Behavioral therapy: exercises and methods. Methods of behavioral therapy. Behavioral approach in psychology

Cognitive-behavioral psychotherapy How to learn to realize that you do not always behave correctly Today, cognitive-behavioral psychotherapy is widely used to treat various mental disorders, such as depression, phobias,

Chapter 4. Behavioral psychotherapy History of the behavioral approach Behavioral therapy as a systematic approach to the diagnosis and treatment of psychological disorders arose relatively recently - in the late 1950s. In the early stages of development, behavioral therapy

The basis for behavioral therapy was experimentally based learning theory. Over time, the techniques and concepts of behavioral therapy have improved and now it includes a variety of practical treatment methods, the essence of which boils down to a logical but controversial theory.

One of the most serious conditions of this therapy is the objective re-verification of treatment results through experiments, which gives the right to include it in the natural science section of psychology, the distinctive feature of which is the application of general laws to a specific individual.

Mental disorders are modeled and tried to be eliminated in laboratory conditions, following a simple scheme: desire (Reiz) - reaction, and therefore behavioral therapy is very accessible and easy to study. So. for example, a phobia, according to behavioral therapy, is a pathological conditioned reaction that arose as a consequence of a threatening situation for a person. Fantasies, repressed desires and defense mechanisms are not taken into account. The cause of the disorder is sought not in childhood, but in the patient’s present. No weight is given to the possible symbolic meaning of the feared object; it is considered as a causative agent of fear, and everything else is considered the consequences of such arousal. The goal of behavioral therapy is to replace the patient’s inappropriate behavior with adequate behavior.

Unlike behavior therapy, psychoanalysis places great emphasis on unconscious mental processes. The subject of psychoanalysis is the person himself, therefore all therapeutic methods of psychoanalysis are based on a complex and sophisticated psychoanalytic theory of personality.

Despite major differences, behavior therapy and psychoanalysis have much in common. Both methods are intended for understanding complex mental phenomena, both are of no small importance for improving social relations, recognize the inevitability of errors that arise during the research process, and accept as a necessary condition re-checking the results obtained. It should, however, be recognized that the necessity of the latter condition was postulated in psychoanalysis only recently.

Many psychoanalysts, in particular Hans-Volker Wertmann in his article published in the Journal of Psychosomatic Medicine and Psychoanalysis (Zeitschrift fuer psychosomatische Medizin und Psychoanalyse) l. point to sharp contradictions between behavior therapy and psychoanalysis, but a growing number of scientists are trying to find ways to synthesize the two methods. A combination of these two approaches proposed by Reiner Krause 2 is very effective, for example. in the treatment of stuttering. Representatives of behavioral therapy are also not standing still. Psychologist Eva Jaeggi 3 in the context of cognitive therapy, developed on the basis of behavioral therapy, considers mental disorders not only as specific “thinking errors” (Denkfehler), but also as a consequence of irrational thoughts and internal contradictions that are not realized by patients.

To an even greater extent, E. Hand builds his conclusions on the similarities between behavioral therapy and psychoanalysis (E. Hand 1986). He carries out a consistent analysis of individual human needs, functions, motivations and behavioral disorders, distinguishing between conscious and so-called “unconscious” (“nicht-bewusste”) functions (see Rosenbaum & Merbaum), the significance of which becomes obvious in the course of therapy.

Thus Hand. avoiding the use of psychoanalytic terminology, in essence repeats a truth long known in psychoanalysis. However, adherents of behavioral therapy are in no hurry to admit this. “The hypothesis or, more precisely, the recognition of the existence of unconscious or unconscious (nichtgewusster) intentions by a person does not contain a transition to an analytical structure postulating the unconscious motivation of actions, but is only a practical means that allows the use of a speculative, abstract analysis of functions for therapeutic purposes” ( Hand 1986. p.289).

Paul Wachtel, on the contrary, is not afraid to acknowledge psychoanalytic “constructs,” as evidenced by his book “Psychoanalysis and Behavioral Therapy. A Speech in Defense of Their Integration" (Paul Wachtel 1981), in which he synthesizes the largely weak theory of the emergence of phobias from behavior therapy and psychoanalysis, introducing into behavior therapy the concept of the unconscious meaning of the feared object.

Nevertheless, psychoanalysts should take into account that behavioral therapy also pays off in practice, therefore, in the case when the detected disorders of the unconscious do not contribute to the cure of a patient suffering, for example, from stuttering, the psychoanalyst should, without any doubt, refer him to a psychologist practicing behavioral therapy . Such cooperation can only be welcomed.

1.2. Conversational psychotherapy

The basis for conversational psychotherapy, as in the case of behavioral therapy, was experimental psychology. In conversational psychotherapy, a description of clinical phenomena is practiced, great attention is paid to monitoring the results of treatment, and, above all, a specific goal of therapy is outlined. Revealing unconscious contents is not part of the therapist's plans. Of great importance are three basic conditions (Basisvariablen), developed by Carl R. Rogers (Carl R. Rogers 1957):

1. Authentic, human response.

2. Kind attitude and understanding of the patient.

3. Verbalization of the patient's feelings.

In conversational psychotherapy, as in psychoanalysis, the personal experience of the therapist is recognized as an essential factor. According to conversational psychotherapy, in order to fully understand the hidden meaning of the patient's feelings, it is necessary to achieve the so-called “behavior modification” (“Verhaltensmodifikation”). Unlike behavioral therapy, directive treatment methods are not practiced here, since it is believed that the patient himself understands perfectly well what he needs and in what direction the therapeutic process should develop. The function assigned to the psychotherapist is, therefore, to accompany the patient on this path and verbalize, i.e. verbally designate his feelings.

In this regard, psychotherapeutic interventions in the patient’s monologue are of no small importance. The latter may be asked various leading questions, for example: “How do you feel at the moment?”, “Is something bothering you?”, “Do you feel abandoned by everyone?” At the same time, the therapist always trusts the patient’s answers. The revival of early relational patterns, the inevitability of which is emphasized in the psychoanalytic concept of transference, is avoided or its significance is completely denied. No attempt is made to penetrate into the unconscious meaning of behavior and thereby determine whether a person has one or another unconscious conflict. By adhering to such principles, the creators of conversational psychotherapy were able to get rid of the “bogeyman” * “sacred cow” of psychoanalysis - the concepts of resistance, repetition compulsion, transference and counter-transference. From a psychoanalytic point of view, 4 conversational psychotherapy, “which has at its disposal neither a theory of mental disorders nor a specific disease-oriented therapeutic technique,” ​​appears to be only a psychological method of conversation.

However, Carl R. Rogers put forward in 1959 not only a personality theory of talk psychotherapy, but also a theory of the therapy itself. In his work, he talks, in particular, about the use for therapeutic purposes of contradictions between real and ideal images present in the patient’s psyche. Despite the fact that this statement can rightfully be called completely psychoanalytic, the creators of conversational psychotherapy tend to deny any resemblance to the inconvenient neighbor.

1.3. Other psychotherapeutic methods

From the extensive list of various psychotherapeutic methods currently used to treat mental disorders, the following should be noted:

* The above expression was first heard at the seminar “Psychoanalysis and Behavioral Therapy. Commonality and differences”, conducted jointly with K. Heinerth - in the winter semester 1976/77.

