cognitive behavioral. Who can benefit from cognitive therapy? Cognitive Behavioral Therapy: Methods of Learning and Assimilation

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

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a popular method of treatment in psychotherapy, based on the correction of thoughts, feelings, emotions and behavior, designed to improve the quality of life of the patient and rid him of addictions or psychological disorders.

AT modern psychotherapy CBT is used to treat neurosis, phobias, depression and other mental problems. And also - to get 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 a specific behavior. If the behavior is negative (for example, taking psychotropic drugs), then you can change it if you change the way of thinking and emotional attitude person to the situation that caused such a detrimental reaction.

Cognitive Behavioral Therapy is relatively short technique, usually it lasts 12-14 weeks. Such treatment is used at the stage of rehabilitation therapy, when intoxication of the body has already been carried out, the patient has received the necessary drug treatment, and there comes a period of work with a psychotherapist.

The essence of the method

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

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

Scheme of impact on the patient during treatment

In addition, a person’s thoughts and emotions can be affected by a number of conditions that “fix” 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, "breaking", etc.).

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

CBT always begins with the establishment of contact between the doctor and the patient and the functional analysis of dependence. 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 set triggers - these are conditioned signals that a person associates with drugs. They can be external (friends, dealers, the specific place where the consumption takes place, the time - Friday night for stress relief, etc.). As well as internal (anger, boredom, excitement, fatigue).

They are used to identify special exercise- the patient should write down his thoughts and emotions in the following table for several days, indicating the date and date:

Subsequently, apply various methods development of personal skills and interpersonal relationships. The former include stress and anger management techniques, various ways to take up leisure time, etc. Teaching interpersonal relationships helps to resist the pressure of acquaintances (an offer to use a drug), teaches you to deal with criticism, re-interact with people, etc.

The technique of understanding and overcoming drug hunger is also used, the skills of refusing drugs and preventing relapse are being developed.

Indications and stages of CPT

Cognitive-behavioral therapy has long been successfully used all over the world, it 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 treatment with CBT there are essential condition– the patient must himself realize that he suffers from a harmful addiction, and make a decision to fight drug addiction on his own. For people who are prone to introspection, accustomed to monitoring their thoughts and feelings, such therapy will have the greatest effect.

In some cases, before the start of CBT, it is required to develop skills and techniques for overcoming difficult life situations (if a 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 consecutive stages:

1. Logical analysis. Here the patient analyzes his own thoughts and feelings, mistakes are revealed 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 his own thoughts and behaviors 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 the methods of cognitive-behavioral therapy is that they involve the most active participation of the patient himself, continuous introspection, and his own (and not imposed from the outside) work on mistakes. CBT may occur in different forms- individual, alone with the doctor, and group - perfectly combined 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) the signs of a psychological disorder;
• significantly increases the benefits of drug treatment;
• improves social adaptation former drug addict;
• reduces the risk of breakdowns in the future.

As studies have shown, best results CBT shows in treatment. Methods of cognitive-behavioral therapy are also widely used in getting rid of cocaine addiction.

The foundation of cognitive behavioral therapy (CBT) was laid by the eminent psychologist Albert Ellis and psychotherapist Aaron Beck. Originating in the 1960s, this technique is recognized by academic communities as one of the most effective methods of psychotherapeutic treatment.

Cognitive behavioral therapy is a universal method of helping people suffering from various neurotic and mental disorders. The authoritativeness of this concept is added by the dominant principle of the methodology - the unconditional acceptance of personality traits, a positive attitude towards each person while maintaining healthy criticism of the negative actions of the subject.

Methods of cognitive-behavioral therapy have helped thousands of people who suffered from various complexes, depressive states, irrational fears. The popularity of this technique explains the combination of obvious advantages of CBT:

• a guarantee of achieving high results and a complete solution of the existing problem;
• long-term, often life-long persistence of the effect obtained;
• short course of therapy;
• understandability of exercises for an ordinary citizen;
• simplicity of tasks;
• the ability to perform exercises recommended by a doctor, independently in a comfortable home environment;
• a wide range of techniques, the ability to use to overcome various psychological problems;
• no side effects;
• atraumatic and safety;
• using hidden resources of the body to solve the problem.

Cognitive behavioral therapy has shown good results in the treatment a variety of disorders neurotic and psychotic levels. CBT methods are used in the treatment of affective and anxiety disorders, neurosis obsessive states, problems in the intimate sphere, anomalies eating behavior. CBT techniques bring excellent results in the treatment of alcoholism, drug addiction, gambling, and psychological addictions.

general information

One of the features of cognitive-behavioral therapy is the division and systematization of all emotions of a person into two broad groups:

• productive, also called rational or functional;
• unproductive, called irrational or dysfunctional.

