Behavioral psychotherapy. Behavior Therapy: Exercises and Techniques

In progress behavioral therapy improvement often occurs earlier than with other types of psychotherapy and is more specific. Rapid improvement can occur even in disorders that have lasted for many years (for example, long-term alcohol addiction, eating disorders, phobias).

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Cognitive-behavioral psychotherapy (narrated by psychotherapist Dmitry Kovpak)

Behavioral psychotherapy

Treatment of phobias in cognitive behavioral therapy.

Anxiety disorders are the scourge of modern civilization. Dmitry Kovpak

Webinar "Cognitive-behavioral psychotherapy of depressive disorders" - Dmitry Viktorovich Kovpak

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Although behavioral therapy is one of the the latest methods Treatments in psychiatry, the techniques that are used in it, existed already in ancient times. It has long been known that people’s behavior can be controlled using positive and negative reinforcements, that is, rewards and punishments (the “carrot and stick” method). However, only with the advent of the theory of behaviorism these methods received scientific basis.

Behaviorism as a theoretical direction in psychology arose and developed at approximately the same time as psychoanalysis (that is, from the end of the 19th century). However, the systematic application of the principles of behaviorism for psychotherapeutic purposes dates back to the late 50s and early 60s.

Methods of behavioral therapy are largely based on the ideas of Russian scientists Vladimir Mikhailovich Bekhterev (1857-1927) and Ivan Petrovich Pavlov (1849-1936). The works of Pavlov and Bekhterev were well known abroad, in particular, Bekhterev’s book “Objective Psychology” had an impact big influence on John Watson. All the major behaviorists in the West call Pavlov their teacher. (See also: reflexology)

The term "behavioral therapy" was first mentioned in 1911 by Edward Thorndike (1874-1949). In the 1940s, the term was used by Joseph Wolpe's research group (English) Russian .

The further development of behavioral therapy is associated primarily with the names of Edward Thorndike and Frederick Skinner, who created the theory of operant conditioning. In classical Pavlovian conditioning, behavior can be changed through modification initial conditions, in which this behavior is manifested. In operant conditioning, behavior can be changed by stimuli that follow for behavior (“rewards” and “punishments”).

1. "The Law of Exercise"(eng. Law of exercise), which states that the repetition of a certain behavior contributes to the fact that in the future this behavior will manifest itself with more and more high probability.
2. "Law of Effect"(eng. Law of effect): if a behavior has a positive outcome for the individual, it will be repeated with a higher probability in the future. If an action leads to unpleasant results, in the future it will appear less and less often or disappear altogether.

By the end of the 60s, behavioral psychotherapy was recognized as an independent and effective form psychotherapy. Currently, this area of ​​psychotherapy has become one of the leading methods of psychotherapeutic treatment. In the 1970s, methods of behavioral psychology began to be used not only in psychotherapy, but also in pedagogy, management and business.

Initially, behavioral therapy methods were based exclusively on the ideas of behaviorism, that is, on the theory of conditioned reflexes and on learning theory. But currently there is a tendency towards a significant expansion of the theoretical and instrumental base of behavioral therapy: it can include any method whose effectiveness has been proven experimentally. Arnold Lazarus (English) Russian called this approach "Broad Spectrum Behavioral Therapy" or "Multimodal Psychotherapy". For example, behavioral therapy currently uses relaxation techniques and breathing exercises(in particular, diaphragmatic breathing). Thus, although behavioral therapy is based on evidence-based methods, it is eclectic in nature. The techniques that are used in it are united only by the fact that they are all aimed at changing behavioral skills and abilities. According to the definition of the American Psychological Association, “ Behavioral psychotherapy involves primarily the use of principles that have been developed experimentally and social psychology... The main goal of behavioral therapy is to build and strengthen the ability to act and increase self-control» .

Methods similar to those of behavioral therapy were used in the Soviet Union starting in the 1920s. However, in the domestic literature for a long time, instead of the term “behavioral psychotherapy,” the term “conditioned reflex psychotherapy” was used.

