Methods of behavioral psychotherapy. Cognitive Behavioral Therapy - what is it and how is it treated

Cognitive Behavioral Therapy How to learn to be aware that you are not always behaving correctly Today, cognitive behavioral therapy is widely used to treat various mental disorders, such as depression, phobias,

Chapter 4. Behavioral Therapy History of the Behavioral Approach psychological disorders emerged relatively recently, in the late 1950s. Early developmental behavioral therapy

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

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

Features of behavioral psychotherapy

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

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

The behavioral approach includes an extensive list various techniques. Although initially such a term as “behavior” in psychology was perceived solely as an externally observed and manifested characteristic. Now this includes a wide range of manifestations - from emotional-subjective and cognitive, to motivational-affective and not only.

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

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

Behaviorism or behavioral therapy also determines the approach to the problems of disease and health. The health of a person or his illness is a natural result of what a person has learned or has not learned. Personality is the experience gained by a person during his life. At the same time, neurosis does not act as an independent unit, since the nosological approach here, in its essence, does not have a place to be. The focus is not on the disease at all, but on the symptom to a greater extent.

Key points

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

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

Application of behavioral therapy

Various methods of behavioral therapy are focused on helping patients who are faced with different difficult situations requiring expert intervention. For example, PT is performed for autism, social phobia, and even obesity.

The Behavior Therapy System is used in the following situations:

• at anxiety states;
• in case of chronic mental disorders;
• with sexual disorders;
• to solve emerging marital and interpersonal problems;
• in psychopathology in children.

Studies have clearly shown that PT can effectively help in case of phobias in humans. In this case, the main technique used is systematic exposure. The concept of exposure is understood as a number of techniques that are based on the presentation of existing fears of patients. Also, as a supplement for anxiety conditions, the technique is used.

Has been proven high efficiency method of behavioral therapy in solving problems in the field of sexual relations.

Many patients prefer this type of psychotherapy because it solves the problem. premature ejaculation, vaginismus, impotence, etc.

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

If we talk about mental disorders, then PT is able to solve the problems of exclusively chronic, but not acute disorders. Behavioral Methods effects are used when working with patients who have observed pronounced change personality or low self-care score.

PT allows you to solve the psychological problems of patients in early childhood - this is bad behavior, excessive aggression and other violations of the norms. In the treatment of hyperactivity, the so-called token technique is widely used. The effectiveness of PT has been clearly proven, if necessary, to increase the child's progress in solving the problem of autism. Autism is a real problem for many children. But it is the PT that demonstrates one of best results on the normalization of behavioral and intellectual development. Of course, the percentage is only about 2% of children with autism who can be cured. But among all the methods that exist today, only PT has managed to achieve such impressive results.

Basic methods of PT

Cognitive restructuring technique

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

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

Rational Emotional Behavior Therapy is a combination of behavioral as well as cognitive methods. RET, REBT, or Rational Emotional Behavior Therapies use reward factors. The simplest of these are a nod, a smile, or attention. Everyone is looking for a reward or promotion. And those people from whom we receive them become important and close to us, friendship develops. Those who do not give encouragement, we do not perceive or even try to avoid.

self control

The method provides for the need for the patient to directly participate in the determination of the goal of his treatment and the strict implementation of the therapy program. For these purposes, different self-control procedures are used.

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

The clearer and shorter the set goals, the higher the likelihood of forming successful self-control. If you just say to yourself, “I won’t eat much from tomorrow,” success will not be achieved. You need to say "From tomorrow I will eat no more than 1 thousand calories." Fuzzy goals lead to failure, which negatively affects self-esteem. If it is possible to achieve the goal, the patient has an incentive to develop success.

Disgust Technique

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

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

Method of Punishment

Unlike the previous method, here the patient receives punishment after an undesirable behavioral situation. For example, the patient made unwanted action and then received an electric shock. Such methods treat writing spasm of tremor and spastic form.

Punishment training stimulates a person to relax the necessary muscle groups, thereby coping with the problem.

Positive reinforcements

This method is based on establishing a connection between the current behavior of the patient and the consequences of his behavior. The most popular method of positive reinforcement is the so-called token system. It is widely used both in working with closed and unsociable children or adults, and in the treatment of people with severe personal or mental retardation.