The group of unproductive emotions includes destructive experiences of an individual, which, according to the concept of CBT, are the result of irrational (illogical) beliefs and beliefs of a person - “irrational beliefs”. According to supporters of cognitive-behavioral therapy, all unproductive emotions and the dysfunctional model of personality behavior associated with it are not a reflection or result of the subject's personal experience. All irrational components of thinking and the non-constructive behavior associated with them are the result of a person's incorrect, distorted interpretation of their real experience. According to the authors of the methodology, the real culprit of all psycho-emotional disorders is the distorted and destructive belief system present in the individual, which was formed as a result of the wrong beliefs of the individual.

These ideas form the foundation of cognitive-behavioral therapy, the main concept of which is as follows: the emotions, feelings and behavior of the subject are not determined by the situation in which he is, but by how he perceives the current situation. From these considerations comes the dominant strategy of CBT - to identify and identify dysfunctional experiences and stereotypes, then replace them with rational, useful, realistic feelings, taking full control of your train of thought.

By changing the personal attitude to some factor or phenomenon, replacing a rigid, rigid, non-constructive life strategy with flexible thinking, a person will acquire an effective worldview.

The resulting functional emotions will improve psycho emotional condition personalities and ensure excellent well-being in any life circumstances. On this basis, it was formulated conceptual model of cognitive behavioral therapy, presented in an easy-to-understand formula ABC, where:

• A (activating event) - a certain event occurring in reality, which is a stimulus for the subject;
• B (belief) - a system of personal beliefs of an individual, a cognitive structure that reflects the process of a person's perception of an event in the form of emerging thoughts, formed ideas, formed beliefs;
• C (emotional consequences) - final results, emotional and behavioral consequences.

Cognitive-behavioral therapy is focused on the identification and subsequent transformation of distorted components of thinking, which ensures the formation of a functional strategy for the behavior of the individual.

Treatment process

The treatment process using cognitive-behavioral therapy techniques is a short-term course, which includes from 10 to 20 sessions. Most patients visit a therapist no more than twice a week. After a face-to-face meeting, clients are given a small “homework assignment”, which includes the performance of specially selected exercises and additional acquaintance with educational literature.

Treatment with CBT involves the use of two groups of techniques: behavioral and cognitive.

Let's take a closer look at cognitive techniques. They are aimed at detecting and correcting dysfunctional thoughts, beliefs, ideas. It should be noted that irrational emotions impede the normal functioning of a person, change a person’s thinking, force them to make and follow illogical decisions. Going off scale in amplitude, affective unproductive feelings lead to the fact that the individual sees reality in a distorted light. Dysfunctional emotions deprive a person of control over himself, force him to commit reckless acts.

Cognitive techniques are conditionally divided into several groups.

Group one

The purpose of the techniques of the first group is to track and become aware of one's own thoughts. For this, the following methods are most often used.

Recording your own thoughts

The patient receives the task: to state on a piece of paper the thoughts that arise before and during the performance of any action. In this case, it is necessary to fix thoughts strictly in the order of their priority. This step will indicate the significance of certain motives of a person when making a decision.

Keeping a diary of thoughts

The client is advised to briefly, concisely and accurately write down all the thoughts that arise in a diary for several days. This action will allow you to find out what a person thinks about most often, how much time he spends thinking about these thoughts, how much he is disturbed by certain ideas.

Distance from non-functional thoughts

The essence of the exercise is that a person must develop an objective attitude towards his own thoughts. In order to become an impartial "observer", he needs to move away from emerging ideas. Detachment from one's own thoughts has three components:

• awareness and acceptance of the fact that a non-constructive thought arises automatically, an understanding that the idea that is now overwhelming was formed earlier under certain circumstances, or that it is not its own product of thinking, but is imposed from outside by outsiders;
• awareness and acceptance of the fact that stereotyped thoughts are non-functional and interfere with normal adaptation to existing conditions;
• doubt about the truth of the emerging non-adaptive idea, since such a stereotyped construct contradicts the existing situation and does not correspond in its essence to the emerging requirements of reality.

Group two

The task of the technicians from the second group is to challenge existing non-functional thoughts. To do this, the patient is asked to perform the following exercises.