Indications

Behavioral psychotherapy is used for a wide range of disorders: mental and so-called psychosomatic disorders, as well as purely somatic diseases. It is especially useful in the treatment anxiety disorders, in particular for panic disorders, phobias, obsessions, as well as the treatment of depression and other affective disorders, eating disorders, sexual problems, schizophrenia, antisocial behavior, sleep and attention disorders, hyperactivity, autism, learning difficulties and other developmental disorders in childhood, as well as for language and conversation problems.

In addition, behavioral psychotherapy can be used to cope with stress and treat clinical manifestations high blood pressure, headaches, asthma and some gastrointestinal diseases, in particular enteritis and chronic pain.

Basic principles

Behavioral therapy scheme

Assessing the client's condition

This procedure in behavior therapy is called “functional analysis” or “applied behavior analysis”. At this stage, the first step is to compile a list of behavior patterns that have negative consequences for the patient. Each behavior pattern is described according to the following scheme:

Then situations and events are identified that cause a neurotic behavioral reaction (fear, avoidance, etc.). Using self-observation, the patient must answer the question: what factors can increase or decrease the likelihood of a desired or undesirable behavior pattern? You should also check whether the undesirable behavior pattern has any “secondary benefit” (English) Russian"for the patient, that is, hidden positive reinforcement of this behavior. The therapist then determines for himself what strengths in the patient's character can be used in the therapeutic process. It is also important to find out what the patient's expectations are regarding what psychotherapy can give him: the patient is asked to formulate his expectations in specific terms, that is, to indicate which behavioral patterns he would like to get rid of and what forms of behavior he would like to learn. It is necessary to check whether these expectations are realistic. In order to obtain the most complete picture of the patient's condition, the therapist gives him a questionnaire, which the patient must fill out at home, using, if necessary, the method of self-observation. Sometimes a stage initial assessment takes several weeks, since in behavior therapy it is extremely important to obtain a complete and exact description patient problems.

In behavior therapy, the data obtained at the preliminary analysis stage is called the “baseline” or “starting point” (English baseline). These data are subsequently used to evaluate the effectiveness of therapy. In addition, they allow the patient to realize that his condition is gradually improving, which increases motivation to continue therapy.

Drawing up a treatment plan

In behavioral therapy, it is necessary for the therapist to adhere to a specific plan when working with the patient, so after assessing the patient's condition, the therapist and patient draw up a list of problems that need to be solved. However, it is not recommended to work on several problems at the same time. Multiple problems must be addressed sequentially. You should not move on to the next problem until you have made significant improvement on the previous problem. If there is a complex problem, it is advisable to break it down into several components. If necessary, the therapist creates a “problem ladder,” which is a diagram that shows the order in which the therapist will work with the client's problems. The behavior pattern that should be changed first is selected as a “target”. The following criteria are used for selection:

If the patient is insufficiently motivated or lacks self-confidence, therapeutic work can begin not with the most important problems, but with easily achievable goals, that is, with those behavior patterns that are easiest to change, or that the patient wants to change first. Move to more complex tasks is carried out only after simpler problems have been solved. During therapy, the therapist constantly checks the effectiveness of the methods used. If the initially chosen techniques are ineffective, the therapist should change the therapy strategy and use other techniques.

The priority in choosing a goal is always consistent with the patient. Sometimes therapeutic priorities may be revised during therapy.

Behavioral therapy theorists believe that the more specific the goals of therapy are formulated, the more effective the therapist's work will be. At this stage, you should also find out how great the patient's motivation is to change a particular type of behavior.

In behavior therapy it is extremely important factor success is how well the patient understands the meaning of the techniques the therapist uses. For this reason, usually at the very beginning of therapy, the basic principles of this approach are explained to the patient in detail, and the purpose of each specific method is explained. The therapist then uses questions to check how well the patient has understood his explanations and answers questions if necessary. This not only helps the patient correctly perform the exercises recommended by the therapist, but also increases the patient's motivation to perform these exercises daily.