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

self-confidence

The technique was developed to work with insecure people. They are not able to express their emotions or defend their rights, their own opinion. Such people are often exploited, they do not respect themselves. What can we say about the respect from the surrounding people.

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

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

Systematic desentation (SD)

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

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

SD or systemic behavioral psychotherapy is also carried out with the help of a real immersion of a person or patient in the situation of his phobia. Moreover, psychotherapists claim that this approach gives the highest effect.

Modeling technique

Not infrequently, specialists resort to the modeling method. It involves teaching the patient the desired behavior by modeling it or visual demonstration.

The simplest example is that a psychotherapist, by his own example, shows his patient how to behave in a particular situation that can provoke fear or anxiety.

Suppose you are very afraid of cockroaches. The specialist clearly demonstrates that they are not dangerous and it is very easy to kill them. First, training is carried out by visual demonstration, then the patient trains on some kind of mock-ups or rubber insects. Gradually, a person independently reacts to his fear without screaming, panic and fear.

Fading methods

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

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

Behavioral therapy can treat symptoms or the disease itself, but this psychotherapy is not designed to address the causes. Therefore, unwanted behavior sometimes appears again after the completion of the course of treatment. In such situations, change the method of exposure or conduct a second course.

Cognitive behavioral therapy is a type of treatment that helps patients become aware of the feelings and thoughts that influence their behavior. It is commonly used to treat a wide range of ailments, including addiction, phobias, anxiety, and depression. Behavioral therapy, which is becoming very popular today, is mostly short-lived and is primarily aimed at helping people with a specific problem. In treatment, clients learn to change and identify disturbing or destructive thought patterns that have a negative impact on their behavior.

origins

How did cognitive-or What made the adherents of popular psychoanalysis turn to the study of various models human cognition and behaviour?

Who founded in 1879 at the University of Leipzig the first official laboratory dedicated to psychological research, is considered the founder of experimental psychology. But it is worth noting that what was then considered experimental psychology is very far from today's experimental psychology. In addition, it is known that the current psychotherapy owes its appearance to the works of Sigmund Freud, known throughout the world.

At the same time, few people know that applied and experimental psychology have found fertile ground for their development in the United States. In fact, after the arrival of Sigmund Freud in 1911, psychoanalysis managed to surprise even prominent psychiatrists. So much so that in a few years, about 95% of the country's psychiatrists were trained in methods of working in psychoanalysis.

This monopoly in the United States on psychotherapy continued until the 1970s, while it lingered in the profile circles of the Old World for another 10 years. It is worth noting that the crisis of psychoanalysis - in terms of its ability to respond to various changes in the demands of society after the Second World War, as well as its ability to "cure" it - began in the 1950s. At this time, alternative alternatives were born. The main role was played among them, of course, by cognitive behavioral therapy. Very few people dared to do exercises on their own from it then.

Arising immediately in different parts light, thanks to the contribution of psychoanalysts, dissatisfied with their tools of intervention and analysis, rational-emotional-behavioral therapy soon spread throughout Europe. She is for a short time has proven itself as a treatment method that can provide effective solution various problems clients.

Fifty years have passed since the publication of G. B. Watson's work on the topic of behaviorism, as well as the application of behavioral therapy, only after that time did it take its place among the working areas of psychotherapy. But its further evolution took place at an accelerated pace. There was a simple reason for this: like other techniques that were based on scientific thought, cognitive behavioral therapy, the exercises of which are given in the article below, remained open to change, integrated and assimilated with other techniques.

She absorbed the results of research that was carried out in psychology, as well as in other scientific fields. This has led to the emergence of new forms of intervention and analysis.

This 1st generation therapy, characterized by a radical shift from the psychodynamic known therapy, was soon followed by a set of "innovations". They already took into account previously forgotten cognitive aspects. This fusion of cognitive and behavioral therapy is next generation behavioral therapy, also known as cognitive behavioral therapy. She is still being trained today.

Its development is still ongoing, more and more new methods of treatment are emerging, which belong to the therapy of the 3rd generation.

Cognitive Behavioral Therapy: The Basics

The basic concept suggests that our feelings and thoughts play a major role in shaping human behavior. So, a person who thinks too much about accidents on the runway, plane crashes and other air disasters may avoid traveling by various air transport. It is worth noting that the goal of this therapy is to teach patients that they cannot control every aspect of the world around them, while they can completely take control of their own interpretation of this world, as well as interaction with it.

