulder level, take a slow breath through the nose, then quickly lower the arms, perform a quick exhalation through the mouth;

in the sixth exercise, the hands are placed at the shoulders, the elbows are at shoulder level, the elbows are brought forward, a slow breath is taken through the nose, the elbows are pulled back as much as possible, bringing the shoulder blades together, a slow exhalation is performed by the mouth;

in the seventh exercise, the hands are at the shoulders, the elbows are pressed to the ribs, the arms are sharply lowered, the fingers are maximally tense and splayed, the shoulders are raised, the stomach is tightened, they take a quick breath through the nose, the arms relax, the hands return to the shoulders, perform a slow exhalation through the mouth, lips " tube";

in the eighth exercise, the hands are placed at the shoulders, one elbow is brought up behind the head, a slow inhalation is performed with the nose, then the elbow is sharply lowered, a quick exhalation is performed with the mouth, and the exercise is repeated with the other hand;

in the ninth exercise, the hands are placed at the shoulders, circular movements are performed in the shoulder joints with arms bent at the elbows forward and backward, 4 circles forward, 4 circles back, repeat 2 times, breathing is arbitrary;

in the tenth exercise, the hands are placed on the knees with the palms up, the fists are clenched with maximum force, a slow inhalation is performed with the nose, then the fists are unclenched, and a slow exhalation is performed with the mouth;

in the eleventh exercise, the arms hang freely, spread straight arms to the sides at shoulder level, palms forward, take a slow breath in through the nose, then hug themselves by the shoulders with maximum strength, perform a slow exhalation through the mouth;

in the twelfth exercise, hands are placed on the hips, closer to the groin, straighten the elbows, stretching the back up, perform a slow breath through the nose, then sharply bend the elbows, relax the back, perform a quick exhalation through the mouth;

in the thirteenth exercise, hands are placed on the belt, thumbs towards the lower back, elbows are brought forward without tilting the torso, the hands slide along the belt, take a slow breath through the nose, take the elbows back, connecting the thumbs on the lower back, bring the elbows together as much as possible, perform a slow exhalation through the mouth ;

in the fourteenth exercise, the arms hang freely, raise straight arms forward and upward, perform a slow breath through the nose, lower the arms through the sides down, clasping the knee of the raised and bent leg, the back is pressed against the back of the chair, perform a slow exhalation through the mouth, do the same with the other leg, repeat the exercise

in the fifteenth exercise, the arms hang freely, straighten one leg forward and keep it on the weight, pull the toe, the other leg goes under the chair, then change legs to the count of one-two-three-four, breathing is arbitrary;

in the sixteenth exercise, the hands hang freely, raise the leg bent at the knee, perform a slow breath through the nose, then sharply lower the leg down, perform a quick exhalation through the mouth, repeat the exercise with the other leg;

in the seventeenth exercise, the hands are at the shoulders, bend the elbows to the knees, the neck muscles are relaxed, the chin is at the cervical fossa, take a slow breath through the nose, straightening up, take the elbows back, throw the head back, perform a slow exhalation through the mouth;

in the eighteenth exercise, the arms are bent at the elbows, the elbows are pressed to the ribs, tensing, raise the shoulders up, perform a slow inhalation with the nose, leaning forward, rest the forearms on the knees, tilt the head, perform a slow exhalation through the mouth;

in the nineteenth exercise, the arms hang freely, the head is turned to the shoulder, turning the head to the other shoulder, inhale slowly with the nose, reaching the shoulder, exhale quickly with the mouth, do the same in the other direction;

in the twentieth exercise, the arms hang freely, the relaxed arms are raised forward and upward, a slow inhalation is performed through the nose, the arms are freely lowered down, and a quick exhalation is performed through the mouth.

Each exercise of the first complex of physical rehabilitation - respiratory gymnastics with elements of full breathing is performed 8 times. For a better discharge of sputum from the bronchi (if necessary), it is recommended to open your mouth wide on exhalation and exhale, as it were, from the depths of the pharynx.

On the second, fourth, sixth, eighth and tenth days in the first half of the day, physical rehabilitation is carried out, exercise therapy, which includes the performance of 3 consecutive sets of exercises in each lesson: breathing exercises with elements of full breathing, a stretching complex that relieves physical stress, a relaxation complex, relieves neuro-emotional stress. Before each of the classes and after it, within the framework of which physical rehabilitation is carried out, the patient's pulse and blood pressure are measured.

The first complex of physical rehabilitation - breathing exercises with elements of complete breathing is carried out similarly to the complex performed in the 2nd lesson on the first day. The use of full breathing, despite all its effectiveness, is rather limited due to the difficulty of mastering complex coordination movements, so the invention used a new, quite accessible way to perform this cycle: not as a single exercise, but as a sequence of three types of breathing (upper, middle, lower), alternating in strict order of exercises with one type of breathing.

The next, extremely necessary, is the second complex of physical rehabilitation - stretching exercises, which allows you to relieve muscle physical tension, which is inevitable after a panic attack, accompanied by an intense release of adrenaline and norepinephrine into the blood.

The essence of this gymnastics is that when stretching different parts and the whole body in the appropriate directions, alternation of tension and relaxation in the muscles is possible. Moreover, by changing the strength and direction of the load in a dynamic mode, it is possible to involve many muscle groups, and a change in short-term muscle tension and relaxation allows you to remove muscle clamps in a short time.

When compiling a set of exercises in this direction, we took into account the recommendations of neurologists and psychiatrists when working with patients with panic attacks: group classes are preferable to individual ones (the realization that the patient is not alone in his “fear”, and there is always a friend’s help nearby).

In addition, we chose a system of patient-partner interaction in pairs. This will allow each practitioner not to go in cycles in their problems, paying attention primarily to interaction with each other, and not to internal sensations.

To successfully complete a set of stretching exercises, it is important to choose pairs in such a way that the height, weight and strength of those exercising are approximately equal. An excessive difference in strength makes the exercises uninteresting for both a strong partner and a weak one. Gender does not matter, the choice of a partner can be left to the partners themselves. This will provide an atmosphere of common interest, goodwill, and exclude the possibility of antagonism in relations.

