Cognitive-behavioural (CBT), or cognitive behavioral psychotherapy- a modern method of psychotherapy used in the treatment of various mental disorders.

This method was originally developed for the treatment depression, then began to be used for treatment anxiety disorders, panic attacks,obsessive-compulsive disorder, and in last years successfully used as an auxiliary method in the treatment of almost all mental disorders, including bipolar disorder And schizophrenia. CBT has the widest evidence base and is used as the main method in hospitals in the USA and Europe.

One of the most important advantages of this method is its short duration!

Of course, this method is also applicable to helping people who do not suffer from mental disorders, but who are simply faced with life’s difficulties, conflicts, and health problems. This is due to the fact that the main postulate of CBT is applicable in almost any situation: our emotions, behavior, reactions, bodily sensations depend on how we think, how we evaluate situations, what beliefs we rely on when making decisions.

The purpose of the CBT is a person’s revaluation of his own thoughts, attitudes, beliefs about himself, the world, other people, because often they do not correspond to reality, are noticeably distorted and interfere with a full life. Low-adaptive beliefs change to ones that are more consistent with reality, and due to this, a person’s behavior and sense of self changes. This happens through communication with a psychologist, and through introspection, as well as through so-called behavioral experiments: new thoughts are not simply accepted on faith, but are first applied in a given situation, and the person observes the result of such new behavior.

What happens during a cognitive behavioral therapy session:

Psychotherapeutic work focuses on what is happening to a person at a given stage of his life. A psychologist or psychotherapist always strives to first establish what is happening to a person at the present time, and only then moves on to analyzing past experiences or making plans for the future.

Structure is extremely important in CBT. Therefore, during a session, the client most often fills out questionnaires first, then the client and the psychotherapist agree on what topics need to be discussed in the session and how much time needs to be spent on each, and only after that the work begins.

The CBT psychotherapist sees in the patient not only a person with certain symptoms (anxiety, low mood, restlessness, insomnia, panic attacks, obsessions and rituals, etc.) that prevent him from living fully, but also a person who is able to learn to live like this , so as not to get sick, who can take responsibility for his well-being in the same way as a therapist takes responsibility for his own professionalism.

Therefore, the client always leaves the session with homework and does a huge part of the work to change himself and improve his condition himself, by keeping diaries, self-observation, training new skills, and implementing new behavioral strategies into his life.

Individual CBT session lasts from40 up to 50minutes, once or twice a week. Usually a course of 10-15 sessions. Sometimes it is necessary to conduct two such courses, as well as include group psychotherapy in the program. It is possible to take a break between courses.

Areas of assistance using CBT methods:

• Individual consultation with a psychologist, psychotherapist
• Group psychotherapy (adults)
• Group therapy (teens)
• ABA therapy

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 from 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 openly face our existence 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.

Cognitive behavioral psychotherapy, Also Cognitive-behavioral psychotherapy(English) Cognitive behavioral therapy) - general concept, describing psychotherapies based on the premise that the cause psychological disorders(phobias, depression, etc.) are dysfunctional beliefs and attitudes.
The foundation for this area of ​​psychotherapy was laid by the works of A. Ellis and A. Beck, which also gave impetus to the development of the cognitive approach in psychology. Subsequently, methods were integrated into the methodology behavioral therapy, which led to the current name.

Founders of the system

In the middle of the 20th century, the works of the pioneers of cognitive behavioral therapy (hereinafter CT) A. Beck and A. Ellis became very famous and widespread. Aaron Beck was originally trained as a psychoanalyst, but became disillusioned with psychoanalysis and created his own model of depression and new method treatment affective disorders which is called cognitive therapy. He formulated its main provisions independently of A. Ellis, who developed a similar method of rational-emotional psychotherapy in the 50s.

Judith S. Beck. Cognitive therapy: complete guide: Per. from English - M.: LLC Publishing House "Williams", 2006. - P. 19.

Goals and objectives of cognitive therapy

In the preface to the famous monograph “Cognitive Therapy and Emotional Disorders,” Beck declares his approach as fundamentally new, different from the leading schools devoted to the study and treatment of emotional disorders - traditional psychiatry, psychoanalysis and behavioral therapy. These schools, despite significant differences among themselves, share a common fundamental assumption: the patient is tormented hidden forces, over which he has no control. ...

