Kbt psychology. What is the peculiarity of the method of cognitive-behavioral psychotherapy? Basic Methods of Cognitive Behavioral Therapy

Psychology has today a wide interest among ordinary people. However, the real techniques and exercises are carried out by specialists who understand what they use all the methods for. One of the areas of work with a client is cognitive psychotherapy.

Specialists of cognitive psychotherapy consider a person as an individual personality that shapes his life depending on what he pays attention to, how he looks at the world, how he interprets certain events. The world is the same for all people, but what people themselves think about it may differ in different opinions.

In order to know why certain events, sensations, experiences occur to a person, it is necessary to deal with his ideas, attitude, views and reasoning. This is what cognitive psychologists do.

Cognitive psychotherapy helps a person deal with their personal problems. These can be individual experiences or situations: problems in the family or at work, self-doubt, low self-esteem, etc. It is used to eliminate stressful experiences as a result of disasters, violence, wars. It can be used both individually and when working with families.

What is cognitive psychotherapy?

In psychology, many techniques are used on how to help a client. One of these areas is cognitive psychotherapy. What it is? This is a purposeful, structured, directive, short-term conversation aimed at transforming the inner "I" of a person, which is manifested in the sensation of these transformations and new behaviors.

That is why one can often come across such a name as cognitive behavioral therapy, where a person not only considers his situation, studies its components, puts forward new ideas for changing himself, but also practices new actions that will support new qualities and characteristics that he develops himself.

Cognitive Behavioral Therapy performs many useful functions that help healthy people transform their own lives:

1. First, a person is taught a realistic perception of the events that happen to him. Many problems are taken from the fact that a person distorts the interpretation of events happening to him. Together with the psychotherapist, the person reinterprets what happened, now being able to see where the distortion occurs. Along with the development of adequate behavior, there is a transformation of actions that become consistent with situations.
2. Second, you can change your future. It depends solely on the decisions and actions that a person makes. By changing your behavior, you can change your entire future.
3. Thirdly, the development of new models of behavior. Here the psychotherapist not only transforms the personality, but also supports it in these transformations.
4. Fourth, fixing the result. For a positive outcome to exist, you need to be able to maintain and maintain it.

Cognitive psychotherapy uses many methods, exercises and techniques that are applied at different stages. They are ideally combined with other directions in psychotherapy, supplementing or replacing them. Thus, the therapist can use several directions at the same time, if this helps in achieving the goal.

Beck's Cognitive Psychotherapy

One of the directions in psychotherapy is called cognitive therapy, the founder of which was Aaron Beck. It was he who created the idea, which is the main one in all cognitive psychotherapy - the problems that arise in a person's life are the wrong worldview and attitudes.

Various events happen in the life of each individual. Much depends on how a person perceives the promises of external circumstances. The thoughts that arise are of a certain nature, provoking the corresponding emotions and, as a result, the actions that a person performs.

Aaron Beck did not consider the world to be bad, but people's views of the world as negative and wrong. It is they who form the emotions that others experience, and the actions that are then performed. It is actions that affect how events unfold further in the life of each person.

Mental pathology, according to Beck, occurs when a person distorts external circumstances in his own mind. An example would be working with people who have suffered from depression. Aaron Beck found that all depressed individuals had the following thoughts: inadequacy, hopelessness, and defeatism. Thus, Beck brought out the idea that a depressive state occurs in those who comprehend the world through 3 categories:

1. Hopelessness, when a person sees his future exclusively in gloomy colors.
2. Negative view, when the individual perceives the current circumstances exclusively from a negative point of view, although for some people they may cause pleasure.
3. Reduced self-esteem, when a person perceives himself as helpless, worthless, insolvent.

Mechanisms that help in correcting cognitive attitudes are self-control, role-playing games, homework, modeling, etc.

Aaron Beck worked with Freeman mostly on people with personality disorders. They were convinced that every disorder is the result of certain beliefs and strategies. If you identify thoughts, patterns, patterns and actions that automatically appear in your head in people with a specific personality disorder, you can correct them by transforming your personality. This can be done by re-experiencing traumatic situations or by using the imagination.

In psychotherapeutic practice, Beck and Freeman considered important a friendly atmosphere between the client and the specialist. The client should have no resistance to what the therapist is doing.

The ultimate goal of cognitive psychotherapy is to identify destructive thoughts and transform the personality by eliminating them. What is important is not what the client thinks, but how he thinks, reasons, what mental patterns he uses. They should be transformed.