Examining arguments for and against stereotyped thoughts

A person studies his own maladaptive thought and fixes on paper the arguments “for” and “against”. The patient is then instructed to reread their notes daily. With regular exercise in the mind of a person, over time, the “correct” arguments will be firmly fixed, and the “wrong” ones will be eliminated from thinking.

Weighing the advantages and disadvantages

In this exercise in question not about analyzing your own unconstructive thoughts, but about studying existing options solutions. For example, a woman makes a comparison of what is more important for her: to maintain her own safety by not coming into contact with persons of the opposite sex, or to allow a share of risk in her life in order to eventually create a strong family.

Experiment

This exercise provides that a person experimentally, through personal experience, comprehends the result of demonstrating one or another emotion. For example, if the subject does not know how society reacts to the manifestation of his anger, he is allowed to express his emotion in full force, directing it to the therapist.

Return to the past

The essence of this step is a frank conversation with impartial witnesses of past events that left a mark on the human psyche. This technique is especially effective in disorders of the mental sphere, in which memories are distorted. This exercise is relevant for those who have delusions that have arisen as a result of an incorrect interpretation of the motives that move other people.

This step involves giving the patient arguments drawn from the scientific literature, official statistics, and the doctor's personal experience. For example, if a patient is afraid of air travel, the therapist points him to objective international reports, according to which the number of accidents when using airplanes is much lower compared to disasters that occur on other modes of transport.

Socratic method (Socratic dialogue)

The doctor's task is to identify and point out to the client logical errors and obvious contradictions in his reasoning. For example, if the patient is convinced that he is destined to die from a spider bite, but at the same time declares that he has already been bitten by this insect before, the doctor points out a contradiction between anticipation and the real facts of personal history.

Change of mind - reassessment of facts

The purpose of this exercise is to change the person's existing point of view on the existing situation by checking whether alternative causes the same event. For example, the client is invited to reflect and discuss whether this or that person could have done the same to him if she had been guided by other motives.

Reducing the significance of the results - decatastrophication

This technique involves the development of a non-adaptive thought of the patient to a global scale for the subsequent devaluation of its consequences. For example, to a person who is terrified of leaving his own home, the doctor asks questions: “In your opinion, what will happen to you if you go out into the street?”, “How much and how long will you be overcome negative feelings?”, “What happens next? Are you going to have a seizure? Are you dying? Will people die? The planet will end its existence? A person understands that his fears in a global sense are not worth attention. Awareness of the temporal and spatial framework helps to eliminate the fear of the imagined consequences of a disturbing event.

Softening the intensity of emotions

The essence of this technique is to conduct an emotional reassessment of a traumatic event. For example, the injured person is asked to summarize the situation by saying to herself the following: “It is very unfortunate that such a fact took place in my life. However, I will not allow

this event to control my present and ruin my future. I'm leaving the trauma in the past." That is, the destructive emotions that arise in a person lose their power of affect: resentment, anger and hatred are transformed into softer and more functional experiences.

Role reversal

This technique consists in the exchange of roles between the doctor and the client. The task of the patient is to convince the therapist that his thoughts and beliefs are maladaptive. Thus, the patient himself is convinced of the dysfunctionality of his judgments.

Shelving ideas

This exercise is suitable for those patients who cannot give up their impossible dreams, unrealistic desires and unrealistic goals, but thinking about them makes him uncomfortable. The client is invited to postpone the implementation of his ideas for a long time, while specifying a specific date for their implementation, for example, the occurrence of a certain event. The expectation of this event eliminates psychological discomfort, thereby making a person's dream more achievable.

Drawing up an action plan for the future

The client, together with the doctor, develops an adequate realistic program of actions for the future, which specifies specific conditions, determines the actions of a person, sets step-by-step deadlines for completing tasks. For example, the therapist and the patient agree that in the event of a critical situation, the client will follow a certain sequence of actions. And until the onset of a catastrophic event, he will not exhaust himself with disturbing experiences at all.

Group three

The third group of techniques is focused on activating the sphere of the individual's imagination. It has been established that the dominant position in thinking of anxious people is not occupied by “automatic” thoughts at all, but by obsessive frightening images and exhausting destructive ideas. Based on this, therapists have developed special techniques that act on the correction of the area of ​​​​imagination.

termination method

When a client has an obsessive negative image, he is advised to utter a conditional laconic command in a loud and firm voice, for example: “Stop!”. Such an indication terminates the action of the negative image.

repetition method

This technique involves the repeated repetition by the patient of the settings characteristic of a productive way of thinking. Thus, over time, the formed negative stereotype is eliminated.