These three leading schools maintain that the source of the patient's disorder lies outside his consciousness. They pay little attention to conscious concepts, concrete thoughts and fantasies, that is, cognition. A new approach, cognitive therapy, believes that emotional disorders can be approached in a completely different way: the key to understanding and solving psychological problems lies in the minds of patients.

Aleksandrov A. A. Modern psychotherapy. - St. Petersburg: Academic Project, 1997. - P. 82.

There are five goals of cognitive therapy: 1) reduction and/or complete elimination of symptoms of the disorder; 2) reducing the likelihood of relapse after completion of treatment; 3) increasing the effectiveness of pharmacotherapy; 4) solving psychosocial problems (which can either be a consequence of a mental disorder or precede its occurrence); 5) eliminating the causes contributing to the development of psychopathology: changing maladaptive beliefs (schemas), correcting cognitive errors, changing dysfunctional behavior.

To achieve these goals, a cognitive psychotherapist helps the client solve the following tasks: 1) understand the influence of thoughts on emotions and behavior; 2) learn to identify and observe negative automatic thoughts; 3) explore negative automatic thoughts and arguments that support and refute them (“for” and “against”); 4) replace erroneous cognitions with more rational thoughts; 5) discover and change maladaptive beliefs that form fertile ground for the occurrence of cognitive errors.

Of these tasks, the first, as a rule, is solved already during the first (diagnostic) session. To solve the remaining four problems, special techniques are used, the most popular of which are described below.

Methodology and features of cognitive psychotherapy

Today, CT is at the intersection of cognitivism, behaviorism and psychoanalysis. As a rule, textbooks published in Russian in recent years do not address the question of the existence of differences between the two most influential variants of cognitive therapy - CT by A. Beck and REBT by A. Ellis. An exception is the monograph by G. Kassinov and R. Tafrate with a foreword by Albert Ellis.

As the founder of rational emotive behavior therapy (REBT), the first cognitive behavioral therapy, ... I was naturally drawn to chapters 13 and 14 of this book. Chapter 13 describes Aaron Beck's cognitive therapy techniques, and Chapter 14 introduces some basic REBT techniques. … Both chapters are excellently written and reveal both many similarities and the main differences between these approaches. … But I would also like to point out that the REBT approach is definitely to a greater extent, than cognitive therapy, emphasizes emotional-memory-(evocative-)experiential methods.

Preface / A. Ellis // Kassinov G., Tafreyt R. Ch. Psychotherapy of anger. - M.: AST; St. Petersburg: Sova, 2006. - P. 13.

Although this approach may seem similar to Beck's cognitive therapy, there are significant differences. In the REBT model, the initial perception of the stimulus and automatic thoughts are not discussed or questioned. ... The psychotherapist does not discuss reliability, but finds out how the client evaluates the stimulus. Thus, in REBT the main emphasis is on... assessing the stimulus.

Kassinov G., Tafreyt R. Ch. Psychotherapy of anger. - M.: AST; St. Petersburg: Sova, 2006. - P. 328.

Features of CT:

1. Natural science foundation: having your own psychological theory normal development and factors in the occurrence of mental pathology.
2. Target-oriented and technological: for each nosological group there is a psychological model that describes the specifics of the disorders; Accordingly, the “targets of psychotherapy”, its stages and techniques are highlighted.
3. Short-term and cost-effective approach (unlike, for example, psychoanalysis): from 20-30 sessions.
4. The presence of integrating potential inherent in the theoretical schemes of CT (existential-humanistic orientation, object relations, behavioral training, etc.).

