Cognitive behavioral psychotherapy

First use experience behavioral therapy was based on the theoretical principles of I.P. Pavlova(classical conditioning) And Skinner(Skinner V. F.), ( operant conditioning).

As new generations of physicians applied behavioral techniques, it became clear that a number of patient problems were much more complex than previously reported. Conditioning did not adequately explain difficult process socialization and learning. Interest in self-control and self-regulation within the framework of behavioral psychotherapy brought “environmental determinism” (a person’s life is determined primarily by his external environment) closer to reciprocal determinism (a personality is not a passive product of the environment, but an active participant in its development).

The publication of the article “Psychotherapy as a Learning Process” in 1961 by Bandura and his subsequent work was an event for psychotherapists seeking more integrative approaches. Bandura presented in them theoretical generalizations of the mechanisms of operant and classical learning and at the same time emphasized the importance of cognitive processes in the regulation of behavior.

The conditioning model of human behavior has given way to a theory based on cognitive processes. This trend was evident in the reinterpretation systematic desensitization Wolpe J. as a counterconditioning technique in terms of cognitive processes such as expectation, coping strategy and imagination, which led to such specific areas of therapy as covert modeling (Cautela J., 1971), training skills and abilities. There are currently at least 10 areas of psychotherapy that focus on cognitive learning and emphasizing the importance of one or another cognitive component (Beck A.T., 1976; Ellis A., 1977; Meichenbaum D., 1986). Let us present their general principles.

1. Many symptoms and behavioral problems are the result of gaps in training, education and upbringing. To help a patient change maladaptive behavior, the psychotherapist must know the patient's psychosocial development, see disturbances in the family structure, and various forms communications. This method is highly individualized for each patient and family. Thus, a patient with a personality disorder exhibits highly developed or underdeveloped behavioral strategies (for example, control or responsibility), monotonous affects predominate (for example, rarely expressed anger in a passive-aggressive person), and at the cognitive level rigid and generalized attitudes in regarding many situations. Since childhood, these patients have been recording dysfunctional patterns of perception of themselves, the world around them and the future, reinforced by their parents. The therapist needs to examine the family history and understand what is maintaining the patient's behavior in a dysfunctional manner. Unlike patients diagnosed with axis 1, it is more difficult for individuals with personality disorders to form a “benign” alternative cognitive system.
2. There are close relationships between behavior and environment. Deviations in normal functioning are supported mainly by reinforcement of random events in the environment (for example, a child's parenting style). Identification of the source of disturbances (incentives) - important stage method. It requires functional analysis, i.e., a detailed study of behavior, as well as thoughts and responses in problem situations.
3. Behavioral disorders are quasi-satisfaction of basic needs for security, belonging, achievement, freedom.
4. Behavior modeling is both an educational and psychotherapeutic process. K.-p. p. uses the achievements, methods and techniques of classical and operant learning models, cognitive learning and self-regulation of behavior.
5. The patient's behavior, on the one hand, and his thoughts, feelings and their consequences, on the other, have a mutual influence on each other. Cognitive is not the primary source or cause of maladaptive behavior. The patient's thoughts influence his feelings to the same extent as feelings influence his thoughts. Thought processes and emotions are seen as two sides of the same coin. Thought processes are only a link, often not even the main one, in a chain of causes. For example, when a therapist is trying to determine the likelihood of recurrence of unipolar depression, he can make a more accurate prediction if he understands how critical the patient's spouse is, rather than relying on cognitive measures.
6. Cognitive can be considered as a set of cognitive events, cognitive processes and cognitive structures. The term “cognitive events” refers to automatic thoughts, internal dialogue, and imagery. This does not mean that a person is constantly talking to himself. Rather, we can say that human behavior in most cases is thoughtless and automatic. A number of authors say that it is going “according to the script.” But there are times when automatism is interrupted, a person needs to make a decision under conditions of uncertainty, and then internal speech “turns on.” In cognitive-behavioral theory, it is believed that its content can influence a person's feelings and behavior. But, as already mentioned, the way a person feels, behaves and interacts with others can also significantly influence his thoughts. A schema is a cognitive representation of past experience, unspoken rules that organize and direct information relating to the personality of the person himself. Schemas influence processes of evaluation of events and processes of adaptation. Because schemas are so important, the primary task of the cognitive behavioral therapist is to help patients understand how they interpret reality. In this regard, K.-p. p. works in a constructivist manner.
7. Treatment actively involves the patient and family. The unit of analysis in K.-p. items currently are examples of relationships in the family and systems common to family members beliefs. Moreover, K.-p. p. also became interested in how belonging to certain social and cultural groups influences the patient’s belief systems and behavior, includes the practice of alternative behavior in psychotherapy sessions and in real environment, provides a system of educational homework assignments, an active program reinforcements, keeping notes and diaries, i.e. the psychotherapy technique is structured.
8. The prognosis and effectiveness of treatment are determined in terms of the observed improvement in behavior. If previously behavioral psychotherapy had as its main goal the elimination or elimination of unwanted behavior or response (aggression, tics, phobias), now the emphasis has shifted to teaching the patient positive behavior (self-confidence, positive thinking, achieving goals, etc.) , activation of the resources of the individual and his environment. In other words, there is a shift from a pathogenetic to a sanogenetic approach.