Methods of cognitive psychotherapy

Since a person’s problems are the result of his incorrect perception of what is happening, inferences and automatic thoughts, the validity of which he does not even think about, the methods of cognitive psychotherapy are:

• Imagination.
• Fight negative thoughts.
• Secondary experience of childhood traumatic situations.
• Finding alternative strategies for perceiving the problem.

Much depends on the emotional experience that the person has experienced. Cognitive therapy helps in forgetting or learning new things. Thus, each client is invited to transform old patterns of behavior and develop new ones. It uses not only a theoretical approach, when a person studies the situation, but also a behavioral one, when the practice of committing new actions is encouraged.

The psychotherapist directs all his efforts to identify and change the negative interpretations of the situation that the client uses. So, in a depressed state, people often talk about how good it was in the past and what they can no longer experience in the present. The psychotherapist suggests finding other examples from life when such ideas did not work, remembering all the victories over one's own depression.

Thus, the main technique is to recognize negative thoughts and modify them into others that help in solving problems.

Using the method of finding alternative ways of acting in a stressful situation, the emphasis is on the fact that a person is an ordinary and imperfect being. You don't have to win to solve a problem. You can just try your hand at solving a problem that seems problematic, accept a challenge, not be afraid to act, try. This will bring more results than the desire to win the first time.

Cognitive Psychotherapy Exercises

The way a person thinks affects how he feels, how he treats himself and others, what decisions he makes and actions he performs. People perceive the same situation differently. If only one facet stands out, then this significantly impoverishes the life of a person who cannot be flexible in his thinking and actions. This is why cognitive psychotherapy exercises become effective.

There are a large number of them. All of them can look like homework, when a person reinforces in real life new skills acquired and developed in sessions with a psychotherapist.

All people from childhood are taught to unambiguous thinking. For example, "If I can't do anything, then I'm a failure." In fact, such thinking limits the behavior of a person who is now not even going to attempt to refute it.

Exercise "Fifth column".

• In the first column on a piece of paper, write down the situation that is problematic for you.
• In the second column, write down the feelings and emotions that you have in this situation.
• In the third column, write down the “automatic thoughts” that often flash through your mind in this situation.
• In the fourth column, write down the beliefs that trigger these "automatic thoughts" in you. What attitudes are you guided by, because of what you think this way?
• In the fifth column, write down the thoughts, beliefs, attitudes, positive statements that refute the ideas from the fourth column.

After identifying automatic thoughts, it is proposed to perform various exercises where a person will be able to change his attitudes by performing other actions, and not those that he did before. Then it is proposed to perform these actions in real conditions in order to see what result will be achieved.

Cognitive Psychotherapy Techniques

When using cognitive therapy, three techniques are actually used: Beck's cognitive psychotherapy, Ellis's rational-emotive concept, and Glasser's realistic concept. The client mentally argues, performs exercises, experiments, fixes models at the level of behavior.

Cognitive psychotherapy aims to teach the client to:

• Identification of negative automatic thoughts.
• Finding the connection between affects, knowledge and actions.
• Finding arguments "for" and "against" automatic thoughts.
• Learning to identify negative thoughts and attitudes that lead to wrong behavior and negative experiences.

For the most part, people expect a negative outcome of events. That is why he has fears, panic attacks, negative emotions, which make him not act, run away, fence off. Cognitive psychotherapy helps in identifying attitudes and understanding how they affect the behavior and life of the person himself. In all his misfortunes, the individual is guilty himself, which he does not notice and continues to live unhappily.

Outcome

Even a healthy person can use the services of a cognitive psychotherapist. Absolutely all people have some kind of personal problems with which he cannot cope on his own. The result of unresolved problems is depression, dissatisfaction with life, dissatisfaction with oneself.

If there is a desire to get rid of an unhappy life and negative experiences, then you can use the techniques, methods and exercises of cognitive psychotherapy, which transforms people's lives, changing it.

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

The cognitive approach proceeds from the assumption that all psychological problems are caused by the thoughts and beliefs of the person himself.

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

A vivid example can be a situation in which a person is sure of his insolvency and impotence. In every difficult situation, he experiences these feelings, gets nervous and despairs, and, as a result, tries to avoid making a decision and cannot realize his desires. Often the cause of neurosis and other similar problems becomes an intrapersonal conflict. Cognitive-behavioral psychotherapy helps to identify the initial source of the current situation, depression and experiences of the patient, and then resolve the problem. The skill of changing one's negative behavior and stereotype of thinking becomes available to a person, which positively affects both the emotional state and the physical state.

