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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">psychiatry</journal-id><journal-title-group><journal-title xml:lang="ru">ПСИХИАТРИЯ</journal-title><trans-title-group xml:lang="en"><trans-title>Psychiatry (Moscow) (Psikhiatriya)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1683-8319</issn><issn pub-type="epub">2618-6667</issn><publisher><publisher-name>FSBSI “The Mental Health Research Centre”;   LLC «Publisher «MIA»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.30629/2618-6667-2025-23-3-111-122</article-id><article-id custom-type="elpub" pub-id-type="custom">psychiatry-1390</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>НАУЧНЫЕ ОБЗОРЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>SCIENTIFIC REVIEWS</subject></subj-group></article-categories><title-group><article-title>Возможности персонализированного подбора психотерапии при коморбидных депрессивных и тревожных расстройствах, мишени КПТ и ЛОРП</article-title><trans-title-group xml:lang="en"><trans-title>Possibilities of Personalized Selection of Psychotherapy for Comorbid Depressive and Stressful Disorders, Targets of Cognitive Behavioral Therapy (CBT) and Person-Centered (Reconstructive) Psychotherapy (LORP)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8653-8183</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Старунская</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Starunskaya</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Диана Андреевна Cтарунская, младший научный сотрудник, отделение лечения пограничных психических расстройств и психотерапииСанкт-Петербург</p></bio><bio xml:lang="en"><p>Diana A. Starunskaya, Junior Researcher, Department of Treatment of Borderline Mental Disorders and Psychotherapy St. Petersburg</p></bio><email xlink:type="simple">stardia@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5116-836X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Васильева</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Vasileva</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Анна Владимировна Васильева, доктор медицинских наук, главный научный сотрудник, отделение лечения пограничных психических расстройств и психотерапии, доцент, кафедра психотерапии и сексологииСанкт-Петербург</p></bio><bio xml:lang="en"><p>Anna V. Vasileva, Dr. Sci. (Med.), Chief Researcher, Department of Treatment of Borderline Mental Disorders and Psychotherapy, Associate Professor, Department of Psychotherapy and SexologySt. Petersburg</p></bio><email xlink:type="simple">annavdoc@yahoo.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8798-3702</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Караваева</surname><given-names>Т. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Karavaeva</surname><given-names>T. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Татьяна Артуровна Караваева, доктор медицинских наук, профессор, главный научный сотрудник, руководитель отделения, отделение лечения пограничных психических расстройств и психотерапии,профессор кафедры, кафедра медицинской психологии и психофизиологии, профессор кафедры общей и прикладной психологии с курсами медико-биологических дисциплин и педагогики, ведущий научный сотрудник, научный отдел инновационных методов терапевтической онкологии и реабилитацииСанкт-Петербург</p></bio><bio xml:lang="en"><p>Tatiana A. Karavaeva, Dr. Sci. (Med.), Professor, Chief Researcher, Head of Department, Department of Treatment of Borderline Mental Disorders and Psychotherapy, Department of Medical Psychology and Psychophysiology, Department of General and Applied Psychology with Courses in Medical and Biological Disciplines and Pedagogy,  Leading Researcher, Scientific Department of Innovative Methods of Therapeutic Oncology and RehabilitationSt. Petersburg</p></bio><email xlink:type="simple">tania_kar@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4765-2423</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ляшковская</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Lyashkovskaya</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Светлана Владимировна Ляшковская, кандидат медицинских наук, cтарший научный сотрудник, научно-организационное отделение, главный специалистСанкт-Петербург</p></bio><bio xml:lang="en"><p>Svetlana V. Lyashkovskaya, Cand. Sci. (Med.), Senior Researcher, Scientific and Organizational Department, Chief SpecialistSt. Petersburg</p></bio><email xlink:type="simple">sl_dok@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-9024-5960</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Андрианова</surname><given-names>А. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Andrianova</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Александра Евгеньева Андрианова, младший научный сотрудник, отделение лечения пограничных психических расстройств и психотерапииСанкт-Петербург</p></bio><bio xml:lang="en"><p>Alexandra E. Andrianova, Junior Researcher, Department of Treatment of Borderline Mental Disorders and PsychotherapySt. Petersburg</p></bio><email xlink:type="simple">alexsandra0013@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФБГУ «Национальный медицинский исследовательский центр психиатрии и неврологии имени В.М. Бехтерева» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health of the Russia</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФБГУ «Национальный медицинский исследовательский центр психиатрии и неврологии имени В.М. Бехтерева» Минздрава России;&#13;
ФГБУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health of the Russia;&#13;
FSBEI HE “North-Western State Medical University named after I.I. Mechnikov”, Ministry of Health of the Russia</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФБГУ «Национальный медицинский исследовательский центр психиатрии и неврологии имени В.М. Бехтерева» Минздрава России;&#13;
ФГБОУ ВО «Санкт-Петербургский государственный университет»;&#13;
ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России;&#13;
ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health of the Russia;&#13;
FSBEI HE “St. Petersburg State University”;&#13;
FSBEI HE “St. Petersburg State Pediatric Medical University”, Ministry of Health of the Russia;&#13;
N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of the Russia</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>07</day><month>09</month><year>2025</year></pub-date><volume>23</volume><issue>3</issue><fpage>111</fpage><lpage>122</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Старунская Д.А., Васильева А.В., Караваева Т.А., Ляшковская С.В., Андрианова А.Е., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Старунская Д.А., Васильева А.В., Караваева Т.А., Ляшковская С.В., Андрианова А.Е.</copyright-holder><copyright-holder xml:lang="en">Starunskaya D.A., Vasileva A.V., Karavaeva T.A., Lyashkovskaya S.V., Andrianova A.E.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.journalpsychiatry.com/jour/article/view/1390">https://www.journalpsychiatry.com/jour/article/view/1390</self-uri><abstract><p>Обоснование: коморбидные депрессивные и тревожные расстройства являются наиболее распространенным сочетанием в клинической практике и нуждаются в тщательном подходе при выборе методов терапии. Возможности адаптации психотерапевтических интервенций к потребностям пациентов в целях повышения эффективности выбранного лечения и улучшения качества жизни изучены недостаточно. Цель обзорной статьи — рассмотреть научные публикации, посвященные таким современным методам лечения как когнитивно-поведенческая терапия (КПТ) и личностно-ориентированная (реконструктивная) психотерапия (ЛОРП), выделить мишени психотерапевтических интервенций для коморбидных депрессивных и тревожных расстройств при каждом рассматриваемом методе. Материал и методы: по ключевым словам «депрессия», «тревожные расстройства», «коморбидность», «личностно-ориентированная реконструктивная психотерапия», «когнитивно-поведенческая терапия», «персонализированная терапия», «мишени психотерапии» проведен поиск научных публикаций в электронных базах данных PubMed, MEDLINE, РИНЦ. Обсуждение: в большинстве статей обсуждаются сложности, возникающие при коморбидности депрессивных и тревожных нарушений, а также их влияние на выбор терапевтического подхода. Проанализированы характеристики и результаты применения КПТ и ЛОРП в лечении коморбидных состояний, выделены мишени, на которые должны быть направлены психотерапевтические интервенции с учетом коморбидности. Показана эффективность этих методов в уменьшении симптоматики и улучшении общего состояния пациентов с сочетанными депрессивными и тревожными расстройствами. Заключение: формирование нозоспецифических психотерапевтических стратегий может решить задачи повышения качества терапевтического воздействия посредством подбора персонализированного подхода к лечению.</p></abstract><trans-abstract xml:lang="en"><p>Background: comorbid depressive and anxiety disorders are the most common combination in clinical practice. These states require a careful approach when choosing treatment methods. The abilities to adapt psychotherapeutic interventions to the needs of patients studied insufficiently. The aim of review was to analyze scientific publications on modern treatment methods, such as cognitive behavioral therapy (CBT) and person-centered (reconstructive) psychotherapy (PCP). Materials and Methods: using keywords “depression”, “stressful disorders”, “comorbidity”, “person-oriented reconstructive psychotherapy”, “cognitive behavioral therapy”, “personalized therapy”, “targets of psychotherapy” a search for articles has been conducted in PubMed, MEDLINE, RSCI, e-Library The purpose of analytical study is to identify the targets of psychotherapeutic interventions for comorbid depressive and stressful disorders in each of the methods. Discussion: the difficulties arising from the comorbidity of depressive and anxiety disorders, as well as their impact according to the choice of therapeutic approach are discussed in most of articles under consideration in connection with the tasks of improving the quality of therapeutic intervention through the selection of a personalized approach to treatment. The characteristics and results of the use of CBT and LORP in the treatment of comorbid conditions are examined, and the targets to which psychotherapeutic interventions should be directed, taking into consideration comorbidity, are identified. The effectiveness of these methods in reducing symptoms and improving the general condition of patients with combined depressive and anxiety disorders is shown. Conclusion: the formation of nosospecific psychotherapeutic strategies can solve problems of increasing the effectiveness of the chosen treatment and improving patients' quality of life</p></trans-abstract><kwd-group xml:lang="ru"><kwd>депрессия</kwd><kwd>тревожные расстройства</kwd><kwd>коморбидность</kwd><kwd>личностно-ориентированная реконструктивная психотерапия</kwd><kwd>когнитивно-поведенческая терапия</kwd><kwd>персонализированная терапия</kwd><kwd>мишени психотерапии</kwd></kwd-group><kwd-group xml:lang="en"><kwd>depression</kwd><kwd>stressful disorders</kwd><kwd>comorbidity</kwd><kwd>person-oriented reconstructive psychotherapy</kwd><kwd>cognitive behavioral therapy</kwd><kwd>personalized therapy</kwd><kwd>targets of psychotherapy</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Исследование выполнено в рамках государственного задания ФГБУ «НМИЦ ПН им. В.М. Бехтерева» Минздрава России 2024–2026 гг. (XSOZ 2024 0014).</funding-statement><funding-statement xml:lang="en">The study was carried out within the framework of the state assignment of V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology of the Ministry of Health of the Russian Federation for 2024-2026 (XSOZ 2024 0014).</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43(2):476–93. doi: 10.1093/ije/dyu038 Epub 2014 Mar 19. PMID: 24648481; PMCID: PMC3997379</mixed-citation><mixed-citation xml:lang="en">Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. 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