Conceptual model and psychocorrective measures of medico-psychological counseling of patients with problem gambling caused by alexithymia

The article analyzes the conceptual model and psychocorrective measures of medical and psychological counseling of patients with problem gambling caused by alexithymia. It is determined that the establishment activity, psychoeducation, psychocor-rective influence in the space of the integrative-eclectic approach, as well as the control and revision activities of the medical psychologist are organically included in part of the developed model of medical and psychological counseling of patients with a comorbid combination of alexithymic disorder and gaming addiction. Their high-quality and effective implementation will allow to radically change the psycho-emotional status of this category of patients from pathological to more optimal, simultaneously correcting both the urge to gamble and the manifestations of the alexithymic radical in the personality structure. Emphasis is placed on the need to take into account key points during the organization of therapeutic influence on such patients, including the comorbidity of pathological gambling with other mental dysfunctions and emotional disorders. An integrative-eclectic approach is offered, which includes cognitive-behavioral therapy, psychodrama, transactional analysis, logotherapy and other techniques. The main goal is not only to overcome the symptoms of gaming addiction, but also to transform the patient’s personality. An important element is psychoeducation aimed at increasing patients’ awareness of their condition and methods of dealing with it. In addition, the described program of psychocorrection of gambling addictive behavior in patients with alexithymia takes into account the selected conceptual conditions for achieving a psychotherapeutic effect in this category of patients and is based on the identified most effective psychotechnologies. Its practical implementation will allow qualitative implementation of all strategic directions of therapeutic psychological influence on this category of patients. It has been proven that the implementation of the conceptual model and psychocorrective measures is of great importance for improving the quality of life of patients suffering from problem gambling caused by alexithymia, and allows to significantly increase the effectiveness of psychological care for this category of patients.

It is worthy of note that in July of 2020, the legalization of the gambling industry in Ukraine resulted in a surge of individuals suffering from addictive behavior related to gambling.According to the Gambling and Lotteries Regulatory Commission, 739 cases of gambling addiction were registered between 2021 and 2023, of which 315 occurred in 2022 and 229 in the first three months of 2023 [1,2].Currently, there exists a rapid escalation of gaming addiction among the population.Despite official data demonstrating an increase in instances of gambling addiction, the veritable reality may be more dire.Given that official statistics solely encompass reported cases, it is highly probable that the factual quantity of individuals afflicted with problem gambling exceeds those figures.
The issue of pathological gambling addiction has been extensively researched in medical psychology, with numerous scholars probing into this matter [3][4][5].Nevertheless, contemporary studies underscore the necessity for a more profound examination of comorbid combinations of ludomania with other psychological disorders.A particular emphasis is placed on alexithymia -a specific psychological trait linked to challenges in articulating emotional experiences and comprehending the emotions of others, which could serve as an essential predictor of problem gambling.
It should be emphasized that in the realm of Ukrainian scientific inquiry, there exists a scarcity of research specifically exploring the co-occurrence of alexithymia and ludomania, with the exception of certain scholars such as A. Salnikova, S. Urkaev and O. Chaban.That said, it is imperative to intensify the efforts aimed at elucidating potential ramifications stemming from alexithymic tendencies in relation to pathological gambling proclivities.
Any comorbid combination of several disorders,where symptoms manifest simultaneously in a patient's daily life, can significantly complicate the clinical picture of their disease.Specifically, it is widely acknowledged that the presence of concurrent disorders and dysfunctions exacerbates and complicates the course of a primary disorder.The remarkable interplay between these conditions highlights how one issue can provoke or aggravate another.Consequently, developing a model for psychocorrective measures through medical and psychological counseling for patients experiencing problematic gambling due to alexithymia is an urgent issue.Its effective solution will significantly improve the quality of medical and psychological care for this category of patients.
