SCIENTIFIC SUBSTANTIATION OF THE OPTIMIZED MODEL FOR PSYCHOLOGICAL REHABILITATION OF ATO PARTICIPANTS BASED ON DETERMINING THEIR PSYCHOLOGICAL VALUES

Після повернення бійця АТО в цивільні умови необхідний час для адаптації до мирного життя. Тому психологічна реабілітація повинна ґрунтуватися на зміні поглядів на проблеми та їхнє місце у житті суспільства. Метою дослідження було обґрунтувати модель проведення психологічної реабілітації учасників АТО на основі встановлення у них психологічних цінностей. Інструментом дослідження слугував модифікований опитувальник Ш. Шварца, який широко використовується при проведенні психологічної реабілітації в госпіталях Литви. За результатами дослідження науково обґрунтовано і розроблено модель проведення психологічної реабілітації учасників АТО відповідно обраним життєвим цінностям, у якій на підставі соціологічного опитування сформульовано стратегічний і тактичний напрямок. Стратегічний – забезпечення ефективної психічної реабілітації, тоді як тактичний – є визначення шляхом тестування життєвих цінностей учасників АТО та відповідно цього складання програми відновлення. Ключові слова: антитерористична операція (АТО), посттравматичні стресові розлади, модель психологічної реабілітації.

Participation in an anti-terrorist operation in the East of Ukraine of servicemen who are morally not ready for military actions becomes the cause of post-traumatic stress disorder (PTSD).
PTSD (F 43.1) in the International Classification of Diseases (ICD-10) is considered to be the state of "reexperiencing trauma" in the form of intrusive memories, dreams or horrors that occur against the background of a chronic sense of anxiety and emotional dullness, alienation from people, indifference in attitude and reactions to the environment, avoidance of situations reminiscent of an injury [1].
When a soldier returns to civilian conditions, time is needed for adaptation to a peaceful life. Therefore, psychological rehabilitation should be based on changing the views on the problems and their place in the life of society.
The question of the rationale for this recovery is particularly acute. Life values are the ground on which mental rehabilitation will be built. Since values are any material or ideal phenomenon that matters to a person or society, for which he/she acts, expends energy, spends time, money, health, and for the sake of which he/she lives [2].
Despite the great arsenal of psychotherapeutic measures for ATO participants, the problem of organizing their psychological rehabilitation remains unresolved. Aim of the paper is to substantiate the model of psychological rehabilitation of ATO participants based on the establishment of psychological values in them.

Materials and methods
The permission for conducting experimental biomedical researches is confirmed by an extract from the minutes of the session of the Commission on Bioethics of Ukrainian Medical Stomatological Academy No. 165 dated May 17, 2018. The research was conducted during 2015-2018 on a sample of ATO participants who were treated at the Poltava Regional Clinical Hospital for the Disabled Veterans of the Poltava Regional Council 126 (66.3%) and the Kremenchug Regional Hospital for the Disabled Veterans 62 (32.6%), in total 188 patients. The average age of respondents was 40.5 ± 0.7 years, the minimum age was 23 and the maximum -60.
The research tool was a modified questionnaire by Sh. Schwartz, which is widely used during psychological rehabilitation in Lithuanian hospitals [9]. It differs by its simplicity, since the respondent needs only to select from the suggested answers those that are valuable for him. The question began with the words "What is important to you?" One-dimensional analysis was conducted, count-ing the frequency of responses in percentages. Based on the data obtained, a logical model for providing psychological rehabilitation of ATO participants was built [7].