Before commanding the beginning of the exercises, it is necessary to check the correctness of the initial positions taken, since the effect of the exercises themselves depends on this.

Exercises in pairs are emotional, they are usually accompanied by noise and laughter. Establishing positive relationships in the group allows you to achieve a deeper therapeutic effect.

Exercises in pairs are performed at a slow pace. Stretching can be carried out both on inhalation and on exhalation, subject to the coordinated performance of the exercise by partners with the same amplitude.

The action of stretching is not limited to the removal of physical muscle tension alone. Stretching is a dynamic work of muscles, and attention is focused not on one muscle, but on the movement of the whole body as a whole.

By focusing on the movements, the trainees gradually master the skills of knowing their body, which distracts from negative thoughts and helps to influence not only the physical state, but also the psycho-emotional one.

In addition, breathing is associated with stretching. The natural connection of breathing with exercise is strengthened as a result of targeted training. To do this, when stretching, do not hold your breath, making sure that it is deep and even, which will accordingly affect the slowing of the pulse. Each couple chooses their own, convenient for her, the pace of the exercise. As a result of mastering the correct technique for performing exercises, there will be no need to control yourself: proper breathing during stretching will become natural. Stretching gymnastics includes 10 consecutive exercises performed at a slow pace in pairs in the initial standing position:

in the first exercise, standing facing each other at arm's length, feet shoulder-width apart, hands on the partner's shoulders, springy swings are performed while standing, bending at the waist;

in the second exercise, kneeling facing each other at arm's length, knees shoulder-width apart, hands on the partner's shoulders, springy swings are performed kneeling, bending at the waist;

in the third exercise, standing close to each other, legs together, hands in a grip with fingers with a partner at the top, perform a simultaneous alternate step forward from the same leg with maximum knee flexion;

in the fourth exercise, standing close to each other, legs together, hands in a grip with fingers with a partner below, then perform a simultaneous alternate step forward from the same leg with maximum knee flexion;

in the fifth exercise, standing close to each other, legs together, arms to the sides, hands connected, then without lowering the arms, perform a simultaneous alternate step forward from the same leg with maximum knee flexion;

in the sixth exercise, standing side by side, legs together, feet of partners touching, hands of near hands are connected in a grip below, far ones - above the head, then they perform a simultaneous step to the side with one leg with maximum knee flexion, after that they repeat the exercise, turning the other side to a partner;

in the seventh exercise, standing side by side at a distance of 20-30 cm, legs together, the near hand in the grip with the fingers of the partner with the far hand, then standing, bending at the waist, jerking the arms back and up;

in the eighth exercise, standing with your back to each other at arm's length, feet shoulder-width apart, arms hanging freely, then perform a simultaneous turn in the opposite direction, without moving your feet, trying to connect your palms with your partner's palms, bending your elbows, then repeat the exercise to the other side;

in the ninth exercise, standing facing the back of the partner’s head at arm’s length, legs shoulder-width apart, hands below are connected with a grip with fingers, then they perform an alternate step forward of the front partner with maximum knee flexion, while the knee goes beyond the line of the foot, then repeat the exercise with a change positions of partners;

in the tenth exercise, standing sideways to each other at arm's length, legs together, hands joined at the bottom with a grip with fingers, then the partners perform a simultaneous step of the partners with the near leg to the side with an institution behind the other leg with a turn of the torso in the direction of movement, then repeat the exercise turning the other side to a partner.

Each exercise in the complex is performed 10 times in total.

After completing this complex, the patient is assessed his physical condition and the measurement of the pulse.

When performing stretching exercises, it is necessary to focus the attention of those involved in controlling the correct posture, which will increase the effect of stretching.

After completing the second set of physical rehabilitation exercises for stretching, the third set of relaxation is performed.

It is relatively easy to learn to relax the muscles, but for most patients with panic attacks, it is much more difficult to calm down mentally. No matter how relaxed the body is, it is quite difficult to get rid of obsessive thoughts and anxieties. Therefore, during the execution of this complex, it is advisable to turn on relaxation music with the orientation of patients during a static delay of 30 seconds for favorable memories.

Stretching and relaxation are inextricably linked. By stretching the muscles and joints, which helps to relieve physical tension, patients prepare themselves directly for the subsequent relaxation: focusing on the movements of their body and controlling it, mental calm occurs.

But after suffering a covid that caused neuro-emotional stress, the mechanism of self-regulation is disrupted. And what most often happened unconsciously before the illness, that is, when performing most of the various movements, the change in muscle relaxation and tension occurred automatically, now it is difficult.

Therefore, the most important way to get rid of nervous psycho-emotional stress is to master the skills of muscle relaxation. At the same time, inhibition is enhanced in the corresponding structures of the central nervous system, which activates recovery processes in the nerve centers. The higher a person's ability to relax muscles, the higher his ability to recover. A more accessible way to perform an exercise to calm and relax is a static load mode.

Neuro-emotional stress, a state of anxiety, worsening a person's well-being, violate the mechanism of self-regulation, which requires the ability to remove excitement. Therefore, the most important way to get rid of nervous tension can be considered muscle relaxation skills. At the same time, inhibition in the corresponding structures of the central nervous system increases, and recovery processes are activated in the nerve endings. The higher the ability to relax the muscles, the higher their ability to recover. The starting position when performing the third complex of physical rehabilitation for relaxation "sitting on a chair" allows you to smoothly reduce the previous load of exercise therapy, while:

in the first exercise, sitting on the edge of the chair, grab the back, sides, legs slightly apart, then straighten your arms, tilt your torso forward without bending in the lower back, stretching your shoulders, upper back, chest for 30 seconds, then return to the starting position, relax;

in the second exercise, sitting on a chair, leaning on the back, legs slightly apart, arms below, then stretched up with both hands, then stretched forward, slightly tilting the torso, arms at shoulder level, head tilted at elbow level, then lean on the chest on the knees, hanging their arms at their sides and stretching down, not trying to touch the floor for 30 seconds, then return to their original position, relax;