To effectively construct a conceptual framework for medical and psychological counseling of gambling addicts who exhibit comorbid alexithymic traits within their personality structure, it is imperative to identify and emphasize essential factors that require careful consideration during the organization of therapeutic psychological influence on such a category of patients, namely: 1) pathological gaming addiction is characterized by pronounced comorbidity and is often combined with other psychopathologies, mental dysfunctions, destructive individual psychological properties of the personality, disorders of the emotional sphere functioning , in particular, emotional disorders; 2) a compulsive desire to gamble, akin to a developed addiction, becomes deeply ingrained in an individual's core personal structures.This leads to a transformation and deformation of their personality, with the addictive behavior forming a malignant growth within their overall structure.As such, it establishes a stable lifestyle for the individual that resists symptomatic correction.Instead, psychological intervention aimed at correcting the entire personality is necessary for effective treatment of this type of addiction.That is, the target of therapeutic psychological influence should be not so much the symptoms of gambling addiction, but the deep and basic personal structures of the patient, which act as essential predictors of addiction; 3) the manifestation of addictive behavior through an intense fixation on gambling is intricately linked to the idiosyncrasies of an individual's emotional realm and their inherent emotive traits, in particular, such as the tendency to form an affect, difficulties in self-control of emotional states, emotional lability, pronounced impoverishment of the emotional sphere, difficulties in awareness and differentiation of emotional states, impulsivity, tendency to experience weakly articulated dysphoric emotional states of a high degree of intensity; 4) the presence of an alexithymic radical in the personality structure of an individual acts as a potent predictor of the onset of pathological gambling, its continuous progression and systematic manifestation.Its intensity constantly increases and gradually acquires increasingly destructive forms.The phenomenon of alexithymia often underlies deficient emotional behavior and supports addictive ways of activating the senses, causing gaming addiction.The symptomatology of alexithymic disorder is a fairly widespread companion of gambling and acts as its internal driving force.The comorbid nature of their combination is justified by the fact that these disorders have an autonomous nosology that is not reducible to one another; 5) the fundamental psychological mechanism underlying the connection between alexithymia and gambling addiction is that individuals with an alexithymic disorder experience a chronic, intense, and ambiguous emotional discomfort.This state of emotional distress prompts them to turn to gambling as a natural compensatory behavior, which provides temporary relief from their negative affectivity while exacerbating their underlying condition.Thus, game activity, whose inherent features dictate its operational fluidity, deceptive triumphs and substantial allure, emerges as one of the scarce outlets for gratification among individuals with alexithy- mia, a valuable opportunity to experience emotions of a positive spectrum.This acts as an important factor in the transformation of isolated cases of spending time in game clubs and casino for passion, which completely absorbs the subject of gaming activity and destroys their lives; 6) the clinical picture and duration of alexithymic disorder can either exacerbate or mitigate symptoms of gaming addiction.Given that alexithymia can heighten the severity of symptoms and increase the likelihood of pathological gambling, it is plausible to hypothesize a reverse effect whereby elimination of the alexithymic root from the patient's personality structure leads to significant amelioration in ludomania symptoms.Therefore, the key strategy of psychological influence on a game addict with alexithymic disorder consists in the formation of the ability to recognize and understand one's emotional states and the development of more effective ways of managing one's emotions, as well as restoring a realistic and adequate perception of one's life situation and the consequences of the progression of addictive behavior; 7) the utilization of a theoretical framework for medical and psychological therapy for individuals with gaming addiction stemming from alexithymia warrants justification only upon the establishment of a validated diagnostic assessment confirming the presence of an alexithymic disorder and its resultant game-related symptoms; 8) the comorbid combination of alexithymia with symptoms of pathological game addiction significantly complicates the psychotherapeutic process and places special demands on the professional competence of a medical psychologist, who must possess the strategy and tactics of interaction with patients suffering from ludomania.Accordingly, this can be included in the process of medical and psychological counseling at various disease stages and exhibit amplified as well as diminished indications of coexisting ailments while undergoing psychotherapeutic intervention.
The creation of a conceptual model of medical and psychological counseling for gambling addicts with alexithymia consists in the use of an integrative and eclectic approach.This approach involves simultaneously addressing the symptoms of gaming addiction and alexithymia, as these conditions are often closely related and mutually influencing.It is important to use various psychotherapeutic techniques, namely: cognitivebehavioral therapy, psychodrama, transact analysis, logotherapy, which have already proven themselves in the treatment of mental and psychosomatic disorders, including alexithymia [6][7][8].
A crucial aspect that distinguishes medical and psychological consultation from classical psychotherapy is its emphasis on the cognitive component of a patient's personality, as well as their acquisition of knowledge to effectively overcome symptoms associated with disorders such as gambling and alexithymia [9,10].
In this light, pychoeducation, particularly utilizing a cognitive-behavioral therapeutic approach that effectively addresses the cognitive realm and eradicates core mental illnesses along with their concomitant emotional disturbances, comproses a significant aspect of such consultation involves .This technique is employed even in treating psychotic-level mental disorders [11].