Use of metaphors

To activate the sphere of the patient's imagination, the doctor uses appropriate metaphorical statements, instructive parables, quotations from poetry. This approach makes the explanation more colorful and understandable.

Image Modification

The method of modifying imagination involves the active work of the client, aimed at gradually replacing destructive images with ideas of a neutral color, and then with positive constructs.

positive imagination

This technique involves replacing a negative image with positive ideas, which has a pronounced relaxing effect.

constructive imagination

The desensitization technique consists in the fact that a person ranks the probability of an expected catastrophic situation, that is, he establishes and orders the expected events of the future according to their significance. This step leads to the fact that the negative forecast loses its global significance and is no longer perceived as inevitable. For example, the patient is asked to rank the probability lethal outcome when meeting with the object of fear.

Group four

Techniques from this group are aimed at improving efficiency medical process and minimizing customer resistance.

Purposeful repetition

The essence of this technique is the persistent repeated testing of various positive instructions in personal practice. For example, after reassessing one's own thoughts during psychotherapeutic sessions, the patient is given the task: to independently reassess the ideas and experiences that arise in everyday life. This step will ensure a stable consolidation of the positive skill gained in the course of therapy.

Identification of hidden motives of destructive behavior

This technique is appropriate in situations where a person continues to think and act in an illogical way, despite the fact that all the “correct” arguments are stated, he agrees with them and fully accepts them.

As noted on classicalhypnosis.ru hypnotherapist Gennady Ivanov, in this case, the task of therapy is to find the hidden motives of his destructive behavior and establish alternative motives for a person's dysfunctional actions.

Other branches of psychotherapy refer to this exercise as seeking secondary gain.

Basic Principles of Cognitive Behavioral Therapy

1. The behavior of the client, on the one hand, and his thoughts, feelings, psychological processes and their consequences - on the other - have a mutual influence on each other. As Bandura (1978) put it, behavior is "two-way determined". CBT theory states that the cognitive is not the primary source or cause of maladapted behavior. The client's thoughts affect his feelings to the same extent as feelings affect his thoughts. CBT views thought processes and emotions as two sides of the same coin. Thought processes are only a link, often not even the main one, in the chain of causes. For example, when a psychotherapist is trying to determine the likelihood of a recurrence of unipolar depression, he may do more accurate prediction if he understands how critical the client's spouse is, instead of relying on cognitive indicators (Hooley et al., 1986).

2. Cognitive can be considered as a set of cognitive events, cognitive processes and cognitive structures. The term "cognitive events" refers to automatic thoughts, internal dialogue, and imagery. I want to note that this does not mean that a person is constantly talking to himself. Rather, we can say that human behavior in most cases is meaningless, automatic. Abelson (1976), Langer (Langer, 1978) and Thorngate (Thomgate, 1976) say that it is "according to the script". But there are cases in which automatism is interrupted, when a person needs to make a decision under conditions of uncertainty, in these cases it "turns on" inner speech. In the cognitive-behavioral theory, it is believed that its content can influence the feelings and behavior of a person. But, as already mentioned, how a person feels, behaves and interacts with others can also significantly affect his thoughts. According to CBT theory, cognitive causes (so-called "irrational" beliefs, cognitive errors, or special thoughts) do not cause emotional distress or maladaptive behavior. Such a view is rather considered a simplification that does not correspond to scientific data. The cognitive is only part of a complex system of interacting processes. Cognitive events represent only one side of the totality of the cognitive. There are also cognitive processes. Social, cognitive, and developmental psychology have done much to describe cognitive processes, in particular, confirmation bias, heuristic thinking, and metacognition. (For a more complete description of these cognitive processes, see Meichenbaum & Gilmore, 1984; Hollon & Kriss, 1984; Taylor & Crocker, 1981)). In short, the confirmation fallacy occurs when a person strictly adheres to certain views about himself and the world around him, rarely paying attention to the facts that refute the correctness of these views. Heuristic thinking is the use of "habitual thinking" in cases where decisions need to be made under conditions of uncertainty (eg Tversky and Kahneman (1977) described accessibility and representativeness heuristic thinking). Moreover, a person's emotional state (for example, depression, anxiety, etc.) can influence specific heuristic examples from the past and color them in their own way. A person does not just react to events, he relies on various ready-made examples from the past, depending on his mood in this moment. Thus, the client's emotions affect what information he chooses as a guide to action, what conclusions he draws and what explanations for his behavior he offers. Metacognition is the processes of self-regulation and their deliberation. The therapist helps the client develop the ability to "notice," "grasp," "interrupt," and "monitor" their thoughts, feelings, and behaviors. In addition, the psychotherapist must make sure that with positive changes in his behavior, the client is aware that he himself has implemented them. Finally, CBT emphasizes the leading role of cognitive structures or schemas. Initially, great importance was attributed to cognitive events, but gradually the emphasis shifted to circuits, the concept of which, as Bartlett (1932) noted, was borrowed from information processing theory. Schemas are a cognitive representation of past experience that influences the perception of today's experience and helps to systematize new information(Goldfried, 1988; Neimeyer & Feixas, 1990). Safran and Segal (1990) say that schemas are most like unspoken rules that organize and direct information about a person's own personality. Schemas influence event evaluation and adjustment processes (Meichenbaum, 1977).