Intrapersonal conflict is one of the most common causes of psychological problems.

CBT has several goals at once:

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

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

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

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

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

The use of CBT for severe mental disorders is unacceptable; special drugs are used for this

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

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

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

Advantages of the technique

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

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

Cognitive-behavioral therapy helps to cope with anxieties and fears of a person

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

Types of therapy

Methods of cognitive-behavioral psychotherapy depend on the specific situation and the patient's problem, and pursue a specific goal. The main thing for a specialist is to get to the bottom of the patient's problem, to teach a person positive thinking and ways of behaving in such a case. The most commonly used methods of cognitive-behavioral psychotherapy can be considered the following:

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

Some of these types of cognitive-behavioral psychotherapy can be done on their own or can be done as "homework" after a session with a specialist. And in working with other methods, one cannot do without the help and presence of a doctor.

Self-observation is considered one of the types of cognitive-behavioral psychotherapy

Techniques of Cognitive Behavioral Therapy

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

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

Psychotherapy by Aaron Beck

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

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

Aaron Beck used a variety of methods in his therapy. All of them were aimed at identifying a specific problem both on the part of the specialist and the patient, and then looking for a solution to these problems without correcting the specific qualities of a person.

Aaron Beck is an outstanding American psychotherapist, creator of cognitive psychotherapy.

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

What happens during a session

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

Therapy session must be conducted by a licensed professional

Also in this document, the main goals of cognitive-behavioral therapy are prescribed, if possible, the desired result. The course of therapy itself can be short-term (15 sessions per hour) or longer (more than 40 sessions per hour). After the end of the diagnosis and getting to know the patient, the doctor draws up an individual plan of work with him and the timing of consultation meetings.

As you can see, the main task of a specialist in the cognitive-behavioral direction of psychotherapy is considered not only to observe the patient, to find out the origins of the problem, but also explaining one's opinion on the current situation to the person himself, helping him to understand and build new mental and behavioral stereotypes. To increase the effect of such psychotherapy and consolidate the result, the doctor can give the patient special exercises and "homework", use various techniques that can help the patient continue to act and develop in a positive direction independently.

Cognitive behavior and learning associated with it combines the highest forms of mental activity, which are more characteristic of adult animals with a highly developed nervous system and based on its ability to form a holistic image of the environment. With cognitive forms of learning, an assessment of the situation occurs, in which higher mental processes are involved; in this case, both past experience and an analysis of available opportunities are used, and as a result an optimal solution is formed.

The cognitive capabilities of animals are determined by their intellect, which means "the highest form of mental activity of animals (monkeys and a number of other higher vertebrates), characterized by the display of not only the subject components of the environment, but also their relationships and connections (situations), as well as a non-stereotypical solution of complex tasks in various ways with the transfer and use of various operations learned as a result of previous individual experience. I. Zh. manifests itself in the processes of thinking, which in animals always has a specific sensory-motor character, is subject-related and is expressed in practical analysis and synthesis of established relationships between phenomena (and objects) that are directly perceived in a visually observed situation "(" A Brief Psychological Dictionary " Edited by A. V. Petrovsky and M. G. Yaroshevsky Rostov-on-Don, Phoenix, 1998).

The intellectual behavior of animals is usually studied using the following approaches: 1) techniques associated with pulling up a bait tied to one of many adjacent ribbons, strings, to establish the ability of animals to capture connections and relationships between various objects; 2) the use of animals as primitive tools of various objects, the construction of pyramids to realize their needs, which cannot be directly satisfied; 3) bypass tasks with rigid and variable labyrinths, on the way to the goal, which is not always within the range of constant visibility for the animal, for this there are obstacles along the way; 4) delayed reactions of active choice, requiring the retention in memory of traces from the stimulus in the form of an image or representation as elements of complex mental processes; 5) selection for a sample (method of paired presentations) to study the identity, generality, discrimination of signals, their shape, shape, size, etc.; 6) problematic situations in various labyrinths, cages, etc. - insight analysis; 7) reflexes to the transfer of experience to new conditions as a technique for reflecting elementary forms of generalization; 8) extrapolation of the direction of movement of the stimulus, the ability to operate with the empirical dimension of figures; 9) teaching the rudiments of the language (sign language, signs, folding phrases from multi-colored plastic chips of various shapes and expressing new sentences, etc., sound communications; 10) studying group behavior, social cooperation; 11) EEG studies of complex forms of behavior and mathematical modeling.