Numerous cognitive-behavioral therapy protocols have been formulated for the treatment of schizophrenia, for which various forms of therapy are used: individual and group, short-term and long-term.Currently, the following protocols of symptom-oriented approaches to cognitive-behavioral therapy are quite well-known, which are used with high efficiency for psychotherapeutic assistance to patients with schizophrenia: "Cognitivebehavioral therapy of guided self-help based on psychosis" (CBTp-GSH), "Coping with voices" (CWV), "Voices Intervention" (GiVE), "Cognitive Adaptation Training" (CAT), "Anxiety Intervention", "Individual Resilience Training" [12][13][14][15].Increasingly, researchers consider the methods of cognitive-behavioral therapy to be the most promising in working with endogenous mental disorders, and psychological training of patients is an important stage in its structure.In our perspective, it is conceivable to infer such a deduction regarding alexithymic disorder, complicated by the consequent pathological urge to gamble.Moreover, these disorders are not as severe and irreversible as endogenous mental illnesses.
Therefore, psychoeducation is an important element of the model of medical and psychological counseling of patients with a comorbid combination of ludomania and alexithymia and allows choosing the form of intervention that is optimal for the corresponding phase of the course of the disease.A medical-psychological counseling model that follows an integrative-eclectic approach should acknowledge the significance of prioritizing individual symptoms, thus providing the basis for better treatment outcomes.Notably, the patient's understanding of this concept has a pronounced therapeutic effect [16][17][18].
In the medical and psychological counseling of patients with gaming addiction and alexithymia, the major emphasis is placed on teaching the management of the symptoms of these disorders.The above approach does not aim to completely eliminate symptoms, but is targeted at mitigating adverse behavioral manifestations and emotional distress, while simultaneously fostering constructive conduct.
At the same time, the efficacy of medical and psychological interventions is evaluated based on the mitigation of emotional distress, amplification of social engagement, and the patient's holistic contentment with their existence.The approach is aimed both at eliminating gaming addiction and improving the psycho-emotional state through work with alexithymia.
We proceed from the fact that medical and psychological counseling of patients with a comorbid combination of ludomania and alexithymia should be based on the principles of psychotherapeutic cooperation, The above principles are widely used within the framework of various theoretical approaches, in particular in cognitivebehavioral psychotherapy: 1. Empathetic, emotionally supportive therapeutic interaction -joint development of a general, understandable for the patient conceptualization, which will shape their idea of the origins and mechanisms that provoke a pathological urge to play, and will also allow them to be aware of a wider range of emotional experiences and control them more efficiently.
2. Familiarization with the standard -providing aid and approval devoid of criticism can mitigate the occurrence of shame or stigma, commonly linked to a condition of psycho-emotional stress and addictive tendencies.
3. The psychological readiness of the patient to accept themselves and overcome a range of alexithymic and addictive symptoms [19,20].
In the model of medical and psychological counseling of patients with gaming addiction caused by alexithymia, it is recommended to use a clinical interview to analyze cognitive, behavioral and emotional reactions to stress.This makes it possible to identify coping strategies, adaptation mechanisms and influential external and internal psychological factors.The said approach helps in comprehending the psychodynamics of each individual case and determine the most effective methods of psychological correction and psychorehabilitation.
In the process of medical and psychological counseling, the history of disorder's occurrence and its specifics are studied, as well as a detailed description of the psychotherapeutic case in the form of a complex of interconnected formulations, which in their completeness represent the form of its structured conceptualization.Formulation refers to the collaborative process of constructing a hypothesis, commonly known as the «best opinion,» regarding the root causes behind a patient's mental disorder manifestations, in the context of their relationships, social circumstances, life events and, most importantly, the assigned meaning [21].
There exist two sources of equal importance that enable the amalgamation of theory and practice to produce a highly dependable formulation: 1) professional knowledge of a medical psychologist, which incorporates the theory of psychology and psychotherapy, research data and clinical experience; 2) information available to the patient, obtained from their own life experience, in particular, features of the manifestation of their disease, relationships with others and life circumstances.
The formulation should consider the patient's available resources and inherent abilities, which can be leveraged to adjust to their current circumstances, the specifics of which are strongly determined by the present psychological disorders and, accordingly, are characterized by an unfavorable nature and significant severity.
It is imperative for medical psychologists to approach patients with profound comprehension and empathy, honoring their thoughts and conduct, irrespective of its intricacy, as emphasized by medical and psychological counseling.The process of creating therapeutic formulations should be collaborative, with respect for the patient's views, use language that is easily comprehensible, devoid of any prejudiced notions, and highlights patient's positive attributes and accomplishments.This contributes to the integration of the patient's unique experience into the psychological theory and the framework of addressing their problems [22].