in the third exercise, sitting on a chair, leaning on the back, legs slightly apart, arms below, then stretch up with one hand, lowering the other to the floor without tension, look at the raised arm for 30 seconds, then return to the starting position, relax, then repeat in the other direction for 30 seconds, then return to the starting position, relax;

in the fourth exercise, sitting on a chair, leaning on the back, legs slightly apart, hands in the “lock” behind the head, elbows slightly brought together, then take the elbows back for 30 seconds, then return to their original position, relax;

in the fifth exercise, sitting on a chair, leaning on the back, legs slightly apart, arms slightly bent at the elbows, in a “lock” above the head, then tilt the torso to one side for 30 seconds, then return to the starting position, relax, then repeat in the other direction for 30 seconds, then return to the starting position, relax;

in the sixth exercise, sitting on a chair, leaning on the back, legs together, hands below, then they take the seat of the chair, raise their legs bent at the knees, leaning on the seat of the chair for 30 seconds, then return to their original position, relax;

in the seventh exercise, sitting on a chair, leaning on the back, legs together, hands down, then they take the seat of the chair, straighten the leg at the knee joint, raising it to the level of the seat, the toe “towards you”, for 30 seconds, then return to the starting position , relax, then repeat with the other leg for 30 seconds, then return to the starting position, relax;

in the eighth exercise, sitting on a chair, tilt the torso forward without bending the lower back, legs wide apart, crossed arms on the knees on the side from the inside, then press the palms on the knees, resisting for 30 seconds, then return to the starting position, relax;

in the ninth exercise, sitting on a chair, legs slightly apart, hands on hips, then straighten the elbows, leaning on the base of the palms, stretching up for 30 seconds, then return to the starting position, relax;

in the tenth exercise, sitting on a chair, legs wide apart, arms hanging freely, then stretching to the floor with one hand to the side across the body for 30 seconds, then returning to the starting position, relaxing, turning to the other side;

in the eleventh exercise, sitting on a chair, legs together, hands below, take the seat of the chair, turn to the side, rotating in the belt, without taking your hands off the support for 30 seconds, then return to the starting position, relax; then repeat in the other direction for 30 seconds, then return to the starting position, relax;

in the twelfth exercise, sitting on a chair, leaning on the back, legs together, hands hanging freely, clasping the knee with palms, pull the leg up for 30 seconds, then return to the starting position, relax, then repeat with the other leg for 30 seconds, then return to starting position, relax;

in the thirteenth exercise, sitting on a chair, leaning on the back, legs together, arms bent at the elbows, palms facing each other with fingers up, then raise their arms up above their heads, squeezing their palms as high as possible for 30 seconds, then slowly release without tension and return to their original position;

in the fourteenth exercise, sitting on a chair, legs together, arms bent at the elbows, to the sides at shoulder level, palms down, then take the elbows to the sides, clenching fists for 30 seconds, then return to the starting position, relax;

in the fifteenth exercise, sitting on a chair, leaning on the back, legs slightly apart, arms hanging freely, then gently dropping the chin on the chest, fixing this position and closing the eyes for 30 seconds.

Before you tense your muscles in any exercise, you need to take a calm breath. With relaxation of the muscles, a calm long exhalation is made.

The repetition of each exercise of this complex throughout the course of rehabilitation is performed in the same way: in each static position, a delay of 30 seconds is necessary, since the dosed alternation of static and dynamic loads provides complete relaxation of the body, which allows not only to relieve tension from the muscles, but also to reduce the level of anxiety patients.

A person's well-being is determined by the ability of alternating muscle tension and relaxation, which most often occurs unconsciously when performing most movements. Physical activity, in our case, three complexes, consisting of a total of 35 exercises, as well as increased anxiety of patients violate the mechanism of self-regulation. Therefore, relaxation skills are essential to relieve physical and psycho-emotional stress, which is provided by a set of relaxation exercises that provide calm and relieve the patient's psycho-emotional stress. The higher the ability to relax the muscles, the higher its ability to recover.

On the second, fourth, sixth, eighth and tenth days, 3 hours after the physical rehabilitation classes, breathing exercises with elements of full breathing are performed.

On the third, fifth, seventh and ninth days, in the first half of the day, psycho-emotional rehabilitation exercises are performed based on the approaches of EMDR and Wingwave-coaching neurotechnics, and including 4 exercises performed, each of which is performed on a specific day. Before each of the sessions and after it, within the framework of which they conduct a session for psycho-emotional rehabilitation, the patient is measured for pulse and blood pressure.

EMDH integrates elements of psychodynamic, exposure approaches, cognitive, interpersonal, experimental and body-oriented psychotherapies, but contains a unique element of bilateral stimulation (eye movements, sound and tactile stimulation).

In the third lesson, an exercise is performed, which is the “Butterfly” DPG technique, carried out in three stages:

at the first stage, tactile bilateral stimulation is carried out: sitting in a comfortable position, they cross their arms on their chest and alternately pat themselves on the shoulders (clap on one shoulder - clap on the other shoulder, etc.). Such pats can be done within 1-2 minutes. Breathing is even. Then rest for 30 seconds, while performing three such approaches.

at the second stage, visual bilateral stimulation is performed. The patient begins to quickly move his eyes to the right and left for 1 minute. After that, he takes a breath and exhale and evaluates his state in the moment. Then rests for 30 seconds, while the stage is performed in three such approaches.

at the third stage, they implement the technique from neurocoaching. Sit in a comfortable position, relax. Represent what gives energy. The trainer asks the question: “What color is this?”. Then the patient takes a deep breath and imagines that he is inhaling energy, inhaling this color and it fills every cell of his body. Then the patient imagines all the most negative that has accumulated inside him, that which takes away his resource. After that, the trainer asks the question: “What color is this?”, Then the patient imagines that he is exhaling it from himself, then he performs a slow smooth deep breath and a slow smooth exhalation twice. Exercise is performed 6 times.

