Introduction

The primary direction of modern medicine is recognized by most authors as preventive, and prevention is most effective in young individuals [1]. In the modern world, studying at a higher education institution places increased demands on the personal characteristics of students, especially when it comes to future doctors. Medical education is traditionally considered one of the most stressful forms of professional training [2]. Medical faculty students face an unprecedented volume of information, the need to assimilate vast amounts of material in a limited time, emotional strain when working with patients, and the constant fear of making a mistake, the cost of which is a human life. These demands intensify during the examination period, which can increase the level of neuroticism and anxiety in students [3].

Consequently, the relevance of preventing the consequences of exam stress, such as the development of neuroses and psychosomatic diseases, is increasing [4,5].

Despite a significant amount of research on this issue, with results published in both domestic [1-5] and foreign [6-8] literature, this problem cannot be considered fully resolved.

Objective. To determine and compare the psychological personality characteristics of medical faculty students during the pre-exam period before and after psychological correction of the identified psychophysiological changes to reduce the risk of developing neuroses and psychosomatic diseases.

Materials and Methods

To achieve this goal, we observed 44 individuals (male and female) studying at the university's medical faculty, with an average age of 21 (20.0; 21.2) years. For an objective assessment of the psychophysiological state of medical faculty students, a set of complementary methods was applied, each revealing a specific aspect of the individual's psychophysiological status [9-13].

The Toronto Alexithymia Scale (TAS), adapted at the V.M. Bekhterev Institute, is intended to objectify the level of alexithymia as an independent risk factor for psychosomatic diseases. In the context of observing young individuals, the scale allows for the identification of the maladaptation phase, where emotional tension has not yet transformed into organic pathology but is already manifested by a disturbance in the body's non-specific adaptive reactions [11].

The Spielberger State-Trait Anxiety Inventory (adapted by Yu. Khanin) represents the gold standard for anxiety assessment, differentiating between situational (reactive) anxiety as a state at a given moment and trait anxiety as a stable individual characteristic [12].

S. Subbotin's Method is designed to diagnose tolerance to stress factors and the style of behavioral self-regulation; it allows for an assessment of how effectively an individual copes with stress, flexibly responds to changing conditions, and evaluates intermediate and final results of their actions [13]. Students with low stress tolerance indicators fall into the maximum risk group for developing maladaptive states, as they cannot effectively structure their activities under high loads [14].

The application of a comprehensive approach allows for the creation of a multidimensional student profile, considering:

●       the current level of stress load;

●       individual characteristics of stress response;

●       the effectiveness of self-regulation mechanisms;

●       basic personality traits and adaptive potential.

Before the study, each participant signed a voluntary informed consent. Statistical processing of the obtained results was performed using the STATISTICA 10 software package.

Results

The results of the psychological examination are illustrated in Figures 1-6.

Figure 1. Distribution of TAS testing indicators among the observed students (in %).

Note: Group I – individuals without alexithymia; Group II – students at risk; Group III – study participants with alexithymia.

The caption on the Figure 1 is:

●       I group

●       II group

●       III group

As can be seen from the data presented in Figure 1, the predominant subjects were students without signs of alexithymia, while the number of individuals in Groups II and III (i.e., those in whom alexithymia is either developing or clinically expressed) totaled almost half of all the young people we observed.

Figure 2. Distribution of stress tolerance indicators according to S. Subbotin among the observed individuals (in %).

Note: Group designations are the same as in Fig. 1

The caption on the Figure 2 is:

●       High degree of stress tolerance (green)

●       Average degree of stress tolerance (yellow)

●       Low degree of stress tolerance(red)

As follows from the data shown in Figure 2, students with the following degrees of stress tolerance prevailed: 2/3 of all observed individuals had an average degree of tolerance, one-fifth of the examined individuals had a high degree of stress tolerance, and one-sixth were unstable to stressful situations.

Figure 3. Distribution of trait anxiety levels among the observed students according to Spielberger-Khanin (in %).

Note: Group designations are the same as in Fig. 1

The caption on the Figure 3 is:

●       High anxiety (red)

●       Moderate anxiety (yellow)

As can be seen from the data shown in Fig. 3, among the students, half of the respondents had moderate trait anxiety, and exactly half had a high level of anxiety as a disposition. It is important to note that a low level of trait anxiety was not represented in the study group.

After the initial testing, eight individuals were randomly selected for psychological correction of their identified personality response characteristics.

