Cognitive behavioral therapy cpt. Cognitive-behavioral exercises. Cognitive Behavioral Therapy: The Basics

Behavioral psychotherapy- this is perhaps one of the youngest methods of psychotherapy, but along with this, it is one of the methods prevailing today in modern psychotherapeutic practice. The behavioral direction in psychotherapy emerged as a separate method in the middle of the 20th century. This approach in psychotherapy is based on various behavioral theories, the concepts of classical and operant conditioning, and the principles of learning. The key task of behavioral psychotherapy is to eliminate unwanted behaviors and develop useful behaviors. The most effective use of behavioral techniques in the treatment of various phobias, behavioral disorders and addictions. In other words, such states in which one can detect some individual manifestation as a so-called "target" for further therapeutic effects.

Cognitive Behavioral Psychotherapy

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

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

Cognitive Behavioral Therapy and its techniques are used to eliminate negative thoughts, create new thought patterns and problem analysis methods, and reinforce new statements. These techniques include:

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

— design of new templates;

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

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

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

The main emphasis of this approach of psychotherapy is on the fact that absolutely all psychological problems of a person come from the direction of his thinking. It follows from this that circumstances are not at all the main barrier on the way of an individual to a happy and harmonious life, but the personality itself, with its own mind, develops an attitude to what is happening, forming in itself far from the most good qualities like panic. A subject who is not able to adequately assess the surrounding people, the significance of events and phenomena, endowing them with qualities that are not characteristic of them, will always be overcome by various psychological problems, and his behavior will be determined by the formed attitude towards people, things, circumstances, etc. For example, in the professional sphere If the head of the subordinate enjoys unshakable authority, then any of his points of view will immediately be accepted by the subordinate as the only correct one, even if the mind understands the paradoxical nature of such a view.

In family relationships, the influence of thoughts on the individual has more pronounced features than in the professional sphere. Quite often, most subjects find themselves in situations in which they fear some important event, and then, after its occurrence, begin to understand the absurdity of their own fears. This happens due to the contrived nature of the problem. When faced with any situation for the first time, an individual evaluates it, which is later imprinted in memory as a template, and later, when a similar situation is reproduced, the behavioral reactions of the individual will be determined by the existing template. That is why individuals, for example, survivors of a fire, move several meters away from the source of fire.

Cognitive-behavioral psychotherapy and its techniques are based on the discovery and subsequent transformation of the internal "deep" conflicts of the personality, which are available for its awareness.

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

Methods of behavioral psychotherapy

The behavioral direction in psychotherapy concentrates on the transformation of behavior. Key difference this method psychotherapy from others is, first of all, that therapy is any form of learning new patterns of behavior, the absence of which is responsible for the emergence of psychological problems. Quite often, training involves the elimination of erroneous behaviors or their modification.

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

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

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

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

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

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

In addition to these methods, others are also used, for example, model learning, phased reinforcement and self-reinforcement, reinforcement learning, and self-instruction, systematic desensitization, covert and targeted reinforcement, self-assertion training, a penalty system, conditioned reflex therapy.

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

Behavioral Therapy Techniques

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

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

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

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

Today, in modern psychotherapy, the further development and modification of cognitive-behavioral techniques, their enrichment with techniques from other areas is considered quite important. For this purpose, an association of cognitive-behavioral psychotherapy was created, the main tasks of which are the development of this method, the unification of specialists, the provision of psychological assistance, the creation of various training courses and psycho-correction programs.

This method of psychotherapy appeals to consciousness and helps to get rid of stereotypes and preconceived ideas that deprive us of the freedom of choice and push us to act according to a pattern. The method allows, if necessary, to correct the unconscious, "automatic" conclusions of the patient. He perceives them as truth, but in reality they can greatly distort real events. These thoughts often become the source of painful emotions, inappropriate behavior, depression, anxiety disorders, and other illnesses.

Operating principle

Therapy is based on the joint work of the therapist and the patient. The therapist does not teach the patient how to think correctly, but together with him understands whether the habitual type of thinking helps him or hinders him. The key to success is the active participation of the patient, who will not only work in sessions, but also do homework.

If at the beginning therapy focuses only on the symptoms and complaints of the patient, then gradually it begins to affect the unconscious areas of thinking - deep-seated beliefs, as well as childhood events that influenced their formation. The principle of feedback is important - the therapist constantly checks how the patient understands what is happening in therapy, and discusses possible errors with him.

Progress

The patient, together with the psychotherapist, find out under what circumstances the problem manifests itself: how “automatic thoughts” arise and how they affect his ideas, experiences and behavior. In the first session, the therapist only listens carefully to the patient, and in the next they discuss in detail the patient's thoughts and behavior in numerous everyday situations: what does he think about when he wakes up? What about breakfast? The goal is to make a list of moments and situations that cause anxiety.

Then the therapist and the patient plan a program of work. It includes tasks to perform in places or circumstances that cause anxiety - take the elevator, eat dinner in a public place ... These exercises allow you to consolidate new skills and gradually change behavior. A person learns to be less rigid and categorical, to see different faces problematic situation.

The therapist constantly asks questions and explains points that will help the patient understand the problem. Each session is different from the previous one, because each time the patient moves forward a little and gets used to living without the support of the therapist in accordance with new, more flexible views.

Instead of "reading" other people's thoughts, a person learns to distinguish his own, begins to behave differently, and as a result, his emotional condition. He calms down, feels more alive and free. He begins to be friends with himself and stops judging himself and other people.

In what cases is it necessary?

Cognitive therapy is effective in dealing with depression, panic attacks, social anxiety, obsessive-compulsive disorder and eating behavior. This method is also used to treat alcoholism, drug addiction and even schizophrenia (as a supportive method). At the same time, cognitive therapy is also suitable for dealing with low self-esteem, relationship difficulties, perfectionism, and procrastination.

It can be used both in individual work and in work with families. But it is not suitable for those patients who are not ready to take an active part in the work and expect the therapist to give advice or simply interpret what is happening.

How long does therapy take? How much does it cost?

The number of meetings depends on the willingness of the client to work, on the complexity of the problem and the conditions of his life. Each session lasts 50 minutes. The course of therapy is from 5-10 sessions 1-2 times a week. In some cases, therapy can last longer than six months. A consultation with a cognitive psychologist costs from 2,000 to 4,000 rubles.

History of the method

1913. American psychologist John Watson publishes his first articles on behaviorism (eng. behavior - behavior). He urges colleagues to focus exclusively on the study of human behavior, on the study of communication " external stimulus- external reaction (behavior).

