What is cognitive psychotherapy. Human cognitive behavior

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

Founders of the system

In the middle of the 20th century, the works of the pioneers of cognitive behavioral therapy (hereinafter CT) A. Beck and A. Ellis became very famous and widespread. Aaron Beck originally received psychoanalytic training, but, disillusioned with psychoanalysis, created his own model of depression and a new method of treatment affective disorders which is 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: complete guide: Per. from English - M.: LLC Publishing House "Williams", 2006. - P. 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 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, cognition. New approach- cognitive therapy - believes that emotional disorders can be approached in a completely different way: the key to understanding and solving psychological problems is in the minds of patients.

Aleksandrov A. A. Modern psychotherapy. - St. Petersburg: Academic Project, 1997. - P. 82.

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

To achieve these goals, a cognitive psychotherapist helps the client solve the following tasks: 1) understand the influence of thoughts on emotions and behavior; 2) learn to identify and observe negative automatic thoughts; 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 fertile ground for the occurrence 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 most popular of which are described below.

Methodology and features of cognitive psychotherapy

Today, CT is at the intersection of cognitivism, behaviorism and psychoanalysis. As a rule, in textbooks, published in last years in Russian, the issue of the existence of differences between the two most influential variants of cognitive therapy - CT by A. Beck and REBT by A. Ellis - is not addressed. An exception is the monograph by G. Kassinov and R. Tafrate with a foreword by Albert Ellis.

As the founder of rational emotive behavior therapy (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 techniques, and Chapter 14 introduces some basic REBT techniques. … Both chapters are excellently written and reveal both many similarities and the main differences between these approaches. … But I would also like to point out that the REBT approach certainly, to a greater extent than cognitive therapy, emphasizes emotional-memory-(evocative-)experiential modes.

Preface / A. Ellis // Kassinov G., Tafreyt R. Ch. Psychotherapy of anger. - M.: AST; St. Petersburg: Sova, 2006. - P. 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 are not discussed or questioned. ... The psychotherapist does not discuss reliability, 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: Sova, 2006. - P. 328.

Features of CT:

1. Natural scientific foundation: the presence of one’s own psychological theory of normal development and factors in the occurrence of mental pathology.
2. Target-oriented and manufacturable: for everyone nosological group exists psychological model, describing the specifics of violations; Accordingly, the “targets of psychotherapy”, its stages and techniques are highlighted.
3. Short-term and cost-effective approach (unlike, for example, psychoanalysis): from 20-30 sessions.
4. The presence of integrating potential inherent in the theoretical schemes of CT (existential-humanistic orientation, object relations, behavioral training, etc.).