Transactions-Analysis, developed by Eric Berne (1974). According to Berne, there are three states of the human self: the child self, the adult self, and the parent self. Berne considers human conflicts as a kind of “game” (“Spiele”), the essential condition of which he considers the provocative behavior of one of the conflicting parties. A person’s behavior may thus have as its goal the motivation of another person to take certain actions. Berne notes, in particular, such provocations as “rush at me” or “kick me out,” etc. In transactive analysis, just as in psychoanalysis, typical patterns of relationships and behavior are taken into account, in addition, it contributes to the patient’s awareness of his own t n. “unconscious life plan” (unbewusster Lebensplan), i.e. i.e. a kind of unconscious “instruction” (Skript) that controls certain human actions. Thus, transactive analysis turns out to be an adapted analogue of psychoanalysis. The theory and methods of transactional analysis are described in detail by Leonhard Schlegel in the fifth volume of his “Fundamentals of Depth Psychology” (Leonhard Schlegel “Grundriss der Tiefenpsychologie” Band 5. 1979).

Image therapy (Gestalttherapy). According to the theory of imagery therapy, blocked internal reserves appear in the process of a person’s contact with hidden images, visions, etc. And if the phenomena of resistance (WiderstancJsphaenomene), as in psychoanalysis, are subject to interpretation, then interpretation of the unconscious content is not given (see. Hartmann-Kottek-Schroederl986).

Bioenergetics (Bio-Energetik) is a method of treating mental disorders based on the understanding of certain bodily symptoms. In his book covering the current state of bioenergy. Alexander Lowen (1979), following Wilhelin Reich, whose work devotes much of its attention, in particular, to the consideration of various physical manifestations of mental disorders, emphasizes the need for a thorough study of body language. The kinship of the above theory with psychoanalytic concepts, in particular with the character analysis (Charakteranalyse) of Wilhelm Reich (1933), is recognized and perceived by representatives of bioenergetics as a positive factor in many respects.

The so-called psychoanalysis has a lot in common with psychoanalysis. “primal cry therapy” (“Urschreitheraple”). better known as primary therapy (Primaertherapie, Arthur Janovs 1970).

The main tool of this therapy is regression, in which the patient plunges into unconscious areas of pain, fear, suffering, despair and anger that are otherwise inaccessible to him due to the existence of defense mechanisms. Through this, the “primary pain” (“Urschmera”) is revealed. associated with dramatic experiences of early childhood. Re-revival of unpleasant emotions or. in other words, "primrose" (Primein) allows the patient to openly express the suppressed "primary cry" ("Urschrei"). that is, without any embarrassment, cry, complain, get angry, etc. This in turn leads to the disappearance of the symptoms that bother him *.

In a certain sense, primary therapy is an undertaking even more daring than psychoanalysis itself. Long-term group sessions conducted in a darkened room as part of primary therapy allow one to achieve deeper and longer-lasting regression and, in a sense, even more effective results than psychoanalytic sessions.

However, it must be emphasized once again that all of the above types of therapy are not entirely satisfactory: behavioral therapy misses the unconscious meaning of human behavior, the problem of transference and counter-transference; conversational psychotherapy, taking into account the possibility of transference reactions, nevertheless perceives them as something harmful; and only within the framework of transactive analysis, focused primarily on bioenergetics, and to an even greater extent in primary therapy, is the psychoanalytic concept recognized, according to which mental disorders are the consequence of dramatic experiences in a person’s early relationships and cannot be overcome without their re-vitalization. The last statement essentially contains the definition of the most important psychoanalytic principle.

* As for the commonality between psychoanalysis and primary therapy, proof of this can be found, in particular, in the example of psychologist and psychoanalyst Albert Goerres. who practiced primary therapy along with psychoanalysis at the Munich University Clinic.

2. Conditions necessary for the successful application of psychoanalytic methods

2.1. From the psychoanalyst's perspective

The most important factor in the successful application of the psychoanalytic method, along with the external conditions of therapy, seems to be the personality of the psychoanalyst himself. Unfortunately, this fact is rather sparingly covered in the literature on psychoanalysis. The lack of this kind of information has been somewhat compensated for by a recently published collection, which includes works on this topic written by famous psychoanalysts (Kutter et al., 1988). The main idea of ​​this collection can be formulated as follows: the psychoanalyst must perceive himself as an important subjective factor in therapy and strive for self-knowledge. It is in this regard that educational analysis becomes an integral part of psychoanalytic education. The latter provides the novice therapist with the opportunity to study himself, understand his own conflicts and thus achieve a fairly high level of self-knowledge. At the same time, there are serious reasons to believe that a high level of knowledge of one’s own personality guarantees a more successful understanding of other people, that is, in our case, patients.

The above applies equally to psychoanalysts who have received psychological education and to those. who graduated from medical school.

The analyst’s self-knowledge is also facilitated by group-dynamic workshops. The group atmosphere allows future specialists to get a clear picture of their own behavior. Participant

* Previously, there was an opinion that medical education, which implies instilling a sense of responsibility for the patient’s life, is the best guarantor of truly psychoanalytic behavior, but ten years of teaching at the University of Frankfurt convinced me personally that purely psychological education has its undeniable advantages. Psychology is, simply put, the science of human experiences. Therefore, students studying psychology deal primarily with this issue, which is, in a sense, the key to self-knowledge. Of course, one cannot fail to mention in the context of psychology the danger of turning a person into an abstract object of statistical or any other study. Modern medicine has proven the reality of such a threat. Concentrating their attention on pathology and chemical drugs, doctors seem to have completely forgotten about the human person.

Participants in the group dynamic workshop openly express their opinions about their colleagues, opening their eyes to aspects of their personality that are unknown to them. In this case, the criterion for the objectivity of the expressed opinion can be its support by the majority of the workshop participants. The maximum information about one's own positive and negative qualities provided by such activities makes it easier for the future psychoanalyst to understand the patient's reaction, which in many respects is nothing more than a reaction to the analyst's behavior. It, in turn, must comply with the main rule of psychoanalytic therapy - “restraint” (Abstinenz). The psychoanalyst needs to learn to control his feelings towards the patient.

2.2. From the patient's side

The ideal patient not only complains of certain symptoms, but also associates them with specific mental experiences, and is therefore willing to actively participate in the process of analysis. On the success of the collaboration between the analyst and the patient or, in other words, on the degree of participation of the latter in the so-called “therapeutic alliance” (Arbeitsbuendnis), which implies a non-voicism. the rational and reasonable attitude of the analysand towards the analyst largely depends on the effectiveness of the therapy itself (Greenson 1967). Cooperation is understood, first of all, as the patient’s willingness to freely associate, that is, to talk about everything. whatever comes to his mind, regardless of feelings of shame, embarrassment, fear or guilt. Such frankness implies a high degree of trust, which cannot arise immediately at the beginning of analysis, but is built up gradually.

A short example will give the reader an idea. How does a psychoanalyst determine whether a patient is ready to cooperate?

Analyst. I'm trying to understand you. I would really like to collaborate with you. This would help us better understand the cause of your suffering.

Patient. But why then don’t you help me?

Analyst. I’m already helping you, I just don’t make any hasty conclusions. I'm not interested in the symptoms at all, I'm interested in the mental problems that the symptoms cause. Why don't you become interested in this too?

Patient. Fine. But I doubt whether I can help you. It seems to me that the reasons are unknown to me.

Analyst. I am ready to help you understand them. The main thing is our joint work, and it will become possible under one condition. You need to tell me everything you feel. So, what do you think your suffering may be related to?

Patient. Most likely with my married life.

Analyst. This is quite likely. We will look into this issue. However, something else is more important: you yourself understand that you are unhappy in your marriage, which means that it will be easier to understand the causes of unhappiness.