At the fifth lesson, an exercise is performed, which is the “Working with the Elements” technique, carried out in six stages with a neurocoach. This exercise is aimed at mobilizing the internal resources available to a person. This exercise will also be useful when working with difficult life situations. The exercise can be used within the framework of this invention and independently as needed, the duration of work in each element is 10 minutes:

at the first stage, the patient closes his eyes and remembers the purest light "AIR" that they have ever breathed, then they take a slow, smooth breath, feel how light clean air fills the hands, shoulders, exhale and it exits through the hands., then they inhale - air fills the feet, legs, thighs, stomach, chest; exhale - and it smoothly exits through the legs. Inhale - the air fills your entire body. The properties of air are now the properties of the body: lightness, transparency, weightlessness. The patient feels that he is this pure, transparent, light air;

at the second stage, the patient imagines a gentle blue "WATER", the patient imagines that he is lying in a blue pool or in the sea. Inhale - and the water fills the arms, shoulders. Exhale - and it comes out through the hands. Inhale - and the water fills the legs, exhale - out through the legs. Inhale - and the water fills the head, exhale - out. Inhale - and the whole body is completely filled with pure blue water. The patient seems to be immersed in it. The properties of water are now the properties of the body and psyche: fluidity, mobility, all-permeability;

in the third stage, the patient imagines a raging "FIRE", then that breathes the entire surface of the body, and with each breath the fire fills the arms, legs, chest, stomach, head. His whole body is, as it were, filled with a raging flame, and the properties of fire are henceforth its properties;

at the fourth stage, the patient imagines a light silvery "METAL". Performs a slow smooth breath, imagining how the arms and legs are filled with metal, then how the properties of the metal become its properties: strength, reliability, durability;

at the fifth stage, the patient imagines a heavy, loose and reliable "EARTH", then feels that he is lying on the ground and breathes the entire surface of the body. With each breath, you draw the earth into yourself and, finally, dissolve in it, and the properties of the earth are now its properties: stability, reliability, confidence;

at the sixth stage, the patient imagines a powerful, beautiful "TREE". Inhale - and he imagines that the arms and shoulders become the branches of this tree. Exhale - and acquires all the properties of this tree: flexibility, grace, strength.

At the seventh lesson, an exercise is performed, which is the “Refuge” neurotechnics, carried out with a neurocoach.

To perform the exercise, the patient closes his eyes and mentally creates a refuge for himself - a real or fictional place where he feels completely safe, calm and comfortable. Anything can be a refuge - a cozy little house, a desert island, the most ordinary room, a deserted beach. The neurocoach then says the following words:

“In this place you feel absolutely protected, absolutely comfortable. Now look around. What surrounds you? Mentally create an atmosphere where you are comfortable, calm. Surround yourself with everything you love. Can you smell any pleasant smells? Do you hear any sounds or music? Are you warm or cool? Is the lighting bright or is it dim?

In your refuge there is no one but you, you do not need to rush anywhere, here you can wish and get anything you want, everything you would like to have.

But always remember that at any moment of your life you can get into your shelter, where you can rest and gain strength. When you feel calm and rested, you can leave your shelter and return to the real world - all you need to do is take a deep breath and open your eyes.

How did you feel while doing the exercise? What did this exercise give you?

A patient facing panic attacks needs to calm down, sometimes to quickly gather himself, bring himself into a cheerful state, recharge with energy. Or, for example, it causes discomfort, torments, haunts the memory of an unpleasant event.

The event will not change, but you can separate from it the emotions that are associated with it, and make sure that the memory of it no longer brings unpleasant experiences. You can learn to internally prepare yourself for unpleasant events that are about to happen so that you can act more effectively when they do come.

This technique is aimed at inducing a state of inner peace and comfort in patients, reducing stress levels, and increasing self-confidence. Having mastered the technique, the patient receives an excellent tool for controlling himself and his emotional state, the duration of the exercise is 20 minutes.

At the ninth session, an exercise is performed, which is the “Safe Place” neurotechnics, performed with a neuro-coach, who pronounces important points, the group listens and presents, each of which is important and close to him, without saying out loud. The exercise includes the implementation of 5 stages, while:

At the first stage, a visual image is created. The patient imagines a place where he feels very good and calm, where he would like to be now. When creating his safe place, he needs to describe it with text as a kind of three-dimensional picture. At the same time, the neurocoach says: “Look what you see around. What is behind you, you specify the distance, make accents on colors (purple flowers, blue sea, white sand, etc.). If this is any closed room or place, it is worth clarifying the height of the walls and ceiling. You can add plants, flowers, people, animals (if you want, of course) to your image.”

At the second stage, a voice sound track is created, while the neurocoach says: “Now listen. What sounds do you hear? Are they quiet or loud? What sound do you like the most? Often these are the sounds of nature: the rustle of the wind, the sound of the surf, the chirping of grasshoppers, etc. It can also be your favorite songs.

At the third stage, kinesthetic sensations are formed. This stage is aimed at creating the most comfortable bodily sensation for the patient “inside” your safe place (kinesthetic image). To understand it, the neurocoach says: “The following statement must be taken for granted: A person’s posture (including the very position of the body and muscle tension) affects his emotional state automatically. This means that you should take care to describe for yourself in what position, on what and how you will be in your safe place. For example, it can be an armchair, sofa, sand, grass, carpet, etc. The choice you make is solely for reasons of your own feelings. The only clarifying point. If you're creating a kinesthetic image, it's important that you eliminate randomness. That is, if there is a rocking chair in your imaginary place and you also have it at home, then for your own safety it is worth supplementing your kinesthetic image with some other detail (for example, a headrest or pillow) so that you “anchor” your sense of security and at the physical level. It's important to understand that the safe place technique works when you run it consistently. Plus, it gives the maximum result when connecting all possible senses.

At the fourth stage, the “Smell” technique is performed, for this the neurocoach says: “Any place you are in has a smell. We can ignore it, not focus attention, neglect it. But he is. Let's say at sea - this is the smell of algae. In the forest - needles. In the meadow - flowers. In a country house - the smell of burning firewood. Similarly, in your safe place, he can be. Your task is to snatch it from the stream of fantasies or memories. Grab and play. Get something that was for you: smelled good or was associated with your safe place. It can be a sandalwood keychain, tangerines, a freshly printed book or a handful of sand, whatever. There are no restrictions. The main thing is that this smell complements your image of a safe place.