Basic theoretical principles

1. The way an individual structures situations determines his behavior and feelings. Thus, the center is the subject’s interpretation of external events, which is implemented according to the 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. Affective pathology is a strong exaggeration of normal emotion, resulting from incorrect interpretation under the influence of many factors (see point No. 3). The central factor is “private possessions (personal space)” ( personal domain), at the center of which lies the Ego: emotional disturbances depend on whether a person perceives events as enriching, depleting, threatening, or encroaching on his domain. Examples:
   • Sadness arises from the loss of something valuable, that is, the deprivation of private possession.
   • Euphoria is the feeling or expectation of acquisition.
   • Anxiety is a threat to physiological or psychological well-being.
   • Anger results from the feeling of being directly attacked (either intentionally or unintentionally) or of a violation of the laws, morals, or standards of the individual.
3. Individual differences. They depend on past traumatic experiences (for example, a situation of prolonged stay in a confined space) and biological predisposition (constitutional factor). E. T. Sokolova proposed the concept differential diagnosis and psychotherapy for two types of depression, based on the integration of CT and psychoanalytic object relations theory:
   • Perfectionistic melancholy(occurs in the so-called “autonomous personality”, according to Beck). It is provoked by frustration of the need for self-affirmation, achievement, and autonomy. Consequence: development of the compensatory structure of the “Grandiose Self”. Thus, here we are talking about a narcissistic personality organization. Strategy of psychotherapeutic work: “containing” ( careful attitude to heightened self-esteem, wounded pride and feelings 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 clinging to the Other. Strategy of psychotherapeutic work: “holding” (emotional “pre-feeding”).
4. The normal functioning of the cognitive organization is inhibited under the influence of stress. Extremist judgments, problematic thinking arise, concentration is impaired, etc.
5. Psychopathological syndromes (depression, anxiety disorders, etc.) consist of hyperactive patterns with unique content that characterize a particular syndrome. Examples: depression - loss, anxiety disorder - threat or danger, etc.
6. Intense interactions with other people create a vicious circle of maladaptive cognitions. A wife suffering from depression, misinterpreting her husband’s frustration (“I don’t care, I don’t need her...” instead of the real “I can’t help her”), attributes a negative meaning to it, continues to think negatively about herself and her relationship with her husband, withdraws, and, as a consequence, 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 ideological 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 schema: “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, first of all, to the person himself, creating difficulties for him in communicating with the opposite sex, since subconsciously he will be negatively inclined in advance, and the interlocutor may understand this and be offended.
   • positive/negative
   • idiosyncratic/universal. Example: depression - maladaptive, negative, idiosyncratic.
2. Automatic thoughts. These are thoughts that the brain records in the “fast” area of ​​​​memory (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 repeatedly slowly thinking about this thought, 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 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 and return them from the area quick 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 compression
   • Not subject to conscious control
   • Transience
   • Perseveration and stereotyping. Automatic thoughts are not the result of thinking or reasoning; they are subjectively perceived as reasonable, even if they seem absurd to others or contradict obvious facts. Example: “If I get a “good” grade on 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 divorce,” “Everything I I do it, I do it poorly.”
3. Cognitive errors. These are supervalent and affectively charged schemas that directly cause cognitive distortions. They are common to everyone psychopathological syndromes. Kinds:
   • Arbitrary conclusions- 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, followed by their generalization.
   • Selective abstraction- focusing the individual’s attention on any details of the situation while ignoring all its other features.
   • Exaggeration and understatement- opposite assessments of oneself, situations and events. The subject exaggerates the complexity of the situation while simultaneously downplaying his ability to cope with it.
   • Personalization- an individual’s attitude towards external events as having something to do with him, when in reality this is not the case.
   • Dichotomous Thinking(“black and white” thinking or maximalism) - assigning oneself or any event to one of two poles, positive or negative (in absolute terms). In a psychodynamic sense, this phenomenon can be qualified as a protective mechanism of splitting, which indicates the “diffusion of self-identity.”
   • Ought- excessive focus on “I should” act or feel in a certain way, without evaluating the real consequences of such behavior or alternative options. Often arises from previously imposed standards of behavior and thought patterns.
   • Prediction- an 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 and 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 one or another type of psychopathology (see below).

Theory of psychopathology

Depression

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

• Negative self-image: “I’m inferior, I’m a failure, at the very least!”
• Negative assessment of the surrounding world and external events: “The world is merciless to me! Why is all this falling on me?”
• Negative assessment of the future. “What can I say? I simply have no future!”

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

• 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 the Ought

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 loss of control (for example, over your body, as in the case of fear of getting sick). Claustrophobia - fear of enclosed spaces; mechanism (and in agoraphobia): fear that in case of danger, help may not arrive in time. Themes:

• Anticipation of negative events in the future, so-called. “anticipation of all kinds of misfortunes.” With agoraphobia: fear of dying or going crazy.
• The discrepancy between the level of aspirations and the conviction of 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.
• Persistent perception of inevitable failure in attempts to improve interpersonal relationships, of being humiliated, ridiculed, or rejected.

Perfectionism

Phenomenology of perfectionism. Main parameters:

• High standards
• All or nothing thinking (either complete success or complete failure)
• Focusing on failures

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

Psychotherapeutic relationship

The client and therapist must agree on what problem they want to work on. It is problem solving (!), not change personal characteristics or the patient's deficiencies. The therapist must be very empathic, natural, congruent (principles taken from humanistic psychotherapy); there should be no directiveness. Principles:

• The therapist and client collaborate in an experimental test of erroneous maladaptive thinking. Example: client: “When I walk down the street, everyone turns to look at me,” therapist: “Try to walk normally down the street and count how many people turn to look at you.” Usually this 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 at them and discusses them, still have a real factual basis - it’s all about how the mentally ill person 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 from one point, does not look around at all, or looks around with fear at those around him, then such a person will certainly attract attention to himself. They will actually turn around, look at him and discuss him - simply because passers-by are interested in why he behaves this way. In this situation, a psychologist can help the client understand that the interest of others is caused by his 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 goals:
  1. Clarify or identify problems
  2. Help in identifying thoughts, images, sensations
  3. Explore the meaning of events for the patient
  4. Assess the consequences of maintaining maladaptive thoughts and behaviors.
• Guided Cognition: The therapist-guide encourages patients to address facts, evaluate probabilities, gather information, and put it all to the test.