AT recent times cognitive behavioral therapy alone is being used more and more. This type of treatment basically does not take much time, due to which it is considered more accessible than other types of therapy. Its effectiveness has been empirically proven: experts have found that it enables patients to cope with inappropriate behavior in its various manifestations.

Types of therapy

Representatives of the British Association of Cognitive and Behavioral Therapists note that this is a range of treatments based on principles and concepts created on the basis of patterns of human behavior and emotions. They include a huge range of approaches to getting rid of emotional disorders, as well as self-help opportunities.

The following types are regularly used by specialists:

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

Behavior Therapy Methods

They are used in cognitive learning. Main Method This is behavioral rational-emotional therapy. Initially, the irrational thoughts of a person are established, then the reasons for the irrational belief system are found out, after which the goal is approached.

As a rule, general training methods are ways of solving problems. The main method is biofeedback training, which is used mainly to get rid of the effects of stress. In this case, an instrumental study of the general state of muscle relaxation takes place, as well as optical or acoustic feedback occurs. Muscle relaxation with feedback is positively reinforced, after which it leads to complacency.

Cognitive Behavioral Therapy: Methods of Learning and Assimilation

Behavior therapy systematically uses the postulate of education, according to which it is possible to teach, as well as learn the right behavior. Learning by example is one of the most important processes. Methods of assimilation are guided mainly by then people build their desired behavior. A very important method is simulation learning.

The model is systematically imitated in vicarious learning - a person or a symbol. In other words, inheritance can be induced through participation, symbolically or implicitly.

Behavioral therapy is actively used when working with children. Exercise in this case contains reinforcing immediate stimuli, such as candy. In adults, this goal is served by a system of privileges, as well as rewards. Prompting (support of the therapist leading by example) is gradually reduced when successful.

Weaning methods

Odysseus in Homer's Odyssey, on the advice of Circe (the sorceress), orders himself to be tied to the mast of the ship in order not to be subjected to the singing of seductive sirens. He covered the ears of his companions with wax. With overt avoidance, behavioral therapy reduces the impact, while making some changes that increase the likelihood of success. For example, an aversive stimulus, such as a smell that causes vomiting, is added to negative behavior, alcohol abuse.

Cognitive behavioral therapy exercises are very different. So, with the help of a device designed for the treatment of enuresis, it turns out to get rid of nocturnal urinary incontinence - the mechanism of awakening the patient immediately works when the first drops of urine appear.

Elimination Methods

Elimination methods should deal with inappropriate behavior. It is worth noting that one of the main methods is systematic desensitization to decompose the fear response using 3 steps: training deep muscle relaxation, compiling a complete list of fears, and alternating irritation and relaxation of fears from the list in ascending order.

Methods of confrontation

These methods use accelerated contact with initial fear stimuli regarding peripheral or central phobias in various mental disorders. The main method is flooding (storming various stimuli using firm methods). At the same time, the client is subjected to direct or intense mental influence of all kinds of fear stimuli.

Components of therapy

Often people experience feelings or thoughts that only reinforce them in a wrong opinion. These beliefs and opinions lead to problematic behavior that can affect all areas of life, including romantic relationship, family, study and work. For example, a person who suffers from low self-esteem may have negative thoughts about himself, his abilities, or his appearance. Because of this, a person will begin to avoid situations of interaction with people or refuse career opportunities.

Behavioral therapy is used to correct this. To combat such destructive thoughts and negative behaviors, the therapist begins by helping the client establish problematic beliefs. This stage, also known as "functional analysis", is important for understanding how situations, feelings and thoughts can contribute to inappropriate behavior. This process can be problematic, especially for clients who struggle with self-introspection tendencies, although it can lead to the conclusions and self-knowledge that are considered an essential part of the healing process.

Cognitive behavioral therapy includes the second part. It focuses on the actual behavior that contributes to the development of the problem. A person begins to practice and learn new skills, which can then be applied in real situations. So, a person who suffers from drug addiction, is able to learn the skills to overcome this craving and can avoid social situations that could potentially cause a relapse, as well as cope with all of them.