At the fifth stage, the “Implementation” technique is performed, for this the neurocoach says: “Hug your shoulders. Stroke your shoulders and combine all the images in your mind. Mix your sounds, comfortable posture, pleasant smell, closed eyes, a locked door or going somewhere else (where you can be in a safe place without being distracted by others). You stay in it for 5-10 minutes, focusing on the voice of the coach, the main thing is that you notice changes in your emotional state during this time. Once you are ready and have spent the right amount of time in a safe place, return to the real world with your eyes open. If something will strain you in your safe place, feel free to correct it. After all, both the process of creation and the final result contribute to the improvement of your emotional state. The more times you use it, the faster relaxation and calm comes.

The fourth exercise is a simple practical way to bring a person into a more resourceful state, reduce stress and anxiety, relax and cope with negative emotions, based on a description of a safe place. The Safe Place practice can be used as an independent tool for emotional regulation when anxiety or waves of irritation interfere with work and communication with people. This is a practical way that allows you to influence not only anxiety, but also any chronically suppressed experiences. As an effective way, it can be used by those who, in principle, have difficulties with the transition to a relaxed state. And also for those who suffer from impulsive and compulsive urges (overeating, smoking, gambling, using psychoactive substances), the duration of the exercise is 30 minutes.

On the third, fifth, seventh and ninth days, 3 hours after the psycho-emotional rehabilitation classes, breathing exercises with elements of full breathing are performed.

After the end of the rehabilitation course, the patient undergoes an assessment of the respiratory system (pulse oximetry (SO ₂ saturation), assessment of forced vital capacity (FVC), lying respiratory rate (RR), cardiovascular system (6-minute walk test (TSH), assess neurological status (level of depression, anxiety), severity and frequency of occurrence of panic attacks before and after the rehabilitation course according to the Spielberger-Khanin questionnaire and the Hamilton Depression Scale (HRDS).

Thus:

1. Using a method for restoring the physical and psycho-emotional state of patients after suffering a coronavirus infection, which makes it possible to restore the physical and psycho-emotional state after suffering a coronavirus infection in patients with panic attacks, can significantly reduce the frequency and severity of attacks.

2. The method of restoring the physical and psycho-emotional state of patients after suffering a coronavirus infection is suitable for patients with panic attacks that appeared after COVID-19, regardless of gender, age, level of lung damage.

3. The method of restoring the physical and psycho-emotional state of patients after a coronavirus infection can be effectively used in the complex treatment of anxiety disorders as a safe non-drug method of treatment without side effects.

4. Sets of exercises that help restore the physical condition of patients who have had a coronavirus infection can also be used in the absence of complications such as panic attacks.

Examples of the invention.

The study on the implementation of the claimed invention included 16 patients (8 men, 8 women).

Patient Inclusion Criteria:

- confirmed diagnosis of COVID-19;

- saturation, that is, the level of blood oxygen saturation, not less than 94%, without artificial oxygen delivery for at least 14 days;

- CT scan of the lungs according to the terms corresponding to the discharge from the covid hospital;

- while in a covid hospital, compliance with the 14-day self-isolation regime;

- negative test for polymerase chain reaction no more than 48 hours;

- no complications requiring hospitalization;

- Complaints about the occurrence of panic attacks after suffering COVID-19.

All patients included in the study, at the time of signing the informed consent, were inpatients of the Federal State Budgetary Institution "NMIC TPM" of the Ministry of Health of Russia under the program "Recovery after COVID-19". This made it possible to ensure 100% attendance at rehabilitation events.

The parameters of the respiratory system were assessed (SO2 saturation, forced vital capacity of the lungs FVC, respiratory rate lying down NRR), cardiovascular (6-minute walk test TSH), neurological status (level of depression, anxiety), severity and frequency of panic attacks. before and after the study.

All patients received no medication for panic attacks, and medication for chronic conditions was dose stable over the last 3 months and did not change during the study.

The level of anxiety is determined by the Spielberger-Khanin questionnaire, which serves as an informative way to self-assess the level of anxiety at the moment (reactive anxiety as a state) and personal anxiety (as a stable personality characteristic). The scale consists of 40 questions. The overall score for each of the subscales ranges from 20 to 80 points. At the same time, the higher the final indicator, the higher the level of anxiety (situational or personal). Interpretation of indicators: up to 30 points - low, 31-44 points - moderate, 45 points or more - high.

The level of anxiety was determined as follows:

- personal anxiety (PT) as a more stable characteristic was determined before and after the study;

- situational anxiety was determined not only before and after the study, but also after each lesson on neurocoaching techniques (to correct the exercise at the next lesson, if necessary).

Depression was assessed using the Hamilton Depression Scale (HRDS) before and after the study.

The scale consists of 17 items, each of which is evaluated in points:

The minimum score is 0, the maximum score is 4. HRDS allows you to clinically assess the severity of depression and its dynamics during treatment. Interpretation of results:

0-7 - norm;

8-13 - mild depressive disorder;

14-18 - depressive disorder of moderate severity;

19-22 - severe depressive disorder;

more than 23 - depressive disorder of an extremely severe degree.

All 16 patients successfully completed the rehabilitation course, there were no dropouts.

When comparing the data before and after the application of the rehabilitation course (Tables 1, 2), the following results were obtained.

Panic attacks are more susceptible to patients whose lung damage was assessed as moderate to moderate according to the results of CT. There were no patients complaining of the appearance of panic attacks after suffering a coronavirus infection with a mild form of damage or zero.

As for the indicators of the respiratory system (SO ₂ , FVC, respiratory rate lying down), in all patients, regardless of age, gender, degree of lung damage, they returned to the physiological norm.