In connection with the methods used, it is customary to distinguish the following forms of cognitive behavior: elementary rational activity (according to L.V. Krushinsky), latent learning, the development of psychomotor skills (psycho-nervous learning according to I.S. Beritashvili), insight and probabilistic forecasting.

According to L.V. Krushinsky (Krushinsky L.V. Biological foundations of rational activity. Moscow State University, 1986), rational (intellectual) activity differs from any form of behavior and learning. This form of adaptive behavior can be carried out at the first encounter of an animal with an unusual situation. The fact that an animal, immediately without special training, can make the right decision is a unique feature of rational activity.

Thinking as something psycho-physiological whole is not reduced to simple associations. The function of generalization in animals is formed on the basis of experience, processes of comparison, identification of essential features in a number of objects, their combination, which contributes to the formation of associations in them and the ability to capture the correctness of the course of events, predicting future consequences. Simple use of previous experience, mechanical reproduction of conditioned reflex connections cannot ensure rapid adaptation in constantly changing environmental conditions, respond flexibly to non-standard situations, or program behavior.

The real relations of objects and phenomena at the stage of intellect can be grasped from the first presentation of the situation. However, rational cognitive activity not only does not exclude previous experience, but also uses it, although it is not reduced to practice, in which it differs significantly from a conditioned reflex. Normally, quick solutions to problems that are increasing in complexity are possible only with their gradual complication. This is natural, because in order to empirically capture any regularity, a series of phenomena is needed.

The psychophysiological interpretation of intelligence should probably be based on the fact that in the brain there is a constant comparison, selection, distraction and generalization of information delivered by sensory systems.

supervisory workshop by A.B. Kholmogorova and N.G. Garanyan

Cognitive psychotherapy is an evidence-based and highly effective approach to the treatment of depressive and anxiety disorders, the growth of which is recorded by epidemiological studies around the world. In foreign countries with a developed mental health service, cognitive psychotherapy is mandatory in the training of psychologists of various profiles. In Russia, the number of specialists using cognitive psychotherapy in their daily practical work is gradually growing. At the same time, there is no in-depth training program for cognitive psychotherapy in any Russian state university. This important gap in the training of domestic psychologists is compensated by this program.

For whom:

for specialists who conduct advisory activities and use the principles of cognitive psychotherapy in their work.

Leading programs:

graduates in the field of cognitive-behavioral psychotherapy, teachers of the Department of Clinical Psychology and Psychotherapy, Ph.D., Professor A.B. Kholmogorova, Ph.D., Professor N.G. Garanyan.

The program is aimed at the formation and development of skills in the diagnosis and psychotherapy of epidemiologically significant disorders (depressive, anxiety, personality) of different ages.

Main sections:

Cognitive psychotherapy of depressive disorders;

Cognitive psychotherapy for anxiety disorders;

Cognitive Psychotherapy for Personality Disorders

CBT emotional disorders of childhood and adolescence.

Program objectives:

1. Formation of ideas about the diagnostic criteria for depressive, anxiety and personality disorders in modern classification systems.

2. Expansion of knowledge about cultural, interpersonal, family, cognitive and behavioral factors of emotional and personality disorders.

3. Acquaintance with the basic theories and principles of cognitive-behavioral therapy of emotional and personality disorders.

4. Mastering the skills of psychodiagnostics of depressive, anxiety and personality disorders using interviews and psychometric techniques.

5. Mastering the skills of describing clinical cases in terms of a cognitive-behavioral approach (drawing up a “cognitive conceptualization of a case” using a diagram).

6. Mastering the skills of planning psychotherapeutic interventions with patients (development of an intervention strategy).

7. Mastering the skills of psychoeducational work with patients suffering from depressive or anxiety disorders.

8. Mastering the skills of psychotherapeutic work with dysfunctional thought processes (methods of identifying, evaluating and coping with negative automatic thoughts).

9. Mastering the skills of psychotherapeutic work with dysfunctional cognitive schemes (methods for identifying, evaluating and modifying maladaptive beliefs).

10. Mastering the skills of diagnosing dysfunctional behavioral patterns associated with the manifestation and chronicity of depressive and anxiety disorders, and methods for changing them.