In behavioral therapy, the use of self-observation and the use of “homework” are widespread, which the patient must complete daily, or even, if necessary, several times a day. For self-observation, the same questions that were asked to the patient at the preliminary assessment stage are used:

Giving the patient " homework", the therapist must check whether the patient correctly understands what he must do, and whether the patient has the desire and ability to carry out this task every day.

We should not forget that behavioral therapy is not limited to eliminating unwanted behavior patterns. From the point of view of the theory of behaviorism, any behavior (both adaptive and problematic) always performs some function in a person’s life. For this reason, when problem behavior disappears, a kind of vacuum is formed in a person’s life, which may be filled with new problem behavior. To prevent this from happening, when drawing up a behavioral therapy plan, the psychologist provides what forms of adaptive behavior should be developed to replace problematic behavior patterns. For example, therapy for a phobia will not be complete unless it is established what forms of adaptive behavior will fill the time that the patient devotes to phobic experiences. The treatment plan should be written in positive terms and indicate what the patient should do rather than what he should not do. This rule is called the "living person rule" in behavior therapy - because the behavior of a living person is described in positive terms (what he is capable of doing), while the behavior of a dead person can only be described in negative terms (for example, a dead person does not may have bad habits, experience fear, show aggression, etc.).

Completion of therapy

Behavioral therapy methods

Problems that arise during therapy

• The client's tendency to verbalize at length what he is thinking and feeling, as well as to try to find the causes of his problems in what he has experienced in the past. The reason for this may be the idea of ​​psychotherapy as a method that “allows you to speak out and understand yourself.” In this case, you should explain to the client that behavioral therapy consists of performing specific exercises, and its goal is not to understand the problem, but to eliminate its consequences. However, if the therapist sees that the client needs to express his feelings or find the underlying cause of his difficulties, then behavioral methods You can add, for example, techniques of cognitive or humanistic psychotherapy.
• The client's fear that correcting his emotional manifestations will turn him into a “robot.” In this case, you should explain to him that thanks to behavioral therapy, his emotional world will not become poorer, just that negative and maladaptive emotions will be replaced by pleasant emotions.
• The client's passivity or fear of the effort required to perform the exercises. In this case, it is worth reminding the client what consequences such an installation may lead to in the long term. At the same time, you can review the treatment plan and start working with more simple tasks, breaking them down into separate stages. Sometimes in such cases, behavioral therapy uses the help of the client's family members.

Sometimes the client has dysfunctional beliefs and attitudes that interfere with his involvement in the therapeutic process. These settings include:

• Unrealistic or inflexible expectations about the methods and results of therapy, which may be a form of magical thinking (assuming that the therapist can solve any client problem). In this case, it is especially important to find out what the client's expectations are, and then create a clear treatment plan and discuss this plan with the client.
• The belief that only the therapist is responsible for the success of therapy, and that the client cannot and should not make any effort (external locus of control). This problem not only significantly slows down the progress of treatment, but also leads to relapses after stopping meetings with the therapist (the client does not consider it necessary to do his “homework” and follow the recommendations that were given to him at the time of completion of therapy). In this case, it is helpful to remind the client that in behavior therapy, success is not possible without the active cooperation of the client.
• Dramatizing the problem, for example: “I have too many difficulties, I will never cope with this.” In this case, it is useful to begin therapy with simple tasks and exercises that provide quick results, which increases the client's confidence in his ability to cope with his problems.
• Fear of judgment: The client is embarrassed to tell the therapist about some of his problems, and this prevents the development of an effective and realistic plan for therapeutic work.

In the presence of such dysfunctional beliefs, it makes sense to use methods of cognitive psychotherapy that help the client reconsider his attitudes.

One of the obstacles to achieving success is the client's lack of motivation. As stated above, strong motivation is a prerequisite for the success of behavior therapy. For this reason, motivation for change should be assessed at the very beginning of therapy, and then, in the course of working with the client, its level should be constantly checked (we should not forget that sometimes the client’s demotivation takes hidden forms. For example, he may stop therapy, assuring that his problem has been solved. In behavioral therapy this is called “escape to recovery”). To increase motivation.