CBT is, in most cases, a smooth process that helps a person take new steps towards changing their behavior. Thus, a sociophobe may start by simply imagining himself in a particular social situation that causes him anxiety. Then he can try to talk to friends, acquaintances and family members. The process with regular movement towards the goal does not seem so difficult, while the goals themselves are absolutely achievable.

Use of CBT

This therapy is used to treat people who suffer from a wide range of diseases - phobias, anxiety, addiction and depression. CBT is considered one of the most studied types of therapy, in part because of the fact that treatment focuses on specific problems and its results are relatively easy to measure.

This therapy is best suited for introspective clients. For CBT to be truly effective, a person must be ready for it, they must be willing to put in the effort and time to analyze their own feelings and thoughts. Such introspection can be difficult, and it wonderful way learn more about the impact internal state on behavior.

Cognitive Behavioral Therapy is also great for people who need fast treatment which does not involve the use of certain medications. So, one of the advantages of cognitive behavioral therapy is that it helps clients develop skills that can be useful today and later.

Development of self-confidence

It is worth mentioning right away that self-confidence arises from various qualities: the ability to express needs, feelings and thoughts, in addition, to perceive the needs and feelings of other people, the ability to say “no”; in addition, the ability to start, end and continue conversations, while speaking to the public freely, etc.

This training is aimed at overcoming possible social fears, as well as difficulties in contacts. Similar effects are also used for hyperactivity and aggressiveness, to activate clients who are long time in the treatment of psychiatrists, and with mental retardation.

This training primarily has two goals: the formation of social skills and the elimination of social phobias. Many methods are used, for example behavioral exercises and role-playing games, training in daily situations, operant techniques, model training, group therapy, video techniques, self-control methods, etc. This means that in this training, in most cases, we are talking about a program using all kinds of methods in some order.

Behavioral therapy for children is also used. Special forms of this training were created for kids with communication difficulties and social phobias. Peterman and Peterman proposed a therapeutic compact program that, along with group and individual training, also includes counseling for the parents of these children.

Criticism of the CBT

Some patients at the beginning of treatment report that, regardless of the simple enough awareness of the irrationality of some thoughts, the mere awareness of the process of getting rid of it does not make it easy. It should be noted that behavioral therapy involves identifying these thought patterns, and it also aims to help get rid of these thoughts using a huge number of strategies. They may include role play, journaling, distraction and relaxation techniques.

Now let's look at some exercises that you can do yourself at home.

Muscular progressive relaxation according to Jacobson

The session is done while sitting. You need to lean your head against the wall, put your hands on the armrests. First, you should cause tension in yourself in all muscles sequentially, while this should occur on inspiration. We give ourselves a feeling of warmth. In this case, relaxation is accompanied by a very fast and rather sharp exhalation. Muscle tension time is about 5 seconds, relaxation time is about 30 seconds. In addition, each exercise must be done 2 times. This method is great for kids too.

1. Muscles of the hands. Stretch your arms forward, spread your fingers in different directions. You need to try to reach the wall with your fingers like that.
2. Brushes. Clench your fists as hard as possible. Imagine that you are squeezing water out of a compressible icicle.
3. Shoulders. Try to reach the earlobes with your shoulders.
4. Feet. Reach to the middle of the leg with your toes.
5. Stomach. Make your stomach stone, as if reflecting a blow.
6. Thighs, shins. The toes are fixed, the heels are raised.
7. Middle 1/3 of the face. Wrinkle your nose, squint your eyes.
8. Upper 1/3 of the face. Wrinkle forehead, surprised face.
9. Lower 1/3 of the face. Fold your lips with a "proboscis".
10. Lower 1/3 of the face. Take the corners of the mouth to the ears.

self instructions

We all say something to ourselves. We give ourselves instructions, orders, information for a specific problem solving or instructions. In this case, the person may start with a verbalization that will eventually become part of the entire behavioral repertoire. People are taught such direct instructions. At the same time, in some cases they become "counter-instructions" to aggression, fear, and others. At the same time, self-instructions with approximate formulas are applied according to the steps below.

1. Prepare for the stressor.

• “It's easy to do. Remember humor."
• "I can create a plan to deal with this."

2. Responding to provocations.

• "As long as I remain calm, I am in complete control of the whole situation."
• “In this situation, anxiety will not help me. I'm absolutely sure of myself."