Cognitive therapy is one of the directions of the modern cognitive-behavioral direction in psychotherapy. Cognitive therapy is a model of a short-term, directive, structured, symptom-oriented strategy for activating self-exploration and changes in the cognitive structure of the Self with confirmation of changes at the behavioral level. Beginning - 1950-60, creators - Aaron Beck, Albert Ellis, George Kelly. The cognitive-behavioral direction studies how a person perceives a situation and thinks, helps a person develop a more realistic view of what is happening and hence more adequate behavior, and cognitive therapy helps a client cope with his problems.

The birth of cognitive psychotherapy was prepared by the development of psychological thought in various directions.

Experimental work in the field of cognitive psychology, in particular Piaget's research, formulated clear scientific principles that could be applied in practice. Even the study of animal behavior showed that it is necessary to take into account their cognitive capabilities in order to understand how they learn.

In addition, there is an awareness that behavioral therapists are unknowingly exploiting the cognitive capabilities of their patients. Desensitization, for example, uses the patient's willingness and ability to imagine. Also, social skills training is not really, but something more complex: patients are not trained in specific responses to stimuli, but in a set of strategies necessary for coping with situations of fear. It has become clear that the use of imagination, new ways of thinking and the application of strategies involve cognitive processes.

It is no coincidence that cognitive therapy originated and began to develop intensively in the United States. If psychoanalysis was popular in Europe with its pessimism about human capabilities, then in the USA the behavioral approach and the rather optimal ideology of “self-made-man” prevailed: a person who can make himself. There is no doubt that in addition to the “philosophy of optimism”, the impressive achievements of information theory and cybernetics, and somewhat later the integration of the achievements of psychobiology by cognitivism, “fueled” the humanistic pathos of the emerging model of man. In contrast to the “psychoanalytic man” with his helplessness in the face of the powerful forces of the irrational and the unconscious, the model of the “cognizing man” was proclaimed, capable of predicting the future, controlling the present and not turning into a slave of his past.

In addition, the belief in positive changes that a person is able to achieve by restructuring their ways of thinking, thereby changing the subjective picture of the world, contributed to the wide popularity of this trend. Thus, the idea of ​​"reasonable man" was strengthened - researching ways of understanding the world, restructuring them, creating new ideas about the world in which he - active person, not a passive pawn.

Aaron Beck is one of the pioneers and recognized leaders of cognitive therapy. He received his MD in 1946 from Yale University and later became professor of psychiatry at the University of Pennsylvania. A. Beck is the author of numerous publications (books and scientific articles), which detail both the fundamentals of theory and practical recommendations for providing psychotherapeutic assistance in suicidal attempts, a wide range of anxiety-phobic disorders and depression. His fundamental manuals (Cognitive Therapy and the emotional disorders, Cognitive therapy of depression) first saw the light in 1967 and 1979. accordingly, and have since been considered classic works and have been repeatedly reprinted. One of the last works of A. Beck (1990) presented a cognitive approach to the treatment of personality disorders.

Albert Ellis, the author and creator of rational-emotive therapy - RET, has been developing his approach since 1947, in the same year he received his doctorate in clinical psychology from Columbia University (New York). In the same place, in 1959, A. Ellis founded the Institute of Rational-Emotive Therapy, of which he is the executive director to this day. A. Ellis is the author of more than 500 articles and 60 books that reveal the possibilities of using rational-emotive therapy not only in an individual format, but also in sexual, marital and family psychotherapy (see, for example: The Practice of Rational-Emotive Therapy, 1973; Humanistic Psychotherapy: The Rational-Emotive approach, 1973; What is Rational-Emotive Therapy (RET), 1985, etc.).

A. Beck and A. Ellis began their professional practice with the use of psychoanalysis and psychoanalytic forms of therapy; both, having been frustrated in this direction, turned their efforts towards creating a therapeutic system capable of helping clients in a shorter time and more focused on the task of improving their personal and social adaptation by recognizing and correcting maladaptive thought patterns. Unlike A. Beck, A. Ellis was more inclined to consider irrational beliefs not in themselves, but in close connection with the unconscious irrational attitudes of the individual, which he called beliefs.

Supporters of the cognitive-behavioral direction proceeded from the fact that a person builds his behavior on the basis of his ideas about what is happening. The way a person sees himself, people and life depends on his way of thinking, and his thinking depends on how a person was taught to think. When a person uses negative, non-constructive, or even simply erroneous, inadequate thinking, he has erroneous or ineffective ideas, and hence - erroneous or ineffective behavior and the problems that follow from this. In the cognitive-behavioral direction, a person is not treated, but taught to think better, which gives a better life.