The psychological correction was conducted within a training form within the framework of group psychotherapy (optimal group size 6-8 people) using the following approaches: positive psychology and psychotherapy, body-oriented psychotherapy, Gestalt psychology and psychotherapy, cognitive-behavioral approach, meditative techniques, art therapy and sand therapy, psychosynthesis, neuro-linguistic programming, and the psychodynamic approach.

The training sessions were led by two co-therapists (a psychosomatic specialist and a clinical psychologist). Therapeutic sessions (four in total) lasted 2.5 hours with a frequency of once a week. After completing the group psychotherapy course, the observed students underwent repeated testing using the psychological methods described above. The obtained results are illustrated in Figures 4-6.

A                                                                      B

Figure 4. Dynamics of TAS testing indicators among the observed individuals following psychological correction (in %).

Note: Group designations are the same as in Fig. 1

A – before psychological correction;

B – after correction.

*Indicates statistically significant differences.

The caption on the Figure 4 is:

A

●       I group

●       II group

●       III group

B

●       I group

●       II group

●       III group

As can be seen from the data presented in Fig. 4, the number of individuals with clinically expressed signs of alexithymia after psychological correction decreased by 4 times (p ≤ 0.05).

A                                                                         B

Figure 5. Dynamics of stress tolerance indicators according to S. Subbotin among the observed students following psychological correction (in %).

Note: Group designations are the same as in Fig. 1

A – before psychological correction;

B – after correction.

*Indicates statistically significant differences.

The caption on the Figure 5 is:

A

●       High degree of stress tolerance (green)

●       Average degree of stress tolerance (yellow)

●       Low degree of stress tolerance(red)

B

●       High degree of stress tolerance (green)

●       Average degree of stress tolerance (yellow)

●       Low degree of stress tolerance(red)

As follows from the data presented in Fig. 5, the number of students unstable to stress factors after psychological correction decreased by half, and the group of respondents with average stress tolerance increased somewhat (by 1/5 of the initial values).

A                                                                              B

Figure 6. Dynamics of trait anxiety indicators among the observed respondents following psychological correction (in %).

Note: Group designations are the same as in Fig. 1

A – before psychological correction;

B – after correction.

*Indicates statistically significant differences.

The caption on the Figure 6 is:

A

●       High anxiety (red)

●       Moderate anxiety (yellow)

B

●       High anxiety (red)

●       Moderate anxiety (yellow)

As follows from the data presented in Fig. 6, the number of individuals with a high level of trait anxiety decreased by a quarter of the initial values, while the number of students with moderate trait anxiety increased by approximately the same proportion.

Discussion of Results

The aspects of personal response we examined in the observed individuals—the absence or presence of alexithymia of varying degrees of expression; different levels of anxiety as a disposition; and the degree of tolerance to stress factors—were chosen by us for a reason, as high levels of anxiety and the presence of clinical signs of alexithymia are recognized as independent risk factors for the development of psychosomatic diseases and cardiovascular events (the latter being the leading cause of death among the working-age population worldwide) [1,6,7,8,15].

As the initial psychological examination of medical faculty students under our observation during the preparation for the upcoming examination session showed, there was a significant proportion of respondents who had alexithymia of varying degrees of severity (were at risk or had clear clinical manifestations), high levels of anxiety, and low stress tolerance.

In this regard, to reduce the pre-exam stress load, it was advisable to conduct psychological correction of the identified changes in the observed students. After implementing the correction in the form described above, a significant positive effect was achieved, manifested as a considerable reduction in the number of individuals with clear signs of alexithymia, high trait anxiety, and low stress tolerance. This allowed us to lower their increased risk of developing neuroses and psychosomatic diseases.

Our study confirms the need for wider implementation of psychological diagnostic methods followed by correction of identified changes within the student environment (especially regarding future doctors) during periods of pre-exam stress.

Conclusion

The psychophysiological characteristics of medical faculty students represent a complex multifactorial phenomenon, determined by the continuous interaction of individual-typological personality traits and the uniquely intense stress-inducing nature of the educational environment. The specifics of medical training place increased demands on the adaptive reserves of students' bodies, reaching a critical peak during examination periods [2].

In the course of this study, it was established that a significant portion of medical students initially fall into the high-risk group for developing psychosomatic disorders and cardiovascular events. This is due to a pathological combination of high levels of anxiety, alexithymia, and low stress tolerance.

Following psychological correction, it was possible to significantly optimize the students' psychological indicators, which suggests the advisability of more active psychological support for medical faculty students (psychodiagnostics followed by correction of established changes), especially during periods of pre-exam and exam stress.