Open Journal of Social Sciences, 2014, 2, 90-95
Published Online May 2014 in SciRes.
How to cite this paper: Pervichko, E. and Zinchenko, Y. (2014) Postnonclassical Methodology in Clinical Psychology: Op-
portunities and Perspectives of Vygotsky-Luria School. Open Journal of Social Sciences, 2, 90-95.
Postnonclassical Methodology in Clinical
Psychology: Opportunities and Perspectives
of Vygotsky-Luria School
Elena Pervichko, Yury Zinchenko
Faculty of Psychology, Lomonosov Moscow State University, Moscow, Russia
Email: elena_pervichko@ma, zinchenko_y@mail. ru
Received January 2014
The primary aim of this research is to show the high efficacy of the psychological syndrome analy-
sis (Vygotsky-Luria School) for a variety of issues embraced by psychodiagnostics and psychothe-
rapy. The syndrome approach applied in theoretical and practical fields of clinical psychology is
highly efficient at the current state of science evolution. The principal method of this study was the
psychological syndrome analysis. We examined 85 patients with hypertension (HTN) at work and
85 essential HTN patients. The results suggest that the psychosomatic syndrome has a multifac-
torial structure. That is, the structure of the psychosomatic syndrome in patients with HTN at
work is determined by three factors. These are as follows: the motivational factor (characterized
by the domination of the achievement motivation); the factor of emotion regulation disorder; and
the factor of repression and denial of the significance of an alarming situation.
Postnonclassical Methodology, Clinical Psychology, Psychological Syndrome Analysis,
Vygotsky-Luria School, Psychosomatic Syndrome, Essential Hypertension, Hypertension at Work
1. Introduction
In recent times the Russian psychology has witnessed repeated attempts of methodological analysis of psycho-
logical concepts conducted on the basis of a well-known classification of the types of scientific rationality, sug-
gested by V.S. Styopin. The classification provides grounds for designation of the following types (and stages) in
development of scientific knowledge: classical, nonclassical and postnonclassical [1]-[6]. To study objects repre-
sented in elementary systems the means of classical science will suffice; non-classical science should operate with
self-regulating systems, and postnonclassical science may cope with complex self-developing systems [1]. “Self-
developing systems are capable of switching from one type of self-adjustment to another. ... They can become
more complicated in the process of development, increase the number of levels in the hierarchical organization of
their elements. The formation of each new level has a reverse effect on the already established ones, it changes
them” [1] [7].
E. Pervichko, Y. Zinchenko
The principle of syndrome analysis of psychic phenomena is one of the most essential methodological prin-
ciples in Russian clinical psychology (the Vygotsky-Luria school) [4] [5] [7] [8]. We presume that the syndrome
approach applied in theoretical and practical fields of clinical psychology is highly efficient at the current state of
the evolution of science due to the potential of the new methodological context of the postnonclassical model of
rationality and a comprehensive character of cultural-historical theory proposed by L.S. Vygotsky and A.R. Luria
regarding the person and his/her mind as a self-developing open systems.
2. Research Objectives
The primary aim of this research is to show the high efficacy of the psychological syndrome analysis (Vy-
gotsky-Luria school) for solving issues in the field of psychodiagnostics and psychotherapy within the framework
of postnonclassical methodology.
Hypertension (HTN) is one of the most dangerous and common diseases of cardiovascular system. Today there
detected more and more patients with HTN, whose blood pressure (BP) values at work time appear to be higher
than those at leisure. This form of HTN is called “HTN at work” [9]. Studies of emotional and personality cha-
racteristics of patients with HTN at work indicated that they usually experience negative emotions in more pro-
longed and excessive way with a tendency not to express them openly [10]-[14].
We take an example of description of a psychosomatic syndrome in patients with HTN at work to demonstrate
that a psychosomatic syndrome may serve as a means not only for establishing a diagnosis, but for evidence of the
role of stress in BP increase, and for making psychological and clinical prognoses for each particular patient.