1960s The founder of rational-emotional psychotherapy, the American psychologist Albert Ellis, declares the importance of an intermediate link in this chain - our thoughts and ideas (cognitions). His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various therapies, he came to the conclusion that our emotions and our behavior depend on the style of our thinking. Aaron Beck became the founder of cognitive-behavioral (or simply cognitive) psychotherapy.

This suggests that their perception of the situation is the same. Behavior will depend on the perception of the situation, and views on life are formed during a person’s life.

Definition of Cognitive Behavioral Psychotherapy

Cognitive-behavioral psychotherapy or cognitive-behavioral psychotherapy is one of the areas of science, based on the assumption that the causes mental disorders are dysfunctional attitudes and beliefs.

This can be said about the useful habit of preparing for tomorrow in order to get ready on time and not be late for school or work. It is worth not doing this once and there will be an unpleasant experience of untimely arrival, for example, to a meeting. As a result of acquiring negative experience in the subconscious of a person, it is memorized. When such a situation repeats, the brain gives a signal or a guide to action in order to get away from trouble. Or vice versa, do nothing. That is why some people, having received the first time a refusal of an offer, the next time they try not to do it again. We are always guided by our thoughts, we are under the influence of our own images. What about a person who has had many negative contacts throughout his life, and under their influence a certain worldview has been formed. It prevents you from moving on, conquering new heights. There is an exit. It's called Cognitive Behavioral Therapy.

This method is one of modern trends in the treatment of mental illness. The treatment is based on the study of the origin of human complexes and his psychological problems. The American psychiatrist Aaron Beck is considered the creator of this method of therapy. Currently, Beck's cognitive psychotherapy is one of the most effective ways to treat depression and suicidal tendencies. Psychotherapy uses the principle of changing the patient's behavior and discovering the thoughts that cause illness.

Purpose of therapy

The main goals of cognitive therapy are:

1. Elimination of the symptoms of the disease.
2. Reducing the frequency of relapses after treatment.
3. Increases the effectiveness of the use of drugs.
4. Solving many social problems of the patient.
5. Eliminate causes that may cause given state, changing human behavior, adapting it to various life situations.

Basic principles of cognitive-behavioral psychotherapy

This technique allows you to eliminate negative thoughts, create new ways of thinking and analysis. real problem. Psychoanalysis includes:

• The emergence of new stereotypes of thinking.
• Exploring unwanted or desirable thoughts and what causes them.
• Visualizing that a new pattern of behavior can lead to emotional well-being.
• How to apply new conclusions in your life, new situations.

The main idea of ​​cognitive psychotherapy is that all the patient's problems come from his thinking. A person himself forms his attitude to everything that happens. Thus, he has the corresponding feelings - fear, joy, anger, excitement. That person who inadequately assesses the things, people and events around him can endow them with qualities that are not inherent in them.

Help doctor

First of all, the psychiatrist in the treatment of such patients tries to identify how they think, which leads to neurosis and suffering. And how to try to replace these categories of feelings with positive ones. People are again learning new methods of thinking that will lead to a more adequate assessment of any life situation. But the main condition of treatment is the desire of the patient to be cured. If a person is not aware of his disease, experiences some resistance, then the treatment may be ineffective. An attempt to change negative thoughts and stimulation to change is quite difficult, because a person does not want to change his behavior, thinking. Many do not understand why they should change something in their lives if they are already doing so well. Conducting cognitive-behavioral psychotherapy alone will be ineffective. Treatment, diagnosis and assessment of the degree of violations should be handled by a specialist.

Varieties of therapy

Like other treatments, cognitive psychotherapy has a variety of techniques. Here are some of the most popular ones:

• Treatment by modeling. A person represents the possible development of the situation as a consequence of his behavior. An analysis is being made of his actions and how to deal with it. Apply various methods relaxation, which will allow you to get rid of anxiety and remove possible provoking factors leading to stress. The method has proven itself in the treatment of self-doubt and various fears.
• Cognitive therapy. It is based on the acceptance that when the patient is emotionally disturbed, he certainly has thoughts of failure. A person immediately thinks that he will not succeed, while self-esteem is low, the slightest hint of failure is perceived as the end of the world. In treatment, the cause of such thoughts is studied. Various situations are given to get a positive life experience. The more successful events in life, the more confident the patient is, the faster he creates a positive opinion about himself. Over time, a person from a loser turns into a successful and self-confident person.
• Anxiety control training. The doctor teaches the patient to use the feeling of anxiety as a relaxant. During the session, the psychiatrist works possible situations to prepare the patient for common events. This technique is used for those people who, in stressful situations, cannot control themselves and cannot make a decision quickly.
• Fight stress. As a result of applying this technique against stress, the patient learns relaxation with the help of a psychotherapist. The person gets stressed on purpose. This helps to gain experience in applying the relaxation technique, which may be useful in the future.
• Rational-emotive therapy. There are people who consider themselves the best. These thoughts often lead to a discrepancy between real life and dreams. Which can lead to constant stress, the divergence of dreams and reality is perceived as a terrible event. Treatment consists in motivating a person to a real, not fictional life. Over time, the ability to accept right decisions protect from unnecessary stress, the patient will cease to be dependent on their dreams.

What the patient will receive as a result of treatment:

• The ability to identify negative thoughts.
• Realistically evaluate thoughts, change them to more constructive ones that do not cause anxiety and depression.
• Normalize and maintain a lifestyle, eliminate provoking factors for stress.
• Use the skills you have learned to deal with anxiety.
• Overcome anxiety, do not hide problems from loved ones, consult with them and use their support.

What is the peculiarity of the method of cognitive-behavioral psychotherapy?

Cognitive behavioral therapy is based on the principles of learning theory, which suggests that different types behavior and the signs that accompany them develop due to the habitual reaction of a person, a response to the situation.

A person reacts to external stress in a certain way and at the same time a certain model of behavior is developed that is unique to this person and a reaction that is familiar only to him, which is far from always correct. " Wrong» pattern of behavior or "wrong" response and cause the symptoms of the disorder. However, you need to clearly understand that this model can be changed, and you can unlearn from the developed habitual reaction, and most importantly, learn " correct”, useful and constructive, which will help to cope with difficulties without incurring new stresses and fears.

Cognitiveness in psychology is a person's ability to mentally perceive and process external information based on their deepest beliefs, attitudes and automatic (unconscious) thoughts. Such thought processes are commonly referred to as the "mental state of a person."

Cognitions are stereotyped, "automatic", sometimes instantaneous thoughts that arise in a person and are a reaction to a certain situation. Cognitions psychologically traumatize a person and lead him to panic attacks, fears, depression and other nervous disorders. Such catastrophic assessments and negative attitudes cause a person to react to what is happening with resentment, fear, guilt, anger, or even hopelessness. This is what the psychologist does.