Techniques and methods of cognitive psychotherapy

CT in Beck's version is a structured training, experiment, mental and behavioral training designed to help the patient master the following operations:

• Identify your negative automatic thoughts.
• Find connections between knowledge, affect and behavior.
• Find facts for and against automatic thoughts.
• Look for more realistic interpretations for them.
• Learn to identify and change disorganizing beliefs that lead to distortion of skills and experience.

Specific methods for identifying and correcting automatic thoughts:

1. Writing down thoughts. The psychologist can ask the client to write down on paper what thoughts arise in his head when he is trying to do the right action (or not do an unnecessary action). It is advisable to write down the thoughts that come to mind at the moment 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 write down their thoughts in a diary over the course of several days to understand what a person thinks about most often, how much time they spend on it, and how strong the emotions they experience from their thoughts. For example, American psychologist Matthew McKay recommended that his clients divide a diary page into three columns, where they briefly indicate the thought itself, the hours of time spent on it, and an assessment of their emotions on a 100-point scale ranging from: “very pleasant/interesting” - “ indifferent" - "very unpleasant/depressing." The value of such a diary is also that sometimes even the client himself cannot always accurately indicate the reason for his experiences, then the diary helps both himself and his psychologist find out what thoughts affect his well-being during the day.
3. Distance. 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 involves 3 components:
   • awareness of the automaticity of a “bad” thought, its spontaneity, the understanding that this pattern arose earlier under different circumstances or was imposed by other people from the outside;
   • awareness that a “bad” thought is maladaptive, that is, it causes suffering, fear or disappointment;
   • the emergence of doubt 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 at the university).
4. Empirical verification(“experiments”). Methods:
   • Find arguments for and against automatic thoughts. It is also advisable to write down these arguments on paper so that the patient can re-read it whenever these thoughts come to his mind 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. Here it is also necessary to take into account the long-term perspective, and not just the short-term benefit (for example, in the long run, the problems from drugs will be many times greater than the temporary pleasure).
   • Constructing an experiment to test a judgment.
   • Conversation with witnesses of past events. This is especially true when mental disorders ah, where memory is sometimes distorted and replaced by fantasy (for example, in schizophrenia) or, if the delusion is caused by an incorrect interpretation of the motives of another person.
   • The therapist turns to his experience, fiction and academic literature, statistics.
   • The therapist incriminates: points out logical errors and contradictions in the patient’s judgments.
5. Revaluation technique. Checking the probability of alternative causes of an event.
6. Decentration. With social phobia, patients feel like the center of everyone's attention and suffer from it. Empirical testing of these automatic thoughts is also needed here.
7. Self-expression. Depressed, anxious, etc. patients often think that their illness is under control higher levels consciousness, constantly observing themselves, they understand that symptoms do not depend on anything, and attacks have a beginning and an end. Conscious self-observation.
8. Decatastrophizing. For anxiety disorders. Therapist: “Let's see what would happen if...”, “How long will you experience such negative feelings?”, “What will happen then? You will die? Will the world collapse? Will this 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. Playing out the desired behavior, repeatedly trying out various positive instructions in practice, which leads to increased self-efficacy. Sometimes the patient completely agrees with the correct arguments during psychotherapy, but quickly forgets them after the session and again returns to the previous “wrong” arguments, since 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 re-read them regularly.
10. Using the Imagination. In anxious patients, it is not so much “automatic thoughts” that predominate as “obsessive images”, that is, it is not thinking that maladapts, but imagination (fantasy). Kinds:
    • Stopping technique: loud command to yourself “stop!” - the negative way of thinking or imagining stops. It can also be effective in stopping obsessive thoughts in some mental illnesses.
    • Repetition technique: repeat the correct way of thinking several times to destroy the formed stereotype.
    • Metaphors, parables, poems: the psychologist uses such examples to make the explanation more understandable.
    • 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 severe failure, you can find at least something positive in what happened (for example, “I got good lesson") and concentrate on that.
    • 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 abandon achieving this goal altogether, discard the unfulfilled desire, reduce requests, set more realistic goals for oneself, for starters, try to get more comfortable with what you have or find something substitute. This is true in cases where the cost of refusing to solve a problem is lower than suffering from the problem itself. However, in other cases, it may be better to tense up and solve the problem, especially if delaying the solution only makes the situation worse and causes more suffering for the person.
12. Replacing emotions. Sometimes the client needs to come to terms with his past negative experiences and change his emotions to more adequate ones. For example, sometimes it will be better for a victim of a crime not to replay the details of what happened in his memory, but to say to himself: “It’s very unfortunate that this happened to me, but I won’t let my offenders ruin the rest of my life, 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, which will allow you to build your future life more comfortably.
13. Role reversal. Ask the client to imagine that he is trying to console a friend who finds himself in a similar situation. What could you say to him? What do you recommend? What advice could 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, and write this plan down on paper. For example, if a catastrophic event occurs, the client will perform a certain sequence of actions at the designated time, and before this event occurs, the client will not torment himself needlessly with worries.
15. Identifying alternative causes of behavior. If all the “correct” arguments are presented, 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 is not aware of or prefers to remain silent about. For example, with obsessive thoughts, the very process of thinking often brings a person great satisfaction and relief, since it allows him to at least mentally imagine himself as a “hero” or “savior,” solve all problems in fantasies, punish enemies in dreams, correct his mistakes in an imaginary world, etc. .d. Therefore, a person scrolls through such thoughts again and again, no longer for the sake of a real solution, but for the sake of the very process of thinking and satisfaction; gradually this process draws the person deeper and deeper like a kind of drug, although the person understands the unreality and illogicality of such thinking. In particularly severe cases, irrational and illogical behavior may even be a sign of a serious mental illness(eg, obsessive-compulsive disorder or schizophrenia), then psychotherapy alone may not be enough, and the client also needs the help of medication to control thinking (i.e., requires the intervention of a psychiatrist).