Results and discussion
In the expanded form, respondents' answers were as it is followed in Table 1. The highest percentage of responses accounts for family relationships 147 (77.8%), health 99 (52.4%), mother's support 87 (46.0%), and friends' support 81 (42.9%), such psychological values as joy were noted by 83 people (43.9%). While the lowest number of responses accounts for clothing 6 (3.2%), food 10 (5.3%), and among the psychological ones -the influence on other people 7 (3.7%) and belonging to the social group 6 (3.2%) ( Table 1). The analysis of the values of the ATO participants made it possible to classify their answers according to the main directions. Thus, the survey results were divided into 8 blocks, each of which included relevant questions that allow us to study the structure of values that affect the whole personality (Table 2). Based on the life values, a person will be able to go through life, feeling his importance and satisfaction to whatever he/she does. Their association with kinship in blocks or classes, allowed us to determine the most important of them. As a result, we obtained the following structure (Fig. 1). The highest percentage of answers about values is the feeling of harmony -414 (23%) and in a close proximity to each other there is a family -388 (21%), in the second place we have moral values 217 (12%), the third place is equally divided by the support 210 (11%) and professional development 201 (11%), hobby received 153 (8%), and the smallest number of votes received self-development 136 (7%) and selfrecognition 125 (7%).

Fig. 1 Structure of life values of ATO participants
Depending on the data obtained, a model for providing psychological rehabilitation was created according to the chosen life values (Fig. 2). In order to determine the rehabilitation program, these blocks were even further enlarged by their affinity. The strategic direction of the model is to ensure effective mental rehabilitation, while its tactical direction is to determine by testing the life values of ATO participants and, accordingly, drawing up a recovery program. The subject of management is a team consisting of a psychologist and a physician.
The behaviour of ATO participants often does not correspond to their inner convictions, since they often experience anxiety and irritation [3,4]. The process of determining life values will allow the respondent to identify markers and to make sure whether the chosen path is correct or false. Then the solution to the daily tasks will be more understandable, because all the words and actions will be brought in accordance with values, life will acquire meaning, and the person -confidence and selfsatisfaction.

Fig. 2. Model for providing psychological rehabilitation of ATO participants according to chosen life values
As shown in Figure 2, respondents who chose family as their main value obviously see their socialization through the relationships of the closest people, therefore the work program of the psychologist includes work with friends and relatives who have a decisive influence on the behaviour of the respondents, as well as group practice "Childhood Memories", which will allow to mentally establish a connection with their closest relatives.
For those who have defined their hobby and selfdevelopment as their life value, personal self-realization and the feeling of manifestation of the "inner self" is probably important. Being engaged in favourite business, the person, first of all, satisfies the most important need for self-realization, provides spiritual growth, his/her life becomes much brighter, and it has more colours and positive emotions. Hobbies are the key to success [5]. Therefore, the program of classes with the psychologist included art therapy, visits to museums, and walks around the city. These types of psychotherapy would make it possible to determine the personal interest and hobbies.
Profession as a value implies the significance of its content for the individual, professional promotion, realization of his/her potential in the working sphere. The value of the profession forms an adequate motivation for successful activity [6]. Because of this, courses on the career guidance of various types of activities for those who do not have a profession and advanced training courses for specialists will be of great importance.
The next block was harmony and moral values. These chosen values give birth to sympathy, and this is what encourages sympathy and helps to see the best in people, while they see the best in us [7,8].
As a result, psychotherapy should necessarily include cinema therapy, music therapy, relaxation classes, walks around the city, which will most of all contribute to the development of these feelings.
The study is limited by the fact that today there is no group of people who did not participate in the antiterrorist operation, and therefore a two-dimensional analysis was not carried out in this paper, which we plan to do in our further study.

Conclusion.
1. When determining the life values of ATO participants, it was found that the highest percentage of answers about value is the feeling of harmony -414 (23%) and in a close proximity to each other there is a family -388 (21%), in the second place we have moral values 217 (12%), the third place is equally divided by the support 210 (11%) and professional development 201 (11%), hobby received 153 (8%), and the smallest number of votes received self-development 136 (7%) and selfrecognition 125 (7%).
2. The model for providing psychological rehabilitation of ATO participants was scientifically substantiated and developed according to the chosen life values. In this model, a strategic and tactical direction was formulated on the basis of a sociological survey. Strategic direction ensures effective mental rehabilitation, while tactical direction is the determination by testing the life values of ATO participants and, therefore, drawing up a recovery program.