K.-p. p. (behavior modeling) is one of the leading areas of psychotherapy in the USA, Germany and a number of other countries, and is included in the standard of training for psychiatrists.

Behavior modeling is a method that can be easily applied in outpatient setting, it is problem-oriented and more commonly referred to as education, which attracts clients who would rather not be called “patients.” It stimulates independent problem solving, which is very important for patients with borderline disorders, which are often based on infantilism. In addition, many techniques of K.-p.p. present constructive coping strategies, helping patients acquire adaptation skills in the social environment.

K.-p. p. refers to short-term methods of psychotherapy. It integrates cognitive, behavioral and emotional strategies for personality change; emphasizes the influence of cognitions and behavior on the emotional sphere and the functioning of the body in a broad social context. The term "cognitive" is used because disturbances in emotion and behavior often depend on errors in cognitive process, deficits in thinking. “Cognitions” include beliefs, attitudes, information about the individual and the environment, prediction and assessment of future events. Patients may misinterpret the stresses of life, judge themselves too harshly, come to the wrong conclusions, and have negative beliefs about themselves. A cognitive behavioral psychotherapist, working with a patient, applies and uses logical techniques and behavioral techniques to solve problems through the joint efforts of the therapist and the patient.

K.-p. I found it wide application in the treatment of neurotic and psychosomatic disorders, addictive and aggressive behavior, anorexia nervosa.

Anxiety can be a normal and adaptive response to many situations. The ability to recognize and avoid threatening events is necessary component behavior. Some fears disappear without any intervention, but long-standing phobias can be assessed as a pathological response. Anxious and depressive disorders are often associated with a pseudo-perception of the surrounding world and environmental requirements, as well as rigid attitudes towards oneself. Depressed patients rate themselves as less capable than healthy faces, in connection with such cognitive errors as “selective sampling”, “overgeneralization”, “all or nothing principle”, minimizing positive events.

Behavioral psychotherapy serves as the means of choice for obsessive-phobic disorders and, if necessary, is supplemented by pharmacotherapy with tranquilizers, antidepressants, and beta blockers.

The following behavioral treatment goals are carried out in patients with obsessive-phobic disorders: complete elimination or reduction of obsessive symptoms (thoughts, fears, actions); translating it into socially acceptable forms; elimination of individual factors (feeling of low value, lack of confidence), as well as violations of contacts horizontally or vertically, the need for control from a significant microsocial environment; elimination of secondary manifestations of the disease, such as social isolation, school maladjustment.

K.-p. for anorexia nervosa, it pursues the following short- and long-term treatment goals. Short-term goals: restoration of premorbid body weight as necessary condition for psychotherapeutic work, as well as restoration of normal eating behavior. Long-term goals: creating positive attitudes or developing alternative interests (other than dieting), updating a behavioral repertoire that gradually replaces anorexic behavior; treatment of phobia or fear of loss of weight control, body diagram disorders, which consists of the ability and need to recognize one’s own body; eliminating uncertainty and helplessness in contacts, regarding gender-role identity, as well as problems of separation from the parental home and accepting the role of an adult. These are the key goals of psychotherapy, which lead not only to changes in weight (symptom-centered level), but also to the resolution of psychological problems (person-centered level). The following algorithm of psychotherapeutic measures is common: cognitive-oriented behavioral psychotherapy, initially in an individual form. It consists of self-control techniques, goal scaling, assertive behavior training, problem solving training, signing contracts for weight restoration, progressive muscle relaxation Jacobson. The patient is then included in group psychotherapy. Intensive practice supportive psychotherapy. In parallel with this, systemic family psychotherapy.

Addictive behavior can be assessed in terms of positive (positive reinforcement) and negative consequences (negative reinforcement). When conducting psychotherapy, the distribution of both types of reinforcements is determined when assessing the patient's mental status. Positive reinforcement includes the pleasure of taking a psychoactive substance, the pleasant experiences associated with it, the absence unpleasant symptoms abstinence in the initial period of taking substances, maintaining social contacts with peers through drugs, sometimes conditional pleasantness of the role of the patient. Negative consequences Addictive behavior is a more common reason for contacting a specialist. This is the appearance of physical complaints, deterioration of cognitive functions. To include such a patient in a treatment program, it is necessary to find “replacement behavior” without taking psychoactive substances or other types of deviant behavior. Volume psychotherapeutic interventions depends on the development of social skills, the severity of cognitive distortions and cognitive deficits.