You may ask how often modern world Are there people with various mental disabilities and disorders? The answer will be thousands and millions of people! Yes, disorders can be very diverse, from severe disorders of a psychoneurological nature, to mild forms and simply accentuations of character. We all live in conditions of constant latent stress and are forced to adapt, constantly adapt to more and more new things. social norms, which increases our basal level of anxiety. It is not surprising that in such conditions people experience severe psychological discomfort, which can lead to various disorders mental health and even diseases. One of the modern and very effective methods The fight against such disorders is precisely cognitive behavioral psychotherapy. The method is relatively new and is actively being introduced into the clinical practice of minor psychiatry.

The term cognitive behavioral psychotherapy or cognitive behavioral psychotherapy in psychiatric practice is usually understood as a direction in the treatment of patients with psychiatric personality disorders and other disorders by combining the psychoanalytic approach with behaviorism, i.e. study of the structure of the patient’s behavior and response to various actions and stimuli. This approach turns out to be very effective, as it allows us to reveal the full complexity of psychological disorders in a particular patient. The combination of these two types of therapy allows for greater benefit from the patient, which also speeds up the psychoanalytic study of the patient. Correction of behavior and manifestations of the disease occurs through motivated reinforcement of the patient’s positive actions and reactions in combination with ignoring pathological behavioral traits.

This direction in psychiatric practice was formed by an American-born psychiatrist, Aaron Beck. The theoretical justification for this approach to the treatment of psychiatric patients was formed in the middle of the last century, but the active implementation of cognitive behavioral therapy methods began to be widely used only from the late 90s of the last century. Cognitive analytical psychotherapy has not been recognized by the Association of American Psychotherapists for quite a long time.

Initially, the method of psychotherapy was developed and justified only for a narrow range of diseases, for example, it was used for therapy depressive disorder personality within the psychoanalytic approach.

Methodology of the cognitive approach

Cognitive therapy plays important role in the study and analysis of psychopathological patterns formed in a particular psychiatric patient. The cognitive approach allows you to find the essence of the problem in order to further target psychopathological defense mechanisms sick. With a cognitive approach, it is very important to establish trusting contact with the patient so that the relationship between the specialist and the patient is built on the most open and reliable information. Cognitive psychotherapy methods include the following steps:

1. First of all, the psychotherapist creates a list of problems; for convenience, all problems are written down on a sheet and ranked from the most noticeable to the specialist and the patient, to hidden or latent problems.
2. The specialist must identify all the patient’s negative thoughts, especially those that are on the subconscious level, i.e. arise automatically for him.

Behavioral approach

The behavioral approach to the treatment of personality disorders is in close contact with the theory of behaviorism, i.e. based on behavioral patterns characteristic of people. The behavioral approach allows us to assess the patient’s response to certain cognitive manipulations. In this way, the specialist examines the patient’s behavior during a psychoanalytic study, which makes it possible to confirm a number of the patient’s psychopathological reactions.

Differences from the classical psychoanalytic approach

Despite the similar structure of psychoanalytic and cognitive techniques, both directions have some differences. Unlike psychoanalysis, cognitive therapy sets the goal of analyzing and correcting psychopathological disorders here and now, while psychoanalysts look for the root of the problem in childhood and youth memories. Cognitive psychotherapy uses an approach to targeted research and influence on the patient, only at the time of training. Cognitive psychotherapy of personality disorders includes a complex set of analytical and psychotherapeutic influences of a specialist on the patient, which allows for the correction of psychopathological disorders in the patient in a short time.

Cognitive therapy technique

For the most accurate examination and interpretation of the results of the patient’s diagnostic data, cognitive psychotherapy uses various techniques to influence the patient. To achieve the goal, namely, convincing the patient of his pathological thought processes, an in-depth analysis of his protective psychological mechanisms and behavioral characteristics is required. The following techniques are used for this:

• Recording in writing all the patient’s negative attitudes and mental acts. To do this, during a psychotherapeutic session, after establishing trusting contact with a specialist, the patient writes down all his anxious and negative thoughts, after which he builds a list from the most unpleasant to less intense negative factors.
• Recording thoughts and actions in your own diary. It is recommended to write down in the diary as many thoughts as possible that arise in the patient during the day. The diary must be kept for at least a week to ensure that the data is adequate and correct.
• Application of catharsis techniques. Catharsis is based on the reproduction of actions associated with those emotions and emotional state which prevails in the patient. For example, in a depressed mood, when the patient is sad, a specialist may invite the patient to cry or scream in order to better understand the psychopathological mechanisms of the disease.
• Research on negative attitudes. This technique is used to detect self-deprecating influences in the patient's thought process. With reduced self-esteem, the specialist offers the patient to perform a number of small actions, but the actions must necessarily lead to a positive result, which will help to form the right motivation in the patient and overcome negative thoughts.
• Using imagination with therapeutic purpose. Imagination is a very powerful tool in understanding and also treating patients with various psycho-emotional disorders. To begin with, the psychotherapist asks the patient to imagine a situation in his mind and examines his reaction and the course of his imagination, after which he helps to direct the process of imagination in a positive direction.
• Three column technique. An interesting technique that allows the patient to independently correct some negative thought and behavioral processes in the future. To do this, the patient draws up a table of three columns. In the first, he writes down a situation, secondly, a negative thought formed in response to the situation, and thirdly, the action necessary to overcome this thought.
• Also high efficiency has a record of any actions performed by the patient during the day. After successfully completing the observation sheet, the psychotherapist analyzes the data and makes a decision on prescribing certain sets of exercises and training.

Benefits of the Cognitive Behavioral Approach

Cognitive behavioral therapy allows us to study in detail the psychopathological mechanisms formed in response to any traumatic event. Comprehensive identification of triggers leading to the emergence of a psychopathological reaction in a patient makes it possible to more effectively influence the underlying cause of the disorder. After analyzing the psychopathological mechanisms, the specialist can specifically influence the patient’s psyche, which allows minimizing the psychotherapist’s impact on the patient, which means that the patient independently learns to cope with his own problems. psychological disorders, and the specialist just pushes the patient in the right direction. Cognitive behavioral psychotherapy allows you to correct and treat wide range psychiatric disorders and in most cases, allows you to cope with the current situation without the use of pharmacotherapy.

Special mention should be made about effective application this technique in patients with various types psychological dependencies. The use of a cognitive behavioral approach in addictive patients allows them to get rid of addiction on their own, which significantly reduces the percentage of relapses of the disease.

Cognitive psychotherapy for personality disorders can significantly increase the effectiveness of therapeutic non-drug effects on patients with soft forms violations mental health, as well as in people with various character accentuations and addictions. Integrated cognitive techniques and behavioral analysis of the patient allow us to flexibly influence his defense and behavioral mechanisms.

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Behavioral psychotherapy- This is perhaps one of the youngest methods of psychotherapy, but at the same time it is one of the prevailing methods in modern psychotherapeutic practice today. The behavioral direction in psychotherapy emerged as a separate method in the mid-20th century. This approach to psychotherapy is based on various behavioral theories, concepts of classical and operant conditioning, and principles of learning. The key goal of behavioral psychotherapy is to eliminate unwanted behaviors and develop behaviors that are beneficial for skills. The most effective use of behavioral techniques in the treatment of various phobias, behavioral disorders and addictions. In other words, such conditions in which some individual manifestation can be detected as a so-called “target” for further therapeutic intervention.

Cognitive behavioral psychotherapy

Today, the cognitive-behavioral direction in psychotherapy is known as one of the most effective methods providing assistance with depressive states and preventing subjects from suicidal attempts.

Cognitive-behavioral psychotherapy and its techniques are a current methodology in our time, which is based on its significant role in the origin of complexes and various psychological problems cognitive processes. The individual's thinking performs the main function of cognition. American psychiatrist A. T. Beck is considered the creator of the cognitive-behavioral method of psychotherapy. It was A. Beck who introduced such fundamental conceptual concepts and models of cognitive psychotherapy as a description of anxiety and anxiety, a scale of hopelessness and a scale used to measure suicidal ideation. This approach is based on the principle of transforming an individual's behavior to reveal existing thoughts and identify those thoughts that represent the source of problems.