3. Reflection of experience.

• If the conflict is unresolvable: “Forget about the difficulties. To think about them is only to destroy yourself.
• If the conflict is resolved or the situation is handled well: "It wasn't as scary as I expected."

Introduction……………………………………………………………………………………………………………3

1. Theoretical base……………………………………………………………………………………….3

2. Methods of behavioral therapy ..………………………………………………………………..4

2.1 Stimulus control techniques………………………………………………………………………….4

2.2.Consequence control techniques………………………………………………………………..9

2.3. Learning from models……………………….……………………………………………………….11
Introduction

Behavioral psychotherapy is one of the main directions in foreign psychotherapy. In the domestic literature, her methods were usually used under the name of conditioned reflex psychotherapy. It was formed between 1950 and 1960 and is associated with the names of A. Lazarus, J. Wolpe, G. Eysenck, S. Rahman, B. Skinner.

Theoretical base

Theory of reflexes I.P. Pavlova.
Experiments on conditioned reflexes have shown that the formation of a conditioned reaction is subject to a number of requirements:

1) adjacency - coincidence in time of indifferent and unconditioned stimuli;

2) repetition, but under certain conditions it is possible to form after the first combination.

3) the higher the intensity of the need, the easier the conditioned reflex is formed.

4) a neutral stimulus must be strong enough to stand out from the general background of stimuli;

5) the extinction of the conditioned reflex after the termination of its reinforcement occurs gradually and not completely;

6) the most resistant to extinction are conditioned reflexes formed with a variable interval and a variable ratio.

7) it is important to take into account the law of generalization and differentiation of the stimulus.

At the second stage of the development of behavioral psychotherapy, theories of instrumental or operant conditioning acted as theoretical foundations.

The formation of a conditioned reaction takes place through trial and error, as a result of the choice (selection) of the desired standard of behavior and its subsequent consolidation on the basis of the law of effect.

It is formulated as follows: behavior is fixed (controlled) by its results and consequences.

Instrumental reflexes are controlled by their outcome, and in classical conditioned reflexes, reactions are controlled by the presentation of a preceding stimulus.

The main ways to change behavior in therapy:

1. Impact on the consequences (results) of behavior and

2. Management of stimulus presentation.

3. Correcting inappropriate behavior and teaching adequate behavior.

Man is a product of the environment and at the same time its creator. Behavior is formed in the process of learning and learning. Problems arise as a result of flaws in learning. The consultant is an active party: he plays the role of a teacher, a coach, trying to teach the client more effective behavior. The client must actively test new ways of behaving. Instead of a personal relationship between the consultant and the client, a working relationship is established to carry out the training procedures.

The main goal is the formation and improvement of skills. These techniques also improve self-control.

Behavioral psychotherapy is designed to reduce human suffering and limit a person's ability to act.

The concept of mental disorders is based on the notion that “disturbed” or “abnormal” behavior can be explained and changed along the same lines as “normal” behavior.

In the behavioral approach, everything is based on “functional analysis”, the essence of which is to describe complaints in the form of psychological problems (problem analysis) and find out those basic conditions, the change of which will lead to a change in the problem and find out those basic conditions, the change of which will lead to a change in the problem . For the analysis, a multilevel analysis is used (micro- and macro-perspectives).

Basic points of behavioral therapy:

1. Using the achievements of fundamental empirical psychological research, especially the psychology of learning and social psychology;

2. Orientation to behavior as a mental variable that can be formed or suppressed as a result of learning;

3. Predominant (but not exclusive) concentration on present rather than past determinants of behavior;

4. Emphasis on empirical testing of theoretical knowledge and practical methods;

5. Significant predominance of methods based on training.

Behavior Therapy Methods

Stimulus control techniques

A group of techniques by which the patient is given a strategy for coping with problem situations.

A classic example of stimulus control is the so-called. methods of confrontation in the behavior of avoidance, due to fear.

In the presence of anticipated fear, when the patient is not able to endure certain situations, the task of the psychotherapist is to encourage the client to confront the frightening situation, then extinction and overcoming of fear can occur. According to cognitive learning theory, the patient's problem in the behavioral repertoire remains so stable precisely because, due to complete avoidance, the person does not experience safe behavior, and therefore no extinction occurs.

If a person seeks to get out of a situation that he considers dangerous as quickly as possible, then avoidance is additionally negatively reinforced.