3. Because of the importance of schemas, the main task of the cognitive-behavioral psychotherapist is to help clients understand how they construct and interpret reality. In this regard, CBT works in a constructivist way. The therapist also helps clients see how they inadvertently select from the information flow only that which confirms their pre-existing ideas about themselves and the world around them. Cognitive behavioral theory supports an interactive view of behavior (Coyne & Gotlib, 1983; Kiesler, 1982; Wachtel, 1982). For example, people with chronic depression often behave in ways that turn others away from them, and this once again confirms the conviction they have formed in their rejection and shows that their fear of loneliness is justified. So when a depressed person claims that "no one loves" him, this is more of an accurate description than a cognitive distortion. However, at the same time, he does not understand that he himself unwittingly caused such an attitude towards himself. The task of the psychotherapist in this case is to help the client break the vicious circle. Because CBT is constructivist, it does not believe that there is a "single reality" or that the therapist's job is to educate the client or correct misconceptions (such as thinking errors or irrational thoughts). Rather, the KBT recognizes the existence of "multiple realities" as in Kurosawa's Rashomon. The common task of the client and the psychotherapist is to understand how the client creates these realities and what price he pays for it. Moreover, it is necessary to answer the question: does he want to pay with his emotions and relationships with other people? What does he lose by continuing to adhere to his views on himself and on the world? These questions are not answered in the abstract, but by experimenting with emotions during psychotherapy sessions, creating what Alexander and French called "corrective emotional experience" (Alexander & French, 1946). Together with the client, the possibilities of changing personal structures and behavior are considered. In addition, during sessions great attention attention is paid to the obstacles that may stand in the way of change.

4. Today's version of CBT has disagreements with psychotherapeutic approaches that stand on the positions of rationalism and objectivism. As Neimeyer (1985) and Mahoney (Mahoney, 1988) noted, in a rationalistic approach, the client must monitor and correct "incorrect" or "irrational" beliefs. The therapist helps him develop a more correct and objective view of reality through logical challenge, instruction, and the collection of empirical evidence that puts the client's incorrect beliefs to the test of reality. In contrast, CBT, being a phenomenologically oriented branch of psychotherapy, seeks to explore the client's worldview through non-directive reflective methods. The therapist tries to see the world through the eyes of the client, rather than challenging or interpreting his thoughts. The main way to achieve this goal is as follows: the therapist "chooses" from the client's speech keywords and phrases and repeats them with interrogative intonations, but without distorting the meaning. The therapist can also use the client's background information and behavior during psychotherapy sessions to help the client sort out their feelings.

5. CBT attaches great importance collaboration and discovery processes. An indicator of the good work of a psychotherapist is the situation when the client manages to offer an answer to a question before him. The therapist helps the client gather information (for example, how the problem changes depending on the situation) and then asks what could have been done differently. If the client says: "I don't know," the therapist echoes him: "I don't know either. Let's think about how we can find out." Saying "we", attracting the client to cooperation, the psychotherapist, as it were, offers the client to share responsibility, giving him the strength to work on his problem himself. The goal of CBT is to help the client become their own psychotherapist. In order to achieve this goal, the psychotherapist must not be didactic. With this attitude of the psychotherapist, the client begins to experiment with his beliefs, opinions and assumptions, checking their correctness, gradually moving on to experimenting with new types of behavior. Some patients require extensive behavioral training (eg, modeling, rehearsals, role-playing games) before they can move on to such experiments.
6. Critical to CBT is relapse prevention. Its importance was initially emphasized by Marlatt and Gordon (Marian. & Gordon, 1985) when working with alcoholics and drug addicts, but great importance is attached to the prevention of relapse.