Cognitive behavioral psychotherapy and its techniques are used to eliminate negative thoughts, create new thinking patterns and methods of analyzing problems, and reinforce new statements. Such techniques include:

- detection of desirable and unnecessary thoughts with further determination of the factors of their occurrence;

— designing new templates;

- using imagination to visualize the alignment of new patterns with desired behavioral responses and emotional well-being;

- application of new beliefs in real life and situations where main goal there will be acceptance of them as a habitual way of thinking.

Therefore, today cognitive-behavioral psychotherapy is considered a priority direction of modern psychotherapeutic practice. Teaching the patient the skills to control their own thinking, behavior and emotions is her most important task.

The main emphasis of this approach to psychotherapy is that absolutely all psychological problems of an individual arise from the direction of their thinking. It follows that it is not circumstances that are the main barrier on the individual’s path to a happy and harmonious life, but the individual himself, with his own mind, develops an attitude to what is happening, forming in himself far from the most good qualities, for example, panic. A subject who is not able to adequately assess the people around him, the significance of events and phenomena, endowing them with qualities not characteristic of them, will always be overcome by various psychological problems, and his behavior will be determined by his formed attitude towards people, things, circumstances, etc. For example, in the professional sphere, if a subordinate’s boss enjoys unshakable authority, then any of his points of view will immediately be accepted by the subordinate as the only correct one, even if that the mind will understand the paradoxical nature of such a view.

IN family relationships the influence of thoughts on an individual has more pronounced features than in the professional sphere. Quite often, most subjects find themselves in situations in which they fear some important event, and then, after its occurrence, they begin to understand the absurdity of their own fears. This happens because the problem is far-fetched. When faced with any situation for the first time, an individual makes an assessment of it, which is subsequently imprinted in memory as a template, and in the future, when a similar situation is reproduced, the individual’s behavioral reactions will be determined by the existing template. This is why individuals, for example, those who survived a fire, move several meters away from the source of the fire.

Cognitive-behavioral psychotherapy and its techniques are based on the detection and subsequent transformation of internal “deep” conflicts of the individual, which are accessible to its awareness.

Cognitive-behavioral psychotherapy today is considered practically the only area of ​​psychotherapy that has confirmed its high effectiveness in clinical experiments and has a fundamental scientific basis. Now an association of cognitive-behavioral psychotherapy has even been created, the purpose of which is to develop a system of prevention (primary and secondary) of psycho-emotional and mental disorders.

Methods of behavioral psychotherapy

The behavioral direction in psychotherapy focuses on behavior transformation. Key Difference this method psychotherapy from others is, first of all, that therapy is any form of teaching new patterns of behavior, the absence of which is responsible for the occurrence of problems of a psychological nature. Quite often, training involves the elimination of erroneous behavior patterns or their modification.

One of the methods of this psychotherapeutic approach is aversive therapy, which involves the use of stimuli that are unpleasant for the individual in order to reduce the likelihood of painful or even dangerous behavior. More often, aversive psychotherapy is used in cases where other methods have not shown results and with severe symptoms, for example, with dangerous addictions such as alcoholism and drug addiction, uncontrolled outbursts, self-destructive behavior, etc.

Today, aversive therapy is considered as an extreme undesirable measure, which should be used with caution, not forgetting to take into account numerous contraindications.

This type of therapy is not used as a separate method. It is used only in conjunction with other techniques aimed at developing replacement behavior. The elimination of undesirable behavior is accompanied by the formation of desirable behavior. Also, aversive therapy is not recommended for use with individuals suffering from severe fears and patients who are clearly inclined to run away from problems or unpleasant situations.

Aversive stimuli should be used only with the consent of the patient, who has been informed of the essence of the proposed therapy. The client must have complete control over the duration and intensity of the stimulus.

Another behavioral therapy method is the token system. Its meaning is for the client to receive symbolic things, for example, tokens for any useful action. The individual can subsequently exchange the received tokens for objects or things that are pleasant and important to him. This method is quite popular in prisons.