In the process of confrontation, the patient must gain concrete experience in the cognitive, behavioral and physiological plane and experience that confrontation with a subjectively disturbing situation does not entail the expected "catastrophe"; having passed the "plateau" in excitement, fear is removed in several planes, which also leads to an increase in faith in one's own ability to overcome.

Techniques can be varied: systematic desensitization, exposures, flooding techniques, implosion techniques, and paradoxical interventions. The emphasis in them may be on control or self-control, but in all there is a confrontation of the individual with a situation that causes fear. Such a situation is realized with a gradually increasing intensity of fear and in the representation, or really (in vivo), or without growth and really (exposure), or to carry out massively - either in the representation (implosion), or really (flood). Self-control implies compliance with the rule, that therapy is carried out step by step by the patient. When a patient takes step-by-step self-management, it makes a huge difference both ethically and in terms of sheer effectiveness and cost/benefit ratio.

Systematic desensitization

The method of systematic desensitization suggests that pathogenic responses are maladaptive responses to the external situation.

After being bitten by a dog, the child extends his reaction to all kinds of situations and to all dogs. Afraid of dogs on TV, in a picture, in a dream ...

Task: to make the child insensitive, resistant to a dangerous object.

Elimination mechanism: the mechanism of mutual exclusion of emotions, or the principle of reciprocity of emotions. If a person experiences joy, then he is closed to fear; if relaxed, then also not subject to reactions of fear.

Therefore, if you “immerse” in a state of relaxation or joy, and then show stressful stimuli, then there will be no fear reactions.

Methodology: in a person in a state of deep relaxation, ideas about situations leading to the emergence of fear are evoked. Then, by deepening relaxation, the patient relieves the emerging anxiety.

There are 3 stages in the procedure:

1. Mastering the technique of muscle relaxation,

2. Drawing up a hierarchy of situations that cause fear,

3. Actually desensitization (connection of representations with relaxation)

Relaxation is a universal resource. The technique of progressive muscle relaxation according to E. Jacobson is used.

He suggested that the relaxation of the muscles entails a decrease in neuromuscular tension. He also noticed that a different type of response corresponds to the tension of a certain muscle group. Depression - tension of the respiratory muscles; fear - muscles of articulation and phonation. Differentiated relaxation of muscle groups can selectively influence negative emotions.

In the course of performing progressive muscle relaxation, with the help of concentration of attention, the ability to catch tension in the muscles and a feeling of muscle relaxation is first formed, then the skill of mastering voluntary relaxation of tense muscle groups is developed.

All muscles of the body are divided into sixteen groups. The sequence of exercises is as follows: from the muscles of the upper limbs (from the hand to the shoulder, starting with the dominant arm) to the muscles of the face (forehead, eyes, mouth), neck, chest and abdomen and then to the muscles lower extremities(from hip to foot, starting with the dominant leg).

Exercises begin with a short-term, 5-7-second, tension of the first muscle group, which then completely relax within 30-45 seconds; attention is focused on the feeling of relaxation in that area of ​​the body. The exercise in one muscle group is repeated until the patient feels complete muscle relaxation; Only then do they move on to the next group.

To successfully master the technique, the patient must perform the exercise independently during the day twice, spending 15-20 minutes on each exercise. As the skill in relaxation is acquired, muscle groups become larger, the strength of tension in the muscles decreases, and gradually attention is increasingly focused on the memory.

With the help of a psychotherapist, the client builds a hierarchy of stimuli that provoke, first of all, anxiety, and then reproduce psychotrauma as a whole. Such a hierarchy should include 15-20 objects. It is also important to organize incentives correctly. Then he is presented with these stimuli, starting with the most harmless. Stressfulness of stimuli should increase gradually. After he copes with one stimulus, the next one is presented.

When presenting stimuli, two methods can be used: either desensitization in the imagination, or graduated exposure (in vivo desensitization).

Desensitization in the imagination is that the client, being in a state of relaxation, imagines scenes that cause him anxiety, imagines the situation for 5-7 seconds, then eliminates anxiety by increasing relaxation. This period lasts up to 20 seconds. The performance is repeated several times. If the alarm does not occur, then move on to the next more difficult situation on the list.

At the final stage, after daily analysis of local muscle tensions arising from anxiety, fear and excitement, the client independently achieves muscle relaxation and thus overcomes emotional stress.