Basic theoretical principles

1. The way an individual structures situations determines his behavior and feelings. Thus, the center is the subject’s interpretation of external events, which is implemented according to the following scheme: external events (stimuli) → cognitive system → interpretation (thoughts) → affect (or behavior). If interpretations and external events diverge greatly, this leads to mental pathology.
2. Affective pathology is a strong exaggeration of normal emotion, resulting from incorrect interpretation under the influence of many factors (see point No. 3). The central factor is “private possessions (personal space)” ( personal domain), which is centered on the ego: emotional disturbances depend on whether a person perceives events as enriching, as depleting, as threatening or as encroaching on his domain. Examples:
   • Sadness arises from the loss of something valuable, that is, the deprivation of private possession.
   • Euphoria is the feeling or expectation of acquisition.
   • Anxiety is a threat to physiological or psychological well-being.
   • Anger results from the feeling of being directly attacked (either intentionally or unintentionally) or of a violation of the laws, morals, or standards of the individual.
3. Individual differences. They depend on past traumatic experiences (for example, a situation of prolonged stay in a confined space) and biological predisposition (constitutional factor). E. T. Sokolova proposed the concept of differential diagnosis and psychotherapy of two types of depression, based on the integration of CT and psychoanalytic theory of object relations:
   • Perfectionistic melancholy(occurs in the so-called “autonomous personality”, according to Beck). It is provoked by frustration of the need for self-affirmation, achievement, and autonomy. Consequence: development of the compensatory structure of the “Grandiose Self”. Thus, here we are talking about a narcissistic personality organization. Strategy of psychotherapeutic work: “containment” (careful attitude towards heightened pride, wounded pride and feelings of shame).
   • Anaclitic depression(occurs in the so-called “sociotropic personality”, according to Beck). Associated with emotional deprivation. Consequence: unstable patterns of interpersonal relationships, where emotional avoidance, isolation and “emotional dullness” are replaced by overdependence and emotional clinging to the Other. Strategy of psychotherapeutic work: “holding” (emotional “pre-feeding”).
4. The normal functioning of the cognitive organization is inhibited under the influence of stress. Extremist judgments, problematic thinking arise, concentration is impaired, etc.
5. Psychopathological syndromes (depression, anxiety disorders, etc.) consist of hyperactive patterns with unique content that characterize a particular syndrome. Examples: depression - loss, anxiety disorder - threat or danger, etc.
6. Intense interactions with other people create a vicious circle of maladaptive cognitions. A wife suffering from depression, misinterpreting her husband’s frustration (“I don’t care, I don’t need her...” instead of the real “I can’t help her”), attributes a negative meaning to it, continues to think negatively about herself and her relationship with her husband, withdraws, and, as a consequence, her maladaptive cognitions are further strengthened.

Key Concepts

1. Scheme. These are cognitive formations that organize experience and behavior, this is a system of beliefs, deep ideological attitudes of a person in relation to himself and the world around him, influencing actual perception and categorization. Schemes can be:
   • adaptive/non-adaptive. An example of a maladaptive schema: “all men are bastards” or “all women are bitches.” Of course, such schemes do not correspond to reality and are an excessive generalization, however, such a life position can cause damage, first of all, to the person himself, creating difficulties for him in communicating with the opposite sex, since subconsciously he will be negatively inclined in advance, and the interlocutor may understand this and be offended.
   • positive/negative
   • idiosyncratic/universal. Example: depression - maladaptive, negative, idiosyncratic.
2. Automatic thoughts. These are thoughts that the brain records in the “fast” area of ​​​​memory (the so-called “subconscious”), because they are often repeated or a person attaches special importance to them. In this case, the brain does not spend a lot of time repeatedly slowly thinking about this thought, but makes a decision instantly, based on the previous decision recorded in the “fast” memory. Such “automation” of thoughts can be useful when you need to quickly make a decision (for example, quickly pull your hand away from a hot frying pan), but can be harmful when an incorrect or illogical thought is automated, so one of the tasks of cognitive psychotherapy is to recognize such automatic thoughts and return them from the area quick memory again into the area of ​​slow rethinking in order to remove incorrect judgments from the subconscious and rewrite them with correct counterarguments. Main characteristics of automatic thoughts:
   • Reflexivity
   • Collapse and compression
   • Not subject to conscious control
   • Transience
   • Perseveration and stereotyping. Automatic thoughts are not the result of thinking or reasoning; they are subjectively perceived as reasonable, even if they seem absurd to others or contradict obvious facts. Example: “If I get a “good” grade on the exam, I will die, the world around me will collapse, after that I will not be able to do anything, I will finally become a complete nonentity,” “I ruined the lives of my children with divorce,” “Everything I I do it, I do it poorly.”
3. Cognitive errors. These are supervalent and affectively charged schemas that directly cause cognitive distortions. They are characteristic of all psychopathological syndromes. Kinds:
   • Arbitrary conclusions- drawing conclusions in the absence of supporting facts or even in the presence of facts that contradict the conclusion.
   • Overgeneralization- conclusions based on a single episode, followed by their generalization.
   • Selective abstraction- focusing the individual’s attention on any details of the situation while ignoring all its other features.
   • Exaggeration and understatement- opposite assessments of oneself, situations and events. The subject exaggerates the complexity of the situation while simultaneously downplaying his ability to cope with it.
   • Personalization- an individual’s attitude towards external events as having something to do with him, when in reality this is not the case.
   • Dichotomous Thinking(“black and white” thinking or maximalism) - assigning oneself or any event to one of two poles, positive or negative (in absolute terms). In a psychodynamic sense, this phenomenon can be qualified as defense mechanism splitting, which indicates the “diffusion of self-identity.”
   • Ought- excessive focus on “I should” act or feel in a certain way, without assessing the real consequences of such behavior or alternative options. Often arises from previously imposed standards of behavior and thought patterns.
   • Prediction- an individual believes that he can accurately predict the future consequences of certain events, although he does not know or does not take into account all the factors and cannot correctly determine their influence.
   • Mind Reading- the individual believes that he knows exactly what other people think about this, although his assumptions do not always correspond to reality.
   • Labeling- associating oneself or others with certain patterns of behavior or negative types
4. Cognitive content(“themes”) corresponding to one or another type of psychopathology (see below).