The manual “Correcting the Behavior of Children and Adolescents” describes in detail the organizational and methodological issues of behavioral psychotherapy, including legal and ethical standards, principles of payment, features of conducting therapy in medical and educational institutions, as well as counseling centers. The basic methods used in behavior modification and general techniques for developing intellectual and social skills and coping with stress, necessary when working with any category of problems, are described.

The situation with psychotherapy for children and adolescents in Germany has completely changed thanks to the adoption of the law on psychotherapists. After this law came into force on January 1, 1999, behavioral therapy for children and adolescents was separated into an independent branch of psychotherapy. Behavioral therapy can be carried out by psychologists and teachers who have undergone special training. The services of psychotherapists officially admitted to work in associations at health insurance funds are paid according to established tariffs.

The passage of the law contributed to a revival of behavioral therapy for children and adolescents; many specialists began to receive remuneration for their work; the demand for basic education in this area of ​​psychotherapy is growing; parents and teachers are less skeptical than before about the conduct of psychotherapeutic treatment using behavioral therapy methods, and its methods of influence, or interventions , are positively assessed in the media (for example, interventions to reduce the severity of aggressive and delinquent behavior, hyperkinetic disorders in children, childhood anxiety).

However, there is still some confusion about what actually constitutes the essence of child and adolescent behavior therapy; whether therapy should be behaviorally oriented; whether behavior therapy is simply talking about everyday problems; how much therapy should delve into the analysis of the details of everyday life. A brief excursion into the history of behavioral therapy in childhood and adolescence can provide the first answers to the questions posed.

Historical excursion

The tradition of behavioral therapy for children and adolescents has a history of almost 80 years. Its formation and development are closely intertwined with the therapy of adults; many therapeutic methods were first tested on children and adolescents before they were applied to adults. Over time, child and adolescent therapy increasingly faded into the background.

There are four main stages in the development of behavior therapy.

On first stage (1920s) therapy was mainly focused on theoretical teachings (classical conditioning, operant conditioning, behaviorism). For example, Watson and Rayner published a report in 1920 of an eleven-month-old infant who developed a fear of a white rat after its repeated appearance was accompanied by a loud, frightening noise. Then his fear generalized, i.e. began to be transferred to other objects covered with fur. Thus, it was proven that fear can appear in accordance with the model of classical conditioning.

A few years later, Jones (1924) published the results of a therapy that used the mechanisms of classical conditioning to eliminate fear in a child who was afraid of rabbits. Children's fear was overcome with the help desensitization method. Subsequently, reports began to appear of therapies based on classical conditioning and its derivative treatment mechanisms (partial confrontation with fear-inducing stimuli, desensitization).

On second stage therapy was carried out under the influence of the paradigm operant conditioning(in particular, B. Skinner). Therapeutic techniques were very close to everyday situations, and therapists tried to change the problem behavior of children with the help of methods developed in the 1930s and 1940s. laws of learning. At first, a very scrupulous study was carried out of the difficulties in the child’s behavior (in particular, a detailed analysis of the behavior of the child’s reference persons was made, observations of behavior in everyday life, observations of the relationship between mother and child were carried out, and the mother and child were behind glass.

In accordance with this approach, diagnosis was aimed not so much at a differentiated classification of symptoms (for example, oppositional defiant disorder F91.3), but at identifying certain functional disorders. Therefore, therapy was focused, in particular, on modifying the contingent behavior of adults in everyday situations or changing other situational conditions (for example, when children do homework).

A very characteristic feature of the second stage of therapy development was that the success of therapeutic measures was directly checked against the therapy plan. The content of such a plan was, in particular, that at the first stage it reflected the frequency of manifestations of, say, oppositional-aggressive behavior during the observation stage without therapeutic interventions, and then at the second stage (intervention stage) therapeutic principles were used (for example, ignoring aggressive behavior of a student on the part of the teacher, as well as systematic strengthening of norm-conforming behavior). At the third stage, these principles were removed, and at the fourth stage they were reintroduced (the so-called therapeutic plans). If the frequency of manifestations of the child’s aggressive-oppositional behavior in such conditions actually systematically decreased, then this indicated the correctness of the therapeutic approach and the interventions used.

Thus, therapeutic interventions were focused mainly on everyday behavior and changing living conditions (for example, modifying the behavior of adults). This approach has yielded a large number of well-controlled results in selected cases (eg, early childhood autism, stereotypies, aggressiveness). Accordingly, therapy sought primarily to change the functional conditions and relationships in everyday life. Its goal was, for example, to change the educational behavior of parents, to deliberately create situations (in particular, when a student does homework, including the behavior of parents), training parents and teachers as mediators, using rewards in schools and at home (in the form of tokens), systematic formation of desired behavior.

On third stage (in the late 1970s) there was a turn to cognitive therapy, which led to a stronger focus of therapy towards the personality and the behavior that structures it. Researchers such as Kanfer, Mahoney, Meichenbaum, Ellis, Beck, no longer proceeded from the direct cause of difficulties and problems in the child’s behavior, as was assumed by B. Skinner and adherents of the operant paradigm. Instead, they believed that behavior is governed by cognitive structures (e.g., self-prescriptions, situational perceptions, beliefs, irrational beliefs, attitudes). But thinking, according to this therapeutic model, is ultimately nothing more than internalized speaking(self-instruction). This suggested the conclusion that the task of therapy is to unlearn self-prescriptions, covertly address oneself and, ultimately, internalize speaking, i.e. thinking.

With this approach, the child had to learn to better and better manage his behavior in a domestic environment. This therapeutic approach is closely related to the laws of learning, but it expands the methodological spectrum by introducing a method for changing self-prescriptions, modifying the perception of everyday situations, as well as developing social and cognitive skills. Therapy could thus be structured as a series of modeling exercises 1 (training), thanks to which the child learned to develop appropriate self-prescriptions and transfer them to everyday situations with the help of adults. (1 This refers to exercises that model one or another desired behavior. - Prim. scientific. edit.)

During this period, many therapeutic guidelines appeared (in particular, for reducing impulsivity, reducing aggressive behavior, improving self-affirmation, increasing social competence), which, on the one hand, offer characteristic exercises with children, and on the other, structure the child’s interaction with reference adults ( parents, teachers). The compilation and use of such therapy manuals is also stimulated by the increasingly widespread use of classification systems for diseases and disorders (International Classification of Mental Disorders ICD-9, Classification of the World Health Organization), as it has been possible to achieve a more accurate definition of homogeneous groups of disorders.

During the 1980s. was formed fourth stage child and adolescent therapy, which increasingly began to move away from its behavioral orientation. Obviously, this happened under the influence of the therapy for adults that was dominant at that time. The goal of therapy was not so much the modification of specifically observed behavior (the success of therapy was measured by changing problem behavior for the better in everyday settings), but rather change in cognitions(in particular, the formation of appropriate situational perceptions in aggressive children, setting moderately complex cognitive tasks for children who do not want to learn, teaching impulsive children self-prescriptions, etc.).