Stepwise, graded exposure (or in vivo desensitization) suggests that the patient must face anxiety-producing stimuli (starting with the weakest) in real life, accompanied by a therapist who encourages them to increase anxiety. Faith in and contact with the therapist is a counter-conditioning factor.

This option is preferred by most psychotherapists, since it is the collision with real-life stressors that is always the ultimate goal of treatment, and this method is more effective.

Other types of desensitization:

1. Contact desensitization - in addition to bodily contact with an object, modeling is also added - performing actions on the list by another person without fear.

2. Emotive imagination - identification with a favorite hero and the hero's encounter with situations that cause fear. This option can be used in real life as well.

3. Game desensitization.

4. Drawing desensitization.

Many of the methods used in behavioral therapy require the use of an exposure technique in which the patient is exposed to fear-inducing stimuli or conditioning stimuli.

This is done in order to create conditions for the extinction (as the situation becomes habitual) of the conditioned reflex emotional reaction to this set of incentives. It is believed that this technique can also serve as a means of refuting the patient's expectations or beliefs about certain situations and their consequences.

There are several varieties of treatments based on the use of exposure techniques; they differ depending on the way the stimuli are presented (the patient can be exposed to them in imagination or in vivo) and the intensity of the impact (whether a gradual transition to stronger stimuli is carried out during treatment or the patient is immediately confronted with the most powerful of them). In some cases, for example, when adapting to traumatic memories during the treatment of post-traumatic stress disorder, already due to the specific nature of the disorder, only exposure in the imagination is applicable.

Similarly, the patient's irrational thoughts are challenged by exposing him to situations that show that these ideas are false or unrealistic.

Dive, flood

If the approach used in desensitization could be compared to how a person is taught to swim first in a shallow place, gradually moving to a depth, then when “immersing” (using the same analogy), on the contrary, he is immediately thrown into whirlpool.

When using this method, the patient is placed in the most difficult situation for him, related to the top of the hierarchy of stimuli (this may be, for example, visiting a crowded store or a bus ride at rush hour), and he must be exposed to it until until the anxiety disappears spontaneously ("acquiring a habit"). The technique emphasizes the value of a quick collision, experiencing a strong emotion of fear. The sharper the encounter with the situation, the longer it lasts, the more intense the experience, the better.

The essence of the technique is that a long-term exposure of a psycho-traumatic object leads to transcendental inhibition, which is accompanied by a loss of psychological sensitivity to the impact of the object. The patient must make sure that there are no possible negative consequences. The patient, together with the therapist, finds himself in a traumatic situation until the fear begins to decrease. Covert avoidance mechanisms should be excluded. It is explained to the patient that covert avoidance-reducing the subjective level of fear reinforces this avoidance further. The procedure takes an hour and a half. The number of sessions is from 3 to 10.

Flooding and desensitization difference parameters:

1) fast or slow confrontation (collision) with a stimulus that causes fear;

2) the emergence of intense or weak fear;

3) the duration or short duration of the encounter with the stimulus.

Although many are not easy to convince to go for it, immersion is a faster and more effective method than desensitization.

implosion

Implosion is a flood technique in the form of a story, imagination.

The therapist writes a story that reflects the patient's main fears. The goal is to create maximum fear.

The task of the psychotherapist is to support enough high level fear, do not let it decrease for 40-45 minutes.

After several sessions, you can move on to the flood.

Paradoxical Intention

The patient is asked to stop fighting the symptom and deliberately bring it on voluntarily or even try to increase it.

Those. it is necessary to radically change the attitude towards the symptom, the disease. Instead of passive behavior - the transition to an active offensive on your own fear.

The evoked anger technique uses anger as a reciprocal inhibitor of fear and is based on the assumption that anger and fear cannot coexist at the same time.

In the process of in vivo desensitization, at the moment of the appearance of fear, they are asked to imagine that at that moment something was insulted or something happened that caused intense anger.

Stimulus control techniques are based on the premise that for some stimuli the relationship between stimulus and response is quite rigid.

Events that precede behavior can be grouped as follows:

1) discriminant stimuli, in the past associated with a certain reinforcement,

2) facilitating stimuli that promote certain behavior ( new clothes can help develop communication

3) conditions that increase the strength of reinforcement (deprivation period).