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

• With schizophrenia, patients sometimes begin to behave mental dialogues with imaginary images of people or otherworldly creatures (so-called “voices”). The psychologist, in this case, can try to explain to the schizophrenic that he is not talking with real people or creatures, but with the artistic images of these creatures created by him, thinking in turn first for himself, then for this character. Gradually, the brain “automates” this process and begins to produce phrases that are suitable for the invented character in a given situation automatically, even without a conscious request. You can try to explain to the client that conversations with imaginary characters normal people They also sometimes do this, 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, thinking in turn for several characters at once. However, a normal person understands well that this image is fictitious, so he is not afraid of it and does not treat it as a real being. The brains of healthy people do not attach interest or importance to such characters, and therefore do not automate fictional conversations with them. It’s like the difference between a photograph and a living person: you can safely put a photograph in the table and forget about it, because it doesn’t matter, and if it were a living person, they wouldn’t do that to him. When a schizophrenic understands that his character is just a figment of his imagination, he will also begin to handle him much more easily and will stop pulling this image out of his memory when it is not necessary.

• Also, with schizophrenia, the patient sometimes begins to mentally replay a fantasy image or plot many times, gradually such fantasies are deeply recorded in memory, enriched with realistic details and become very believable. However, this is the danger that a 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 with the help of external reliable sources: documents, people whom the patient trusts, scientific literature, conversation with witnesses, photographs, video recordings, design of an experiment to test judgment, etc.

• In obsessive-compulsive disorder, when an intrusive thought occurs, it may be helpful for the patient to repeat counter-arguments several times about how they are being harmed intrusive thoughts how he uselessly 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, work, etc. As stated above, it is better to write down such useful counterarguments on paper so that you can re-read them regularly and try to remember them by heart.

The effectiveness of cognitive psychotherapy

Factors of 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, once a good therapist feels the dullness and impersonality of therapy (“solving problems according to formal logic”), he is not afraid of self-disclosure, is not afraid of using imagination, parables, metaphors, etc. P.
2. The right psychotherapeutic relationship. Taking into account the patient’s automatic thoughts about the psychotherapist and the proposed tasks. Example: Automatic thought of the patient: “I will write in my diary - in five days I will become the happiest person in the world, all problems and symptoms will disappear, I will begin to truly live.” Therapist: “The diary is just a separate help, there will be no immediate effects; your journal entries are mini-experiments that give you new information about yourself and your problems.”
3. High-quality application of techniques, an informal approach to the CT process. Techniques must be applied according to the specific situation; a formal approach greatly reduces the effectiveness of CT and can often generate new automatic thoughts or frustrate the patient. Systematicity. Accounting for feedback.
4. Real problems - real effects. Effectiveness decreases if the therapist and client do whatever they want, ignoring the real problems.