Cognitive-behavioral psychotherapy can be expressed as a cognitive formula:

Negative experiences of a person are not the result of this situation, but the ability of a person, having got into a certain situation, to develop his own opinion on it and after that decide how he relates to this situation, who he sees himself in it and what emotions it causes in him .

In other words, for a person it is not so important what happens to him, as much as what he thinks about it, what thoughts underlie his experiences and how he will act further. It is precisely these thoughts that lead to negative experiences (panic fears, phobias and other nervous disorders) that are unconscious “for granted” and therefore are poorly understood by a person.

The main task of a CBT psychologist is to work with thoughts, with an attitude to a given situation, with the correction of distortions and errors of thinking, which will ultimately lead to the formation of more adaptive, positive, constructive and life-affirming stereotypes of further behavior.

Cognitive behavioral therapy consists of several stages. At consultations with a psychologist, the client gradually “step by step” learns to change his thinking, which leads him to panic attacks, he gradually breaks the vicious circle consisting of fear that causes this panic, and also learns techniques aimed at reducing the level of anxiety. As a result, the client overcomes frightening situations and qualitatively changes his life.

The main advantage of cognitive-behavioral psychotherapy is that the result obtained from consultations with a psychologist is stable and is retained sufficiently. for a long time. This is due to the fact that after CBT, the client becomes his own psychologist, since during consultations he masters the methodology and techniques of self-control, self-diagnosis and self-treatment.

The main provisions of cognitive-behavioral psychotherapy:

1. Your negative experiences are not the result of the past situation, but your personal assessment of this situation, your thoughts about it, and also how you see yourself and the people who surround you in this situation.
2. It is possible to radically change your assessment of a particular situation and change the flow of thoughts about it from negative to positive.
3. Your negative beliefs, in your opinion, although they look plausible, but this does not mean that they are true. It is from such false "plausible" thoughts that you get worse and worse.
4. Your negative experiences are directly related to the patterns of thought you are used to, as well as to the erroneous processing of information that you have received. You can change the way you think and check for errors.

• identify negative thoughts that cause PA, fears, depression and other nervous disorders;
• review the lifestyle and normalize it (for example, avoid chronic overload, review the poor organization of work and leisure, eliminate all provoking factors, etc.);
• to keep the results obtained for a long time and not to lose the acquired skills in the future (not to avoid, but to resist future negative situations, to be able to cope with depression and anxiety, etc.);
• overcome shame for anxiety, stop hiding your existing problems from loved ones, use support and gratefully accept help.

Cognitive techniques (methods) of cognitive-behavioral psychotherapy:

During consultations, the CBT psychologist, depending on the problem, uses various cognitive techniques (techniques) that help analyze and recognize the negative perception of the situation in order to eventually change it to a positive one.

Very often a person is afraid of what he prophesied for himself, and in anticipation of this moment, he begins to panic. On a subconscious level, he is already ready for danger, long before it happens. As a result, a person is mortally frightened in advance and tries to possible ways avoid this situation.

Cognitive techniques will help to control negative emotions and allow you to change negative thinking, thereby reducing premature fear that develops into panic attacks. With the help of these techniques, a person changes his fatal perception of panic (which is characteristic of his negative thinking) and thereby shortens the duration of the attack itself, and also significantly reduces its impact on the general emotional state.

During consultations, the psychologist creates an individual system of tasks for his client. (It depends on the active participation of the client and the completion of homework how positive the result of the course of therapy will be). This technique is better called "learning". The psychologist teaches the client to control their negative thoughts and resist them in the future.

Such homework includes entering a special diary, following step-by-step instructions, practicing an optimistic internal dialogue, using relaxation (relaxing) exercises, doing certain breathing exercises, and much more. In each case, different cognitive techniques are selected.

Cognitive psychotherapy - methods and techniques for the treatment of personality disorders

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

Cognitive Therapy - What is it?

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

Methods of cognitive psychotherapy

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

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

Cognitive Psychotherapy Techniques

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

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

Cognitive Therapy - Exercises

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

Cognitive therapy for social phobia

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

Cognitive Addiction Therapy

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

Cognitive Behavioral Therapy - Best Books

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

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

Cognitive-behavioral psychotherapy. Cognitive Behavioral Therapy Techniques

Studying the world, we look at it through the prism of already acquired knowledge. But sometimes it may turn out that our own thoughts and feelings can distort what is happening and hurt us. Such stereotyped thoughts, cognitions, arise unconsciously, showing a reaction to what is happening. However, despite their unintentional appearance and seeming harmlessness, they prevent us from living in harmony with ourselves. These thoughts need to be dealt with through cognitive behavioral therapy.

History of therapy

Cognitive Behavioral Therapy (CBT), also called Cognitive Behavioral Therapy, originated in the 1950s and 1960s. The founders of cognitive behavioral therapy are A. Back, A. Ellis and D. Kelly. Scientists studied the perception of a person in various situations, his mental activity and further behavior. This was the innovation - the fusion of the principles and methods of cognitive psychology with behavioral ones. Behaviorism is a branch of psychology that specializes in the study of human and animal behavior. However, the discovery of CBT did not mean that such methods had never been used in psychology. Some psychotherapists have used the cognitive capabilities of their patients, thus diluting and supplementing behavioral psychotherapy in this way.

It is no coincidence that the cognitive-behavioral direction in psychotherapy began to develop in the United States. At that time, behavioral therapy was popular in the United States - a positively minded concept that believes that a person can create himself, while in Europe, on the contrary, psychoanalysis, which was pessimistic in this regard, dominated. The direction of cognitive-behavioral psychotherapy was based on the fact that a person chooses behavior based on his own ideas about reality. A person perceives himself and other people based on his own type of thinking, which, in turn, is obtained through training. Thus, the wrong, pessimistic, negative thinking that a person has learned brings with it wrong and negative ideas about reality, which leads to inadequate and destructive behavior.

The therapy model

What is Cognitive Behavioral Therapy and what does it entail? The basis of cognitive behavioral therapy are elements of cognitive and behavioral therapy aimed at correcting the actions, thoughts and emotions of a person in problem situations. It can be expressed as a kind of formula: situation - thoughts - emotions - actions. In order to understand the current situation and understand your own actions, you need to find answers to questions - what did you think and feel when it happened. Indeed, in the end it turns out that the reaction is determined not so much by the current situation as by your own thoughts on this matter, which form your opinion. It is these thoughts, sometimes even unconscious ones, that lead to the appearance of problems - fears, anxieties and other painful sensations. It is in them that the key to unraveling many of the problems of people is located.