The indicator of the state of the cardiovascular system (six-minute walk test), as an adequate indicator of the functional class, as well as the response of the heart rate to the load, has undergone significant changes. 15 out of 16 passed the distance allowing them to be transferred to the next functional class, 1 - significantly increased the distance by 90 meters, but remained in the same functional class.

That is, from the point of view of the physical condition of the patients, this invention suited all participants in the study, and can be recommended to those who suffer from panic attacks to restore the respiratory cardiovascular systems after COVID-19.

As for the psycho-emotional state of patients, the frequency of occurrence of panic attacks has significantly decreased, the number of symptoms during attacks has decreased, the level of depression has decreased; in 3 from mild depressive disorder it returned to normal, in 9 from moderate depressive disorder to the lung, in 4 it decreased significantly, but along the lower border of mild depressive disorder.

The data of the anxiety scale of the Spielberger-Khanin questionnaire indicate that all participants in the study initially belonged to the category of patients with an increased level of personal anxiety (> 45%), and despite the fact that a significant decrease in it is observed during the rehabilitation process, none of the patients moved into the category of moderate anxiety.

This conclusion also applies to indicators of situational anxiety: there was a significant decrease, but only 1 out of 16 moved into the category with moderate anxiety, remaining at the lower limit of increased anxiety.

Based on the foregoing, patients are recommended to continue classes to restore and maintain their physical and psycho-emotional state at home, for which all students were provided with methodological material and the possibility of feedback from a doctor and exercise therapy instructor, a neurocoaching trainer.

A comparative analysis was also carried out for men and women (Table 3).

Despite the fact that the age of men was significantly older than women (51.37% and 39.87%, respectively), the degree of lung damage was higher (55.37% and 50.75%), the respiratory system indicators returned to normal in all TSHH, then the increase in men is much greater, which, apparently, can be explained by the greater commitment of men to physical education or sports.

The rates for panic attacks are also similar: the number of symptoms and attacks decreased almost equally. In terms of levels of depression and anxiety, at baseline they were higher in women, despite milder lung damage, but at the end of the study, these rates were equal in men and women.

Therefore, the program is suitable for both men and women, regardless of age.

We also made a comparative analysis for patients with moderate and moderate lung damage (Table 4).

The indicators of the respiratory system returned to normal in all of them, the indicator of the state of the cardiovascular system TSH in both groups increased significantly, and even more in the group with moderate damage, but the patients initially performed the III f.c. norm for health reasons, moving into the II f. to., in contrast to the group with a moderately pronounced lesion, which remained in the II f.k.

The number of symptoms and seizures decreased in both groups, as well as the levels of depression and anxiety to almost the same level, although initially they were higher in patients with moderate lesions.

Therefore, the program is suitable for patients with any level of lung disease.

Claims (62)