Literature

• Beck A., Judith S. Cognitive Therapy: The Complete Guide = Cognitive Therapy: Basics and Beyond. - M.: “Williams”, 2006. - P. 400. - ISBN 0-89862-847-4.
• Aleksandrov A. A. Modern psychotherapy. - St. Petersburg, 1997. - ISBN 5-7331-0103-2. (Lectures on Cognitive Therapy No. 5, 6 and 13).
• Beck A., Rush A., Shaw B., Emery G. Cognitive therapy for depression. - St. Petersburg: Peter, 2003. - ISBN 5-318-00689-2.
• Beck A., Freeman A. Cognitive psychotherapy for personality disorders. - St. Petersburg: Peter, 2002.
• McMullin R. Workshop on cognitive therapy. - St. Petersburg, 2001.
• Vasilyeva O. B. List of literature on cognitive behavioral psychotherapy
• Cognitive-behavioral approach to psychotherapy and counseling: Reader / Comp. T. V. Vlasova. - Vladivostok: State Institute of Moscow State University, 2002. - 110 p.
• Patterson S., Watkins E. Theories of psychotherapy. - 5th ed. - St. Petersburg: Peter, 2003. - Ch. 8.
• Sokolova E. T. Psychotherapy: Theory and practice. - M.: Academy, 2002. - Ch. 3.
• Fedorov A.P. Cognitive-behavioral psychotherapy. - St. Petersburg: Peter, 2002. -

Cognitive-behavioural (CBT), or cognitive behavioral psychotherapy— modern method psychotherapy used in the treatment of various mental disorders.

This method was originally developed for the treatment depression, then began to be used for treatment anxiety disorders, panic attacks ,obsessive-compulsive disorder, and in recent years has been successfully used as an auxiliary method in the treatment of almost all mental disorders, including bipolar disorder And schizophrenia. CBT has the widest evidence base and is used as the main method in hospitals in the USA and Europe.

One of the most important advantages of this method is its short duration!

Of course, this method is also applicable to helping people who do not suffer from mental disorders, but who are simply faced with life’s difficulties, conflicts, and health problems. This is due to the fact that the main postulate of CBT is applicable in almost any situation: our emotions, behavior, reactions, bodily sensations depend on how we think, how we evaluate situations, what beliefs we rely on when making decisions.

The purpose of the CBT is a person’s revaluation of his own thoughts, attitudes, beliefs about himself, the world, other people, because they often do not correspond to reality, are noticeably distorted and interfere full life. Low-adaptive beliefs change to ones that are more consistent with reality, and due to this, a person’s behavior and sense of self changes. This happens through communication with a psychologist, and through introspection, as well as through so-called behavioral experiments: new thoughts are not simply accepted on faith, but are first applied in a given situation, and the person observes the result of such new behavior.

What happens during a cognitive behavioral therapy session:

Psychotherapeutic work focuses on what is happening to a person at a given stage of his life. A psychologist or psychotherapist always strives to first establish what is happening to a person at the present time, and only then moves on to analyzing past experiences or making plans for the future.

Structure is extremely important in CBT. Therefore, during a session, the client most often fills out questionnaires first, then the client and the psychotherapist agree on what topics need to be discussed in the session and how much time needs to be spent on each, and only after that the work begins.

The CBT psychotherapist sees in the patient not only a person with certain symptoms (anxiety, low mood, restlessness, insomnia, panic attacks, obsessions and rituals, etc.) that prevent him from living fully, but also a person who is able to learn to live like this , so as not to get sick, who can take responsibility for his well-being in the same way as a therapist takes responsibility for his own professionalism.

Therefore, the client always leaves the session with homework and does a huge part of the work to change himself and improve his condition himself, by keeping diaries, self-observation, training new skills, and implementing new behavioral strategies into his life.

Individual CBT session lasts from40 up to 50minutes, once or twice a week. Usually a course of 10-15 sessions. Sometimes it is necessary to conduct two such courses, as well as include group psychotherapy in the program. It is possible to take a break between courses.