The main task of the psychotherapist is to identify erroneous, inadequate and inapplicable thinking that needs to be corrected or completely changed, instilling in the patient acceptable thoughts and behavior patterns. For this, therapy is carried out in three stages:

• logical analysis;
• empirical analysis;
• pragmatic analysis.

At the first stage, the psychotherapist helps the patient analyze the emerging thoughts and feelings, finds errors that need to be corrected or removed. The second stage is characterized by teaching the patient to accept the most objective model of reality and compare the perceived information with reality. At the third stage, the patient is offered new, adequate life attitudes, on the basis of which he needs to learn how to respond to events.

cognitive errors

Inadequate, painful and negatively directed thoughts are considered by the behavioral approach as cognitive errors. Such errors are quite typical and can occur in different people in different situations. These include, for example, arbitrary inferences. In this case, a person draws conclusions without evidence or even in the presence of facts that contradict these conclusions. There is also over-generalization - generalization based on several incidents, implying the allocation of general principles of action. However, what is abnormal here is that such overgeneralization is also applied in situations in which this should not be done. The next mistake is selective abstraction, in which certain information is selectively ignored, and information is also pulled out of context. This happens most often with negative information to the detriment of the positive.

Cognitive errors also include inadequate perception of the significance of an event. Within the framework of this error, both exaggeration and underestimation of significance can occur, which, in any case, does not correspond to reality. Such a deviation as personalization also does not bring anything positive. People who are prone to personalization regard other people's actions, words, or emotions as related when, in fact, they had nothing to do with them. Maximalism, which is also called black-and-white thinking, is also considered abnormal. With it, a person differentiates what happened into completely black or completely white, which makes it difficult to see the essence of actions.

Basic principles of therapy

If you want to get rid of negative attitudes, you need to remember and understand some of the rules that CBT is based on. The most important thing is that your negative feelings are primarily caused by your assessment of what is happening around, as well as yourself and everyone around you. The significance of the situation that has occurred should not be exaggerated, you need to look inside yourself, in an effort to understand the processes that drive you. The assessment of reality is usually subjective, so in most situations it is possible to radically change the attitude from negative to positive.

It is important to be aware of this subjectivity even when you are sure of the truth and correctness of your conclusions. This frequent discrepancy between internal attitudes and reality disturbs your peace of mind, so it is better to try to get rid of them.

It is also very important for you to understand that all this - wrong thinking, inadequate attitudes - can be changed. The typical mindset you have developed can be corrected for small problems, and completely corrected for major problems.

Teaching new thinking is carried out with a psychotherapist in sessions and self-study, which subsequently ensures the patient's ability to adequately respond to emerging events.

Therapy Methods

Most important element CBT in psychological counseling is teaching the patient to think correctly, that is, to critically evaluate what is happening, use the available facts (and search for them), understand the probability and analyze the collected data. This analysis is also called pilot verification. This check is done by the patient himself. For example, if it seems to a person that everyone constantly turns to look at him on the street, you just have to take it and count, but how many people will actually do it? This simple test can achieve serious results, but only if it is performed, and performed responsibly.

Therapy of mental disorders involves the use of psychotherapists and other techniques, such as reassessment techniques. When applied, the patient performs a check on the likelihood of this event occurring due to other causes. Conducted as much as possible full analysis many possible causes and their influence, which helps to soberly assess what happened as a whole. Depersonalization is used in cognitive behavioral therapy for those patients who feel constantly in the spotlight and suffer from it.

With the help of tasks, they understand that others are most often passionate about their affairs and thoughts, and not about the patient. An important direction is also the elimination of fears, for which conscious self-observation and decatastrophe are used. By such methods, the specialist achieves from the patient an understanding that all bad events end, that we tend to exaggerate their consequences. Another behavioral approach involves repeating the desired result in practice, its constant consolidation.

Treating neuroses with therapy

Cognitive Behavioral Therapy is used to treat a wide variety of diseases, the list of which is long and endless. In general, using its methods, they treat fears and phobias, neurosis, depression, psychological trauma, panic attacks and other psychosomatics.

There are a lot of methods of cognitive-behavioral therapy, and their choice depends on the individual and his thoughts. For example, there is a technique - reframing, in which the psychotherapist helps the patient get rid of the rigid framework into which he has driven himself. In order to better understand oneself, the patient may be offered to keep a kind of diary in which feelings and thoughts are recorded. Such a diary will also be useful for the doctor, as he will be able to choose a more suitable program in this way. A psychologist can teach his patient positive thinking, replacing the formed negative picture of the world. The behavioral approach has interesting way- role reversal, in which the patient looks at the problem from the outside, as if it were happening to another person, and tries to give advice.

Behavioral therapy uses implosion therapy to treat phobias or panic attacks. This is the so-called immersion, when the patient is deliberately forced to remember what happened, as if to relive it.

Also use systematic desensitization, which differs in that the patient is preliminarily taught relaxation methods. Such procedures are aimed at the destruction of unpleasant and traumatic emotions.

Treatment for depression

Depression is a common mental disorder, one of the key symptoms of which is impaired thinking. Therefore, the need for the use of CBT in the treatment of depression is undeniable.

Three typical patterns have been found in the thinking of people suffering from depression:

• thoughts about the loss of loved ones, the destruction of love relationships, loss of self-esteem;
• negatively directed thoughts about oneself, the expected future, others;
• an uncompromising attitude towards oneself, the presentation of unreasonably rigid requirements and limits.

In solving the problems caused by such thoughts, behavioral psychotherapy should help. For example, stress inoculation techniques are used to treat depression. For this, the patient is taught to be aware of what is happening and intelligently deal with stress. The doctor teaches the patient, and then fixes the result with independent studies, the so-called homework.

But with the help of the reattribution technique, one can show the patient the inconsistency of his negative thoughts and judgments and give new logical attitudes. Used to treat depression and such methods of CBT as a stop technique, in which the patient learns to stop negative thoughts. At the moment when a person begins to return to such thoughts, it is necessary to build a conditional barrier for the negative, which will not allow them. Having brought the technique to automatism, you can be sure that such thoughts will no longer bother you.

Cognitive behavioral therapy - the essence and effectiveness of the method

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

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a popular form of treatment in psychotherapy based on the treatment of thoughts, feelings, emotions, and behaviors to improve the patient's quality of life and to rid them of addictions or psychological disorders.

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

CBT is based on a simple principle. Any situation first forms a thought, then comes an emotional experience, which results in a specific behavior. If the behavior is negative (for example, taking psychotropic drugs), then it can be changed by changing the way the person thinks and emotionally relates to the situation that caused such a detrimental reaction.