A method for restoring the physical and psycho-emotional state of patients after suffering a coronavirus infection COVID-19, which includes determining the patient's complaints and performing breathing exercises, characterized in that that, based on complaints about the appearance of panic attacks 1.5-2.0 months ago after suffering COVID-19, with the results of the examination: saturation (SO ₂ ) of at least 94%, a negative result of the polymerase chain reaction (PCR) test for COVID-19 for no more than 48 hours, a confirmed diagnosis of "panic attacks" patients are given a rehabilitation course to restore the physical and psycho-emotional state, including conducting 20 lessons with patients for 10 days in a hospital, two lessons a day, with the first lesson being held in the morning , and the second after 3 hours, while: at the first lesson, information and explanatory work is carried out, organized according to the principle of "School of the patient" in a group mode, including the formation of maintaining the patient's motivational readiness for responsible and conscious inclusion in the rehabilitation process due to awareness of the means and methods used in the classes, the terms of rehabilitation, the expected results, as well as behavior during panic attacks and the use of aromatherapy, then they practice behavior skills during panic attacks in order to relieve an attack, for this, the patient at the beginning of practicing skills tries to slow down the rhythm of breathing, breathes less deeply, paying attention to inhalation and exhalation, at the same time, the breath is short, the breath is held a little longer than the breath and a slow exhalation, then he conducts grounding - he stops with his feet on the floor or on the ground, after that he enumerates any objects in his field of vision, by color or shape, in the second lesson on the first day of classes, breathing exercises are performed with elements of full breathing, which includes 20 consecutive exercises performed in the initial position “sitting on a chair”, the back is straight, pressed against the back of the chair, while: in the first exercise, the hands are placed on the knees, the head is thrown back, the gaze is up, a slow breath is taken through the mouth, the head is tilted forward, touching the cervical fossa with the chin, the gaze is lowered, the breath is slowly exhaled through the nose; in the second exercise, the arms hang freely, raise the shoulders up, stretch the diaphragm as much as possible, perform a slow inhalation through the nose, then quickly lower the shoulders, relaxing them, perform a quick exhalation through the mouth; in the third exercise, the fingers are clasped on the stomach into a “lock”, they draw in the stomach, pressing on it with their hands, perform a slow breath through the nose, then sharply push the hands out of the stomach, perform a quick exhalation through the mouth; in the fourth exercise, the fingers are clasped on the stomach in a “lock”, inflate the stomach, bending in the lower back, perform a slow breath through the nose, then slowly deflate the stomach with the help of the hands, return the lower back to the back of the chair, perform a slow exhalation through the mouth; in the fifth exercise, the fingers are clasped in a "lock" on the stomach, turn the palms outward and stretch forward, the fingers remain in the "lock", the elbows are straightened, the head is tilted forward, the arms are at shoulder level, take a slow breath through the nose, then quickly lower the arms, perform a quick exhalation through the mouth; in the sixth exercise, the hands are placed at the shoulders, the elbows are at shoulder level, the elbows are brought forward, a slow breath is taken through the nose, the elbows are pulled back as much as possible, bringing the shoulder blades together, a slow exhalation is performed by the mouth; in the seventh exercise, the hands are at the shoulders, the elbows are pressed to the ribs, the arms are sharply lowered, the fingers are maximally tense and splayed, the shoulders are raised, the stomach is tightened, they take a quick breath through the nose, the arms relax, the hands return to the shoulders, perform a slow exhalation through the mouth, lips " tube"; in the eighth exercise, the hands are placed at the shoulders, one elbow is brought up behind the head, a slow inhalation is performed with the nose, then the elbow is sharply lowered, a quick exhalation is performed with the mouth, and the exercise is repeated with the other hand; in the ninth exercise, the hands are placed at the shoulders, circular movements are performed in the shoulder joints with arms bent at the elbows forward and backward, 4 circles forward, 4 circles back, repeat 2 times, breathing is arbitrary; in the tenth exercise, the hands are placed on the knees with the palms up, the fists are clenched with maximum force, a slow inhalation is performed with the nose, then the fists are unclenched, and a slow exhalation is performed with the mouth; in the eleventh exercise, the arms hang freely, spread straight arms to the sides at shoulder level, palms forward, take a slow breath in through the nose, then hug themselves by the shoulders with maximum strength, perform a slow exhalation through the mouth; in the twelfth exercise, hands are placed on the hips, closer to the groin, straighten the elbows, stretching the back up, perform a slow breath through the nose, then sharply bend the elbows, relax the back, perform a quick exhalation through the mouth; in the thirteenth exercise, hands are placed on the belt, thumbs towards the lower back, elbows are brought forward without tilting the torso, the hands slide along the belt, take a slow breath through the nose, take the elbows back, connecting the thumbs on the lower back, bring the elbows together as much as possible, perform a slow exhalation through the mouth ; in the fourteenth exercise, the arms hang freely, raise straight arms forward and upward, perform a slow breath through the nose, lower the arms through the sides down, clasping the knee of the raised and bent leg, the back is pressed against the back of the chair, perform a slow exhalation through the mouth, do the same with the other leg, repeat the exercise in the fifteenth exercise, the arms hang freely, straighten one leg forward and keep it on the weight, pull the toe, the other leg goes under the chair, then change legs to the count of one-two-three-four, breathing is arbitrary; in the sixteenth exercise, the hands hang freely, raise the leg bent at the knee, perform a slow breath through the nose, then sharply lower the leg down, perform a quick exhalation through the mouth, repeat the exercise with the other leg; in the seventeenth exercise, the hands are at the shoulders, bend the elbows to the knees, the neck muscles are relaxed, the chin is at the cervical fossa, take a slow breath through the nose, straightening up, take the elbows back, throw the head back, perform a slow exhalation through the mouth; in the eighteenth exercise, the arms are bent at the elbows, the elbows are pressed to the ribs, tensing, raise the shoulders up, perform a slow inhalation with the nose, leaning forward, rest the forearms on the knees, tilt the head, perform a slow exhalation through the mouth; in the nineteenth exercise, the arms hang freely, the head is turned to the shoulder, turning the head to the other shoulder, inhale slowly with the nose, reaching the shoulder, exhale quickly with the mouth, do the same in the other direction; in the twentieth exercise, the arms hang freely, relaxed arms raise forward and upward, perform a slow breath through the nose, freely lower the arms down, perform a quick exhalation through the mouth, at the same time, each exercise of the complex is performed 6-8 times, then in the first half of the day on the second, fourth, sixth, eighth and tenth days, a complex of physical rehabilitation is carried out, including the performance of three consecutive sets of exercises at each lesson, including: breathing exercises with elements of full breathing, a stretching complex, a relaxation complex, while the stretching complex includes 10 exercises performed at a slow pace in pairs in the initial “standing” position, in addition, pairs are selected in such a way that the height, weight and strength of the participants are approximately equal, while: in the first exercise, standing facing each other at arm's length, feet shoulder-width apart, hands on the partner's shoulders, springy swaying is performed while standing, bending at the waist; in the second exercise, kneeling facing each other at arm's length, knees shoulder-width apart, hands on the partner's shoulders, springy swings are performed kneeling, bending at the waist; in the third exercise, standing close to each other, legs together, hands in a grip with fingers with a partner at the top, perform a simultaneous alternate step forward from the same leg with maximum knee flexion; in the fourth exercise, standing close to each other, legs together, hands in a grip with fingers with a partner below, perform a simultaneous alternate step forward from the same leg with maximum knee flexion; in the fifth exercise, standing close to each other, legs together, arms to the sides, hands connected, without lowering the arms, perform a simultaneous alternate step forward from the same leg with maximum knee flexion; in the sixth exercise, standing side by side, legs together, feet of partners touching, hands of near hands are connected in a grip