Goals K.-p. items are presented as follows:

1) conducting functional behavioral analysis;

2) changing ideas about oneself;

3) correction of maladaptive forms of behavior and irrational attitudes;

4) development of competence in social functioning.

Behavioral and problem analysis is considered the most important diagnostic procedure in behavioral psychotherapy. The information should reflect the following points: specific signs of the situation (facilitating, aggravating conditions for the target behavior); expectations, attitudes, rules; behavioral manifestations (motor, emotion, cognition, physiological variables, frequency, deficit, excess, control); temporary consequences (short-term, long-term) with different quality (positive, negative) and with different localization (internal, external). Observation of behavior in natural situations and experimental analogies (for example, role-playing game), as well as verbal messages about situations and their consequences.

The purpose of behavioral analysis is a functional and structural-topographic description of behavior. Behavioral analysis helps plan therapy and its progress, and also takes into account the influence of the microsocial environment on behavior. When conducting problem and behavioral analysis, there are several schemes. The first and most developed is the following: 1) describe detailed and behavior-dependent situational features. Street, house, school - these are too global descriptions. More subtle differentiation is required; 2) reflect behavioral and life-related expectations, attitudes, definitions, plans and norms; all cognitive aspects of behavior in the present, past and future. They are often hidden, so they are difficult to detect even for an experienced psychotherapist at the first session; 3) identify biological factors manifested through symptoms or deviant behavior; 4) observe motor (verbal and non-verbal), emotional, cognitive (thoughts, pictures, dreams) and physiological behavioral signs. Global designation (for example, fear, claustrophobia) is of little use for subsequent psychotherapy. Qualitative and quantitative description of features is necessary; 5) assess the quantitative and qualitative consequences of behavior.

Another option for functional behavioral analysis is the compilation of a multimodal profile (Lazarus A. A.) - a specifically organized version system analysis, carried out in 7 directions - BASIC-ID (in the first English letters: behavior, affect, sensation, imagination, cognition, interpersonal relation, drugs - behavior, affect, sensations, ideas, cognitions, interpersonal relationships, drugs and biological factors). In practice, this is necessary for planning options for psychotherapy and for training novice psychotherapists in the methods of psychotherapy. p. The use of a multimodal profile allows us to better understand the patient’s problem, correlates with the multi-axis diagnosis of mental disorders, and makes it possible to simultaneously outline options for psychotherapeutic work (see. Multimodal psychotherapy by Lazarus).

In the works typical problem it is necessary to ask the patient a series of questions to clarify the existing difficulties: does the patient evaluate the events correctly? Are the patient's expectations realistic? Is the patient's point of view based on false conclusions? Is the patient's behavior appropriate in this situation? Is there really a problem? Was the patient able to find all possible solutions? Thus, the questions allow the therapist to build a cognitive-behavioral concept of why the patient is experiencing difficulties in a particular area. During the interview, ultimately, the psychotherapist's task is to select one or two key thoughts, attitudes, and behaviors for psychotherapeutic intervention. The first sessions are usually aimed at joining the patient, identifying the problem, overcoming helplessness, making choices priority direction, discovering the connection between irrational belief and emotion, identifying errors in thinking, identifying zones possible change, patient inclusion in a cognitive-behavioral approach.

The task of a cognitive behavioral psychotherapist is to make the patient an active participant in the process at all its stages. One of the fundamental problems of K.-p. n. - establishing a partnership between the patient and the psychotherapist. This collaboration takes the form of a therapeutic contract in which the therapist and patient agree to work together to eliminate the latter's symptoms or behavior. This joint activity serves at least 3 purposes: first, it reflects confidence that both have achievable goals at each stage of treatment; secondly, mutual understanding reduces resistance the patient, often arising as a result of the psychotherapist being perceived as an aggressor or identifying him with a parent if he tries to control the patient; thirdly, the agreement helps prevent misunderstanding between the two partners. Failure to take into account the motives of the patient's behavior can force the psychotherapist to move blindly or lead the former to false conclusions about the tactics of psychotherapy and its failure.

Since K.-p. Since this is a short-term method, this limited time must be used carefully. The central problem of “psychotherapeutic training” is determining the patient’s motivation. To enhance motivation for treatment, take into account the following principles: joint determination of the goals and objectives of psychotherapy. It is important to work only on those decisions and commitments that are verbalized through “I want” and not “I would like”; drawing up a positive action plan, its achievability for each patient, careful planning of stages; the psychotherapist showing interest in the patient’s personality and his problem, reinforcing and supporting the slightest success; Strengthening motivation and responsibility for one’s results is facilitated by the “agenda” of each lesson, analysis of achievements and failures at each stage of psychotherapy. Upon signing psychotherapeutic contract It is recommended to write down the plan or repeat it using positive reinforcement techniques, communicating that it is good plan, which will contribute to the fulfillment of desires and recovery.