3. Research Methods and Design
The principal method of this research was psychological syndrome analysis (Vygotsky-Luria school). The re-
search was carried out with the implication of methods of psychological experiment and psychological testing, and
methods of physiological data registration. A stressful situation was created experimentally, employing the pro-
cedure of aspiration level (AL) research. A situation was set up that induced a state of mental tension. In the course
of the experiment participants were asked to solve 12 tasks. As stimulating material Raven’s Progressive Matrices
were suggested. Before and after the experiment participants’ level of state anxiety (SA) (the Spielberger SA
Inventory), and physiological indices (BP reaction, catecholamines (CA) level in urine, rennin and angiotensin 1
(А1) level in blood plasma) were assessed. In the course of experiment there were estimated features of AL and
characteristics of participants’ nonverbal behavior. The clinical and physiological part of the study was conducted
on participatory terms with specialists in Department of General medicine at the Moscow State University of
Medicine and Dentistry (Professor E.I. Sokolov, Professor O.D. Ostroumova). Statistical processing of the data
was conducted with implication of various methods: calculation of mean values and the standard deviation; fre-
quency analysis; certainty computation for distinctions between samples based on indicators of the probability of
distinctions between indicators (Mann-Whitney U-test). Cluster analysis (Hierarchical clustering method) was
used for solving the task of feature combination in relatively homogeneous groups.
The study comprised 85 participants with HTN at work, mean age was 44.7 ± 4 .3 years, and 85 patients with
essential HTN, mean age was 47.4 ± 4.5 years.
4. Results and Their Discussion
The received results showed that within our research employing experimental stress modeling, a state of emo-
tional tension was formed in practically all the patients with HTN. This fact is confirmed by BP and SA increase
in all the patients with HTN in the course of experiment (Table 1, and Table 2). However, some patients with
HTN were characterized not by increase (which is regarded as a norm for stressful reaction), but decrease of in-
dices of all measured biochemical parameters, as well as by decrease of SA level (Table 3, and Table 4). Be-
sides, patients with decrease of biochemical and SA indices in the course of stress-modeling were also characte-
rized by initially lower indices of CA in urine, and renin and АI in blood plasma (Table 4). This may be ac-
counted for by the absence of essential biochemical “pre-race readiness”, exceedingly important for entering a
stressful situation and efficient coping with it. On the basis of statistical data analysis we may conclude that
HTN at work patients demonstrate more significant stress reactions, which in certain cases appear paradoxical
(Tables 1-4). Patients with HTN at work also differ from patients with essential HTN by initially higher level of
E. Pervichko, Y. Zinchenko
Table 1. Average blood pressure indices in the compare groups of HTN patients (mmHg).
Blood pressure indices Patients with HTN at work,
n = 85 (Me ± SD) Patients with essential HTN,
n = 85 (Me ± SD) Significant difference on the
Mann-Whitney U-test
Systolic BP before experiment 141.0 ± 3.5 149.0 ± 3.8 -
Systolic BP after experiment 157.1 ± 4.1 153.1 ± 4.0 -
Systolic BP 16.1 ± 1.9 4.1 ± 0.7 p < 0.001
Diastolic BP before experiment 92.8 ± 2.0 98.9 ± 2.4 -
Diastolic BP after experiment 97.3 ± 2.9 101.3 ± 2.8 -
Diastolic BP 4.5 ± 0.7 2.4 ± 0.5 p < 0.05
Table 2. Average indices of satate anxiety level in the compare groups of HTN patients (points).
State anxiety level Patients with HTN at work,
n = 85 (Me ± SD) Patients with essential HTN,
n = 85 (Me ± SD) Significant difference on the
Mann-Whitney U-test
SA before experiment 42.8 ± 3.6 37.0 ± 2.3 p < 0.05
SA after experiment 45.2 ± 2.9 38.3 ± 2.0 p < 0.05
SA 2.4 ± 0.5 1.3 ± 0.2 p < 0.05
Table 3. Frequency of positive and negative changes of satate anxiety level in HTN patients (%).