Theory of psychopathology

Depression

Depression is an exaggerated and chronic experience of real or hypothetical loss. Cognitive triad of depression:

• Negative self-image: “I’m inferior, I’m a failure, at the very least!”
• Negative assessment of the surrounding world and external events: “The world is merciless to me! Why is all this falling on me?”
• Negative assessment of the future. “What can I say? I simply have no future!”

In addition: increased dependence, paralysis of the will, suicidal thoughts, somatic symptom complex. On the basis of depressive schemas, corresponding automatic thoughts are formed and cognitive errors of almost all types occur. Themes:

• Fixation on real or imaginary loss (death of loved ones, collapse of relationships, loss of self-esteem, etc.)
• Negative attitude towards oneself and others, pessimistic assessment of the future
• Tyranny of the Ought

Anxiety-phobic disorders

Anxiety disorder is an exaggerated and chronic experience of real or hypothetical danger or threat. A phobia is an exaggerated and chronic experience of fear. Example: fear of loss of control (for example, over your body, as in the case of fear of getting sick). Claustrophobia - fear confined spaces; mechanism (and in agoraphobia): fear that in case of danger, help may not arrive in time. Themes:

• Anticipation of negative events in the future, so-called. “anticipation of all kinds of misfortunes.” With agoraphobia: fear of dying or going crazy.
• The discrepancy between the level of aspirations and the conviction of one’s own incompetence (“I should get an “excellent” mark on the exam, but I’m a loser, I don’t know anything, I don’t understand anything.”)
• Fear of losing support.
• Persistent perception of inevitable failure in attempts to improve interpersonal relationships, of being humiliated, ridiculed, or rejected.

Perfectionism

Phenomenology of perfectionism. Main parameters:

• High standards
• All or nothing thinking (either complete success or complete failure)
• Focusing on failures

Perfectionism is very closely related to depression, not the anaclitic type (due to loss or bereavement), but the kind that is associated with frustration of the need for self-affirmation, achievement and autonomy (see above).

Psychotherapeutic relationship

The client and therapist must agree on what problem they will be working on. It is problem solving (!), not change personal characteristics or the patient's deficiencies. The therapist must be very empathic, natural, congruent (principles taken from humanistic psychotherapy); there should be no directiveness. Principles:

• The therapist and client collaborate in an experimental test of erroneous maladaptive thinking. Example: client: “When I walk down the street, everyone turns to look at me,” therapist: “Try to walk normally down the street and count how many people turn to look at you.” Usually this automatic thought does not coincide with reality. The bottom line: there is a hypothesis, it must be tested empirically. However, sometimes the statements of psychiatric patients that on the street everyone turns around, looks at them and discusses them, still have a real factual basis - it’s all about how the mentally ill person looks and how he behaves at that moment. If a person talks quietly to himself, laughs for no reason, or vice versa, without looking away from one point, does not look around at all, or looks around with fear at those around him, then such a person will certainly attract attention to himself. They will actually turn around, look at him and discuss him - simply because passers-by are interested in why he behaves this way. In this situation, a psychologist can help the client understand that the interest of others is caused by his unusual behavior, and explain to the person how to behave in public so as not to attract undue attention.
• Socratic dialogue as a series of questions with the following goals:
  1. Clarify or identify problems
  2. Help in identifying thoughts, images, sensations
  3. Explore the meaning of events for the patient
  4. Assess the consequences of maintaining maladaptive thoughts and behaviors.
• Guided Cognition: The therapist-guide encourages patients to address facts, evaluate probabilities, gather information, and put it all to the test.

Techniques and methods of cognitive psychotherapy

CT in Beck's version is a structured training, experiment, mental and behavioral training designed to help the patient master the following operations:

• Identify your negative automatic thoughts.
• Find connections between knowledge, affect and behavior.
• Find facts for and against automatic thoughts.
• Look for more realistic interpretations for them.
• Learn to identify and change disorganizing beliefs that lead to distortion of skills and experience.

Specific methods for identifying and correcting automatic thoughts:

1. Writing down thoughts. The psychologist can ask the client to write down on paper what thoughts arise in his head when he tries to do required action(or not do an unnecessary action). It is advisable to write down the thoughts that come to mind at the moment of making a decision strictly in the order of their priority (this order is important because it will indicate the weight and importance of these motives in making a decision).
2. Thought Diary. Many CT specialists suggest that their clients briefly write down their thoughts in a diary over the course of several days to understand what a person thinks about most often, how much time they spend on it, and how strong the emotions they experience from their thoughts. For example, American psychologist Matthew McKay recommended that his clients divide a diary page into three columns, where they briefly indicate the thought itself, the hours of time spent on it, and an assessment of their emotions on a 100-point scale ranging from: “very pleasant/interesting” - “ indifferent" - "very unpleasant/depressing." The value of such a diary is also that sometimes even the client himself cannot always accurately indicate the reason for his experiences, then the diary helps both himself and his psychologist find out what thoughts affect his well-being during the day.
3. Distance. The essence of this stage is that the patient must take an objective position in relation to own thoughts, that is, move away from them. Suspension involves 3 components:
   • awareness of the automaticity of a “bad” thought, its spontaneity, the understanding that this pattern arose earlier under different circumstances or was imposed by other people from the outside;
   • awareness that a “bad” thought is maladaptive, that is, it causes suffering, fear or disappointment;
   • the emergence of doubt about the truth of this non-adaptive thought, the understanding that this scheme does not correspond to new requirements or a new situation (for example, the thought “To be happy means to be the first in everything”, formed by an excellent student at school, can lead to disappointment if he does not manages to become the first at the university).
4. Empirical verification(“experiments”). Methods:
   • Find arguments for and against automatic thoughts. It is also advisable to write down these arguments on paper so that the patient can re-read it whenever these thoughts come to his mind again. If a person does this often, then gradually the brain will remember the “correct” arguments and remove “wrong” motives and decisions from quick memory.
   • Weigh the advantages and disadvantages of each option. Here it is also necessary to take into account the long-term perspective, and not just the short-term benefit (for example, in the long run, the problems from drugs will be many times greater than the temporary pleasure).
   • Constructing an experiment to test a judgment.
   • Conversation with witnesses of past events. This is especially true in those mental disorders where memory is sometimes distorted and replaced by fantasies (for example, in schizophrenia) or if the delusion is caused by an incorrect interpretation of the motives of another person.
   • The therapist turns to his experience, fiction and academic literature, statistics.
   • The therapist incriminates: points out logical errors and contradictions in the patient’s judgments.
5. Revaluation technique. Checking the probability of alternative causes of an event.
6. Decentration. With social phobia, patients feel like the center of everyone's attention and suffer from it. Empirical testing of these automatic thoughts is also needed here.
7. Self-expression. Depressed, anxious, etc. patients often think that their illness is under control higher levels consciousness, constantly observing themselves, they understand that symptoms do not depend on anything, and attacks have a beginning and an end. Conscious self-observation.
8. Decatastrophizing. For anxiety disorders. Therapist: “Let's see what would happen if...”, “How long will you experience such negative feelings?”, “What will happen then? You will die? Will the world collapse? Will this ruin your career? Will your loved ones abandon you? etc. The patient understands that everything has a time frame, and the automatic thought “this horror will never end” disappears.
9. Purposeful repetition. Playing out the desired behavior, repeatedly trying out various positive instructions in practice, which leads to increased self-efficacy. Sometimes the patient completely agrees with the correct arguments during psychotherapy, but quickly forgets them after the session and again returns to the previous “wrong” arguments, since they are repeatedly recorded in his memory, although he understands their illogicality. In this case, it is better to write down the correct arguments on paper and re-read them regularly.
10. Using the Imagination. In anxious patients, it is not so much “automatic thoughts” that predominate as “obsessive images”, that is, it is not thinking that maladapts, but imagination (fantasy). Kinds:
    • Stopping technique: loud command to yourself “stop!” - the negative way of thinking or imagining stops. It can also be effective in stopping obsessive thoughts in some cases. mental illness.
    • Repetition technique: repeat several times correct image thinking in order to destroy the formed stereotype.
    • Metaphors, parables, poems: the psychologist uses such examples to make the explanation more understandable.
    • Modifying imagination: the patient actively and gradually changes the image from negative to more neutral and even positive, thereby understanding the possibilities of his self-awareness and conscious control. Usually, even after a severe failure, you can find at least something positive in what happened (for example, “I learned a good lesson”) and concentrate on it.
    • Positive imagination: a positive image replaces a negative one and has a relaxing effect.
    • Constructive imagination (desensitization): the patient ranks the probability of the expected event, which leads to the fact that the forecast loses its globality and inevitability.
11. Change of world view. Often the cause of depression is unfulfilled desires or excessively high demands. In this case, the psychologist can help the client weigh the cost of achieving the goal and the cost of the problem, and decide whether it is worth fighting further or whether it would be wiser to abandon achieving this goal altogether, discard the unfulfilled desire, reduce requests, set more realistic goals for oneself, for starters, try to get more comfortable with what you have or find something substitute. This is true in cases where the cost of refusing to solve a problem is lower than suffering from the problem itself. However, in other cases, it may be better to tense up and solve the problem, especially if delaying the solution only makes the situation worse and causes more suffering for the person.
12. Replacing emotions. Sometimes the client needs to come to terms with his past negative experiences and change his emotions to more adequate ones. For example, sometimes it will be better for a victim of a crime not to replay the details of what happened in his memory, but to say to himself: “It’s very unfortunate that this happened to me, but I won’t let my offenders ruin the rest of my life, I will live in the present and the future, rather than constantly looking back at the past.” You should replace the emotions of resentment, anger and hatred with softer and more adequate ones, which will allow you to build your future life more comfortably.
13. Role reversal. Ask the client to imagine that he is trying to console a friend who is in trouble. similar situation. What could you say to him? What do you recommend? What advice could your loved one give you in this situation?
14. Action plan for the future. The client and therapist jointly develop a realistic “action plan” for the client for the future, with specific conditions, actions and deadlines, and write this plan down on paper. For example, if a catastrophic event occurs, the client will perform a certain sequence of actions at the designated time, and before this event occurs, the client will not torment himself needlessly with worries.
15. Identifying alternative causes of behavior. If all the “correct” arguments have been presented, and the client agrees with them, but continues to think or act in a clearly illogical way, then you should look alternative reasons such behavior that the client himself is not aware of or prefers to remain silent about. For example, with obsessive thoughts, the very process of thinking often brings a person great satisfaction and relief, since it allows him to at least mentally imagine himself as a “hero” or “savior,” solve all problems in fantasies, punish enemies in dreams, correct his mistakes in an imaginary world, etc. .d. Therefore, a person scrolls through such thoughts again and again not for the sake of real solution, and for the sake of the very process of thinking and satisfaction, gradually this process draws a person deeper and deeper like a kind of drug, although the person understands the unreality and illogicality of such thinking. In particular severe cases However, irrational and illogical behavior may even be a sign of a serious mental illness (for example, obsessive-compulsive disorder or schizophrenia), in which case psychotherapy alone may not be enough, and the client also needs the help of medication to control thinking (i.e., requires the intervention of a psychiatrist).