below, far ones - above the head, perform a simultaneous step to the side with one leg with maximum knee flexion, then repeat the exercise, turning the other side to a partner; in the seventh exercise, standing side by side at a distance of 20-30 cm, legs together, the near hand in the grip with the fingers of the partner with the far hand, standing, bent at the waist, jerking the arms back and up; in the eighth exercise, standing with their backs to each other at arm's length, legs shoulder-width apart, arms hanging freely, perform a simultaneous turn in the opposite direction, without moving the feet, trying to connect the palms with the palms of the partner, bending the elbows, then repeat the exercise to the other side; in the ninth exercise, standing facing the back of the partner's head at arm's length, legs shoulder-width apart, hands below joined with a grip with fingers, perform an alternate step forward of the front partner with maximum knee flexion, while the knee goes beyond the line of the foot, then repeat the exercise with a change positions of partners; in the tenth exercise, standing sideways to each other at arm's length, legs together, hands joined at the bottom with a grip with fingers, perform a simultaneous step of the partners with the near leg to the side with an institution behind the other leg with a turn of the torso in the direction of movement, then repeat the exercise, turning to the other side by side with a partner at the same time, each exercise in the complex is performed a total of 10 times, then the third complex of physical rehabilitation is performed - a relaxation complex, which includes 15 consecutive exercises performed in the initial position "sitting on a chair", while: in the first exercise, sitting on the edge of the chair, grab the back, on the sides, legs slightly apart, then, straightening the arms, tilt the torso forward without bending in the lower back, stretching the shoulders, upper back, chest for 30 seconds, then return to the starting position, relax; in the second exercise, sitting on a chair, leaning on the back, legs slightly apart, arms below, stretched up with both hands, then stretched forward, slightly tilting the torso, arms at shoulder level, head tilted at elbow level, then lean on the chest on the knees, hanging their arms at their sides, and stretch down, not trying to touch the floor for 30 seconds, then return to their original position, relax; in the third exercise, sitting on a chair, leaning on the back, legs slightly apart, arms below, stretch up with one hand, lowering the other to the floor without tension, look at the raised arm for 30 seconds, then return to the starting position, relax, then repeat in the other direction for 30 seconds, then return to the starting position, relax; in the fourth exercise, sitting on a chair, leaning on the back, legs slightly apart, hands in the “lock” behind the head, elbows slightly brought together, take the elbows back for 30 seconds, then return to the starting position, relax; in the fifth exercise, sitting on a chair, leaning on the back, legs slightly apart, arms slightly bent at the elbows, in a “lock” above the head, tilt the torso to one side for 30 seconds, then return to the starting position, relax, then repeat in the other direction for 30 seconds, then return to the starting position, relax; in the sixth exercise, sitting on a chair, leaning on the back, legs together, hands below, take the seat of the chair, raise the legs bent at the knees, leaning on the seat of the chair, for 30 seconds, then return to the starting position, relax; in the seventh exercise, sitting on a chair, leaning on the back, legs together, hands below, take the seat of the chair, straighten the leg at the knee joint, raising it to the level of the seat, the toe “towards you”, for 30 seconds, then return to the starting position , relax, then repeat with the other leg for 30 seconds, then return to the starting position, relax; in the eighth exercise, sitting on a chair, tilt the torso forward without bending the lower back, legs wide apart, crossed arms on the knees on the side from the inside, press the palms on the knees, resisting, for 30 seconds, then return to the starting position, relax; in the ninth exercise, sitting on a chair, legs slightly apart, hands on hips, straighten the elbows, resting on the base of the palms, stretching up for 30 seconds, then return to the starting position, relax; in the tenth exercise, sitting on a chair, legs wide apart, arms hanging freely, stretching to the floor with one hand to the side across the body for 30 seconds, then returning to the starting position, relaxing, turning to the other side; in the eleventh exercise, sitting on a chair, legs together, hands below, take the seat of the chair, turn to the side, rotating in the belt, without taking your hands off the support, for 30 seconds, then return to the starting position, relax; then repeat in the other direction for 30 seconds, then return to the starting position, relax; in the twelfth exercise, sitting on a chair, leaning on the back, legs together, hands hanging freely, clasping the knee with palms, pull the leg up for 30 seconds, then return to the starting position, relax, then repeat with the other leg for 30 seconds, then return to the starting position, relax; in the thirteenth exercise, sitting on a chair, leaning on the back, legs together, arms bent at the elbows, palms facing each other, fingers up, raise your arms up above your head, as high as possible, squeezing your palms, for 30 seconds, then slowly release without tension and return to their original position; in the fourteenth exercise, sitting on a chair, legs together, arms bent at the elbows, to the sides at shoulder level, palms down, move the elbows to the sides, clenching fists, for 30 seconds, then return to the starting position, relax; in the fifteenth exercise, sitting on a chair, leaning on the back, legs slightly apart, arms hanging freely, gently dropping the chin on the chest, fixing this position and closing the eyes for 30 seconds, in addition, three hours after the physical rehabilitation complex in patients on the second, fourth, sixth, eighth and tenth days, only breathing exercises with elements of full breathing are performed, on the third, fifth, seventh and ninth days in the first half of the day, they perform psycho-emotional rehabilitation exercises based on the approaches of desensitization and processing by eye movements (EMDR) and Wingwave-coaching neurotechnics, while: on the third day of classes, an exercise is performed, which is the “Butterfly” technique, carried out in three stages, where at the first stage tactile bilateral stimulation is performed, at the second stage visual bilateral stimulation is performed, and at the third stage, carried out with a neurocoach, patients sitting in a relaxed state, imagine what gives energy, its color, then the patient takes a deep breath and imagines that he inhales energy, inhales this color, then the patient imagines all the most negative that has accumulated inside him, its color, and the patient imagines that exhales it from himself, then the patient performs a slow deep breath and a slow exhalation twice, the exercise is performed 6 times; on the fifth day of classes, an exercise is performed, which is the “Working with the Elements” technique, carried out in six stages with a neuro-coach, with each stage representing the study of one of the elements: “air”, “water”, “fire”, “metal”, "earth", "tree", the duration of work in each element is 10 minutes; on the seventh day of classes, an exercise is performed, which is a neurotechnical "Refuge", carried out with a neurocoach, in which the patient closes his eyes and mentally creates a refuge for himself - a real or fictional place where he feels safe, while the duration of the exercise is 20 minutes; on the ninth day of classes, they perform an exercise representing the “Safe Place” neurotechnics, performed with a neurocoach, the group listens to the neurocoach and presents what is important and close, without speaking out loud, carried out in 5 successive stages, while: at the first stage, they create a visual image, at the second stage, a voice sound track is created, at the third stage, kinesthetic sensations are formed, at the fourth stage, the “Smell” technique is performed, at the fifth stage, the “Implementation” technique is performed, while the duration of the exercise is 30 minutes, three hours after the patient completes the complex for psycho-emotional rehabilitation on the third, fifth, seventh and ninth days, only breathing exercises with elements of full breathing are performed, in addition, before and after each session, the patient's blood pressure (BP) and pulse are measured, in addition, after performing the stretching complex, the patient's pulse is additionally measured, and to assess the physical condition of patients before the start of the rehabilitation course and at the end of it, an assessment of the respiratory system is carried out, including pulse oximetry with the determination of SO ₂ , an assessment of the forced vital capacity of the lungs (FVC), respiratory rate, lying down (RR), an assessment of the cardiovascular system, including a 6-minute walk test (TSW), the psycho-emotional state is also assessed before the start of the rehabilitation course and at its end, including determining the severity and frequency of panic attacks, assessing the Spielberger-Khanin questionnaire and the Hamilton Depression Scale (HRDS).