Areas of assistance using CBT methods:

• Individual consultation with a psychologist, psychotherapist
• Group psychotherapy (adults)
• Group therapy (teens)
• ABA therapy

The other day a man called. He says you do psychotherapy? Yes, I answer. Which one exactly? I say, “My specialty is cognitive behavioral therapy.” “Ah-ah,” he says, “that is normal Don’t you do psychotherapy, psychoanalysis?”

So what is cognitive behavioral psychotherapy? This Is it psychoanalysis or not?? CBT is better than psychoanalysis or not? These are the questions potential clients often ask.

In this article I want to talk about the main differences between the cognitive behavioral approach and the others. I will tell you without going deep into theory, but on a simple everyday level. And I hope, in the end, readers will understand whether this is psychoanalysis or not.

Modern approaches in psychotherapy

The word “psychotherapy” consists of 2 parts: “psycho-” and “therapy”. That is, this entire word means “mental treatment.” This can be done in a variety of ways; over the entire existence of psychology, people have accumulated enormous experience in this area.

These methods of “mental treatment” are called “approaches” or “directions” in psychotherapy. You can approach from the side of the head, or from the side of the body, for example. Or you can treat the psyche individually one-on-one, or in a group with other people who also need similar help.

Today there are dozens of approaches in the world. Here list not intended to be complete, just everything that came to my mind right now, in alphabetical order:

• art therapy
• gestalt therapy
• cognitive-behavioral psychotherapy (or cognitive-behavioral)
• Third wave approaches derived from cognitive behavioral therapy, such as ACT (Acceptance and Commitment Therapy)
• psychoanalysis
• psychodrama
• systemic family therapy
• fairytale therapy
• body-oriented psychotherapy
• transactional analysis, etc.

Some approaches are older, some are newer. Some occur frequently, others less frequently. Some are advertised in movies, such as psychoanalysis or family counseling. All approaches require long-term basic training and then additional training from intelligent teachers.

Each approach has its own theoretical basis, that is, a set of some ideas why this approach works who it helps and how it should be used. For example:

• In art therapy, the client is likely to conceptualize and solve problems through artistic and creative methods, such as sculpting, painting, film, story-telling, etc.
• In Gestalt therapy, the client will be brought to awareness of his problems and needs "here and now", expanding his understanding of the situation.
• In psychoanalysis there will be conversations with the therapist about dreams, associations, situations that come to mind.
• In body-oriented therapy, the client works together with the therapist in the form physical exercise with tension in the body, which are in a certain way associated with mental problems.

And ardent adherents of some approach will always argue with adherents of other approaches about the effectiveness and applicability of their particular method. I remember when I was studying at the institute, our rector dreamed that someday a single unified approach would finally be created that would be accepted by everyone, and it would be effective, and in general then happiness would come, apparently.

However, all these approaches have the same right to exist. None of them are “bad” or “good”. A specialist who uses, say, CBT, but does not use psychoanalysis, is not somehow insufficiently professional. We do not require that the surgeon also be able to treat ear infections, otherwise he is not a surgeon at all. Some methods are better researched than others, but more on that later.

The essence of the cognitive behavioral approach

The basic theoretical premises of cognitive behavioral psychotherapy were developed by Aaron Beck and Albert Ellis.

Now let's take one of these approaches: cognitive-behavioral.

One of key concepts CBT is that the source of a person's problems is most likely to be within the person himself, and not outside of him. What What causes him discomfort is not situations, but his thoughts, assessments of situations, assessments of himself and other people.

People tend to cognitive schemas(For example, "real men don't do that") And cognitive distortions(for example, “predicting the future” or ““), as well as automatic thoughts that provoke the appearance of negative emotions.

In cognitive behavioral therapy, the client and the therapist are something like thinking researchers client. By asking various, sometimes tricky or funny questions, suggesting experiments, the therapist encourages the client to discover prejudices, irrational logic, belief in untruths masquerading as truth, and try to challenge them, that is, to question them.

Some of these “assessments” or “beliefs” do not help a person adapt to this world and other people, but, on the contrary, seem to push him towards isolation from other people, himself, and the world.

They contribute to the worsening of depression, the emergence of anxiety, phobias, etc.

In the process of cognitive-behavioral psychotherapy, the client will be able to see his beliefs from the outside and decide whether to continue to adhere to them, or to try to change something - and a cognitive-behavioral psychotherapist helps him with this.