In CBT in general. Psychotherapists work with clients to consider high-risk situations in which relapse may occur, as well as the client's thoughts and feelings that may lead to a relapse. They are also dealt with during psychotherapeutic sessions (for example, see: Meichenbaum, 1985). Cognitive behavioral therapists believe that clients, like scientists, learn from mistakes and failures. Without failure, there would be no progress. In short, psychotherapists help clients see failures and disappointments as lessons and trials rather than disasters. The cognitive-behavioral psychotherapist serves as a conduit of hope, combating the decadence and hopelessness, helplessness, and vulnerability with which clients come to him (Frank, 1974). He may even tell the client that the symptoms are a good sign that the client is feeling okay: “Given all that you have been through, I am not surprised that you are depressed (alarmed, furious). I became alarmed would if it wasn't." In other words, what is essential to the behavior change process is not that the client is depressed, anxious, or angry (all of which are normal responses to the vicissitudes of life), but rather how he relates to these emotional reactions. In cognitive-behavioral therapy, the whole range of cognitive restructuring techniques is used: social comparison, paradoxical techniques, reframing, etc.

7. All of these techniques are effective only in the context of a collaborative relationship. The relationship that has developed between the client and the therapist is essential to achieving positive results. Safran and Segal (1990) recently reviewed the literature looking at various variables that influence the outcome of psychotherapy and argued conclusively that relationships in the process of psychotherapy have a much greater influence on outcome than special technical factors (ratio 45% to 15%). Cognitive-behavioral psychotherapists place a lot of emphasis on establishing and maintaining a collaborative relationship with the client. It is very important for them that during the sessions there is an atmosphere of warmth, empathy, emotional "consonance", acceptance and trust. The psychotherapeutic relationship is ideally a model for building relationships outside the therapist's office. The relationship with the therapist gives the client the courage to change. Moreover, as Meichenbauin and Turk (1987) point out, such relationships become an important factor in helping to overcome client resistance. This is extremely important because, according to available data, 70% of patients refuse psychotherapy after the 4th session (Phillips, 1986). As Safran and Segal (1990, p. 35) have noted, CBT recognizes "the inseparability of the relationship between psychotherapeutic techniques, the therapist's personality, and the relationship with the client. Very often, psychotherapy becomes too didactic, more like elementary logic. With this approach the client does not have the opportunity to understand his view of things and experiment with a new attitude towards them, try to create a different view of reality and consider its possible consequences Collaboration in the process of psychotherapy gives clients the courage to undertake such personality and behavioral experiments. itself becomes the result of behavioral changes and their consequences.

8. It's all about big emotional stress. Emotions play a very important role in CBT. According to Greenberg and Safran (1986), emotions are often given too little attention in psychotherapy. CBT, on the other hand, believes that emotions are extremely important in understanding the cognitive structures and schemas of clients. Just as Freud considered emotions to be the "royal road to the unconscious," we also think of emotions as the "royal road" to personality schemas. There are many ways to tap into the client's emotions; here we will only touch on the use of transfer. In communicating with a psychotherapist, clients often use emotional patterns that have been formed in communication with significant people in the past. The psychotherapist, as a participant-observer of these relationships, discusses them with the client. Here, the unit of analysis is not the automatic thoughts or way of thinking, but the manner in which the patient interacts with the therapist. The therapist, together with the client, explores both the emotions that arise in the process of psychotherapy and the various factors that have led to today's emotional problems. In a nutshell. CBT helps the client make sense of their behavior. As a result, the client begins to understand that he is not crazy, that his beliefs are not pathological, as some theorists say (Weiss & Sampson, 1986). We try to bring the client to the realization that he has certain beliefs that are understandable because of what he has gone through, but that at the moment these beliefs, being transferred to new life circumstances, have become an obstacle to achieving his goals. As systems-oriented psychotherapists say, the solutions to problems found by the client are often part of the problems themselves. CBT believes that the client's understanding of what is happening should be judged not in terms of its correctness, but in terms of its suitability under the circumstances. Neimeyer and Feixas (1990) observed that in the constructivist approach, the psychotherapist is more interested in the suitability of a system of meanings for adaptation than in its correctness. Taylor and Brown (Taylor & Brown, 1988) found that motivated thinking (adherence to delusions, denial of the existence of a problem, a positive view of oneself and one's surroundings) is often adaptive. This also seems to be true of illusory beliefs that do not translate into meaningful actions. Where inaction does no harm, motivated thinking can be adaptive (Kunda, 1990). It is not customary in CBT to attack the client's beliefs head-on, as this can lead to "stuck" on them (Kmglansky, 1990). A psychotherapist who wants to help a client change beliefs must take "detours". There is different ways make emotionally charged beliefs open to change: you can make the client your colleague, reduce him defensive reactions, or you can show him his beliefs in an exaggerated way to get his reaction. The process of change is usually saturated with "hot" cognitions (Zajonc & Markus, 1984). "Cold" cognitions - providing information, challenging, logic - rarely help to change the beliefs that the client stubbornly holds and the behavior that accompanies them (Meichenbaum & Turk, 1987).