The advantage of this new orientation was that, moving away from everyday life, therapy began to gravitate toward the organizational forms of the “medical therapeutic model.” The possibilities for conducting therapy in the premises provided for it and in the framework of conversations with parents and the children themselves have significantly increased. In this case, it was not so much specific behavioral deviations in everyday situations that were subjected to therapy, but rather the attitude towards certain moments of everyday life. Along with many advantages (which include, in particular, a noticeable expansion of the methodological spectrum), this approach had a drawback: relatively high demands were placed on the client (for example, in the field of speech proficiency, prudence, motivation), which are beyond the capabilities of small, lagging people. in their development for children and adolescents who do not want to undergo psychotherapy. As a result, therapy began to be mainly applied to older children, who had predominant difficulties and problems of an introvertive nature (fears, depression, self-esteem problems), while younger children, who were developmentally delayed and negatively disposed towards psychotherapy (in particular, aggressive ones) found themselves on the periphery of therapists' attention. In addition, the child and his parents had to apply their knowledge of therapy in everyday practice, which is not always possible.

This medical-like approach is also encouraged by the use of differential diagnostic classification systems (International Classification of Mental Disorders ICD-9 or ICD-10). For example, to recognize “hyperkinetic disorder” (F90.1), observations of reference adults (parents and teachers), observations in the therapist's office, as well as a differential diagnostic examination, which can also be carried out in the therapist's office, are sufficient. Home visits by a therapist, observation of the mother-child relationship, or direct observation of the child's behavior in kindergarten are not required (and are not covered by the health insurance fund).

This short excursion shows that we have at our disposal a wide and well-tested arsenal of methodological tools, which, however, are not fully used in modern behavioral therapeutic practice. Moreover, some well-proven and easily accessible methods and techniques (for example, training of cotherapists, systematic influence on reinforcing contingents, bringing therapy closer to everyday conditions, establishing a diagnosis in everyday life) are clearly not used enough in our time.

Age groups and main types of disorders

Behavior therapy deals with children and adolescents of a wide age range. It is addressed to four clearly differentiated age groups, which have their own age-related types of disorders.

Infants and early childhood (0 to 3 years). This group is dominated by characteristic disorders and disorders (feeding and nutrition disorders, communication disorders, developmental delays and various developmental disorders), which until now have received almost no attention from specialists in behavioral therapy. Hence, due to the lack of interest, the great rarity of therapeutic interventions (although behavioral-therapeutic concepts are successful). Modern therapy mainly concerns pediatric, ergotherapeutic, physiotherapeutic, therapeutic-pedagogical and social-pedagogical activities.

Preschool age (from 3 to 6 years). Developmental disorders dominate (in particular, speech and motor disorders), but behavioral disorders also appear (in particular, aggressiveness, anxiety). This group has received much attention from behavioral therapists, but interventions are not conducted within the behavioral therapy paradigm, but rather within the context of educational, family, or occupational therapy and pediatric interventions.

School age (from 6 to 14 years). In principle, any disorder can be found in children of this age. However, they are concentrated in the area of ​​school-relevant behaviors (for example, learning difficulties and underachievement, described developmental disorders). This age category in most cases receives close attention from behavioral therapists.

Teenagers (14 to 18 years old). Problems of adaptation and self-esteem dominate (in particular, anorexia, bulimia, depression, learning difficulties, academic failure, drug addiction, aggression, delinquent behavior). This group can be considered the most advantaged from the point of view of behavioral therapy, since the treatment of adolescents is organized in many ways similar to the treatment of adults. However, the adolescent group with extraverted disorders (antisocial behavior, crime) is relatively little covered by behavioral therapy.

Thus, in the field of behavioral therapeutic support, one can detect the presence of obvious “blank spots”: first of all, we are talking about insufficient coverage of children of the youngest age group and children (adolescents) with expansive forms of behavioral disorders. It can be assumed that the reasons for this deficit lie in the insufficient speech development of young children, their inability to understand the significance of therapy for them, the lack of necessary interdisciplinary interaction and direct influence on the structuring of clients' daily lives (for example, optimization of family relationships, influence on the educational behavior of significant adults). Older children who are more accessible to therapists and who have sufficiently developed speech (for example, anxious children or children with depressive symptoms) are more likely to use appropriate services from therapists. This is because therapy is largely removed from everyday life situations and is conducted through direct contact between therapist and client.

Behavioral disorders and treatment prospects

Disorders in children and adolescents depend on context, i.e. from certain situations, the action of certain stimuli, personal contacts and forms of interaction. Quite often, there are rather transient deviations in behavior that disappear when material and social conditions are normalized (Esser, Schmidt, Blanz, Fätkenheuer, Fritz, Koppe, Laucht, Rensch, Rothenberger, 1992). This finding is important from a diagnostic and therapeutic point of view. For diagnosis, it follows that the causes that cause and maintain problem behavior in the spirit of behavioristic analysis of environmental conditions should be identified as close as possible to everyday conditions; for therapy - interventional activities should also be aimed at the environment, i.e. are aimed at changing situations and optimizing the patient’s interaction with other people, as well as modifying the behavior of reference persons.

Disorders in childhood and adolescence are more often classified on the basis of statistical data (in particular, based on factor and cluster analyses). Such studies typically identify several factors that describe the type of disorder (for example, impaired social behavior, anxiety, indecisiveness and shyness, immaturity syndromes, psychotic disorders and autism). It is also partially possible to classify disorders in terms of their “localization” (for example, extroverted and introverted disorders, as well as mixed syndromes).

Descriptive classification systems, on the contrary, provide a limited number of categories of violations, differentiated by their content. The International Classification of Mental Disorders (ICD-10; WHO, 1994) identifies, for example, the following categories of diseases, which generally apply to both adults and children:

• F1: mental and behavioral disorders due to the use of psychoactive substances (in particular alcohol, F10; sedatives and hypnotics, F13);
• F2: schizophrenia, schizotypal and delusional disorders (in particular, hebephrenic schizophrenia, F20.1; schizotypal disorder, F21);
• F3: affective mood disorders (eg, depressive episode, F32; recurrent depressive disorder, F33);
• F4: neurotic, stress-related and somatoform disorders (eg, phobias, F40; obsessive-coimpulsive, F42; reaction to severe stress and adjustment disorders, F43);
• F5: behavioral syndromes associated with physiological disorders and physical factors (eg, eating disorders, F50.0; psychological and behavioral factors associated with disorders classified elsewhere, F54);
• F6: Disorders of mature personality and behavior in adults (eg, pathological gambling, F63.0; gender identity disorders, F64);
• F7: mental retardation (eg, mild mental retardation, F70; severe mental retardation, F72);
• F8: developmental disorders (eg, specific language development disorder, F80; expressive language disorder, F80.1; specific reading disorder, F81.0; specific numeracy disorder, F81.2; childhood autism, F84.0);
• F9: Behavioral and emotional disorders typically beginning in childhood and adolescence (eg, hyperkinetic disorder, F90; oppositional defiant disorder, F91.3; childhood separation anxiety disorder, F93.0; childhood social anxiety disorder , F93.2; disorder of social functioning with onset specific to childhood, F94; reactive attachment disorder of childhood, F94.1; tics, F95; non-organic enuresis, F98.0; feeding disorders in infancy, F98.2; stereotypical movement disorders, F98.4).

All these disorders differ quite significantly from each other, therefore the main goals of treatment are posed differently.

The goal of treatment for some of the previously mentioned disorders is to reduce the frequency of their manifestation (for example, phobias, obsessive disorders, enuresis, aggressiveness). Therapy aggressiveness is aimed, in particular, at reducing its intensity and teaching the client to follow the rules more. An essential feature of behavior therapy, then, is the systematic introduction of reinforcing conditions into the child's daily life. This can be achieved by purposefully stimulating the child’s behavior by parents and teachers, for which a “token” reward system and other everyday incentives are used (for example, spending interesting time together as a family, increased attention to the child). If necessary, behavioral training is carried out in order to increase impulse control, empathy towards the child, who learns appropriate social skills and their application in everyday situations by receiving reinforcing stimuli. Such operant and environmentally shaping activities, including the behavior of the most important adults for the child, are indicated primarily for the treatment of behavior disorders in young children.

