Features of post-traumatic stress disorder, resilience and attitude to the disease in patients of different groups (on the example of oncological and cardiovascular diseases)

Tulitbaeva Galina Fanilevna ORCID: 0000-0002-3754-9473 PhD in Psychology Associate Professor, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology 3/4 Karl Marx str., Ufa, Republic of Bashkortostan, 450000, Russia tulitbaevagf@rambler.ru Other publications by this author     Politika Oksana Ivanovna ORCID: 0000-0002-5538-7711 PhD in Psychology Associate Professor, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology 450,000, Russia, Republic of Bashkortostan, Ufa, Karl Marx str., 3/1 okcanapolitika@yandex.ru Shafigullina Liliya Rashidovna ORCID: 0009-0003-9555-8380 Assistant, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology 45000, Russia, Republic of Bashkortostan, Ufa, Karl Marx str., 3/1 tulitbaevagf@rambler.ru

Bozhko Aigul' Anasovna ORCID: 0000-0000-0000-0000 Master's degree, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology 45000, Russia, Republic of Bashkortostan, Ufa, Karl Marx str., 3/1 tulitbaevagf@rambler.ru

The relevance of research. There is a steady increase in oncological diseases all over the world. Malignant tumors are one of the most common causes of death in the population of developed countries. In itself, the fact of having a severe somatic disease is a powerful mental and physiological stress for the patient ^{[5; 6; 3; 1]}.

It is known that the internal picture of the disease in cancer correlates with the concepts of "suffering", "pain", "death" and acquires exceptional significance for a person. The diagnosis of this disease is one of the most powerful stressful factors leading to disruption of all adaptive mechanisms, depletion of psychological resources and the patient's health. The diagnosis of cancer and information about the upcoming treatment triggers a number of experiences and causes severe psychological distress in every person, which, with a lack of coping mechanisms, can lead to the development of concomitant mental disorders.

Personal characteristics, features of the psychological state of patients with oncological diseases have repeatedly become objects of psychological research (Nepomnyashchaya N.I., Ivashkina M.G., Vasilyeva A.V., Kazennaya E.V., etc.). The least studied among the mental features of concomitant malignant neoplasms are post-traumatic stress disorder (PTSD) and resilience. Post-traumatic stress disorder is a complex of mental and physical symptoms that develop as part of a reaction to a traumatic situation and persist for more than one month ^[5]. For the development of post-traumatic stress disorder, it is not so much the type of stressor that is important, as its characteristics. The disease develops after events that are extreme in nature, go beyond ordinary human experiences and cause intense fear for their lives, horror and a sense of helplessness. Important characteristics of a severe traumatic factor are surprise, the rapid development of a catastrophic event and the duration of exposure. Knowledge about cancer meets these criteria and can cause post-traumatic stress disorder.

The aim of the study is to study the features of post-traumatic stress disorder, resilience and attitude to the disease in patients with oncological and cardiovascular diseases.

The hypothesis of the study: post-traumatic stress disorder, resilience, attitude to the disease in cancer patients has its own characteristics in dealing with patients with cardiovascular diseases.

To solve the tasks and test the hypothesis, the following methods were used: "Scale of assessment of the impact of a traumatic event" (M. Horowitz et al.), "Test of resilience" (S. Maddi, adaptation by D.A. Leontiev, E.I. Rasskazova), "Scale of psychological stress" (Lemura–Tessier–Fillion), "Questionnaire diagnostics of types of attitude to the disease" (V.M. Bekhterev Research Psychoneurological Institute).

Quantitative data analysis was performed using a nonparametric criterion U-Mann–Whitney criterion. All calculations are performed in the SPSS software (version 17.0)

The empirical basis of the study was the department of antitumor drug therapy of the Republican Clinical Oncological Dispensary of the Ministry of Health of the Republic of Bashkortostan, Oktyabrsky; the oncological department of the State Budgetary Healthcare Institution of the Republic of Bashkortostan City Hospital No. 1. October.

The study sample consisted of 80 people aged 40 to 73 years. The average age is 58 years. The sample included 40 patients with cancer and 40 patients with diseases of the cardiovascular system. The study involved able-bodied men and women who are fluent in Russian, without cognitive disorders.

Table 1 shows the revealed statistically significant differences in the groups with oncological diseases and with cardiovascular diseases in twelve variables.

Table 1

Differences in indicators in groups of patients with oncological and cardiovascular diseases, average

Note: significant differences at the 0.05 level are highlighted in bold

The analysis of the available statistically significant differences between the samples for the presented variables showed the following. When studying the effect of a traumatic event on a person, statistically significant differences were found in the invasion indicator (14.70; 9.5; p=0.008). Thus, patients with cancer are more likely to relive what happened when reminded of a traumatic event, they often have unexpected feelings of a direct return to a traumatic situation than patients with the musculoskeletal group.