At the beginning of each interview session, a joint decision is made on which list of issues will be addressed. The formation of responsibility for one’s results is facilitated by an “agenda”, thanks to which it is possible to consistently work on psychotherapeutic “targets”. The “agenda” usually begins with a short review of the patient's experience from the last session. It includes feedback psychotherapist about homework. The patient is then encouraged to express what problems he would like to work on in class. Sometimes the psychotherapist himself suggests topics that he considers appropriate to include on the “agenda”. At the end of the session, the most important conclusions of the psychotherapeutic session are summarized (sometimes in writing), analyzed emotional condition patient. Together with him, the nature of independent homework, the task of which is to consolidate the knowledge or skills acquired in the lesson.

Behavioral techniques are focused on specific situations and actions. In contrast to strict cognitive techniques, behavioral procedures focus on how to act or cope with a situation rather than how to perceive it. Cognitive-behavioral techniques are based on changing inadequate thinking stereotypes, ideas with which a person reacts to external events, often accompanied by anxiety, aggression or depression. One of the fundamental goals of every behavioral technique is to change dysfunctional thinking. For example, if at the beginning of therapy the patient reports that nothing makes him happy, and after behavioral exercises changes this attitude to a positive one, then the task is completed. Behavioral changes often occur as a result of cognitive changes.

The most well-known are the following behavioral and cognitive techniques: reciprocal inhibition; flood technique; implosion; paradoxical intention; induced anger technique; stop tap method; use of imagination, hidden modeling, self-instruction training, methods relaxation simultaneously; training of confident behavior; self-control methods; introspection; scaling technique; study of threatening consequences (decatastrophization); Advantages and disadvantages; interviewing witnesses; exploration of choice (alternatives) of thoughts and actions; paradoxical techniques, etc.

Modern K.-p. etc., emphasizing the importance of the principles of classical and operant learning, is not limited to them. IN last years it also absorbs the principles of the theory of information processing, communication and even large systems, as a result of which the methods and techniques of this direction in psychotherapy are modified and integrated.

PHOTO Getty Images

Anxiety and depression, eating disorders and phobias, problems in couples and communication - the list of questions that cognitive behavioral therapy undertakes to answer continues to grow from year to year. Does this mean that psychology has found a universal “key to all doors”, a cure for all diseases? Or are the advantages of this type of therapy somewhat exaggerated? Let's try to figure it out.

Put your psyche back in place

In the beginning there was behaviorism. This is the name of the science of behavior (hence the second name of cognitive behavioral therapy - cognitive behavioral therapy, or CBT for short). The first to raise the banner of behaviorism was the American psychologist John Watson at the beginning of the twentieth century. His theory was a response to the European fascination with Freudian psychoanalysis. The birth of psychoanalysis coincided with a period of pessimism, decadent moods and expectations of the end of the world. This was also reflected in the teachings of Freud, who argued that the source of our main problems is outside the mind - in the unconscious, and therefore it is extremely difficult to cope with them. The American approach, on the contrary, assumed some simplification, healthy practicality and optimism. John Watson believed that we need to focus on human behavior, on how we react to external stimuli. And - work to improve these very reactions. However, this approach was successful not only in America. One of the fathers of behaviorism is considered to be the Russian physiologist Ivan Petrovich Pavlov, who received a Nobel Prize and studied reflexes until 1936.

Between the external stimulus and the reaction to it there is a very important authority - in fact, the person himself who reacts. More precisely, his consciousness

It soon became clear that in its desire for simplicity, behaviorism threw out the baby with the bathwater - essentially, reducing a person to a set of reactions and putting the psyche as such out of the picture. And scientific thought moved in the opposite direction. In the 1950–1960s, psychologists Albert Ellis and Aaron Beck “returned the psyche to its place,” rightly pointing out that between an external stimulus and the reaction to it there is a very important authority - in fact, the person himself who reacts.

More precisely, his consciousness. If psychoanalysis places the origins of the main problems in the unconscious, inaccessible to us, then Beck and Ellis suggested that we are talking about incorrect “cognitions” - errors of consciousness. Finding them, although not easy, is much easier than penetrating the dark depths of the unconscious. The work of Aaron Beck and Albert Ellis is considered today the foundation of cognitive behavioral therapy.

Errors of consciousness can be different. One simple example is the tendency to view any event as having something to do with you personally. Let’s say your boss was gloomy today and greeted you through gritted teeth. “He hates me and is probably about to fire me” is a fairly typical reaction in this case. But it’s not necessarily true. We do not take into account circumstances that we simply do not know about. What if the boss’s child is sick? What if he quarreled with his wife? Or have you just been criticized at a meeting with shareholders? However, one cannot, of course, exclude the possibility that the boss really has something against you. But even in this case, repeating “What a horror, everything is lost” is also a mistake of consciousness. It is much more productive to ask yourself whether you can change something in the situation and what benefits might come from leaving your current job.