A. Beck wrote about this: “Human thoughts determine his emotions, emotions determine the corresponding behavior, and behavior, in turn, forms our place in the world around us.” In other words, thoughts shape the world around us. However, the reality that we imagine is very subjective and often has nothing to do with reality. Beck repeatedly said, "It's not that the world is bad, but how often we see it that way."

sadness provoked by the willingness to perceive, conceptualize, interpret what is happening mainly in terms of loss, deprivation something or defeat. In depression, "normal" sadness will be transformed into an all-encompassing feeling of total loss or complete fiasco; the usual desire for a preference for peace of mind will turn into a total avoidance of any emotions, up to the state of "emotional dullness" and emptiness. At the level of behavior, in this case, there are maladaptive reactions of refusal to move towards the goal, a complete refusal of any activity. Anxiety or anger are a response to the perception of the situation as threatening and as a coping strategy for anxiety-phobic disorders, avoidance or aggression towards the “aggressor” most often becomes when emotions are activated anger.

One of the main ideas of cognitive therapy is that our feelings and behavior are determined by our thoughts, almost directly. For example, a person who is at home alone in the evening heard a noise in the next room. If he thinks they are robbers, he may get scared and call the police. If he thinks that someone forgot to close the window, he may get angry at the person who left the window open and go to close the window. That is, the thought that evaluates the event determines emotions and actions. On the other hand, our thoughts are always some interpretation of what we see. Any interpretation implies some freedom, and if the client made, let's say, a negative and problematic interpretation of what happened, then the therapist can offer him, on the contrary, a positive and more constructive interpretation.

Beck called unconstructive thoughts cognitive errors. These include, for example, distorted conclusions that clearly do not reflect reality, as well as exaggeration or understatement of the significance of certain events, personalization (when a person ascribes to himself the significance of events to which, by and large, he has nothing to do) and overgeneralization (on based on one small failure, a person makes a global conclusion for life).

Let us give more specific examples of such cognitive errors.

a) arbitrary inferences- drawing conclusions in the absence of supporting factors or even in the presence of factors that contradict the conclusions (to paraphrase P. Watzlawick: "If you don't like garlic, then you can't love me!");

b) overgeneralization- the derivation of general principles of behavior on the basis of one or more incidents and their broad application to both appropriate and inappropriate situations, for example, the qualification of a single and private failure as a "total failure" in psychogenic impotence;

in) selective arbitrary generalizations, or selective abstraction,- understanding what is happening on the basis of taking details out of context while ignoring other, more significant information; selective bias towards negative aspects of experience while ignoring positive ones. For example, patients with anxiety-phobic disorders in the flow of media messages "hear" mainly reports of disasters, global natural disasters or murders;

G) exaggeration or understatement- a distorted assessment of the event, understanding his as more or less important than it really is. Thus, depressed patients tend to underestimate their own successes and achievements, underestimate self-esteem, exaggerating "damages" and "losses". Sometimes this feature is called “asymmetric attribution of luck (failure), which implies a tendency to attribute responsibility for all failures to oneself, and “write off” good luck due to random luck or a happy accident;

e) personalization - seeing events as the results of one's own efforts in the absence of the latter in reality; the tendency to relate to oneself events that are not really related to the subject (close to egocentric thinking); seeing in the words, statements or actions of other people criticism, insults addressed to oneself; with certain reservations, this can include the phenomenon of "magical thinking" - hyperbolic confidence in one's involvement in any or especially "grand" events or accomplishments, faith in one's own clairvoyance, and so on;

e) maximalism, dichotomous thinking, or "black-and-white" thinking, - attributing an event to one of two poles, for example, absolutely good or absolutely bad events. As one of the patients we observed said: “From the fact that I love myself today, it does not follow that tomorrow I will not hate myself.” .

All these examples of irrational thinking are the field of activity for a cognitive psychotherapist. Using various techniques, he instills in the client the ability to perceive information in a different, positive light.

In summary, the general scheme used in cognitive therapy is:

External events (stimuli) → cognitive system → interpretation (thoughts) → feelings or behavior.