Exist specific methods CT scans used only for certain types of severe mental disorders, in addition to drug treatment:

• With schizophrenia, patients sometimes begin to conduct mental dialogues with imaginary images of people or otherworldly beings (so-called “voices”). The psychologist, in this case, can try to explain to the schizophrenic that he is not talking with real people or creatures, but with the artistic images of these creatures created by him, thinking in turn first for himself, then for this character. Gradually, the brain “automates” this process and begins to produce phrases that are suitable for the invented character in a given situation automatically, even without a conscious request. You can try to explain to the client that normal people also sometimes have conversations with imaginary characters, but consciously, when they want to predict the reaction of another person to a certain event. Writers and directors, for example, even write entire books, thinking in turn for several characters at once. However, at the same time normal person understands well that this image is fictitious, so he is not afraid of it and does not treat it as a real being. Brain healthy people does not attach interest or importance to such characters, and therefore does not automate fictional conversations with them. It’s like the difference between a photograph and a living person: you can safely put a photograph in the table and forget about it, because it doesn’t matter, and if it were a living person, they wouldn’t do that to him. When a schizophrenic understands that his character is just a figment of his imagination, he will also begin to handle him much more easily and will stop pulling this image out of his memory when it is not necessary.

• Also, with schizophrenia, the patient sometimes begins to mentally replay a fantasy image or plot many times, gradually such fantasies are deeply recorded in memory, enriched with realistic details and become very believable. However, this is the danger that a schizophrenic begins to confuse the memory of his fantasies with real memory and may, because of this, begin to behave inappropriately, so the psychologist can try to restore real facts or events with the help of external reliable sources: documents, people whom the patient trusts, scientific literature, conversation with witnesses, photographs, video recordings, constructing an experiment to test judgment, etc.

• With obsessive-compulsive disorder, during the appearance of any obsessive thought, it may be useful for the patient to repeat counter-arguments several times about how obsessive thoughts harm him, how he is uselessly wasting his precious time on them, that he has more important things to do, that obsessive dreams become a kind of drug for him, scatter his attention and impair his memory, and these obsessions can cause ridicule from others, lead to problems in the family, at work, etc. As mentioned above, it is better to write down such useful counterarguments on paper so that they re-read regularly and try to memorize it by heart.

The effectiveness of cognitive psychotherapy

Factors of effectiveness of cognitive therapy:

1. Personality of the psychotherapist: naturalness, empathy, congruence. The therapist must be able to receive feedback from the patient. Since CT is a fairly directive (in a certain sense of the word) and structured process, once a good therapist feels the dullness and impersonality of therapy (“solving problems according to formal logic”), he is not afraid of self-disclosure, is not afraid of using imagination, parables, metaphors, etc. P.
2. The right psychotherapeutic relationship. Taking into account the patient’s automatic thoughts about the psychotherapist and the proposed tasks. Example: Automatic thought of the patient: “I will write in my diary - in five days I will become the most happy man in the world, all problems and symptoms will disappear, I will begin to truly live.” Therapist: “The diary is just a separate help, there will be no immediate effects; your journal entries are mini-experiments that give you new information about yourself and your problems.”
3. High-quality application of techniques, an informal approach to the CT process. Techniques must be applied according to specific situation, a formal approach dramatically reduces the effectiveness of CT and can often generate new automatic thoughts or frustrate the patient. Systematicity. Accounting for feedback.
4. Real problems - real effects . Effectiveness decreases if the therapist and client do whatever they want, ignoring the real problems.

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. The skill of changing one’s negative behavior and thinking pattern becomes available to a person, which has a positive effect on emotional condition, and to the physical.

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 neuropsychic 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 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 Only severe mental disorders can occur, 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 those around him.

Experts cannot say exactly at what age cognitive-behavioral psychotherapy is used, since this parameter will vary depending on the situation and the methods of working with the patient selected by the doctor. 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, and 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 severe mental illnesses, for example, 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 and teach the person positive thinking and ways of behavior 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 to change positive side patient stereotypes;
• examples from literature when a doctor talks and gives specific examples 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. Also, a person begins to understand where his destructive behavior and mental messages lead, together with a doctor or independently collects necessary information and tests 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.