One of the errors of consciousness is the tendency to perceive all events as relevant to us personally.

This example clearly illustrates the “scope” of CBT, which does not seek to understand the mystery that was happening behind the door of our parents’ bedroom, but helps to understand specific situation. And this approach turned out to be very effective: “Such scientific evidence base does not have any type of psychotherapy,” emphasizes psychotherapist Yakov Kochetkov. He is referring to a study by psychologist Stefan G. Hofmann that supported the effectiveness of CBT methods. 1: A large-scale analysis of 269 articles, each of which in turn reviewed hundreds of publications.

Costs of Efficiency

“Cognitive-behavioral psychotherapy and psychoanalysis are traditionally considered the two main areas of modern psychotherapy. Thus, in Germany, in order to obtain a state certificate as a psychotherapist with the right to pay through insurance companies, you must have basic training in one of them. Gestalt therapy, psychodrama, systemic family psychotherapy, despite their popularity, are still recognized only as types of additional specialization,” note psychologists Alla Kholmogorova and Natalya Garanyan 2. In almost all developed countries, psychotherapeutic assistance and cognitive behavioral psychotherapy are almost synonymous for insurers. For insurance companies, the main arguments are scientifically proven effectiveness, wide range application and relatively short duration of therapy.

Related to the last circumstance funny story. Aaron Beck said that when he started practicing CBT, he almost went broke. Traditionally, psychotherapy took a long time, but after just a few sessions, many clients told Aaron Beck that their problems had been successfully resolved, and therefore they did not see the point in further work. A psychotherapist's earnings have dropped sharply.

Questions for David Clark, cognitive psychotherapist

You are considered one of the pioneers of cognitive behavioral therapy. What path did she take?

I think we were able to improve a lot. We have improved the system for measuring the effectiveness of therapy and were able to understand which components are most important. It was possible to expand the scope of CBT – after all, it was initially considered only as a method of working with depression.

This therapy is attractive to authorities and insurance companies economically – a relatively short course brings a noticeable effect. What are the benefits for clients?

Exactly the same! It quickly gives positive results, allowing you to avoid spending money on going to a therapist for many years. Imagine, 5-6 sessions in many cases are enough for a noticeable effect. Moreover, often the most significant changes occur at the beginning of therapeutic work. This applies, for example, to depression, and in some cases to anxiety disorders. This does not mean that the work is already done, but the patient begins to experience relief in a very short term, and this is extremely important. In general, CBT is a very focused therapy. She does not set the goal of improving the condition in general; she works with the specific problems of a particular client, be it stress, depression or something else.

How to choose a therapist who works using the CBT method?

Find someone who has completed a certified, internationally recognized training program. Moreover, one that provides supervision: the work of a therapist with an experienced colleague. You can't become a therapist by just reading a book and deciding you're ready. Our research shows that supervised therapists are much more successful. Russian colleagues who began to practice CBT had to regularly travel to the West, because they could not undergo supervision in Russia. But now the best of them are ready to become supervisors themselves and help spread our method.

Method of use

The duration of the CBT course may vary. “It is used both short-term (15–20 sessions in the treatment of anxiety disorders) and long-term (1–2 years in the case of personality disorders),” point out Alla Kholmogorova and Natalya Garanyan. But on average this is significantly less than, for example, a course of classical psychoanalysis. Which can be perceived not only as a plus, but also as a minus.

CBT is often accused of being superficial, likening it to a painkiller pill that relieves symptoms without addressing the causes of the disease. “Modern cognitive therapy begins with working with symptoms,” explains Yakov Kochetkov. – But working with deep-seated beliefs also plays a big role. We just don't think it's necessary to work with them for many years. The usual course is 15-20 meetings, not two weeks. And about half of the course is working with symptoms, and half is working with causes. In addition, working with symptoms also affects deep-seated beliefs.”

The exposure method consists of controlled exposure of the client to the very factors that are the source of problems

This work, by the way, includes not only conversations with a therapist, but also the exposure method. It consists in the controlled influence on the client of the very factors that serve as the source of problems. For example, if a person has a fear of heights, then during the course of therapy he will have to climb onto the balcony of a high-rise building more than once. First - together with a therapist, and then independently, and each time to a higher floor.

Another myth stems, apparently, from the very name of therapy: since it works with consciousness, then the therapist is a rational coach who does not show empathy and is not able to understand what concerns personal relationships. This is not true. Cognitive therapy for couples, for example, in Germany is recognized as so effective that it has the status of a state program.