The essence of the method

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

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

Scheme of impact on the patient during treatment

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

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

Then you need to set triggers - these are conditioned signals that a person associates with drugs. They can be external (friends, dealers, the specific place where the consumption takes place, the time - Friday night for stress relief, etc.). As well as internal (anger, boredom, excitement, fatigue).

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

Feelings that appeared after rational thought

Feelings that appeared after rational thought

In the future, various methods of developing personal skills and interpersonal relationships are applied. The former include stress and anger management techniques, various ways to spend leisure time, etc. Learning interpersonal relationships helps to resist the pressure of acquaintances (an offer to use a drug), teaches you to deal with criticism, re-interact with people, etc.

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

Indications and stages of CPT

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

However, for treatment with CBT, there is an essential condition - the patient himself must realize that he suffers from a harmful addiction, and make a decision to fight drug addiction on his own. For people who are prone to introspection, accustomed to monitoring their thoughts and feelings, such therapy will have the greatest effect.

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

There are many different methods within the framework of cognitive behavioral therapy - in different clinics, special techniques can be used.

Any CBT always consists of three consecutive stages:

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

Efficiency

The uniqueness of the methods of cognitive-behavioral therapy is that they involve the most active participation of the patient himself, continuous introspection, and his own (rather than imposed from the outside) work on mistakes. CBT can take many forms - individual, alone with the doctor, and group - perfectly combined with the use of medications.

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

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

Cognitive Behavioral Psychotherapy, also Cognitive Behavioral Psychotherapy(English) cognitive behavioral therapy) - general concept describing psychotherapies based on the premise that psychological disorders (phobias, depression, etc.) are caused by dysfunctional beliefs and attitudes.
The basis of this area of ​​psychotherapy was laid by the works of A. Ellis and A. Beck, which also gave impetus to the development of a cognitive approach in psychology. Subsequently, behavioral therapy methods were integrated into the methodology, which led to the current name.

The founders of the system

In the middle of the 20th century, the works of the pioneers of cognitive behavioral therapy (hereinafter referred to as CT) A. Beck and A. Ellis gained great fame and distribution. Aaron Beck originally received a psychoanalytic training, but, disillusioned with psychoanalysis, created his own model of depression and a new method of treatment. affective disorders called cognitive therapy. He formulated its main provisions independently of A. Ellis, who developed a similar method of rational-emotional psychotherapy in the 50s.

Judith S. Beck. Cognitive therapy: a complete guide: Per. from English. - M .: LLC "Publishing House "Williams", 2006. - S. 19.

Goals and objectives of cognitive therapy

In the preface to the famous monograph Cognitive Therapy and Emotional Disorders, Beck declares his approach as fundamentally new, different from the leading schools devoted to the study and treatment of emotional disorders - traditional psychiatry, psychoanalysis and behavioral therapy. These schools, despite significant differences among themselves, share a common fundamental assumption: the patient is tormented by hidden forces over which he has no control. …

These three leading schools maintain that the source of the patient's disorder lies outside his consciousness. They pay little attention to conscious concepts, concrete thoughts and fantasies, that is, cognitions. A new approach - cognitive therapy - believes that to emotional disorders can be approached in a completely different way: the key to understanding and solving psychological problems lies in the minds of patients.

Alexandrov A. A. Modern psychotherapy. - St. Petersburg: Academic project, 1997. - S. 82.

There are five goals of cognitive therapy: 1) reduction and / or complete elimination of the symptoms of the disorder; 2) reducing the likelihood of relapse after completion of treatment; 3) increasing the effectiveness of pharmacotherapy; 4) the solution of psychosocial problems (which may either be a consequence of a mental disorder or precede its appearance); 5) elimination of the causes contributing to the development of psychopathology: changing maladaptive beliefs (schemes), correcting cognitive errors, changing dysfunctional behavior.

To achieve these goals, a cognitive psychotherapist helps the client to solve the following tasks: 1) to realize the influence of thoughts on emotions and behavior; 2) learn to identify negative automatic thoughts and observe them; 3) explore negative automatic thoughts and arguments that support and refute them (“for” and “against”); 4) replace erroneous cognitions with more rational thoughts; 5) discover and change maladaptive beliefs that form a fertile ground for the emergence of cognitive errors.

Of these tasks, the first, as a rule, is solved already during the first (diagnostic) session. To solve the remaining four problems, special techniques are used, the description of the most popular of them is given below.

Methodology and features of cognitive psychotherapy

Today, CT is at the crossroads of cognitivism, behaviorism and psychoanalysis. As a rule, in teaching aids, published in recent years in Russian, does not consider the existence of differences between the two most influential variants of cognitive therapy - A. Beck's CT and A. Ellis' REBT. An exception is the monograph by G. Kassinov and R. Tafreit with a preface by Albert Ellis.

As the founder of Rational Emotive Behavioral Therapy (REBT/REBT), the first cognitive behavioral therapy, … I was naturally drawn to chapters 13 and 14 of this book. Chapter 13 describes Aaron Beck's cognitive therapy methods, while Chapter 14 introduces some of the main REBT methods. … Both chapters are well written and cover many of the similarities as well as the major differences between the two approaches. … But I would also like to point out that the REBT approach definitely emphasizes emotional-memory-(evocative-)experiential ways more than cognitive therapy.

Foreword / A. Ellis // Kassinov G., Tafreyt R. Ch. Psychotherapy of anger. - M.: AST; St. Petersburg: Owl, 2006. - S. 13.

Although this approach may seem similar to Beck's cognitive therapy, there are significant differences. In the REBT model, the initial perception of the stimulus and automatic thoughts is neither discussed nor questioned. ... The therapist does not discuss validity, but finds out how the client evaluates the stimulus. Thus, in REBT, the main emphasis is on ... assessing the stimulus.

Kassinov G., Tafreyt R. Ch. Psychotherapy of anger. - M.: AST; St. Petersburg: Owl, 2006. - S. 328.

Features of CT:

1. Natural science foundation: the presence of its own psychological theory normal development and factors of occurrence of mental pathology.
2. Target-oriented and adaptable: for each nosological group there is a psychological model that describes the specifics of disorders; accordingly, the “targets of psychotherapy”, its stages and techniques are highlighted.
3. Short-term and economical approach (unlike, for example, psychoanalysis): from 20-30 sessions.
4. The presence of an integrating potential inherent in the theoretical schemes of CT (both an existential-humanistic orientation, and object relations, and behavioral training, etc.).