It is important that A. Beck distinguished different types or levels of thinking. First, he singled out arbitrary thoughts: the most superficial, easily realized and controlled. Second, automatic thoughts. As a rule, these are stereotypes imposed on us in the process of growing up and upbringing. automatic thoughts is distinguished by a kind of reflex, curtailment, conciseness, not subject to conscious control, transience. Subjectively, they are experienced as an indisputable reality, a truth that cannot be verified or disputed, according to A. Beck, like the words of parents heard by small and gullible children. And thirdly, basic schemas and cognitive beliefs, that is, the deep level of thinking that occurs in the area of ​​the unconscious, which is the most difficult to change. A person perceives all incoming information at one of these levels (or at all at once), analyzes, draws conclusions and builds his behavior on their basis.

Cognitive psychotherapy in the Beck version is a structured training, experiment, training in the mental and behavioral plans, designed to help the patient master the following operations:

Steps of cognitive correction: 1) detection, recognition of automatic thoughts, 2) identification of the main cognitive theme, 3) recognition of generalized basic beliefs, 4) purposeful change of problematic basic assumptions to more constructive ones, and 5) consolidation of constructive behavioral skills acquired during therapeutic sessions.

Aaron Beck and his co-authors have developed a whole range of techniques aimed at correcting the automatic dysfunctional thoughts of depressed patients. For example, when working with patients who are prone to self-flagellation or taking on excessive responsibility, the technique of reattribution is used. The essence of the technique is to, through an objective analysis of the situation, highlight all the factors that could affect the outcome of events. Exploring fantasies, dreams and spontaneous utterances depressed patients, A. Beck and A. Ellis found three main themes as the content of basic schemes:

1) fixation on a real or imaginary loss - the death of loved ones, the collapse of love, loss of self-esteem;

2) a negative attitude towards oneself, towards the world around, a negative pessimistic assessment of the future;

3) the tyranny of duty, i.e. the presentation of rigid imperatives to oneself, uncompromising demands such as “I must always be the very first” or “I must not allow myself any indulgences”, “I must never ask anyone for anything” and etc.

Homework is of the utmost importance in cognitive therapy. The undoubted advantage of cognitive psychotherapy is its cost-effectiveness. On average, the course of therapy includes 15 sessions: 1-3 weeks - 2 sessions per week, 4-12 weeks - one session per week.

Cognitive therapy is also characterized by high efficiency. Its successful use leads to fewer relapses of depression than the use of drug therapy.

When starting therapy, the client and therapist must agree on what problem they are to work on. It is important that the task is precisely to solve problems, and not to change the personal characteristics or shortcomings of the patient.

Some principles of the work of the therapist and the client were taken by A. Beck from humanistic psychotherapy, namely: the therapist should be empathic, natural, congruent, there should be no directives, client acceptance and Socratic dialogue are welcome.

Curiously, over time, these humanistic requirements were practically removed: it turned out that the straightforward-directive approach in many cases turned out to be more effective than the Platonic-dialogical one.

However, unlike humanistic psychology, where the work was mainly with feelings, in the cognitive approach, the therapist works only with the client's way of thinking. In dealing with a client's problems, the therapist has the following goals: to clarify or define problems, to help identify thoughts, images, and sensations, to explore the meaning of events for the client, and to evaluate the consequences of persisting maladaptive thoughts and behaviors.

In place of confused thoughts and feelings, the client should have a clear picture. In the course of work, the therapist teaches the client to think: to refer to the facts more often, to evaluate the probability, to collect information and put it all to the test.

Experience testing is one of the most important points that the client should be accustomed to.

Much of the testing of hypotheses happens outside of the session, during homework. For example, a woman who assumed that her girlfriend did not call her because she was angry called her to check whether her assumption was correct or not. Similarly, a man who thought everyone was watching him in a restaurant later dined there to make sure that others were more busy eating and talking to friends than they were. Finally, a first-year student, in a state of severe anxiety and depression, tried, using the method of paradoxical intention proposed by the therapist, to act contrary to her basic belief "If I can to do something, I should do it” and chose not to pursue the prestige goals that it was originally oriented towards. This restored her sense of self-control and reduced her dysphoria.

If the client says, "Everyone looks at me when I'm walking down the street," the therapist might suggest, "Try walking down the street and counting how many people have looked at you." If the client completes this exercise, his opinion on this matter will change.

However, if the client's belief was in some way beneficial to him, such an "objection" on the part of the therapist is unlikely to seriously work: the client simply will not do the exercise suggested by the therapist and will remain with his previous belief.