In the treatment of phobias, exposure to heights is used: in reality or using computer simulation PHOTO Getty Images

Many methods in one

“CBT is not universal, it does not displace or replace other methods of psychotherapy,” says Yakov Kochetkov. “Rather, it successfully builds on the findings of other methods, each time testing their effectiveness through scientific research.”

CBT is not one, but many therapies. And today there are CBT methods for almost every disorder. For example, schema therapy was invented for personality disorders. “CBT is now successfully used in cases of psychosis and, continues Yakov Kochetkov. – There are ideas borrowed from psychodynamic therapy. And recently, the authoritative journal The Lancet published an article about the use of CBT for patients with schizophrenia who refused to take medications. And even in this case, this method gives good results.”

All this does not mean that CBT has finally established itself as “psychotherapy No. 1”. She has many critics. However, if quick relief is needed in a specific situation, then 9 out of 10 experts in Western countries will recommend contacting a cognitive behavioral psychotherapist.

1 S. Hofmann et al. "The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses." Online publication in the journal Cognitive Therapy and Research dated 07/31/2012.

2 A. Kholmogorova, N. Garanyan “Cognitive-behavioral psychotherapy” (in the collection “Main directions of modern psychotherapy”, Cogito Center, 2000).

28. Cognitive-behavioral psychotherapy

Cognitive-behavioral approach in psychotherapy assumes that a person’s problems arise from distortions of reality based on misconceptions, which, in turn, arose as a result of incorrect learning in the process of personality development. Therapy is about looking for distortions in thinking and learning an alternative, more realistic way of perceiving your life. The K-B approach works when you need to find new forms of behavior, build the future, and consolidate the result. Representatives of the modern cognitive-behavioral approach are A. T. Beck, D. Maihenbaum.

Initially, the approach was formed on the development of ideas behaviorism. Behaviorism as a theoretical direction in psychology arose and developed at approximately the same time as psychoanalysis, from the end of the 19th century; attempts to systematically apply the principles of learning theory for psychotherapeutic purposes date back to the late 50s and early 60s. At this time, in England, at the famous Model Hospital, G. Eysenck first applied the principles of learning theory to treat mental disorders. In US clinics, the technique of positive reinforcement of desired reactions in patients with severely disturbed behavior, the so-called “token saving” technique, is beginning to be used everywhere. All positively assessed actions of patients receive reinforcement in the form of a special token. The patient can then exchange this token for sweets or get a day off to visit family, etc.

At this time it happens cognitive revolution in psychology, which demonstrated the role of so-called internal variables, or internal cognitive processes, in human behavior. Psychotherapy, which arose on the basis of behaviorism, became known as behavioral-cognitive.

Types of therapy based on the cognitive-behavioral approach:

1. Directions that are closer to classical behaviorism and based primarily on the theory of learning, that is, on the principles of direct and latent conditioning. This is actually behavioral psychotherapy, and among Russian approaches to this group of methods one can include Rozhnov’s emotional stress psychotherapy.

2. Directions based on the integration of the principles of learning theory and information theory, as well as the principles of reconstruction of the so-called dysfunctional cognitive processes and some principles of dynamic psychotherapy. These are, first of all, rational-emotive psychotherapy by Albert Ellis and cognitive psychotherapy by Aron Beck. This also includes the approaches of V. Guidano

3. Other areas such as rational psychotherapy, short-term multimodal psychotherapy, etc.

29. Model of mental pathology in existential-humanistic psychology

Humanistic psychologists believe that humans have an innate tendency toward friendship, cooperation, and creativity. Human beings, these theorists claim, strive for self-actualization—the realization of this potential for goodness and growth. However, they can achieve this only if, along with their strengths, they honestly recognize and accept their shortcomings and identify satisfactory personal values ​​​​to which they should focus in life.

Self-actualization is a humanistic process in which people realize their potential for goodness and growth.

Existentially oriented psychologists agree that people must have an accurate view of themselves and live meaningful, “authentic” lives in order to be psychologically well adjusted. However, their theories do not assume that people are naturally inclined to live in positive ways. These theorists believe that we are born with complete freedom to either face our existence openly and give meaning to our lives, or to shirk this responsibility. Those who choose to “hide” from responsibility and choice will begin to view themselves as helpless and weak, which can result in their lives becoming empty, inauthentic and leading to the appearance of certain symptoms.

Both the humanistic and existential views of pathology date back to the 1940s. During this time, Carl Rogers, often regarded as a humanistic pioneer, developed a client-centered therapy, an accepting and supportive approach that contrasted sharply with the psychodynamic techniques of the time. He also put forward a theory of personality that did not place much emphasis on irrational instincts and conflicts.

The existential view of personality and pathology emerged during the same period. Many of its principles draw on the ideas of 19th-century European existentialist philosophers, who believed that people continually define their existence through their actions, and thus give it meaning. In the late 1950s, May, Angel, and Ellenberger published a book called Existence, which outlined several basic existential ideas and treatment approaches that helped bring attention to this field.