Basic theoretical provisions

1. The way an individual structures situations determines his behavior and feelings. Thus, in the center is the subject's interpretation of external events, which is realized according to following scheme: external events (stimuli) → cognitive system → interpretation (thoughts) → affect (or behavior). If interpretations and external events diverge greatly, this leads to mental pathology.
2. An affective pathology is a severe exaggeration of a normal emotion, resulting from a misinterpretation under the influence of many factors (see point # 3). The central factor is "private possessions (personal space)" ( personal domain), in the center of which lies the Ego: emotional disturbances depend on whether a person perceives events as enriching, as debilitating, as threatening, or as encroaching on his possessions. Examples:
   • Sadness arises as a result of the loss of something valuable, that is, the deprivation of private property.
   • Euphoria is the sensation or expectation of acquisition.
   • Anxiety is a threat to physiological or psychological well-being.
   • Anger results from a feeling of direct attack (whether intentional or unintentional) or a violation of the laws, morals, or standards of the individual.
3. individual differences. They depend on past traumatic experiences (for example, the situation of prolonged stay in a confined space) and biological predisposition (constitutional factor). E. T. Sokolova proposed the concept differential diagnosis and psychotherapy of two types of depression, based on the integration of CT and psychoanalytic object relations theory:
   • Perfectionist melancholy(occurs in the so-called "autonomous personality", according to Beck). It is provoked by the frustration of the need for self-affirmation, achievement, autonomy. Consequence: the development of the compensatory structure of the "Grand Self". Thus, here we are talking about narcissistic personality organization. The strategy of psychotherapeutic work: "containment" (careful attitude to heightened self-esteem, wounded pride and a sense of shame).
   • Anaclitic depression(occurs in the so-called "sociotropic personality", according to Beck). Associated with emotional deprivation. Consequence: unstable patterns of interpersonal relationships, where emotional avoidance, isolation and "emotional dullness" are replaced by overdependence and emotional attachment to the Other. The strategy of psychotherapeutic work: "holding" (emotional "up-nourishment").
4. The normal activity of the cognitive organization is inhibited under the influence of stress. Extremist judgments, problematic thinking arise, concentration of attention is disturbed, and so on.
5. Psychopathological syndromes (depression, anxiety disorders, etc.) consist of hyperactive schemas with unique content that characterize a particular syndrome. Examples: depression - loss, anxiety disorder - threat or danger, etc.
6. Intense interaction with other people creates a vicious circle of maladaptive cognitions. A depressed wife, misinterpreting her husband’s frustration (“I don’t care, I don’t need her ...” instead of the real “I can’t help her in anything”), ascribes a negative meaning to her, continues to think negatively about herself and her relationship with her husband, moves away, and, as a result, her maladaptive cognitions are further strengthened.

Key Concepts

1. Scheme. These are cognitive formations that organize experience and behavior, this is a system of beliefs, deep worldview attitudes of a person in relation to himself and the world around him, influencing actual perception and categorization. Schemes can be:
   • adaptive / non-adaptive. An example of a maladaptive scheme: "all men are bastards" or "all women are bitches." Of course, such schemes do not correspond to reality and are an overgeneralization, but such life position can cause damage primarily to the person himself, creating difficulties for him in communicating with the opposite sex, since subconsciously he will be negatively disposed in advance, and the interlocutor may understand and be offended.
   • positive/negative
   • idiosyncratic/universal. Example: depression - maladaptive, negative, idiosyncratic.
2. automatic thoughts. These are the thoughts that the brain writes to the "fast" memory area (the so-called "subconscious"), because they are often repeated or a person attaches special importance to them. In this case, the brain does not spend a lot of time re-thinking this thought slowly, but makes a decision instantly, based on the previous decision recorded in the "fast" memory. Such “automation” of thoughts can be useful when you need to quickly make a decision (for example, quickly pull your hand away from a hot frying pan), but it can be harmful when an incorrect or illogical thought is automated, so one of the tasks of cognitive psychotherapy is to recognize such automatic thoughts, return them from the area fast memory again into the area of ​​slow rethinking in order to remove incorrect judgments from the subconscious and rewrite them with correct counterarguments. Main characteristics of automatic thoughts:
   • reflexivity
   • Collapse and contraction
   • Not subject to conscious control
   • transience
   • Perseveration and stereotyping. Automatic thoughts are not the result of thinking or reasoning, they are subjectively perceived as justified, even if they seem ridiculous to others or contradict obvious facts. Example: “If I get a “good” mark in the exam, I will die, the world around me will collapse, after that I will not be able to do anything, I will finally become a complete nonentity”, “I ruined the lives of my children with a divorce”, “Everything that I I do, I do poorly.
3. cognitive errors. These are supervalent and affectively charged circuits that directly cause cognitive distortions. They are characteristic of all psychopathological syndromes. Kinds:
   • Arbitrary inferences- drawing conclusions in the absence of supporting facts or even in the presence of facts that contradict the conclusion.
   • Overgeneralization- conclusions based on a single episode, with their subsequent generalization.
   • Selective abstraction- focusing the attention of the individual on any details of the situation, ignoring all its other features.
   • Exaggeration and understatement- opposite assessments of oneself, situations and events. The subject exaggerates the complexity of the situation, while downplaying their ability to cope with it.
   • Personalization- the relation of the individual to external events as having a relation to him, when this is not actually the case.
   • Dichotomous thinking("black-and-white" thinking or maximalism) - attributing oneself or any event to one of two poles, positive or negative (in absolute terms). In a psychodynamic way, this phenomenon can be qualified as a protective mechanism of splitting, which indicates the "diffusion of self-identity".
   • duty- excessive focus on "I should" act or feel in a certain way, without assessing the real consequences of such behavior or alternative options. Often arises from past imposed standards of behavior and patterns of thought.
   • prediction- the individual believes that he can accurately predict the future consequences of certain events, although he does not know or does not take into account all the factors, cannot correctly determine their influence.
   • mind reading- the individual believes that he knows exactly what other people think about this, although his assumptions do not always correspond to reality.
   • Labeling-associating oneself or others with certain patterns of behavior or negative types
4. Cognitive content(“themes”) corresponding to a particular type of psychopathology (see below).

Theory of psychopathology

Depression

Depression is an exaggerated and chronic experience of real or hypothetical loss. The cognitive triad of depression:

• Negative self-image: "I'm inferior, I'm a loser, at least!".
• Negative assessment of the surrounding world and external events: “The world is merciless to me! Why is this all happening to me?"
• Negative assessment of the future. “What is there to say? I just don't have a future!"

