Cognitive behavioral therapy alone. What is Cognitive Psychotherapy

What determines human behavior?

Human thinking, a way of perceiving oneself and the world around - such is the answer cognitive psychotherapy.

If you think that you are absolutely helpless, although in reality this may not be the case, then when difficulties arise, you will experience feelings of anxiety or despair, and therefore you will by all means avoid independent actions and decisions. Your main thoughts will be - " not able to", "can't cope". It is they who will determine your behavior.

If, however, to redirect these irrational thoughts and life beliefs in a different direction and learn to constructively solve current issues and tasks, then it is possible to get rid of feelings and anxiety states. In cognitive psychotherapy developed effective techniques and exercises aimed at developing the ability to think more constructively, creatively, positively and allowing a person to independently cope with emerging negative experiences.

Founder cognitive or cognitive behavioral psychotherapy consider American psychiatrist Aaron Beck. Cognitive Psychotherapy is a therapeutic approach that helps a person recognize and change their erroneous thought processes. Beck thinks that mood and behavior a person is largely determined by the way he interprets the world. He compares such a vision to a filter or glasses through which a person sees the world and interprets it accordingly. The development of self-regulation skills, the replacement of negative thoughts with constructive ones, the study of expectations, attitudes that guide our consciousness, and their rethinking are the main distinctive features cognitive psychotherapy.

To date, cognitive psychotherapy is at the intersection cognitivism, behaviorism and psychoanalysis. Although cognitive behavioral therapy a relatively young direction, it is only about three decades old, it is recognized as very effective in the treatment depressive, anxious and panic states. Cognitive psychotherapy has a longer lasting effect than drug therapy.

Aaron Beck considered therapy to be a training, during which the patient learns new, more effective ways problem solution. " No one requires or expects the patient to master the cognitive and behavioral techniques for coping with depression, the emphasis is on something else - on growth and development. At the end of therapy, the patient will have enough time to hone the acquired skills.".

Cognitive-behavioral psychotherapy is characterized by the belief that a person can be a full-fledged participant in the psychotherapeutic process. The therapist encourages the patient to challenge his destructive thoughts and begin to use in his Everyday life new ways of thinking. It is important that the patient be convinced by experience that, due to his own attitudes, he is not as happy as he could be if he thought differently. The therapist proposes alternative rules for consideration by the patient, and does not suit him " brainwashing". A person has an alternative to start thinking differently. Special attention in cognitive therapy, it is given to the present, to work with conscious content, in contrast to psychoanalysis.

One way to create new beliefs in a person is to offer to lead diary of "dysfunctional thoughts" in which he should record daily his positive and negative experiences during the period when these beliefs are active. You can also use set of cards, on one side of which a person writes down an unpleasant dysfunctional attitude, indicating the facts that testify against it, and on the other side of the card - more functional attitudes and facts. So a person can regularly assess the degree of his conviction in each installation. He learns to take responsibility for his behavior in certain situations and to respond in a way that more likely achieve your goals.

Man is a thinking, active being, capable of changing himself and his life. These are the main fundamental ideas of cognitive psychotherapy.

Currently, the following types of cognitive psychotherapy are distinguished: Ppositive psychotherapy A. Pezeshkian and cognitive behavioral psychotherapy.

Yet Socrates masterfully revealed the distortions of the human mind and helped people get rid of disbelief in themselves, sadness, unbearable fear of death. Cognitive psychotherapy is an art transformed into a science-based system that helps a person start thinking in a new way.

How often do you ask modern world meet people with different mental disorders and disorders? The answer will be - thousands and millions of people! Yes, violations can be very diverse, from gross disorders of a psycho-neurological nature, to mild forms and simply accentuations of character. We all live in conditions of constant latent stress and are forced to adapt, constantly adapt to more and more new social norms, which increases our basal level anxiety. It is no wonder that in such conditions people experience severe psychological discomfort, which can lead to various disorders mental health and even disease. One of the modern and very effective methods combating such disorders is precisely the cognitive behavioral psychotherapy. The method is relatively new and actively implemented in clinical practice minor psychiatry.