Other forms of disorders (eg, described developmental disorders) are characterized by the fact that the child does not master important behavioral skills, and the goal of therapy is thus the systematic formation of complex sets of behavior. This is especially true psychological development disorders(F8), organic disorders(F0) and mental retardation(F7). These disorders are characterized by a disorder in the information processing mechanism. Children are not able to sufficiently build a connection between stimulus and response because, for example, their central nervous system is damaged or stimuli are not accurately perceived, accumulated in memory and translated into concrete actions (for example, a child suffering from reading and writing disorders it is not possible to connect together the images of oral and written speech). In the process of therapy for such children, we are talking primarily about the systematic development of activity skills using techniques for shaping behavior (shaping), preparing new forms of behavior (prompting, fading), as well as systematically stimulating behavioral progress. This technique is similar to neuropsychological functional training, which is also practiced when working with adult clients. At the same time, you should regularly and systematically increase the difficulty of training exercises and constantly encourage the child’s activity in achieving more significant results. For young and less developed children, these activities should be carried out mainly in cooperation with parents, teachers and educators (cotherapist training).

In case of phobias And post-traumatic disorders On the contrary, measures of graduated presentation of stimuli of varying intensity to the client against the background of stabilizing measures are shown. In this case, the client is step by step exposed to a situation that causes him anxiety and fear, in order to experience and process the traumatic experience. Techniques that increase self-esteem and help the child (adolescent) develop the ability to successfully solve the next developmental task (for example, graduating from school, forming friendships with peers, etc.) also play an important role in this process.

Somatic diseases(eg migraine, chronic illnesses) and psychotic disorders(for example, schizophrenia) involve the use of psychotherapy accompanying medical treatment. This support usually consists of conducting psycho-educational activities addressed to the child and his family (for example, providing information, developing forms of behavior favorable to treatment). In addition, it aims to develop clients' competence in dealing with their illness over a long period of time (for example, cognitive training for patients with schizophrenia, relaxation training for patients with bronchial asthma, coping with stress in migraines).

Diagnostic measures

Therapy for children and adolescents is usually preceded by a broad and thorough diagnostics. This is important, if only because in most cases children and adolescents have not undergone a preliminary examination (for example, by a pediatrician or in a clinic). Accordingly, the diagnosis should provide a broad basis for the therapist's orientation, establishing the severity of the disorder, as well as, if possible, the causes of its occurrence. This includes, first of all, detailed developmental history the child, his previous violations, including a wide examination of current complaints about existing difficulties and behavioral problems. In the process of making a diagnosis, hypotheses are developed about the possible causes of the disorder (in particular, organic damage that distorts behavior, educational influences from parents, developmental disorders and partial delays in performance). These hypotheses are purposefully verified during the diagnostic process.

In the course of deepening the diagnosis, it is recommended identification of cognitive and intellectual prerequisites in a child (adolescent) (identifying the level of general mental development, conducting multidimensional intellectual testing, assessing his partial performance). You should also observe how the child interacts with his immediate environment (mother-child interactions, during classes, at home). Often there is a need to identify somatic diseases of the child.

In the process of carrying out diagnostic activities, the foreground is behavioral-analytical examination specific difficulties of problem behavior and its conditionality; The differential diagnostic classification of a behavioral problem within a particular disease classification system for therapy plays a rather secondary role.

Principles of intervention

Regardless of the type of violation and applied intervention methods(classical conditioning, operant conditioning, situational therapy, resource-based therapy, competence orientation, cognitive therapy) there are a number of generally valid principles for the treatment of children and adolescents.

Involving significant others in the therapy process. Treatment of young children and children with developmental delays is impossible without the participation of parents, teachers and educators. In this case, the goal should be to change the conditions of the child’s social context as purposefully as possible (the behavior of parents and other reference persons, recommendations to family members, promoting the development of the child in a preschool institution). Modification of the environment can, for example, occur within training for cotherapists, during which the mother of a developmentally delayed child is trained in the daily support of her child’s speech development (in particular, in the form of regular exercises, stimulation of speech progress, recording developmental progress).

The therapist may influence the daily routine established in the family or the behavior of caregivers (for example, when putting a child to bed, the manner in which certain tasks are set for the child). Problem behavior can be corrected directly contingent stimulation.

In all these cases, the therapist needs to know how specific interactions proceed in “local conditions”, actively involve parents in the process of therapeutic activities (in particular, by informing parents about the conditions that cause the child’s problem behavior, providing reference persons with precise instructions, by training reference persons within the framework of the desired intervention). In addition, there is a need for regular exchange of information and observations between the therapist and reference persons during interventions. It is equally important to determine operational measures of problem behavior and treatment outcome(e.g. number of words spoken, number of tics in the afternoon).

Focusing therapy on specific behavior changes. This approach generally corresponds to the model of behavioral therapy, which defines disorders in the form of specific concepts (“excessive activity”, “insufficient activity”, “lack of competence”, “impaired self-regulation”, “dysfunctional processing of stimuli”), and considers it possible to learn behavior depending on context and therefore evaluates the success of therapy by how behavior modification occurs. By targeting specific behavioral goals (for example, having a child perform 10, then 15, and then 25 minutes in class without interruption), behavior therapy has several benefits: interactions with specific teachers are more targeted, interactions are more manageable, and behavioral outcomes are improved. control, individual difficulties and problems are directly and directly affected. Collaboration with a specific teacher, on the contrary, would be difficult if the goals of therapy are unclear (vague mutual expectations, vague forms of intervention, insufficient criteria for the success of therapy). True, focusing on specific behavioral goals may entail general problems of acceptance on the part of the child (for example, “the child must always be considered in its entirety”).

Carrying out therapy in natural conditions (parents' house, kindergarten, school, boarding school). Therapeutic measures achieve their goal when it is possible to directly and, if possible, target change the conditions of the child’s daily environment that cause and maintain the child’s problem behavior. If, for example, a four-year-old child suffers from urinary incontinence during the day, then the exact time is established when he is taken to the toilet, who does it, how it happens, how “success” in the toilet is encouraged and what to do if the diaper is wet again.

Similar programs, carried out in everyday conditions directly by reference adults, are also used in cases of slowness, provoking behavior, developmental delays, anxiety, etc. In this case, the cooperation of the psychologist with the kindergarten and school is of great importance. In this area, one can often observe professional rivalry (pedagogy and psychology) and competition between various psychotherapeutic directions (psychoanalysis versus behavioral therapy). It is very useful to orient the interaction of therapists and cotherapists towards specific, perhaps even preliminary goals of behavioral therapy, to agree on specific activities and criteria for evaluating therapy.

Development orientation. Problems in the behavior of children and adolescents are closely related to the course of development and its age-related tasks. Certain disorders (for example, enuresis, speech development disorders) are directly defined as age-related, i.e. are considered problematic only from a certain age. Other violations appear only during the transition from one ecological environment to another, when new demands are placed on the child (for example, when entering kindergarten). This fact affects the design of therapy, since it is always aimed at optimizing the conditions for the child’s development, for example: increasing the educational competence of parents, weakening traumatic stressors in the family, improving family communication and, finally, increasing the competence of the children themselves. In this regard, behavior therapy focuses on developmental resources and competence. The point is not only to reduce the severity of problem behavior, but also to generally clear the way for more successful development of the child.