Pattern of SA change after experiment
Patients with HTN at
work, n = 85 Patients with essential
HTN, n = 85 Significant difference on the
Mann-Whitney U-test
Abs. value (%) Abs. value (%)
SA increases after experiment, SA2 > SA1 31 (36.5%) 58 (68.2%) p < 0.05
SA decreases after experiment, SA2 < SA1 54 (63.5%) 27 (31.8%) p < 0.05
Table 4. Lavels of catecholamines in urine, renin, and angiotensin 1 in blood plasma in HTN patients.
Parameters Patients with HTN at work,
n = 85 (Me ± SD) Patients with essential HTN,
n = 85 (Me ± SD) Significant difference on the
Mann-Whitney U-test
Before experiment 81.7 ± 0.2 119.8 ± 0.2 p < 0.05
After experiment 54.3 ± 0.2* 211.4 ± 0.2* p < 0.001
Before experiment 151.6 ± 0.3 182.1 ± 0.3 p < 0.05
After experiment 138.6 ± 0.3* 329.2 ± 0.3* p < 0.001
Renin, (ngr/ml)/s Before experiment 1.04 ± 0.21 0.86 ± 0.21 -
After experiment 0.84 ± 0.01* 0.96 ± 0.01* -
Angiotensin 1,
Before experiment 1.14 ± 0.13 1.26 ± 0.09 -
After experiment 0.96 ± 0.03* 1.35 ± 0.03* -
Note: *Differences in the data before and after the experiment are significant (p < 0.05).
SA, reliably higher but inadequate and instable AL, and more intensive gesticulation, facial expression, and also
active voice modulation (Tables 2, 5, and 6).
Cluster analysis of the data confirmed the hypothesis of general heterogeneity of patients with HTN, as well as
internal heterogeneity of the compared groups of patients with HTN. Three well-interpreted clusters were statis-
tically marked out; they embrace psychological, physiological and behavioral parameters, which made it possible
to describe 3 subgroups inside the groups of patients with HTN:
Patients with openly anxious reaction type (91 patients, 53.5% of all participants with HTN). Patients from this
group are characterized by significant increase of SA level in the course of experiment, open emotion ex-
pression, a rich variety of behavioral exposure accompanied by a slight BP growth and increase of A, NA,
renin and АI level in the course of experiment.
Patients with excessive emotion repression (70 people, 41.2% of participants with HTN). They showed a
significant growth of systolic BP level, initially lower A and NA levels and decrease in the course of expe-
E. Pervichko, Y. Zinchenko
Table 5. Frequency of aspiration level characteristics in the compare groups of HTN patients (%).
Aspiration level characteristics Patients with HTN at
work, n = 85 Patients with essential
HTN, n = 85 Significant difference on the
Mann-Whitney U-test
High AL 71.7 75.3 -
Middle AL 16.5 16.5 -
Low AL 11.8 8.2 -
Stability Stable AL 43.5 60.0 p < 0.05
Unstable AL 56.5 40.0 p < 0.05
Adequacy Adequate AL 30.6 43.5 p < 0.05
Inadequate AL 69.4 56.5 p < 0.05
Table 6. Average values of nonverbal behaviors in the compare groups of HTN patients (points).
Nonverbal behaviors Patients with HTN at work,
n = 85 (Me ± SD) Patients with essential HTN,
n = 85 (Me ± SD) Significant difference on the
Mann-Whitney U-test
Gestures 18.3 ± 2.8 21.6 ± 2.9 p < 0.05
Poses 7.3 ± 2.6 10.1 ± 2.6 p < 0.05
Facial expressions 18.3 ± 2.7 9.4 ± 1.1 p < 0.05
Tone of voice 12.9 ± 1.3 7.2 ± 1.2 p < 0.05
riment of all measured biochemical parameters; decrease of SA level, instability and inadequacy of AL. They
were characterized by outwardly more quiet behavior, less number of poses and gestures but more varied facial
expressions and changes in voice tone.
Patients, who differ from the above mentioned groups by moderate changes in physiological and psychological
parameters under stress with optimal indices of emotion control, which brings them closer to the group of
healthy individuals (9 patients, 5.3% of participants with HTN).