The term cognitive behavioral psychotherapy or cognitive behavioral psychotherapy in psychiatric practice is commonly understood as a direction in the treatment of patients with psychiatric personality disorders and other disorders by combining a psychoanalytic approach with behaviorism, i.e. study of the structure of the patient's behavior and response to a variety of actions and stimuli. This approach is very effective, as it allows you to reveal the full versatility of psychological disorders in a particular patient. The combination of these two types of therapy allows you to achieve greater returns from the patient, which also speeds up the psychoanalytic study of the patient. Correction of behavior and manifestations of the disease occurs through motivated reinforcement affirmative action and reactions of the patient in combination with ignoring pathological traits of behavior.

This trend in psychiatric practice was formed by American-born psychiatrist Aaron Beck. The theoretical substantiation of this approach to the treatment of psychiatric patients was formed back in the middle of the last century, however, the active introduction of cognitive behavioral therapy methods began to be widely used only from the end of the 90s of the last century. Cognitive analytic psychotherapy is enough for a long time not recognized by the Association of American Psychotherapists.

Initially, the method of psychotherapy was developed and justified only for a narrow range of diseases, for example, it was used for therapy depressive disorder personality within the psychoanalytic approach.

Methodology of the cognitive approach

Cognitive therapy plays important role in the study and analysis of psychopathological patterns formed in a particular psychiatric patient. The cognitive approach allows you to find the essence of the problem in order to further target psychopathological effects. defense mechanisms sick. In the cognitive approach, it is very important to establish trusting contact with the patient so that the relationship between the specialist and the patient is built on the most open and reliable information. Methods of cognitive psychotherapy include the following steps:

1. First of all, the psychotherapist forms a list of problems, for convenience, all problems are written out on a sheet and are ranked from the most noticeable to the specialist and the patient, to hidden or latent problems.
2. The specialist necessarily reveals all the negative thoughts of the patient, especially those that are at the subconscious level, i.e. arise automatically.

Behavioral Approach

The behavioral approach to the treatment of personality disorders is in close contact with the theory of behaviorism, i.e. based on behavioral patterns characteristic of humans. The behavioral approach allows assessing the patient's response to certain cognitive manipulations. Thus, the specialist examines the behavior of the patient during a psychoanalytic study, which allows us to confirm a number of psychopathological reactions of the patient.

Differences from the classical psychoanalytic approach

Despite the similar structure of psychoanalytic and cognitive methods, both directions have some differences. Unlike psychoanalysis, cognitive therapy sets itself the goal of analyzing and correcting psychopathological disorders here and now, while psychoanalysis is looking for the root of the problem in childhood and youthful memories. Cognitive psychotherapy uses an approach to spot study and impact on the patient, only at the time of training. Cognitive psychotherapy of personality disorders includes a complex set of analytical and psychotherapeutic influences of a specialist on a patient, which allows short terms to correct psychopathological disorders in the patient.

Cognitive Therapy Technique

For maximum precise research and interpretation of the results of the patient's diagnostic data, cognitive psychotherapy uses various techniques impact on the patient. To achieve the set goal, namely the belief of the patient in his pathological thought processes, requires a deep analysis of his protective psychological mechanisms and behavioral characteristics. For this, the following techniques are used:

• Fixing in writing all negative attitudes of the patient and mental acts. To do this, during a psychotherapeutic session, after establishing a trusting contact with a specialist, the patient writes out all his anxious and negative thoughts, after which he builds a list from the most unpleasant to less intense negative factors.
• Recording thoughts and actions in your own diary. It is recommended to write in the diary as much as possible large quantity thoughts that arise in the patient during the day. The diary must be kept for at least a week so that the data is adequate and correct.
• Applying the Catharsis Technique. Catharsis is based on the reproduction of actions associated with those emotions and emotional state that prevails in the patient. For example, in a depressed mood, when the patient is sad, the specialist may suggest that the patient cry or scream in order to better understand the psychopathological mechanisms of the disease.
• The study of the negative attitude. This technique is used to detect self-deprecating influences in the patient's thought process. With low self-esteem, the specialist suggests the patient to perform a series of small actions, but the actions must necessarily lead to positive result which will help form the right motivation in the patient and overcome negative thoughts.
• The use of the imagination for therapeutic purposes. Imagination is a very powerful tool in understanding as well as treating patients with various violations psychoemotional background. To begin with, the therapist asks the patient to imagine a situation in the patient's mind and examines his reaction and the course of imagination, after which he helps to direct the process of imagination in a positive direction.
• Three column technique. An interesting technique that allows the patient to independently correct some negative thought and behavioral processes in the future. To do this, the patient makes a table of three columns. In the first, he writes down a situation, secondly, a negative thought that is formed in response to the situation, and thirdly, the action necessary to overcome this thought.
• Also high efficiency has a record of any actions performed by the patient during the day. After the successful execution of the observation sheet, the psychotherapist analyzes the data and decides on the appointment of certain sets of exercises and trainings.