Interdisciplinary collaboration between psychotherapist and doctors, educators, teachers, physiotherapists, speech therapists. This cooperation begins already at the diagnostic stage, especially in cases of developmental and well-being disorders.

When working with this category of disorders, it is necessary to clarify medical aspects, in particular the causes of sleep disorders, speech development, motor skills, nutrition or excretory disorders (for example, an encephalogram, a hearing test, a neurological examination, a study of digestive and bladder functions). Interdisciplinary interaction is also required when conducting therapy, which partially takes place with the participation of teachers and educators, and also requires the coordination of various treatment methods (for example, physical therapy, speech therapy, drug treatment). Typically, the task of coordination falls to the responsible behavioral therapist, who must monitor the achievement of specific behavioral goals and strive for clear differentiation of therapeutic interventions.

All of these principles boil down to ensuring that therapy is carried out as concretely and empirically as possible. Everyday therapeutic intervention takes precedence over discussion of the disorder.

Efficiency

The finding that behavioral therapy for children and adolescents produces positive results is not new. However, recently more and more data have emerged on the varying effectiveness of individual techniques. M. Döpfner (1999) published a review article concluding that therapy for both externalizing and internalizing disorders produces both moderate and high results (from 0.76 to 0.91).

This is also confirmed by data from meta-analyses conducted, in particular, by J.R. Weisz (1995), who summarized 150 studies between 1967 and 1993. Children aged 2 to 18 years underwent therapy, and the effectiveness averaged 0.71.

According to A.E. Kazdin and J.R. Weisz, the following methods of behavioral therapy for children and adolescents have proven themselves to be effective in terms of effectiveness:

• cognitive behavioral therapy for introversive disorders (fears, phobias);
• teaching (through training) skills to cope with depression in children and adolescents (for example, identifying depressive patterns, mastering social skills or training in progressive muscle relaxation, encouraging positive experiences that have a beneficial effect on the client's mood);
• training in cognitive problem solving in the presence of externalizing disorders (for example, in aggressive and oppositional children);
• training for parents suffering from the same type of disorder;
• therapy for antisocial behavior by involving the social environment (family, school, peers, neighbors, etc.);
• family-oriented interventions for difficulties in raising young children;
• intensive family-oriented behavioral therapy for autism;
• special measures in special cases, for example in the preparation of invasive interventions through cognitive behavior modification.

Many new studies support the conclusion that behavioral therapy interventions for children and adolescents are highly effective; this applies to both contingent management and cognitive-behavioral techniques (for example, self-prescriptions or cognitive behavior modification).

With regard to expansive disorders (including attention deficit, hyperactive disorders), clearly structured programs aimed at implementation in everyday living conditions and optimizing the management of the behavior of a problem child by parents, teachers, etc. seem to be especially effective. (Pelham, Wheeler, Chronis, 1998). These programs are often more effective than cognitive behavioral therapy (Saile, 1996).

It is much more difficult to measure the effectiveness of interventions for developmental disorders.

On the one hand, there are many individual studies on the treatment of speech disorders, spelling problems, autism symptoms, etc., with very good results. Moreover, it is possible to achieve lasting results in overcoming difficulties and partial inability to work at school: children who have undergone appropriate training have become significantly less likely to encounter problems at school.

On the other hand, it is necessary to constantly repeat courses of treatment for disorders such as autism and similar developmental disabilities in order to avoid long-term relapses.

It is with autistic people that problems arise, depending on whether measures to promote their development were included in educational programs. S.R. Forness and others have shown that training in specific developmental functions (including memory strategies) is highly effective for clients, but only when the training programs are clearly structured and problem-oriented and when therapeutic interventions are constantly adapted to the developmental progress that children make .

(Laut G.IN., Marriage U.B., Linderkamp F. Behavior correction in children and adolescents: A practical guide. I. Strategy and methods / trans. with him. V.T. Altukhova; scientific ed. rus. text by A.B. Kholmogorov. - M.: Publishing house. center "Academy", 2005. - pp. 8-19.)

In order to identify, work through and eliminate any problem, a person is recommended to first find out the reasons for its occurrence. It is very difficult to do this without special techniques and methods. Support from a therapist is also important. Not only the specialist who works with clients undergoes training, but also patients who, as they work with the therapist, must go through all stages of behavioral psychotherapy.

This area of ​​treatment has emerged relatively recently. It is based on the main postulates of behaviorism, which consider behavior as the main source of all emerging problems and a way to overcome difficulties. As they say, how a person created his problem, in the same way he must solve it, that is, take a specific action that will transform him and lead to personal changes.

The online magazine site wishes to acquaint readers with the basic postulates of behavioral psychotherapy in order to demonstrate its usefulness in working through any problems.

What is behavioral psychotherapy?

A fairly new direction in the treatment of many phobias, behavioral negative reactions and manifestations is behavioral psychotherapy. Here we understand psychotherapeutic activity, which is based on changing or correcting an individual’s behavior in order to heal him from the main problem with which he came.

The first step towards solving any problem is its clear formulation. Therefore, a visit to a psychologist begins with studying or receiving a request (a complaint or problem that forced a person to seek help) in order to collect information as completely as possible. Without a thorough examination (diagnosis) of the situation by a specialist, the matter will be limited to only assumptions. The two most common methods of psychodiagnostics are structured conversation (interview) and psychological testing.

In behavioral psychotherapy, the main principles are:

• The concept of operant and classical conditioning.
• Behavioral theories.
• Principles of learning.

If a person has addictions, phobias or destructive behavior patterns, then behavioral psychotherapy is applicable. It is based not only on verbal discussion of the problem, but also on modeling new behavior, its practice and development.

The emphasis is on the “target” - the so-called trigger that triggers a person’s incorrect behavior. If you identify it, eliminate it, or change your attitude towards it, then you can eliminate the problem of incorrect behavior itself.

It should be noted that it is customary for a person to divide actions into good and bad. The psychotherapist does not evaluate. His main task is to help the client if he sees and notices that his behavior creates problems and does not help him live happily.

Actions cannot be bad or good in themselves. It all depends on the situation in which they are used. Actions may be appropriate or inappropriate. In other words, a person performs exactly those actions that help him achieve his goal in a specific situation. If the desired is not achieved, then actions are considered inappropriate.

Most people use exactly those behavioral patterns that have been developed over the years. Conservatism and traditions are precisely those behavioral reactions when a person does not think, but simply performs his usual actions. Various problematic situations often arise here when a person cannot understand that he himself has created a conflict through his stereotyped actions. It is necessary to change actions and be flexible in each individual situation, which is what behavioral psychotherapy teaches.

The worst thing you can do is get hung up on something: you didn’t defend your dissertation, you didn’t say “I love you,” you acted selfishly. It is important to let go of the past, change your thinking and behavior, which no longer gives the desired result. It is important to create something new that will bring the desired result here and now.

Old patterns of behavior, desires, fears and people were useful to a person once in the past. But now this may not bring the desired result, so you need to get rid of ballast and develop something new that will help achieve the goal that is important today.

Old patterns of behavior do not bring the desired results in the present. This means that they need to be replaced. If you continue to do what you usually do, then, accordingly, you will get the result you are accustomed to. It is impossible to perform the same actions and get a different result every time. If you don't change anything about the factors that are involved in creating a particular situation, then you always get the same result. But as soon as you change something in yourself or in external factors, you immediately get a completely new result.