Significant differences in the avoidance criterion were obtained (17.35; 8.85; p=0.000). The orientation of the personality to avoid everything that reminds of a traumatic experience is more characteristic for patients with cancer than for patients with cardiovascular diseases. They are also more prone to internal tension, irritability, alertness.

In addition, statistically significant differences were obtained in the sum of points according to the method (46.25; 29.9; p=0.003), which indicates that post-traumatic stress disorder is more pronounced in patients with oncological diseases, traumatization is more pronounced.

The study of resilience showed the presence of statistically significant differences on the control scale (15.20; 18.1; p= 0.049). Accordingly, control, control of the situation is given to patients with cancer easier and simpler, there is a certainty that the struggle allows you to influence the outcome of what is happening, at the same time, a sense of self-safety is more characteristic of patients with cardiovascular diseases than for cancer patients. The latter are more characterized by oppressive uncertainty.

A study of the types of attitudes to the disease in both groups showed the following differences in the samples.

This type of response to the disease as "alarming" is more typical for cancer patients (13.9; 5.6; p=0.043) than for patients with cardiovascular diseases. This means that they are experiencing restless anxiety, thinking about constant complications.

Hypochondriacal type is also more typical for cancer patients (14.2; 6.8; p= 0.005), which shows excessive concentration on subjective painful and other unpleasant sensations, the desire to discuss this problem in society, to exaggerate suffering.

Behavior of the type of "irritable weakness", active outbursts of irritability in case of failures, adverse sensations, pain, impatience, i.e. the neurasthenic type of attitude to the disease is generally more characteristic for patients with cancer than for patients of the second group (15; 7.55; p=0.030).

At the same time, cancer patients are more likely to feel dejected by the disease, they do not believe in the effect of treatment, there is a pessimistic view of everything around them, which shows the prevailing melancholic type of attitude towards the disease (8; 1.55; p=0.017).

The presence of an apathetic type (6.55; 1.85; p = 0.030) indicates a loss of interest in life, lethargy, complete indifference, which contributes to the increased manifestation of post-traumatic stress disorder, which is also more pronounced in cancer patients.

Oncological patients have excessive vulnerability and vulnerability, at the same time, fear of becoming a burden for loved ones (a sensitive type of attitude to the disease) (21.75; 7.0; p = 0.000).

Note that this type of attitude to the disease as egocentric (11.4; 4.65; p=0.000), which is characterized by the fact that experiences and sufferings are displayed to relatives and others, prevails in cancer patients than in patients of the cardiovascular group.

The study of the types of attitudes to the disease as a whole shows a picture in which it is clearly seen that cancer patients are more characterized by the predominance of maladaptive behavior disorder and usually a violation of social adaptation.

The data of the psychological stress scale indicate that the stress response in patients with cancer is more pronounced than in patients with cardiovascular diseases (95; 81; p=0.043), but at the same time it has a low, adaptive level of severity in both groups.

No statistically significant differences were found in the other studied parameters in the two samples. Thus, excitability as a symptom of post-traumatic stress is inherent in both groups and has a low level of severity (14.20; 11.55; p=0.211). Such indicators of resilience as engagement (22.80; 23.4; p=0.738), risk acceptance (10.40; 13.1; p= 0.086) have the same severity in both groups. Resilience, according to many authors, is formed at the dawn of youth and, therefore, the disease that develops in adulthood cannot greatly affect these characterological features of a person.

The study of the types of attitude to the disease revealed no differences on the presented scales: harmonious (16.6; 13.95; p=0.968), ergopathic (24.7; 23.85; p= 0.659), anosognosic (11.95; 12.75; at p= 0.529). Types of attitude to the disease are characterized by the absence of mental maladaptation in patients.

Thus, statistically significant differences were found between the two study groups. Thus, patients with cancer are more likely to relive what happened when reminded of a traumatic event, the orientation of the personality is characterized by avoidance of everything that reminds of a traumatic experience, post-traumatic stress disorder is expressed. The feeling of self-safety is more typical for patients with cardiovascular diseases than for cancer patients. The latter are more characterized by oppressive uncertainty. If we talk about the types of response to the disease, then among cancer patients there is more often post-sleep anxiety, they think about complications; there is excessive concentration on subjective painful and other unpleasant sensations; behavior like "irritable weakness"; dejection, therefore disbelief in the possibility of recovery and improvement of the condition, as well as in general on the effectiveness of treatment, pessimistic a look at everything around; vulnerability. Exposing experiences and sufferings to relatives and others prevails in cancer patients in comparison with patients of the cardiovascular group.

As we can see, statistically significant differences were found in the studied groups on most scales. In the future, to study the structure of the relationship of variables, a correlation analysis will be performed separately for both groups and presented in the following publications of the authors.