Drawing on the above considerations, we elaborated the author's model of medical and psychological counseling of patients with a comorbid combination of gambling and alexithymia.This model can be an effective addition to psychopharmacotherapy and is focused on eliminating psycho-emotional discomfort associated with the presence of an alexithymic radical in the patient's personality structure, which is the basis of the tendency to abuse gambling.The key assumption regarding the sources of the above mentioned emotional discomfort is the overall accumulation of negative emotional experiences without the possibility of their full awareness.Additionally, adequate and free self-expression is indispensable due to the presence of alexithymic disorder and unsatisfactory development of the cognitive sphere, in particular the skills of formulation and verbalization.
Thus, the author's model of medico-psychological counseling of patients with gaming addiction caused by the condition of alexithymia should include the following mandatory components, which are divided into stages of medico-psychological counseling and included in the general space of therapeutic psychological influence on this category of patients (Fig. ): • first, the review of medical documentation describing the patient's medical history; • second, diagnostic assessment -building a general detailed clinical picture of the course of comorbid psychological disorders and dysfunctions, including their symptoms, which will determine the course of the process of providing psychological assistance; • third, informing the patient about the origin and course of existing disorders, the possibilities of medical and advisory measures, the need for active participation in the process of therapeutic psychological influence; • fourth, developing a cognitive model of existing comorbid disorders and the psychological mechanisms of their combination -building a formulation and determining the main targets of medical and psychological work in the form of maladaptive, irrational cognitions available to the patient, which deepen and intensify addictive behavior, as well as create a closed circle of destabilization of his psycho-emotional state; • fifth, the selection of psychotechnologies based on the most effective psychotherapeutic approaches; approbation of various methods and techniques of the influence of a medical psychologist on the symptoms of alexithymia, which is a primary psychological disorder; • sixth, the application of the entire range of psychotechnologies of various theoretical approaches (gestalt therapy, psychodrama, cognitive-behavioral therapy, logotherapy) aimed at the targets of psychological influence determined at the establishment stage, in particular, reducing the number of manifestations of addictive gaming behavior, improving the ability to perceive and express current emotional states, the reduction of cumulative psycho-emotional discomfort; • seventh, monitoring the dynamics of changes in addictive gaming behavior and the patient's psychoemotional state, in particular, assessing the weakening of correlations between these comorbid psychological disorders; nature, taking into account the patient's perspectives, employing easily comprehensible language to ensure clarity of communication, as well as highlighting any strengths or accomplishments that they may possess.Hence, this approach serves to facilitate seamless integration of the individualized experiences encountered by each patient into both psychological theory and problem-solving models.Therefore, it can be concluded that the establishment activity, psychoeducation, psychocorrective influence in the space of the integrative-eclectic approach, as well as the control and revision activity of a medical psychologist are inherently integrated into the framework of medical and psychological therapy of patients with a comorbid combination of alexithymic disorder with game addiction.Their high-quality and effective implementation will allow to radically change the psychoemotional status of this category of patients from pathological to more optimal, at the same time correcting both the urge to gamble and the manifestation of the alexithymic radical in the personality structure.Simultaneously, it is imperative to underscore the significance of initiatives aimed at offering psychological aid to said patients should correspond to their individual psychological characteristics, which will be expressed in taking into account the specific and unique needs of everyone who sought assistance.
Drawing on the conceptual model of medical and psychological counseling for patients with gaming addiction caused by alexithymia, a psychocorrection program was developed.This program is focused on comprehensive psychological help, utilizing an integrative-eclectic approach and taking into account the peculiarities of alexithymia and its connection with gaming addiction.The major objective of the program is not just to tackle the symptoms of gaming addiction, but to transform the patients' personality.
Therefore, the principal tasks of implementing the author's program of psychocorrection of game addiction in patients with alexithymia: formation of readiness to accept responsibility for one's life, internalization of the control locus; formation of emotional self-regulation skills and verbalization of actual emotional experiences; supporting motivation to engage in psychotherapeutic interventions

Model of medical and psychological counseling of patients with gaming addiction caused by alexithymia
• eighth, the verification of stability and reliability of the achieved positive effect after completion of consultation and psychocorrective work; • ninth, conducting several control meetings aimed at recording the achieved effect of therapeutic psychological influence, during which the work of the advisory alliance is logically completed, a future perspective is built for the patient, and relapse prevention skills are taught.At this stage, communication ought to adopt a collaborative and trusting tone, with the intention of inspiring the patient to utilize the skills obtained during their medical consultation in their daily routine.An important goal of the medical psychologist at this stage is the patient's awareness of his or her selfefficacy, their motivation to lead a healthy lifestyle, which enables the patient to recognize engagement in the realm of interpersonal connections and validation of subsequent accomplishments in life.