In the experiences of people, themes of hopelessness, a gloomy perception of the world and dissatisfaction with oneself often sound. Cognitive psychotherapy helps to identify established stereotypes through working with thinking and replacing "automatic" negative thoughts with positive ones. The patient is an active participant in the therapy process.

Cognitive Therapy - What is it?

Aaron Beck, an American psychotherapist, one of the founders of the direction in 1954, while studying depression in the framework of psychoanalysis, did not receive any encouraging results. reliable results. Thus, a new direction of psychotherapeutic assistance with panic attacks, depression, various addictions. Cognitive therapy is a short-term method aimed at recognizing negative thought patterns that lead a person to suffering and replacing them with constructive thoughts. The client learns a new perception, begins to believe in himself and think positively.

Methods of cognitive psychotherapy

The therapist initially negotiates and establishes a relationship based on cooperation with the patient. A list of target problems is formed in order of the significance of the study for the patient, automatic negative thoughts. Methods of cognitive-behavioral therapy cause positive changes at a fairly deep level, include:

• struggle with thoughts negative direction(“this is pointless”, “this is useless”, “nothing good will come of this”, “unworthy of being happy”);
• alternative ways of perceiving the problem;
• rethinking or living a traumatic experience from the past that affects the present and the patient does not adequately assess reality.

Cognitive Psychotherapy Techniques

The therapist encourages the patient to actively participate fully in therapy. The goal of the therapist is to convey to the client that he is unhappy with his old beliefs, there is an alternative to start thinking in a new way, to take responsibility for his thoughts, state, behavior. Homework is required. Cognitive therapy for personality disorders includes a number of techniques:

1. Tracking and recording negative thoughts, attitudes when you need to take some important action. The patient writes down on paper in order of priority the thoughts that come up during the decision.
2. Keeping a diary. During the day, the thoughts that most often occur in the patient are recorded. A diary helps you keep track of thoughts that affect your well-being.
3. Testing the Negative Install in Action. If the patient claims that "he is not capable of anything," the therapist encourages small successful actions to begin with, then complicates the tasks.
4. Catharsis. Technique of living emotions from the state. If the patient is sad, in self-loathing, the therapist suggests expressing the sadness, for example, by crying.
5. Imagination. The patient is afraid or not confident in his abilities in order to perform an action. The therapist encourages you to imagine and try.
6. Three column method. The patient writes in columns: situation-negative thought-corrective (positive) thought. The technique is useful for learning the skill of replacing a negative thought with a positive one.
7. Recording the events of the day. The patient may believe that people are aggressive towards him. The therapist suggests keeping a list of observations, where to put "+" "-", during the day with each interaction with people.

Cognitive Therapy - Exercises

A stable result and success in therapy is ensured by the consolidation of new constructive attitudes and thoughts. The client does homework and exercises that the therapist will assign him: relaxation, tracking pleasant events learning new behaviors and self-change skills. Cognitive psychotherapy exercises for self-confidence are necessary for patients with high anxiety and in a state of depression from dissatisfaction with themselves. In the course of working out the desired “self-image”, a person tries on and tries different variants behavior.

Cognitive therapy for social phobia

Fear and high unreasonable anxiety prevent a person from performing his social functions normally. Social phobia is a fairly common disorder. Cognitive psychotherapy for social phobia helps to identify the "benefits" of such thinking. Exercises are tailored to the specific problems of the patient: fear of leaving the house, and so on.

Cognitive Addiction Therapy

Alcoholism and drug addiction are diseases caused by genetic factor, sometimes it is a pattern for people who are problem solvers and see stress relief in substance use without actually solving the problems themselves. Cognitive behavioral psychotherapy for addictions is aimed at identifying triggers (situations, people, thoughts) that trigger the mechanism of use. Cognitive therapy successfully helps a person cope with bad habits through awareness of thoughts, elaboration of situations and behavior change.