Statistical data analysis showed that in the group of patients with HTN at work a phenomenon of excessive
emotional repression was detected in 63% of cases; openly anxious type of stress reaction—in 37%. There were
no patients with adaptive reaction to stress in this group. This is consistent with data obtained in other studies
Most patients with essential HTN show the openly anxious type of reaction (69% of cases). The repressive type
of reaction is present in 20% of cases; and that of adaptive—in 10% of patients.
There is an assumption, prevailing in contemporary publications, that emotion repression comes as a leading
psychological factor of psychosomatic syndrome genesis in patients with HTN [11] [15] [16]. The qualitative data
analysis of our results brings us to conclude that this cannot be accounted for pathogenesis of all HTN forms.
Emotion repression phenomenon, according to our data, is particularly specific for patients with HTN at work.
Vygotsky-Luria’s syndrome analysis of this data as well as analysis and interpretation of the whole set of the
results of the study lead to the conclusion that HTN at work possess a steady, meaningfully interpreted complex of
clinical and psychological symptoms and syndromes that may be defined as a psychosomatic syndrome.
Results of the qualitative analysis of the data lead us to assert that the features of motivation sphere of patients
the domination of achievement motivation—appear as the main factor generating the psychological syndrome.
This conclusion was drawn on the basis of Luria’s principles for psychological factors (causes) selection, which
determine the logic and structure of a neuropsychological syndrome, and on the interpretation of the results of
cluster analysis.
A persistent combination of the described features of the motivation sphere, with insufficient control over
motivations and emotions and suboptimal ways of resolving emotiogenic situations, and certain peculiarities of
the emotional experience of patients with HTN at work in stress situations suggest that the structure of this psy-
chosomatic syndrome features one more psychological factor: dysfunction of emotion regulation. This psycho-
logical factor is bipolar. It is represented in two extremes: on the one hand, excessive emotional repression (this is
more typical for HTN at work patients), and insufficient emotional control, on the other.
The factor of repression and denial of the significance of an alarming situation is the third syndrome-generating
factor, according to the statistical and qualitative analysis.
E. Pervichko, Y. Zinchenko
Thus, the results confirmed the hypothesis about the multifactorial structure of psychosomatic syndrome, which
is typical for patients with HTN at work. These results also verified validity of the assumption that factors gene-
rating psychosomatic syndrome have a multilevel structure. In the structure of the described factors we can dis-
tinguish the morpho-functional, psychophysiological and psychological levels. And furthermore, in the structure
of a psychological level there can be allocated levels of voluntary and involuntary regulation (e.g., voluntary and
involuntary emotion regulation).
Reexamination of the patients after 5 years demonstrated that the psychosomatic syndrome has a stable struc-
ture, despite positive or negative dynamics in the patient’s state. This feature sets prognosticating perspectives.
The patients that had been assigned to the “risk group” for plausible symptomatology complications in accordance
with clinical and psychological signs described above (as well as the whole complex of clinical and psychological
features) confirmed our expectations of “hardening” of clinical HTN manifestations under conditions of emo-
tional pressure, if medication and psychological aid had not been provided.
5. Conclusions
The psychosomatic syndrome in patients with HTN at work was described in accordance with the principles of the
postnonclassical scientific paradigm, and the principles of psychological syndrome analysis (Vygotsky-Luria
school). The obtained data suggest that the syndrome is system-defined and has a multifactorial and multi-level
structure. That is, the structure of the psychosomatic syndrome in patients with HTN at work is determined by
three factors, different from the neuropsychological syndrome, which is typically one-factorial [3] [4] [8].
These factors are as follows: the motivational factor (characterized by the domination of achievement motiva-
tion); the factor of emotion regulation disorder; and the factor of repression and denial of the significance of an
alarming situation. We suggest that a psychosomatic syndrome analysis can be used for diagnostic and even
prognostic tasks both in clinical psychology and medicine.
The results of our empirical study based on postnonclassical philosophy and methodology of psychological
syndrome analysis obviously expand the scientific background of the nature of a particular diseaseHTN at
workand establish more fundamental issues in clinical psychology, neuroscience and medicine [17]-[22].
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