In the field of medical and psychological counseling, it is imperative that the psychologist approaches their patient with a profound sense of understanding and empathy, while simultaneously exhibiting respect for both their thoughts and behavior, irrespective of complexity.The process involved in developing therapeutic formulations should be collaborative in and relinquish gambling habits; compensation for personal violations, stimulation of personal growth; establishment of interpersonal relations with others and their realistic perception, restoration of social functioning; enhancing the quality of life, restoring an adequate assessment and realistic perception of one's life situation; enhancement of self-perception, reconstruction of one's personal image; cultivation of self-nurturing abilities; eradication of primary gambling indicators and avoidance of relapses.
The psychocorrective intervention program developed includes group classes, as well as a short-term option with ten sessions.The program surpasses the limit of meetings, as it encompasses personalized interaction with patients, comprehensive psychodiagnostics and enlightening psychoeducational sessions.Notably, a substantial portion of the program is dedicated to enhancing patients' psychological awareness, featuring a psychoeducational segment in nearly every session.
Psychoeducational activities should be arranged with a clear temporal structure, incorporating informative segments that facilitate the resolution of psychological maladies, improving the emotional state and developing strategies for managing psycho-emotional reactions [23][24][25].
As part of psychoeducational interventions, the ensuing subject matters were deliberated with the patients: the basics of alexithymia and its symptoms; the connection between alexithymia and gaming addiction; gaming addiction as a biopsycho-social disorder; the symptoms and stages of the development of gambling; psychosomatic and social consequences of gaming addiction; the functioning of the psychological protection against gambling addiction; prevention of gambling relapse as well as methods of overcoming gambling addiction.
Techniques for identifying inner resources help patients find inner abilities to manage problems related to addiction and achieve psycho-emotional balance, strengthening self-confidence.Autogenic training facilitates the growth of emotional self-control and hastens relaxation.The practice of psychogymnastics and visualization exercises enhances one's emotional well-being, while techniques for self-concept work bolster self-esteem and form a pragmatic self-image.
In overcoming ludomania, an important role is played by the approaches of A. Beck's cognitive therapy and A. Ellis's rational-emotional therapy, which are based on the assumption that the way events are interpreted affects mood and behavior.Dysfunctional assessments and perception "schemes" distort reality, leading to psychological discomfort.Cognitive therapy focuses on the identification, awareness and correction of "automatic thoughts", that is dysfunctional ideas and beliefs based on subjective interpretations and past experiences.Utilizing these tech-niques enables the rectification of irrational assessments and perceptions associated with gambling [26].
The developed psychocorrective program has an integrative-eclectic character, using methods of various psychotherapeutic schools.The program encompasses psychodramatic techniques, relaxation techniques, cognitive psychotechniques, gestalt techniques, works with a sense of happiness and well-being, uses psychotechniques to work with motivation and will, applies the "ABC" model of A. Ellis, client-centered approaches, techniques for working with moods and emotional lability , as well as psychogymnastic techniques.
Thus, on the basis of the conducted research, the methodological foundations of psychological assistance to patients with a comorbid combination of gaming addiction and alexithymia were established.In particular, the strategies and means of medical and psychological counseling and psychocorrective work with such patients were substantiated, a conceptual model of medical and psychological counseling of persons with the corresponding nosology was created, and the author's psychocorrective interview program was elaborated.

CONCLUSIONS
After analyzing the conceptual model and psychocorrective measures for medical and psychological counseling of patients with problem gambling caused by alexithymia, it was concluded that establishment activity, psychoeducation, psychocorrective influence within an integrativeeclectic approach, as well as control and revision activities conducted by a medical psychologist are essential components of the developed medical model for psychological counseling of patients with comorbid alexithymic disorder and gaming addiction.Effective implementation of these measures will lead to a significant improvement in the psycho-emotional state of the patients from pathological to optimal.Additionally, they will simultaneously address both gambling urges and manifestations of alexithymic radicalism within the patients' personality structure.
The program developed for psychocorrection of gaming addiction among patients with alexithymia incorporates selected conceptual conditions to achieve a psychotherapeutic effect in this category of patients.It is grounded on the most effective psychotechnologies identified and its practical application will enable high-quality implementation of all strategic directions for therapeutic psychological intervention within this category of patients.
Author's contribution: adjustment of the performed work, analysis of the obtained results.