Old patterns of behavior do not bring the desired results in the present. And the worst thing you can do in such a situation is not change anything. People often blame circumstances for their troubles, but they themselves allowed old circumstances to participate in shaping the situation. If you change at least the external circumstances, the situation itself will change. And if you also change your behavior, way of thinking, beliefs, you can significantly change the course of events. Thus, if you want to change your life, start by changing your behavior or thinking. And you will notice how your life becomes different.

Cognitive behavioral psychotherapy

Thought precedes actions. Thus, A. T. Beck created a new direction in psychotherapy, which is called cognitive-behavioral. First, a person thinks about something, after which his thoughts provoke actions. Therefore, in order to identify the causes of the problem with which the client came to the psychotherapist, it is necessary to find out what thoughts are spinning in his head at the same time.

Cognitive behavioral psychotherapy is actively used to eliminate negative conditions:

• Phobia.
• Irritations.
• Anxiety.
• Suicidal tendencies, etc.

First, a person must understand what thoughts he is thinking before committing an unpleasant action. Thus, cognitive behavioral psychotherapy helps negative thoughts create new thinking patterns and reinforce new beliefs.

The following techniques are used:

1. Detection of unnecessary and desired thoughts. Finding the causes of unwanted thoughts.
2. Formation of new templates.
3. Visualization that helps you connect new patterns with action and emotional well-being.
4. Using new beliefs and behaviors in real life to make them habitual.

Life can be changed for the better, and it all starts with a person. It is not the circumstances that shape the scenario of life, but the attitude that a person shows towards these circumstances, which is what develops fears, anxiety, panic, and anger. Inadequate assessment of objects, people, phenomena, situations leads to the fact that a person develops a certain attitude towards them. He begins to take actions depending on his attitude. Wherein:

• A person endows people, objects, etc. with qualities that are unusual for them, which indicates an inadequate perception of what is happening.
• A person forms in himself exactly the attitude towards what is happening that corresponds to the direction of his thinking. Cognitive behavioral therapy aims to change the way a person thinks about everything that happens to them.

The absurdity of some thoughts can be noted when a person is afraid of something that has not yet happened. When a situation arises that does not proceed according to the terrible scenario that a person painted in his head, he begins to understand how wrong he was and suffered senselessly. Thus, many experiences are absurd only because a person makes them up before the terrible thing happens, or keeps them in his head for a long time, when the event is already long in the past.

Methods of behavioral psychotherapy

The main goal of behavioral psychotherapy is the transformation of the client's behavior. He must change, alter or modify his actions to make them more effective. Various methods are used here:

1. Aversive therapy, in which a person is directly exposed to a negative stimulus. Infrequently used.
2. A token system, when the client is rewarded with “tokens” for any effective action. Then he can exchange these tokens for useful and pleasant things.
3. Mental “stop”, when the client consciously stops the flow of negative thoughts that cause him unpleasant sensations.
4. Graded reinforcement and self-reinforcement.
5. Self-instruction and self-control.
6. Learning from models.
7. Training in reinforcement techniques.
8. Self-affirmation training.
9. Systematic desensitization.
10. Conditioned reflex therapy.
11. Targeted and covert reinforcement.
12. Penalty system.

Behavioral psychotherapy techniques

Behavioral psychotherapy uses various techniques that help eliminate specific psychological problems:

• The “flood” technique, when a person is created a traumatic situation and is immersed in it. He must remain there until the inhibition functions begin to turn on, that is, the fear itself begins to disappear due to the constant impact of the frightening stimulus on the person. This technique can be used up to 10 times.
• A token system where a person is rewarded for correct behavior.
• Systematic desensitization, when at a time of stress a person relaxes.
• Exposure is the patient's entry into a frightening situation.

What are the results of behavioral psychotherapy?

The main goals of behavioral psychotherapy are to influence the client's thoughts and attitudes in order to regulate behavior to improve their sense of self. Results can be achieved in a matter of sessions if the client fully submits to the guidance of the therapist.

It should be understood that it is through his actions that a person creates his problems. These actions are based on beliefs, thoughts, fears, complexes and other psychological factors. Often a person uses old patterns of behavior, which today do not give the desired effect. That is why, by working through your own stereotypes, you can change your behavior, which will finally give the desired result.

First you need to understand what controls a person, and then begin to control this factor yourself in order to take actions that are beneficial for yourself.

Behavioral therapy, also called behavioral therapy, is one of the newest areas in modern psychotherapy. However, this does not interfere with the fact that behavior therapy is the leading method. It is behavior that acts as the main and fundamental element of psychotherapeutic direction.

In general terms, behavioral therapy is a special psychotherapy based on changes in human behavior. But when behavior itself changes, changes necessarily occur in the volitional, cognitive and emotional spheres of a person. Psychologists believe that this direction is mainly based on behavioral principles and approaches. Here, the principles of learning are used to change three structures - behavioral, emotional and cognitive.

Features of behavioral psychotherapy

In psychology, behavior and its study occupy a significant position in working with patients faced with a wide variety of problems.

It is worth noting that based on the applied behavioral therapy, new directions have been developed, such as dialectical behavioral therapy. The dialectical method is widely used in working with patients who suffer from borderline personality disorder.

The behavioral approach includes an extensive list of different techniques. Although initially such a term as “behavior” in psychology was perceived exclusively as an externally observable and manifested characteristic. Now this includes a wide range of manifestations - from emotional-subjective and cognitive, to motivational-affective and more.

Since all these manifestations are united under one concept, this indicates their subordination to the laws of this psychotherapeutic teaching; based on them, a specialist can control a person’s emotions.

The theoretical basis of the behavioral therapy used is psychology, which is called behaviorism.

Behaviorism or behavior therapy also defines the approach to problems of disease and health. A person’s health or illness is a natural result of what a person has learned or failed to learn. Personality is the experience gained by a person during his life. At the same time, neurosis does not act as an independent unit, since the nosological approach here, in its essence, has no place to be. The focus of attention is not the disease at all, but rather the symptom.

Basic provisions

The behavioral approach or behavioral direction in psychotherapy is based on certain provisions. These are the characteristics of behavioral psychotherapy:

• First position. A number of cases of pathological behavior, previously considered as diseases or symptoms of a disease, from the perspective of behavioral therapy (BT) are non-pathological problems of life. These are alarming situations, reactions, behavioral disorders and sexual deviations.
• Second position. Pathological behavior is predominantly acquired.
• Third position. The behavioral approach mainly focuses on current human behavior rather than the patient's past life. This psychological treatment method allows you to better understand the person being studied, describe and evaluate the situation based on the specific situation, and not the problems of the past.
• Fourth position. Behavioral therapy techniques require a mandatory preliminary analysis of the problem in order to highlight key points. After this, the identified individual components are subjected to certain effects using appropriate psychotherapeutic procedures.
• Fifth position. In behavioral psychotherapy, intervention techniques are developed individually, depending on the specific problems of an individual patient.
• Sixth position. The behavioral approach allows success in treating the patient's problem without the need for data on etiology.
• Seventh position. All methods of behavioral psychotherapy are based exclusively on a scientific approach to the consideration and study of problems. This means that the therapy starts from a basic concept that can be tested through experimentation. Also, the techniques used are described precisely enough for the purpose of their objective measurement and repetition as necessary. An important feature of PT methods is the possibility of experimental evaluation of their concepts.

Application of behavioral therapy

Various methods of behavioral therapy are aimed at helping patients faced with various difficult situations that require intervention from specialists. For example, PT is carried out for autism, social phobia and even obesity.