Benefits of a cognitive behavioral approach

Cognitive behavioral therapy allows you to study in detail the psychopathological mechanisms that have formed in response to any traumatic event. Comprehensive identification of triggers leading to the occurrence of a psychopathological reaction in a patient makes it possible to more effectively influence the underlying cause of the disorder. After analyzing the psychopathological mechanisms, the specialist can point-wise influence the patient's psyche, which allows minimizing the impact of the psychotherapist on the patient, which means that the patient independently learns to cope with his psychological disorders, and the specialist just pushes the patient in the right direction. Cognitive Behavioral Therapy allows you to correct and treat wide range psychiatric disorders and in most cases, allows you to cope with the current situation without the use of pharmacotherapy.

Special mention should be made of effective application of this technique in patients with various types psychological addictions. The use of a cognitive behavioral approach in addictive patients allows you to get rid of addiction on your own, which significantly reduces the percentage of relapses of the disease.

Cognitive psychotherapy of personality disorders can significantly increase the effectiveness of therapeutic non-drug effects on patients with mild forms of disorders. mental health, as well as in people with a variety of character accentuations and addictions. The complex implementation of cognitive techniques and behavioral analysis of the patient allows you to flexibly influence his protective and behavioral mechanisms.

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Cognitive Behavioral Therapy (CBT) deals with correcting thoughts and feelings that determine actions and actions that affect a person's lifestyle. Based on the principle that external influence(situation) causes a certain thought, which is experienced and embodied in specific actions, that is, thoughts and feelings form the behavior of the individual.

Therefore, in order to change your negative behavior, which often leads to serious life problems, you first need to change your stereotype of thinking.

For example, a person is terribly afraid of open space (agoraphobia), at the sight of a crowd he feels fear, it seems to him that something bad will definitely happen to him. He inadequately reacts to what is happening, endows people with qualities that are not inherent in them at all. He himself becomes closed, avoids communication. This leads to mental disorder, depression develops.

In this case, the methods and techniques of cognitive-behavioral psychotherapy can help, which will teach you to overcome panic fear in front of a large crowd of people. In other words, if you cannot change the situation, you can and should change your attitude towards it.

CBT emerged from the depths of cognitive and behavioral psychotherapy, combines all the main provisions of these techniques and sets specific goals that need to be addressed in the treatment process.

These should include:

• Relief of symptoms of a mental disorder;
• Persistent remission after a course of therapy;
• Low probability of recurrence (relapse) of the disease;
• The effectiveness of medicines;
• Correction of erroneous cognitive (mental) and behavioral attitudes;
• Resolution of personal problems that caused mental illness.

1. Find out how his thinking affects emotions and behavior;
2. Critically perceive and be able to analyze their negative thoughts and feelings;
3. Learn to replace negative beliefs and attitudes with positive ones;
4. Based on the developed new thinking, adjust your behavior;
5. Solve the problem of their social adaptation.

Effective, in particular, in the treatment of alcoholism and drug addiction, if after drug therapy the body is cleansed of toxic poisoning. During the rehabilitation course, which takes 3-4 months, patients learn to cope with their destructive thinking and correct their behavioral attitudes.

It's important to know! Cognitive-behavioral psychotherapy will be effective only when the patient himself wishes it and establishes a trusting contact with the psychotherapist.