In behavioral therapy, one should also highlight such a method as the mental “stop”, i.e. trying to stop thinking about what can cause negative emotions and discomfort. This method has become widespread in modern therapy. It consists of the patient pronouncing the word “stop” to himself at the moment of unpleasant thoughts or painful memories. This method is used to eliminate any painful thoughts and feelings that inhibit activity, negative expectations for various fears and depressive states, or positive ones for various addictions. Also this technique can also be used in cases of loss of relatives or other loved ones, career failure, etc. It is easily combined with other techniques, does not require the use of complex equipment and is quite time-consuming.

In addition to the listed methods, others are also used, for example, training with models, gradual reinforcement and self-reinforcement, training in reinforcement techniques and self-instruction, systematic desensitization, hidden and targeted reinforcement, self-affirmation training, a penalty system, conditioned reflex therapy.

Cognitive-behavioral psychotherapy, teaching the basic mechanisms, principles, techniques and techniques today is considered one of priority areas modern psychotherapy, since it is used with equal success in all possible areas of human activity, for example, in enterprises when working with personnel, in psychological counseling And clinical practice, in pedagogy and other fields.

Behavioral psychotherapy techniques

One of the well-known techniques in behavioral therapy is the flood technique. Its essence lies in the fact that prolonged exposure to a traumatic situation leads to intense inhibition, accompanied by a loss of psychological sensitivity to the influence of the situation. The client, together with the psychotherapist, finds himself in a traumatic situation that causes fear. The individual remains in a “flood” of fear until the fear itself begins to subside, which usually takes from one hour to an hour and a half. During the “flooding” process, the individual should not fall asleep or think about outsiders. He should be completely immersed in fear. “Flood” sessions can be carried out from three to 10 times. Sometimes this technique can be used in group psychotherapeutic practice. Thus, the “flooding” technique involves repeatedly playing out disturbing scenarios in order to reduce their “probable anxiety.”

The “flood” technique has its variations. For example, it can be carried out in the form of a story. In this case, the therapist constructs a story that reflects the patient's dominant fears. However, this technique should be carried out with extreme caution, since in the case when the trauma described in the story exceeds the client’s ability to cope with it, he may develop quite profound mental disorders that require immediate attention. therapeutic measures. Therefore, implosion and flooding techniques are used extremely rarely in domestic psychotherapy.

There are also several other popular techniques in behavioral therapy. Among them, systematic desensitization is widely used, which consists of teaching deep muscle relaxation in a state of stress, the token system, which is the use of stimuli as a reward for “correct” actions, “exposure”, in which the therapist stimulates the patient to enter a situation that creates fear in him .

Based on the foregoing, it should be concluded that the main task of the psychotherapist in the behavioral approach to psychotherapeutic practice is to influence the client’s attitudes, his train of thoughts and the regulation of behavior to improve his well-being.

Today in modern psychotherapy it is considered quite important further development and modification of cognitive-behavioral techniques, their enrichment with techniques from other areas. For this purpose, an association of cognitive behavioral psychotherapy was created, the main objectives of which are to develop this method, unite specialists, provide psychological assistance, create various training courses and psychocorrectional programs.

Cognitive behavioral therapy was born from two popular methods in psychotherapy in the second half of the 20th century. These are cognitive (thinking change) and behavioral (behavior correction) therapy. Today, CBT is one of the most studied treatment methods in this field of medicine, has undergone many formal trials and is actively used by doctors around the world.

Cognitive behavioral therapy

Cognitive behavioral therapy is a popular method of treatment in psychotherapy, based on the correction of thoughts, feelings, emotions and behavior, designed to improve the patient's quality of life and relieve him of addictions or psychological disorders.

In modern psychotherapy, CBT is used to treat neuroses, phobias, depression and other mental problems. And also for getting rid of any type of addiction, including drugs.

CBT is based on a simple principle. Any situation first forms a thought, then comes an emotional experience, which results in specific behavior. If the behavior is negative (for example, taking psychotropic drugs), then it can be changed if you change the person’s way of thinking and emotional attitude towards the situation that caused such a harmful reaction.