It is necessary to teach the patient to identify discriminant and facilitating stimuli in a real situation, to identify conditions that increase the strength of reinforcement of unwanted behavior, and then remove stimuli that cause such behavior from the environment.

Teaching the patient to reinforce the stimuli associated with the "correct" desired behavior. They teach the ability to correctly manipulate the period of deprivation, without bringing it to the level of loss of control.

Consequence Control Techniques

They imply managing problem behavior through consequences.

Techniques related to the control of consequences are called operant methods or situational control strategies.

The consequences of some problematic and target behavior are organized in such a way that, as a result, the frequency of the target behavior increases (for example, through positive reinforcement), and the problem behavior (through operant extinction) becomes less frequent.

These techniques solve the following tasks:

1. Formation of a new stereotype of behavior,

2. Strengthening the already existing desirable stereotype of behavior,

3. Weakening of undesirable stereotype of behavior,

4. Maintaining the desired stereotype of behavior in natural conditions.

The solution to the problem of reducing undesirable stereotypes of behavior is achieved using several techniques:

1) punishments,

2) extinction;

3) saturation,

4) deprivation of all positive reinforcements,

5) evaluation of the answer.

Punishment is the technique of applying a negative (abusive) stimulus immediately following a response that is being suppressed.

As a negative stimulus, a painful, subjectively unpleasant stimulus is most often used, and then this technique actually turns into an aversive one.

It can also be social incentives (ridicule, condemnation), but they are purely individual.

Methods of direct punishment have an extremely limited value: punishing and aversive methods lead to a number of ethical problems, so their use is legitimate only in extreme cases (alcoholism, pedophilia)

Punishment

Efficiency conditions:

1. Negative stimulus is applied immediately, immediately after the response.

2. Scheme of application of the aversive stimulus: at the first stage, suppression by means of continuous application of the aversive stimulus; further - a non-permanent extinction scheme.

3. The presence in the repertoire of the patient's behavior of alternative responses is important condition carrying out the technique (but for this, the behavior must be purposeful, i.e. the goal retains its significance and the patient is actively looking for it).

extinction

Extinction is the principle of the disappearance of reactions that are not positively reinforced.

The rate of extinction depends on how the undesirable stereotype was reinforced in real life. This method requires considerable time, with an initial period of increase in frequency and strength first.

Depriving all positive reinforcements is one option for extinction. The most effective is isolation.

Response evaluation could more accurately be called a penalty technique. It is used only with positive reinforcement. In addition, positive reinforcement is reduced for unwanted behavior.

Saturation - behavior that is positively reinforced but continues for a long time tends to deplete itself, and positive reinforcement loses its power. Usually not used separately. The art of the psychotherapist lies in the skillful use of various combinations of methods.

Trial Therapy

Trial therapy is an aversive mechanism in which it is prescribed to perform a task that causes even more discomfort than the symptom itself (for insomnia, spend the whole night reading a book standing up).

Uncontrolled pathological skill is deautomatized by its arbitrary daily implementation.

With enuresis, the task is given to wake up if the bed is wet and do calligraphy.

It is necessary to implement a number of steps of the method:

1. Clear identification of the symptom. (Find only excessive anxiety when doing 40 squats, not normal).

2. Strengthening motivation for healing.

3. The choice of the type of test (it should be harsh, but beneficial).

Model Learning

These techniques occupy an intermediate position between classical behavioral and cognitive ones.

They play a crucial role in role play or in training in self-confidence and social competence.

By observing the behavior of other people (and the consequences of this behavior), they learn this behavior or change the pattern of their own behavior in the direction of the behavior of the model.

The observer can quite quickly learn to imitate and adopt even very difficult ways behavior and actions.

During role play behavior is reinforced (behavior training) and transferred to real situations.

Model learning most economically overcomes social phobias and shapes appropriate interactional behavior.

Shaping ways social behavior in aggressive and retarded children, helps with target behavior, and in many cases where verbal methods are difficult (good for treating children).

It is important to remember that in the eyes of patients, the psychotherapist has the function of a model in all respects.

Behavioral psychotherapy is based on the "aspirin metaphor":

it is enough to give aspirin so that the head does not hurt, i.e. no need to look for the cause of the headache - you need to find the means to eliminate it.