Today, correction of any psychological problems is carried out using a variety of techniques. One of the most progressive and effective is cognitive behavioral psychotherapy (CBT). Let's figure out how this technique works, what it consists of, and in what cases it is most effective.

The cognitive approach is based on the assumption that all psychological problems are caused by the thoughts and beliefs of the person himself.

Cognitive-behavioral psychotherapy is a direction that originates in the middle of the 20th century and today is only being improved every day. The basis of CBT is the opinion that it is human nature to make mistakes when passing life path. That is why any information can cause certain changes in a person’s mental or behavioral activity. The situation gives rise to thoughts, which in turn contribute to the development of certain feelings, and these already become the basis of behavior in a particular case. The behavior then creates a new situation and the cycle repeats.

A striking example would be a situation in which a person is confident in his insolvency and powerlessness. In every difficult situation, he experiences these feelings, gets nervous and despairs, and, as a result, tries to avoid making a decision and cannot realize his desires. Often the cause of neuroses and other similar problems is intrapersonal conflict. Cognitive-behavioral psychotherapy helps to determine the original source of the current situation, the patient’s depression and experiences, and then resolve the problem. A person becomes aware of the skill of changing his negative behavior and thinking patterns, which has a positive effect on both his emotional and physical state.

Intrapersonal conflict is one of the common reasons occurrence of psychological problems

CBT has several goals:

• stop and permanently get rid of the symptoms of a neuropsychiatric disorder;
• achieve a minimum probability of recurrence of the disease;
• help improve the effectiveness of prescribed medications;
• eliminate negative and erroneous stereotypes of thinking and behavior, attitudes;
• resolve problems of interpersonal interaction.

Cognitive behavioral psychotherapy is effective for a wide variety of disorders and psychological problems. But most often it is used when the patient needs to receive quick help and short-term treatment.

For example, CBT is used for deviations in eating behavior, problems with drugs and alcohol, inability to restrain and experience emotions, depression, increased anxiety, various phobias and fears.

Contraindications to the use of cognitive behavioral psychotherapy can only be severe mental disorders, which require the use of medications and other regulatory actions, and seriously threaten the life and health of the patient, as well as his loved ones and others.

Experts cannot say exactly at what age cognitive-behavioral psychotherapy is used, since depending on the situation and the methods of working with the patient selected by the doctor, this parameter will be different. However, if necessary, such sessions and diagnostics are possible in both childhood and adolescence.

Use of CBT for severe mental disorders unacceptable, special drugs are used for this

The following factors are considered the main principles of cognitive behavioral psychotherapy:

1. A person's awareness of the problem.
2. Formation of an alternative pattern of actions and actions.
3. Consolidating new stereotypes of thinking and testing them in everyday life.

It is important to remember that both parties are responsible for the result of such therapy: the doctor and the patient. It is their well-coordinated work that will allow us to achieve maximum effect and significantly improve a person’s life, taking it to a new level.

Advantages of the technique

The main advantage of cognitive behavioral psychotherapy can be considered visible result, affecting all areas of the patient’s life. The specialist finds out exactly what attitudes and thoughts negatively affect a person’s feelings, emotions and behavior, helps to critically perceive and analyze them, and then learn to replace negative stereotypes with positive ones.

Based on the skills developed, the patient creates a new way of thinking, which corrects the response to specific situations and the patient’s perception of them, and changes behavior. Cognitive behavioral therapy helps to get rid of many problems that cause discomfort and suffering to the person himself and his loved ones. For example, in this way you can cope with alcohol and drug addiction, some phobias, fears, part with shyness and indecisiveness. The duration of the course is most often not very long - about 3-4 months. Sometimes it may take much longer, but in each specific case this issue is resolved individually.

Cognitive behavioral therapy helps to cope with a person’s anxieties and fears

It is only important to remember that cognitive behavioral therapy has a positive effect only when the patient himself has decided to change and is ready to trust and work with a specialist. In other situations, as well as in particularly difficult mental illness, for example, in schizophrenia, this technique is not used.

Types of therapy

Methods of cognitive behavioral psychotherapy depend on the specific situation and problem of the patient and pursue a specific goal. The main thing for a specialist is to get to the root of the patient’s problem, teach the person positive thinking and ways to behave in such a case. The most commonly used methods of cognitive behavioral psychotherapy are the following:

1. Cognitive psychotherapy, in which a person experiences uncertainty and fear, perceives life as a series of failures. At the same time, the specialist helps the patient develop a positive attitude towards himself, will help him accept himself with all his shortcomings, gain strength and hope.
2. Reciprocal inhibition. During the session, all negative emotions and feelings are replaced by other more positive ones. Therefore, they cease to have such a negative impact on human behavior and life. For example, fear and anger are replaced by relaxation.
3. Rational-emotive psychotherapy. At the same time, a specialist helps a person realize the fact that all thoughts and actions must be reconciled with the realities of life. And unrealizable dreams are the path to depression and neurosis.
4. Self-control. When working with this technique, a person’s reactions and behavior in certain situations are reinforced. This method works for unmotivated outbursts of aggression and other inappropriate reactions.
5. “Stop tap” technique and anxiety control. At the same time, the person himself says “Stop” to his negative thoughts and actions.
6. Relaxation. This technique is often used in combination with others to completely relax the patient, create a trusting relationship with a specialist, and more productive work.
7. Self-instructions. This technique consists in creating a series of tasks for oneself and independently solving them in a positive way.
8. Introspection. At the same time, a diary can be kept, which will help in tracking the source of the problem and negative emotions.
9. Research and analysis of threatening consequences. A person with negative thoughts changes them to positive ones, based on the expected results of the development of the situation.
10. A method for finding advantages and disadvantages. The patient himself or in pairs with a specialist analyzes the situation and his emotions in it, analyzes all the advantages and disadvantages, draws positive conclusions or looks for ways to solve the problem.
11. Paradoxical intention. This technique was developed by the Austrian psychiatrist Viktor Frankl and consists in the fact that the patient is asked to experience a frightening or problematic situation over and over again in his feelings and does the opposite. For example, if he is afraid to fall asleep, then the doctor advises not to try to do this, but to stay awake as much as possible. In this case, after a while a person stops experiencing negative emotions associated with sleep.

Some of these types of cognitive-behavioral psychotherapy can be carried out independently or act as a homework» after a specialist session. And when working with other methods, you cannot do without the help and presence of a doctor.

Self-observation is considered a type of cognitive behavioral psychotherapy

Cognitive Behavioral Psychotherapy Techniques

Cognitive behavioral psychotherapy techniques can be varied. Here are the most commonly used ones:

• keeping a diary where the patient will write down his thoughts, emotions and situations preceding them, as well as everything exciting during the day;
• reframing, in which, by asking leading questions, the doctor helps change the patient’s stereotypes in a positive direction;
• examples from literature, when the doctor talks and gives specific examples of literary characters and their actions in the current situation;
• the empirical path, when a specialist offers a person several ways to try certain solutions in life and leads him to positive thinking;
• a change of roles, when a person is invited to stand “on the other side of the barricades” and feel like the one with whom he has a conflict situation;
• evoked emotions, such as anger, fear, laughter;
• positive imagination and analysis of the consequences of a person’s choices.

Psychotherapy by Aaron Beck

Aaron Beck- an American psychotherapist who examined and observed people suffering from neurotic depression, and concluded that depression and various neuroses develop in such people:

• having a negative view of everything that happens in the present, even if it can bring positive emotions;
• having a feeling of powerlessness to change something and hopelessness, when when imagining the future a person pictures only negative events;
• suffering from low self-esteem and decreased self-esteem.

Aaron Beck used the most different methods. All of them were aimed at identifying a specific problem both from the specialist and from the patient, and then a solution to these problems was sought without correcting the specific qualities of the person.

Aaron Beck - an outstanding American psychotherapist, creator of cognitive psychotherapy

In Beck's cognitive behavioral therapy for personality disorders and other problems, the patient and therapist collaborate in experimental testing of the patient's negative judgments and stereotypes, and the session itself is a series of questions and answers to them. Each of the questions is aimed at promoting the patient to understand and understand the problem, and find ways to solve it. A person also begins to understand where his destructive behavior and mental messages are leading, together with a doctor or independently collecting the necessary information and testing it in practice. In a word, cognitive behavioral psychotherapy according to Aaron Beck is a training or structured training that allows you to detect negative thoughts in time, find all the pros and cons, and change your behavior pattern to one that will give positive results.

What happens during the session

The choice of a suitable specialist is of great importance in the results of therapy. The doctor must have a diploma and documents permitting his activity. Then a contract is concluded between the two parties, which specifies all the main points, including details of the sessions, their duration and quantity, conditions and time of meetings.

The therapy session must be conducted by a licensed professional

This document also prescribes the main goals of cognitive behavioral therapy, and, if possible, the desired result. The course of therapy itself can be short-term (15 one-hour sessions) or longer (more than 40 one-hour sessions). After completing the diagnosis and getting to know the patient, the doctor draws up an individual plan for working with him and the timing of consultation meetings.

As you can see, the main task of a specialist in the cognitive-behavioral direction of psychotherapy is considered to be not only monitoring the patient and finding out the origins of the problem, but also explaining your opinion on the current situation to the person himself, helping him to understand and build new mental and behavioral stereotypes. To increase the effect of such psychotherapy and consolidate the result, the doctor can give the patient special exercises and “homework”, use various techniques, which can help the patient to further act and develop in a positive direction independently.