Cognitive behavioral therapy is a relatively short treatment, usually lasting 12-14 weeks. This treatment is used at the stage of rehabilitation therapy, when the body has already been intoxicated and the patient has received the necessary drug treatment, and the period of working with a psychotherapist begins.

The essence of the method

From a CBT perspective, drug addiction consists of a number of specific behaviors:

• imitation (“friends smoked/sniffed/injected themselves, and I want to”) – actual modeling;
• based on personal positive experience from taking drugs (euphoria, relief from pain, increased self-esteem, etc.) - operant conditioning;
• coming from the desire to experience pleasant sensations and emotions again - classical conditioning.

Scheme of influence on the patient during treatment

In addition, a person’s thoughts and emotions can be influenced by a number of prerequisites that “perpetuate” the addiction:

• social (conflicts with parents, friends, etc.);
• influence environment(TV, books, etc.);
• emotional (depression, neurosis, desire to relieve stress);
• cognitive (the desire to get rid of negative thoughts, etc.);
• physiological (unbearable pain, withdrawal, etc.).

When working with a patient, it is very important to determine the group of prerequisites that influenced him. If you form other psychological attitudes and teach a person to react to the same situations differently, you can get rid of drug addiction.

CBT always begins with establishing contact between the doctor and the patient and functional analysis dependencies. The doctor must determine what exactly makes a person turn to drugs in order to work with these reasons in the future.

Then you need to establish triggers - these are conditioned signals that a person associates with drugs. They can be external (friends, dealers, a specific place where the use occurs, time - Friday evening to relieve stress, etc.). And also internal (anger, boredom, excitement, fatigue).

To identify them, a special exercise is used - the patient must, for several days, indicate the date and date, write down his thoughts and emotions in the following table:

In the future they will apply various techniques development of personal skills and interpersonal relationships. The first include stress and anger management techniques, various ways occupy leisure time, etc. Training in interpersonal relationships helps to resist pressure from friends (an offer to use drugs), teaches you to deal with criticism, interact with people again, etc.

Also used is a technique for understanding and overcoming drug hunger, practicing drug refusal skills and preventing relapse.

Indications and stages of CBT

Cognitive behavioral therapy has been successfully used all over the world for a long time and is an almost universal technique that can help in overcoming various life difficulties. Therefore, most psychotherapists are convinced that such treatment is suitable for absolutely everyone.

However, for CBT treatment there is the most important condition– the patient must realize that he is suffering from addiction and decide to independently fight drug addiction. For people prone to introspection, accustomed to monitoring their thoughts and feelings, such therapy will have the greatest effect.

In some cases, before starting CBT, it is necessary to develop skills and techniques for overcoming difficult life situations (if the person is not used to coping with difficulties on his own). This will improve the quality of future treatment.

There are many different techniques within cognitive behavioral therapy - different clinics may use specific techniques.

Any CBT always consists of three successive stages:

1. Logical analysis. Here the patient analyzes his own thoughts and feelings, identifying errors that lead to an incorrect assessment of the situation and incorrect behavior. That is, the use of illegal drugs.
2. Empirical analysis. The patient learns to distinguish objective reality from perceived reality, analyzes own thoughts and behavior patterns in accordance with objective reality.
3. Pragmatic analysis. The patient determines alternative ways of responding to the situation, learns to form new attitudes and use them in life.

Efficiency

The uniqueness of cognitive behavioral therapy methods is that they require the most active participation of the patient himself, continuous self-analysis, and his own (and not imposed from outside) work on mistakes. CBT can take place in different forms– individual, alone with a doctor, and group – goes well with the use of medications.

In the process of working to get rid of drug addiction, CBT leads to the following effects:

• provides a stable psychological state;
• eliminates (or significantly reduces) signs of psychological disorder;
• significantly increases the benefit of drug treatment;
• improves social adaptation former drug addict;
• reduces the risk of future breakdowns.

As studies have shown, CBT shows the best results in treatment. Cognitive behavioral therapy methods are also widely used in recovery from cocaine addiction.