Basic Methods of Cognitive Behavioral Therapy

Most significant methods CBT are:

• Cognitive Therapy. If a person is insecure and perceives his life as a streak of failures, it is necessary to fix positive thoughts about himself in his mind, which should return him confidence in his abilities and the hope that he will definitely succeed.
• Rational Emotive Therapy. It is aimed at the patient's awareness of the fact that his thoughts and actions need to be coordinated with real life and not soar in their dreams. This will protect you from inevitable stress and teach you how to make the right decisions in various life situations.
• Reciprocal inhibition. Inhibitors are substances that slow down the course of various processes, in our case we are talking about psychophysical reactions in the human body. Fear, for example, can be suppressed by anger. During the session, the patient may imagine that he can suppress his anxiety, say, by complete relaxation. This leads to the extinction of the pathological phobia. Many special techniques of this method are based on this.
• Autogenic training and relaxation. It is used as an auxiliary technique during CBT sessions.
• self control. Based on the method of operant conditioning. It is understood that the desired behavior in certain conditions must be reinforced. Relevant for difficulties in life situations, for example, study or work, when different kind addictions or neuroses. They help to raise self-esteem, control unmotivated outbursts of rage, extinguish neurotic manifestations.
• Introspection. Keeping a behavior diary is one way to "stop" to interrupt intrusive thoughts.
• self instructions. The patient must set himself tasks that must be followed for a positive solution to his problems.
• Stop Tap Method or Self-Control Triad. Internal "stop!" negative thoughts, relaxation, a positive idea, its mental consolidation.
• Evaluation of feelings. Feelings are “scaled” according to a 10-point or other system. This allows the patient to determine, for example, the level of his anxiety or, conversely, confidence, where on the "scale of feelings" they are. Helps to objectively evaluate your emotions and take steps to reduce (increase) their presence on a mental and sensitive level.
• Investigation of threatening consequences or "what if". Promotes the expansion of limited horizons. When asked “What if something terrible happens?” the patient should not overestimate the role of this "terrible", which leads to pessimism, but find an optimistic answer.
• Advantages and disadvantages. The patient, with the help of a psychologist, analyzes the advantages and disadvantages of his mental attitudes and finds ways to balanced their perception, this allows solving the problem.
• Paradoxical Intention. The technique was developed by the Austrian psychiatrist Viktor Frankl. Its essence is that if a person is very afraid of something, it is necessary that in his feelings he returns to this situation. For example, a person suffers from the fear of insomnia, he should be advised not to try to fall asleep, but to stay awake as long as possible. And this desire to “not fall asleep” causes, in the end, sleep.
• Anxiety control training. It is used in the event that a person in stressful situations cannot control himself, quickly make a decision.

Cognitive Behavioral Therapy Techniques for Treating Neurosis

1. Reframing (English - frame). With the help of special questions, the psychologist forces the client to change the negative "framework" of his thinking and behavior, to replace them with positive ones.
2. Thought diary. The patient writes down his thoughts in order to understand what disturbs and affects his thoughts and well-being during the day.
3. empirical verification. Includes several ways to help you find the right decision and forget negative thoughts and arguments.
4. Examples fiction . Clearly explain the choice of a positive judgment.
5. positive imagination. Helps to get rid of negative ideas.
6. Role reversal. The patient imagines that he is consoling his comrade, who finds himself in his position. What would he be able to advise him in this case?
7. Flood, implosion, paradoxical intention caused by anger. They are used when working with children's phobias.

Treating Depression with Cognitive Behavioral Therapy

This seriously affects the psyche, not only the patient himself suffers, but also his relatives. Today, more than 20% of the population in developed countries is prone to depression. It reduces the ability to work at times, and the likelihood of a suicidal outcome is high.

There are many symptoms of a depressive state, they manifest themselves in the mental (gloomy thoughts, lack of concentration, difficulty in making decisions, etc.), emotional (longing, depressed mood, anxiety), physiological (sleep disturbance, loss of appetite, decreased sexuality) and behavioral ( passivity, avoidance of contact, alcoholism or drug addiction as a temporary relief) level.

If such symptoms are observed for at least 2 weeks, we can confidently talk about the development of depression. In some, the disease proceeds imperceptibly, in others it acquires chronic and drags on for years. AT severe cases The patient is placed in a hospital where he is treated with antidepressants. After drug therapy, the help of a psychotherapist is needed, methods of psychodynamic, trance, existential psychotherapy are used.

Cognitive-behavioral psychotherapy for depression has shown positive results. All symptoms of a depressive state are studied, and with the help of special exercises the patient can get rid of them. One of effective methods CBT is cognitive remodeling.