In addition: increased dependence, paralysis of will, suicidal thoughts, somatic symptom complex. On the basis of depressive schemas, corresponding automatic thoughts are formed and cognitive errors of almost all kinds take place. Topics:

• Fixation on real or imaginary loss (death of loved ones, collapse of relationships, loss of self-esteem, etc.)
• Negative attitude towards oneself and others, pessimistic assessment of the future
• Tyranny of duty

Anxiety-phobic disorders

Anxiety disorder is an exaggerated and chronic experience of real or hypothetical danger or threat. A phobia is an exaggerated and chronic experience of fear. Example: fear of losing control (for example, in front of your body, as in the case of fear of getting sick). Claustrophobia - fear of closed spaces; mechanism (and in agoraphobia): the fear that, in case of danger, help may not come in time. Topics:

• Anticipation of negative events in the future, the so-called. "anticipation of all sorts of misfortunes." In agoraphobia: fear of dying or going mad.
• The discrepancy between the level of claims and the belief in one’s own incompetence (“I should get an “excellent” mark on the exam, but I’m a loser, I don’t know anything, I don’t understand anything”)
• Fear of losing support.
• A persistent notion of inevitable failure in an attempt to improve interpersonal relationships, to be humiliated, ridiculed or rejected.

perfectionism

The Phenomenology of Perfectionism. Main parameters:

• High standards
• Thinking in terms of "all or nothing" (either complete success or complete failure)
• Focus on failure

Perfectionism is very closely related to depression, but not the anaclitic depression (due to loss or loss), but the one associated with the frustration of the need for self-affirmation, achievement and autonomy (see above).

Psychotherapeutic relationship

The client and therapist must agree on what problem they are to work on. It is the solution of problems (!), and not the change in the personal characteristics or shortcomings of the patient. The therapist must be very empathic, natural, congruent (principles taken from humanistic psychotherapy); should not be directive. Principles:

• The therapist and client collaborate on an experimental test of erroneous maladaptive thinking. Example: client: “When I walk down the street, everyone turns to me”, therapist: “Try to walk down the street normally and count how many people turned to you.” Usually such an automatic thought does not coincide with reality. The bottom line: there is a hypothesis, it must be tested empirically. However, sometimes the statements of psychiatric patients that on the street everyone turns around, looks and discusses them, still have a real factual basis - it's all about how the mentally ill looks and how he behaves at that moment. If a person talks quietly to himself, laughs for no reason, or vice versa, without looking away, looks at one point, does not look around at all, or looks around at others with fear, then such a person will certainly attract attention to himself. They will really turn around, look at and discuss it - simply because passers-by are interested in why he behaves this way. In this situation, the psychologist can help the client understand that the interest of others is caused by his own unusual behavior, and explain to the person how to behave in public so as not to attract undue attention.
• Socratic dialogue as a series of questions with the following objectives:
  1. Clarify or identify problems
  2. Help identify thoughts, images, sensations
  3. Explore the meaning of events for the patient
  4. Assess the consequences of persisting maladaptive thoughts and behaviors.
• Directed Cognition: The therapist-guide encourages patients to look at facts, evaluate probabilities, gather information, and put it all to the test.

Techniques and methods of cognitive psychotherapy

CT 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:

• Reveal your negative automatic thoughts.
• Find the connection between knowledge, affects and behavior.
• Find facts for and against automatic thoughts.
• Look for more realistic interpretations for them.
• Learn to identify and change disruptive beliefs that lead to distortion of skills and experience.

Specific methods for identifying and correcting automatic thoughts:

1. Writing down thoughts. The psychologist may ask the client to write down on paper what thoughts come into his head when he tries to do the right action (or not to do the unnecessary action). It is advisable to write down thoughts that come to mind at the time of making a decision strictly in the order of their priority (this order is important because it will indicate the weight and importance of these motives in making a decision).
2. Thought diary. Many CT specialists suggest that their clients briefly record their thoughts in a diary for several days to understand what the person thinks about most often, how much time they spend on it, and how strong emotions they experience from their thoughts. For example, the American psychologist Matthew McKay recommended that his clients break a page in a diary into three columns, where they briefly indicate the thought itself, the hours of time spent on it, and evaluate their emotions on a 100-point scale in the range between: “very pleasant / interesting” - “ indifferent” - “very unpleasant/depressing”. The value of such a diary is also in the fact that sometimes even the client himself cannot always accurately indicate the cause of his experiences, then the diary helps both him and his psychologist to find out what thoughts affect his well-being during the day.
3. estrangement. The essence of this stage is that the patient must take an objective position in relation to his own thoughts, that is, move away from them. Suspension has 3 components:
   • awareness of the automaticity of a “bad” thought, its spontaneity, the understanding that this scheme arose earlier under other circumstances or was imposed by other people from the outside;
   • the realization that a "bad" thought is maladaptive, that is, it causes suffering, fear or frustration;
   • the emergence of doubts about the truth of this non-adaptive thought, the understanding that this scheme does not correspond to new requirements or a new situation (for example, the thought “To be happy means to be the first in everything”, formed by an excellent student at school, can lead to disappointment if he does not manages to become the first in the university).
4. empirical verification("experiments"). Ways:
   • Find arguments for and against automatic thoughts. It is also advisable to put these arguments on paper so that the patient can re-read it whenever these thoughts come to him again. If a person does this often, then gradually the brain will remember the “correct” arguments and remove “wrong” motives and decisions from quick memory.
   • Weigh the advantages and disadvantages of each option. It is also necessary to take into account the long-term perspective, and not just the immediate benefit (for example, in the long term, problems from drugs will many times exceed temporary pleasure).
   • Construction of an experiment to test the judgment.
   • Conversation with witnesses of past events. This is especially true in those mental disorders where memory is sometimes distorted and replaced by fantasies (for example, in schizophrenia) or if the delusion is caused by a misinterpretation of the motives of another person.
   • The therapist refers to his experience, to fiction and academic literature, statistics.
   • The therapist incriminates: points out logical errors and contradictions in the patient's judgments.
5. Revaluation methodology. Checking the likelihood of alternative causes of an event.
6. decentration. With social phobia, patients feel in the center of everyone's attention and suffer from this. Here, too, an empirical test of these automatic thoughts is needed.
7. self-expression. Depressive, anxious, etc. patients often think that their malaise is 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. Conscious self-observation.
8. decatastrophic. At 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.
9. Purposeful repetition. Re-enactment of the desired behavior, repeated testing of various positive instructions in practice, which leads to increased self-efficacy. Sometimes the patient quite agrees with the correct arguments during psychotherapy, but quickly forgets them after the session and returns to the previous "wrong" arguments, because they are repeatedly recorded in his memory, although he understands their illogicality. In this case, it is better to write down the correct arguments on paper and reread them regularly.
10. Use of the imagination. Anxious patients are dominated not so much by "automatic thoughts" as by "obsessive images", that is, it is rather not thinking that maladjusts, but imagination (fantasy). Kinds:
    • Termination Technique: Loudly commanding yourself to “stop!” - the negative way of thinking or imagining stops. It also happens to be effective in stopping intrusive thoughts in some mental illnesses.
    • Repetition technique: repeat several times correct image thinking to break the stereotype.
    • Metaphors, parables, poems: The psychologist uses such examples to make the explanation clearer.
    • Modifying imagination: the patient actively and gradually changes the image from negative to more neutral and even positive, thereby understanding the possibilities of his self-awareness and conscious control. Usually, even after a bad setback, you can find at least something positive in what happened (for example, “I learned a good lesson”) and concentrate on it.
    • Positive imagination: a positive image replaces a negative one and has a relaxing effect.
    • Constructive imagination (desensitization): the patient ranks the probability of the expected event, which leads to the fact that the forecast loses its globality and inevitability.
11. Change of world view. Often the cause of depression is unfulfilled desires or excessively high demands. In this case, the psychologist can help the client weigh the cost of achieving the goal and the cost of the problem, and decide whether it is worth fighting further or whether it would be wiser to refuse to achieve this goal altogether, discard an unfulfilled desire, reduce requests, set yourself, for starters, more realistic goals, try to get more comfortable with what you have or find something to replace it. This is relevant in cases where the cost of not solving the problem is lower than suffering from the problem itself. However, in other cases, it may be better to work hard and solve the problem, especially if delaying the decision only aggravates the situation and causes more suffering for the person.
12. Replacement of emotions. Sometimes the client needs to come to terms with their past negative experiences and change their emotions to more adequate ones. For example, it may sometimes be better for a victim of a crime not to replay the details of what happened, but to say to himself: “It’s very unfortunate that this happened to me, but I will not let my abusers ruin the rest of my life for me, I will live in the present and the future, rather than constantly looking back at the past." You should replace the emotions of resentment, anger and hatred with softer and more adequate ones that will allow you to build your future life more comfortably.
13. Role reversal. Ask the client to imagine that he is trying to comfort a friend who finds himself in a similar situation. What could be said to him? What to advise? What advice would your loved one give you in this situation?
14. Action plan for the future. The client and therapist jointly develop a realistic "action plan" for the client for the future, with specific conditions, actions and deadlines, write this plan down on paper. For example, if a catastrophic event occurs, the client will perform some sequence of actions at the time indicated for this, and before this event occurs, the client will not torment himself needlessly.
15. Identifying Alternative Causes of Behavior. If all the "correct" arguments are stated, and the client agrees with them, but continues to think or act in a clearly illogical way, then you should look for alternative reasons for this behavior, which the client himself does not suspect or prefers to remain silent. For example, with obsessive thoughts, the very process of deliberation often brings a person great satisfaction and relief, since it allows him to at least mentally imagine himself a "hero" or "savior", solve all problems in fantasies, punish enemies in dreams, correct his mistakes in a fictional world, etc. .d. Therefore, a person scrolls such thoughts over and over again not for the sake of a real solution, but for the very process of thinking and satisfaction, gradually this process drags a person deeper and deeper like a kind of drug, even though a person understands the unreality and illogicality of such thinking. In particular severe cases, irrational and illogical behavior can even be a sign of serious mental illness(for example, obsessive-compulsive disorder or schizophrenia), then psychotherapy alone may not be enough, and the client also needs the help of drugs to control thinking (i.e., requires the intervention of a psychiatrist).