One way or another, the client is offered various ways to test his automatic judgments by experience. Sometimes for this it is proposed to find arguments "for" and "against", once the therapist turns to his experience, to fiction and academic literature, statistics. In some cases, the therapist allows himself to "convict" the client, pointing out logical errors and contradictions in his judgments.

In addition to experiential testing, the therapist uses other ways to replace automatic thoughts with measured judgments. The most commonly used here are:

1. Method of reassessment: checking the likelihood of alternative causes of an event. Patients with a syndrome of depression or anxiety often blame themselves for what is happening and even the occurrence of their syndromes ("I think wrong, and therefore I am sick"). The patient has the opportunity to make his reactions more in line with reality by reviewing the many factors influencing the situation, or by applying a logical analysis of the facts. A woman with anxiety syndrome sadly explained that she felt nauseous, dizzy, agitated, and weak when she was "anxious." After checking alternative explanations, she visited a doctor and learned that she was infected with an intestinal virus.

2. Decentration or depersonalization thinking is used when working with patients who feel they are in the center of attention of others and suffer from this, for example, with social phobia. Such patients are always confident in their own vulnerability to the opinions of others about them and are always set to expect negative assessments; they quickly begin to feel ridiculous, rejected, or suspect. A young man habitually thinks that people will think he is stupid if he does not appear to be completely self-confident, on this basis he refuses to go to college. When it came time to apply to an educational institution, he conducted an experiment to determine the actual degree of uncertainty. On the day of the submission of documents, he asked several applicants like him about their well-being on the eve of the upcoming exams and the forecast of their own success. He reported that 100% of the applicants were friendly towards him, and many, like him, experienced self-doubt. He also felt satisfied that he could be of service to other applicants.

3. Conscious self-observation. Depressed, anxious and other patients often think that their ailments are controlled by higher levels of consciousness, constantly observing themselves, they understand that the symptoms do not depend on anything, and the attacks have a beginning and an end. Anxiety correction helps the patient to see that even during an attack, his fear has a beginning, a peak and an end. This knowledge maintains patience, breaks down the destructive notion that the worst is about to happen, and reinforces the patient in the idea that he can survive the fear, that the fear is short-lived, and that he simply has to wait out the wave of fear.

4. Decastrophy. For anxiety disorders. Therapist: “Let's see what would happen if…”, “How long will you experience such negative feelings?”, “What will happen next? You will die? Will the world collapse? Will it ruin your career? Will your loved ones abandon you?" etc. The patient understands that everything has a time frame and the automatic thought “this horror will never end” disappears.

5. Purposeful repetition. Re-enactment of the desired behavior, repeated testing of various positive instructions in practice, which leads to increased self-efficacy.

Methods of work may vary depending on the type of patient's problems. For example, in anxious patients, not so much "automatic thoughts" as "obsessive images" predominate, that is, it is rather not thinking that maladjusts, but imagination (fantasy). In this case, cognitive therapy uses the following methods to stop inappropriate fantasies:

One of the frequently used and very effective techniques here is constructive imagination. The patient is asked to rank the expected event in steps. Thanks to acting out in the imagination and scaling, the forecast loses its globality, assessments become more gradual, and negative emotions become more accessible to self-control and manageable. In fact, the desensitization mechanism works here: a decrease in sensitivity to disturbing experiences due to their calm and methodical reflection.

In dealing with depressed patients, cognitive therapists work on their basic principle: a person's feelings and states are determined by his thoughts. Depression occurs when a person begins to think that he is worthless or that no one loves him. If you make his thoughts more realistic and justified, then the person's well-being improves, depression disappears. A. Beck, observing patients with neurotic depression, drew attention to the fact that in their experiences the themes of defeat, hopelessness and inadequacy constantly sounded. According to his observations, depression develops in people who perceive the world in three negative categories:

To correct these problems, A. Beck compiled a behavioral therapeutic program that uses self-control, role-playing, modeling, homework and other forms of work.

J. Young and A. Beck (1984) point to two types of problems in therapy: difficulties in the relationship between the therapist and the patient and the misuse of techniques. Proponents of CT insist that only those who are not well versed in cognitive therapy can view it as a technique-oriented approach and therefore overlook the importance of the patient-therapist relationship. Although CT is a prescriptive and fairly well structured process, the therapist must remain flexible, ready to deviate from the standard when required, adapting the methodological procedures to the patient's individuality.