The patient, with the help of a psychotherapist, works with his negative thoughts that affect behavior, speaks them out loud, analyzes and, as necessary, changes his attitude to what was said. Thus, he makes sure of the truth of his value attitudes.

The technique includes a number of techniques, the most common are the following exercises:

• Inoculation (grafting) stress. The patient is taught skills (coping skills) that should help in dealing with stress. First you need to realize the situation, then develop certain skills to deal with it, then you should consolidate them through certain exercises. The "vaccination" obtained in this way helps the patient cope with strong feelings and disturbing events in my life.
• Suspension of thinking. A person is fixated on his irrational thoughts, they interfere with adequately perceiving reality, serve as a cause for anxiety, as a result stressful situation. The therapist invites the patient to reproduce them in his internal monologue, then loudly says: “Stop!” Such a verbal barrier abruptly cuts off the process of negative judgments. This technique, repeatedly repeated in the course of therapeutic sessions, develops conditioned reflex to “wrong” ideas, the old stereotype of thinking is corrected, new attitudes towards a rational type of judgments appear.

It's important to know! There is no treatment for depression that is the same for everyone. What works for one may not work at all for another. To find an acceptable technique for yourself, you do not need to dwell on one method only on the grounds that it helped someone close or familiar.

In the formation of psychological difficulties and human complexes. Its creator is the American professor Aaron Temkin Beck. Today, behavioral therapy is considered one of the most effective methods in the treatment of depressive states and prevention of suicidal tendencies in humans.

In the above form of influence, principles are applied that are aimed at changing the behavior of an individual in order to identify existing thoughts (cognitions) and identify sources of problems among them.

Cognitive behavioral therapy is used to eliminate negative thoughts, create and strengthen new analytical methods and thinking patterns and includes several techniques. Among them are:

1. Detection of unwanted and desirable thoughts, identification of factors that provoked their appearance.
2. Designing new stereotypes in the patient.
3. Using the imagination to visualize the alignment of other thoughts with emotional well-being and desired behaviors.
4. Application in current life, real situations of new conclusions.

The main goal pursued by cognitive behavioral therapy is the acceptance of new stereotypes by a person for a habitual mental image.

The technique connects all character with the direction of thoughts. In other words, circumstances are not the main obstacle to achieving harmony and happiness in life. With his mind, a person forms one or another attitude to the environment and what is happening. At the same time, as a rule, far from the best develop. For example, panic, anger, timidity, fear, passivity.

An inadequate assessment of the significance of surrounding people, events and objects, endowing them with uncharacteristic qualities can be present in all spheres of human life. So, for example, when given great importance in the opinion of the authorities, any criticism from his side is perceived by his subordinates very painfully. This affects not only the performance of the employee, but also his own attitude towards himself.

The influence of thoughts on a person has a more pronounced character in the family. So, for example, when a woman considers a man to be the main one in all matters, and herself - not having the right to contradict him, she can be doomed to endure his aggression all her life. Of course, in this case, there is no need to talk about equality in the family. Often, a woman's attitude to the role of family members is formed on the basis of fear - she is afraid of arousing her husband's anger. It should be noted that in many cases the fear is unfounded and provoked only by her own thoughts.

The methods of identifying and subsequently changing the underlying difficulties and problems of a person, which includes cognitive behavioral therapy, are among the most accessible to consciousness. According to many qualified specialists, the most difficult to treat patients with. This is mainly due to the fact that, as a rule, such patients come to a psychotherapist under strong pressure from relatives, without feeling the desire to change in any way. A person who is not aware of his own deep problem, who does not seek to cope with it, feels This often negatively affects the result of treatment.

Designed to encourage the patient to change. The main difficulty with this is that a person is reluctant to leave his own comfort zone, because in many cases he cannot understand why he should change something, because he already feels great with the existing behavioral model and thoughts.

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 a source of painful emotions, inappropriate behavior, depression, anxiety disorders and other diseases.

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. Important principle feedback- The therapist constantly checks how the patient understands what is happening in therapy, and discusses with him possible errors.

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 that must be completed in places or circumstances that cause anxiety - take the elevator, dine at 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 applied in both individual work as well as working 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 the connection "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. Evaluating the results various methods therapy, 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.