Exist specific methods CT, used only for certain types of severe mental disorders, in addition to drug treatment:

• With schizophrenia, patients sometimes begin to engage in mental dialogues with imaginary images of people or otherworldly beings (the so-called "voices"). The psychologist, in this case, may try to explain to the schizophrenic that he is not talking with real people or creatures, but with created by him artistic images these creatures, thinking in turn, now for themselves, then for this character. Gradually, the brain "automates" this process and begins to issue phrases that suit the invented character in this situation automatically, even without a conscious request. You can try to explain to the client that normal people also sometimes conduct conversations with invented characters, but consciously when they want to predict the reaction of another person to a certain event. Writers and directors, for example, even write entire books like this, thinking in turn for several characters at once. However, at the same time, a normal person is well aware that this image is fictional, so he is not afraid of him and does not treat him like a real being. Brain healthy people does not give interest and importance to such characters, therefore, does not automate fictional conversations with them. It's like the difference between a photograph and a living person: you can safely put a photo on the table and forget about it, because it doesn't matter, and if it were a living person, then they wouldn't do this to him. When the schizophrenic realizes that his character is just a figment of his imagination, he will also begin to deal with him much easier and stop getting this image from memory when not needed.

• Also, with schizophrenia, the patient sometimes begins to repeatedly mentally scroll through a fantasy image or plot, gradually such fantasies are deeply recorded in memory, enriched with realistic details and become very believable. However, this is the danger that the schizophrenic begins to confuse the memory of his fantasies with real memory and may, because of this, begin to behave inappropriately, so the psychologist can try to restore real facts or events using external reliable sources: documents, people who the patient trusts, scientific literature, conversation with witnesses, photographs, videos, construction of an experiment to test judgment, etc.

• In obsessive-compulsive disorder, it may be helpful for the patient to repeat counter-arguments about how he is being harmed several times during the occurrence of any obsessive thought. intrusive thoughts how he wastes his precious time on them, that he has more important things to do, that obsessive dreams become a kind of drug for him, scatter his attention and impair his memory, that these obsessions can cause ridicule from others, lead to problems in the family, on work, etc. As mentioned above, it is better to write down such useful counterarguments on paper so that you can reread them regularly and try to memorize them.

Effectiveness of Cognitive Psychotherapy

Factors in the Effectiveness of Cognitive Therapy:

1. Personality of the psychotherapist: naturalness, empathy, congruence. The therapist must be able to receive feedback from the patient. Since CT is a fairly directive (in a certain sense of the word) and structured process, as soon as a good therapist feels the dullness and impersonality of therapy (“solving problems according to formal logic”), he is not afraid of self-disclosure, he is not afraid of using imagination, parables, metaphors, etc. P.
2. The right psychotherapeutic relationship. Accounting for the patient's automatic thoughts about the therapist and the proposed tasks. Example: The patient's automatic thought: "I will make entries in my diary - in five days I will become the most happy man in the world, all problems and symptoms will disappear, I will begin to live for real. Therapist: “The diary is just a separate help, instant effects will not; your diary entries are mini-experiments that give you new information about yourself and your problems.”
3. Qualitative application of methods, an informal approach to the CT process. Techniques must be applied according to the specific situation, a formal approach drastically reduces the effectiveness of CT and can often generate new automatic thoughts or frustrate the patient. Systematic. Feedback accounting.
4. Real problems - real effects. Effectiveness is reduced if the therapist and the client do whatever they want, ignoring the real problems.