Cognitive Behavioral Therapy - Best Books

People may not always be able to seek help from a specialist. Techniques and methods of well-known psychotherapists can help to independently move forward on the path to solving some problems, but will not replace the psychotherapist himself. Cognitive behavioral therapy books:

1. "Cognitive therapy for depression" A. Beck, Arthur Freeman.
2. "Cognitive psychotherapy of personality disorders" A. Beck.
3. "Psychotraining according to the method of Albert Ellis" A. Ellis.
4. "The practice of rational-emotional behavioral psychotherapy» A.Ellis.
5. "Methods of behavioral therapy" V. Meyer, E. Chesser.
6. "Guide to Cognitive Behavioral Therapy" S. Kharitonov.

Last update: 17/07/2014

Cognitive behavioral therapy (CBT) is one type of treatment that helps patients understand the thoughts and feelings that influence behavior. It is commonly used to treat a wide range illnesses, including phobias, addictions, depression, and anxiety. Cognitive behavioral therapy is usually short-lived and focuses on helping clients with a specific problem. During the course of treatment, people learn to identify and change destructive or disturbing thought patterns that Negative influence on behavior.

Fundamentals of Cognitive Behavioral Therapy

The basic concept implies that our thoughts and feelings play a fundamental role in shaping our behavior. For example, a person who thinks too much about plane crashes, runway accidents, and other air disasters may begin to avoid air travel. The goal of CBT is to teach patients that they cannot control every aspect of the world around them, but that they can control their interpretation of and interaction with that world.
AT last years Cognitive Behavioral Therapy is becoming increasingly popular among both clients and therapists. Because this type of treatment usually does not take much time, due to which it is considered more affordable than other types of therapy. Its effectiveness has been empirically proven: experts have found that it helps patients overcome inappropriate behavior in its most diverse manifestations.

Types of cognitive behavioral therapy

According to the British Association of Behavioral and Cognitive Therapists, “Cognitive behavioral therapy is a range of treatments based on concepts and principles formulated on the basis of psychological models of human emotions and behavior. They include both a wide range of approaches to the treatment of emotional disorders and self-help opportunities.”
The following are regularly used by professionals:

• rational-emotional-behavioral therapy;
• cognitive therapy;
• multimodal therapy.

Components of Cognitive Behavioral Therapy

People often experience thoughts or feelings that only reinforce them in a wrong opinion. Such opinions and beliefs can lead to problematic behavior that can affect numerous areas of life, including family, romantic relationships, work, and school. For example, a person suffering from low self-esteem may have negative thoughts about himself or his own abilities or appearance. As a result, a person may begin to avoid situations of social interaction or refuse, for example, opportunities for promotion at work.
In order to combat these destructive thoughts and behaviors, the therapist begins by helping the client identify problematic beliefs. This stage, also known as functional analysis, has importance to understand how thoughts, feelings and situations can contribute to inappropriate behaviors. This process can be challenging, especially for patients who struggle with overintrospection tendencies, but it can ultimately lead to self-discovery and insight, which is an integral part of the healing process.
The second part of cognitive behavioral therapy focuses on the actual behavior that contributes to the development of the problem. The client begins to learn and practice new skills, which can then be used in real situations. For example, a person suffering from drug addiction can learn skills to overcome cravings and ways to avoid or cope with social situations that could potentially trigger a relapse.
In most cases, CBT is a gradual process that helps a person take additional steps towards behavior change. A social phobic may start by simply imagining himself in a social situation, disturbing. He may then try talking to friends, family members, and acquaintances. With constant movement towards the goal, the process seems less complicated, and the goals themselves seem quite achievable.

Application of CBT

I use cognitive behavioral therapy to treat people suffering from a wide range of illnesses - anxiety, phobias, depression and addiction. CBT is one of the most studied therapies, in part because the treatment focuses on specific problems and results are relatively easy to measure.
Cognitive Behavioral Therapy is often best for those clients who tend to be introspective. In order for CBT to be effective, a person must be ready for it, and must be willing to put in the time and effort to analyze their thoughts and feelings. Such introspection can be difficult, but it great way learn more about how internal state affects behavior.
Cognitive behavioral therapy is also well suited for those who need short-term treatment that does not involve the use of medication. One of the benefits of CBT is that it helps clients develop skills that can be useful now and in the future.