The behavioral therapy system is used in the following situations:

• for anxiety conditions;
• in case of chronic mental disorders;
• for sexual disorders;
• to solve emerging marital and interpersonal problems;
• for psychopathologies in children.

Research has clearly proven that PT can effectively help in cases of phobias in a person. In this case, the basic technique used is systematic exposure. The concept of exposure refers to a number of techniques that are based on the presentation of patients’ existing fears. Also, as a supplement for anxiety conditions, the technique is used.

The method of behavioral therapy has been proven to be highly effective in solving problems in the field of sexual relationships.

Many patients prefer this type of psychotherapy, since it allows them to solve the problem of premature ejaculation, vaginismus, impotence, etc.

Couples therapy is a method of training the members of a couple to positively as well as productively achieve desired positive behavioral changes. In some situations, full-fledged family behavioral psychotherapy is required. The fact is that a number of difficulties and problems experienced by a person can be directly related to members of his family. Therefore, everyone should take part in therapy. This allows you to analyze the situation, determine the role of each family member and solve the current problem.

If we talk about mental disorders, then PT is capable of solving problems exclusively of chronic, but not acute disorders. Behavioral methods of influence are used when working with patients who have significant personality changes or low levels of self-care.

PT allows you to solve the psychological problems of patients in early childhood - bad behavior, excessive aggression and other violations of norms. In the treatment of hyperactivity, the so-called token technique is widely used. The effectiveness of PT has been clearly proven when it is necessary to improve a child’s academic performance and solve the problem of autism. Autism is a pressing problem for many children. But it is PT that demonstrates some of the best results in normalizing behavioral and intellectual development. Of course, the percentage is only about 2% of children with autism who have been cured. But among all the methods existing today, only PT has managed to achieve such impressive results.

Basic methods of PT

Cognitive restructuring technique

These methods are based on assumptions about the emergence of emotional disorders as a result of cognitions, that is, maladaptive stereotypes of human thinking. The goal of the method is to change cognitions.

Experts teach how to use calming thoughts when a patient is in a stressful situation. One of the most popular techniques is based on stress inoculation training. It involves the need for the patient to imagine being in a stressful situation and apply new skills. The practice of rational emotional behavioral therapy - the emotive method - is widely used.

The practice of rational emotional behavior therapy is characterized by a combination of behavioral and cognitive methods. RET, REBT, or Rational Emotional Behavioral Therapy uses reward factors. The simplest of them are a nod, a smile, or attention. Everyone is looking for a reward or encouragement. And those people from whom we receive them become important and close to us, and friendship develops. Those who do not give encouragement, we do not accept or even try to avoid.

Self-control

The method requires the patient to directly participate in determining the goals of his treatment and strict implementation of the therapy program. For these purposes, various self-control procedures are used.

Self-control is the basis for successful self-regulation of problem behavior. Using this method, a person better understands the essence of his problem and his own actions. The therapist's task is to help the patient almost independently determine the goal or establish certain standards that govern behavior. An example is the treatment of obesity, where the amount of calories for each day is jointly prescribed as part of the therapy.

The clearer and shorter-term the goals set, the higher the likelihood of developing successful self-control. If you simply tell yourself, “I won’t eat much from tomorrow,” you won’t be able to achieve success. You need to say, “Starting tomorrow, I will eat no more than 1 thousand calories.” Unclear goals lead to failure, which negatively affects self-esteem. If the goal is achieved, the patient has an incentive to develop success.

Disgust technique

A technique aimed at inducing disgust is called aversive psychotherapy. A striking example of this method is the treatment of alcohol addiction, when the patient is offered small portions of alcohol, but at the same time he uses substances that can cause discomfort (nausea, vomiting, etc.).

Enuresis, tremors in the hands, stuttering and other similar disorders can be cured with electric shocks.

Method of punishment

Unlike the previous method, here the patient receives punishment after an undesirable behavioral situation. For example, a patient performed an undesirable action and subsequently received an electric shock. Writer's cramp of the tremor and spastic form is treated with these methods.

Training using punishment methods stimulates a person to relax the necessary muscle groups, thereby coping with the problem.

Positive reinforcement

This method is based on establishing a connection between the patient’s current behavior and the resulting consequences of his behavior. The most popular method of positive reinforcement is the so-called token system. It is widely used both in working with withdrawn and uncommunicative children or adults, and in treating people with severe personality or mental retardation.

The essence of the token technique is to reward the patient for the actions they perform. For example, they are tasked with speaking clearly, doing homework, cleaning their room, or washing their dishes. At the same time, there must be a price list system, which indicates how many conditional tokens a person will receive if he completes certain tasks or achieves certain goals.

Self-confidence

The technique was developed to work with people who lack self-confidence. They are not able to express their emotions or defend their rights and their own opinions. Such people are often exploited, they do not respect themselves. What can we say about respect from the people around us.

Similar psychotherapy trainings are conducted in groups. Through exercise, patients develop self-confidence, develop a model of self-affirming behavior and try to change the reaction towards themselves from the environment. This technique helps to raise self-esteem, gain confidence and the ability to defend one’s opinion, beliefs or rights.

Also, this method of PT is able to develop in a person the appropriate ability to communicate, the ability to listen to others and establish trusting relationships.

Systematic Desensitization (SD)

Here the focus is on the anxiety that a person faces in certain situations. Anxiety is a persistent response from the nervous system that is learned through classical conditioning. The author of this method has developed a technique that allows you to extinguish these autonomous conditioned reactions - systematic desensitization or SD.

Practice has shown that the most effective stimulus for getting rid of anxiety is muscle relaxation. After mastering this relaxation technique, the second stage begins - a hierarchical composition of the situation, which provokes anxiety or fear. Then the patient, who is already in a relaxed state, should vividly imagine a situation occupying the lowest level of the constructed hierarchy. This is the level that is least associated with anxiety or fear.

SD or systemic behavioral psychotherapy is also carried out by actually immersing a person or patient in the situation of their phobia. Moreover, psychotherapists claim that this approach gives the highest effect.

Modeling technique

It is not uncommon for specialists to resort to the modeling method. It involves teaching the patient the required behavior by modeling or visually demonstrating it.

The simplest example is that a psychotherapist uses his own example to show his patient how to behave in a given situation that can provoke fear or anxiety.

Let's say you are very afraid of cockroaches. The specialist clearly demonstrates that they are not dangerous and are very easy to kill. First, training is carried out through a visual demonstration, then the patient trains on some models or rubber insects. Gradually, a person independently reacts to his fear without screaming, panic or fear.

Extinction methods

Such techniques are called immersion or immersion. The peculiarity of the technique is that a person faces his fear directly without the condition of prior relaxation. There are several methods that are based on the phenomenon of immersion, that is, extinction.

• Flood. The patient and the specialist are immersed in situations that provoke fear and remain there until the moment when the feeling of fear subsides. At the same time, you should not try to distract yourself in order to reduce the intensity of anxiety.
• Intention (paradoxical). In simple terms, this is a method of detaching from neurosis. Therapy involves deliberately evoking the symptom and dealing with it with humor. Having laughed at his own fear, he will cease to be such.
• Implosion. Based on the hierarchy of fear. Therapy begins from the lowest levels, gradually increasing the patient’s anxiety level more and more. The main task is to achieve the maximum level of fear within 30-60 minutes.

Behavioral therapy can help manage symptoms or the disease itself, but this psychotherapeutic method is not intended to eliminate the causes. Therefore, unwanted behavior sometimes appears again after completion of treatment. In such situations, the method of exposure is changed or a repeat course is carried out.