Such a “revision” of your ideas about yourself, the world around you and other people helps you cope with depression, get rid of anxiety or self-doubt, increase assertiveness and self-esteem and solve other problems. Albert Ellis, in one of his books, outlined his point of view on mental health, having composed .

Another important basic point in cognitive behavioral psychotherapy is considering thoughts, feelings and behavior as a whole, as interconnected, and, accordingly, strongly influencing each other.

By easing the tension that comes from thoughts, the tension in feelings and actions naturally eases. Typically, people find it easy to put CBT skills into practice. In a sense, this branch of psychotherapy is something like education / training / coaching, with the goal of improving the client’s condition here, now and in the future.

Basic components of cognitive behavioral psychotherapy

CBT is known for the fact that it supposedly has a “protocol” for each condition. Like an easy-to-follow instruction manual for a psychotherapist, which he takes and applies to the client. And the client went happy without any problems. At the beginning of each training session, it is common to ask what the expectations of those present are, and at CBT trainings someone is sure to mention “I want a work protocol.”

In fact, these are not step-by-step protocols, but rather diagrams, plans of psychotherapy, which take into account the characteristics of the conditions. So, for example, for CBT the plan will include a stage of working with, but in this case it is necessary to devote time to working with self-esteem and incorrect standards regarding oneself.

There are no verbatim, step-by-step instructions (aka protocol) in CBT.

Typical and general stages cognitive behavioral psychotherapy:

1. Psychological education.
2. Addressing beliefs that contribute to maintaining the problem.
3. , experiments in life and imagination to test beliefs.
4. Preventing future relapses.

Within these stages, a variety of methods are used: cognitive restructuring, Socratic dialogue, continuum of thinking, falling arrow method, etc.

The effectiveness of cognitive behavioral psychotherapy

The results of CBT have been studied quite well. There have been sooo many studies that have found it to be highly effective in solving many troubling problems, well received by clients, and relatively short-term.

On the same topic:

I’m too lazy to copy links to all these studies here; to be honest, there are too many of them. Effective in terms of self-esteem, anxiety, depression, phobias, personal problems, chronic pain, self-doubt, eating disorders...fill in your own. I don't mean that other approaches are worse. What I'm saying is that the specific cognitive behavioral approach has been studied many times and found to work.

“By easing the tension that comes from thoughts, the tension in feelings and actions naturally eases.” - anacoluthus Well, the speech of an educated person should not contain such errors! Immediately, once again, trust is undermined.

I admire this science called PSYCHOLOGY. And specialists in this profile sometimes simply work miracles. But psychologists say that everything can be corrected while a person is alive in body and soul, it is always possible to heal! Very interesting article, I read it in one go)) maybe you can help me, 3 years ago I witnessed a terrible picture... I still can’t come to my senses. I'm worried about constant fear, what do you recommend?

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

Cognitive psychotherapy specialists view a person as individual personality who shapes her life depending on what she pays attention to, how she looks at the world, and how she interprets certain events. The world is the same for all people, but what people themselves think about it may differ in different opinions.

In order to know why certain events, sensations, experiences happen to a person, it is necessary to understand his ideas, worldview, views and reasoning. This is what cognitive psychologists do.

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

What is cognitive psychotherapy?

Psychology uses many techniques to help a client. One such area is cognitive psychotherapy. What it is? This is a targeted, structured, directive, short-term conversation aimed at transforming a person’s inner “I,” which is manifested in the feeling of these transformations and new patterns of behavior.

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

Cognitive behavioral psychotherapy performs many beneficial functions that help healthy people transform their lives:

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

Cognitive psychotherapy uses many methods, exercises and techniques that are used to different stages. They are ideally combined with other areas of psychotherapy, complementing or replacing them. Thus, the therapist can use several directions at the same time if this will help achieve the goal.

Beck's cognitive psychotherapy

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

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

Aaron Beck didn't think the world was bad, but rather people's views on the world were negative and wrong. They form the emotions that others experience and the actions that are then performed. It is actions that influence how events unfold further in the life of each person.

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

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

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

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

In psychotherapeutic practice, Beck and Freeman believed that a friendly atmosphere between the client and the specialist was important. The client should not have resistance to what the therapist is doing.

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

Methods of cognitive psychotherapy

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

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

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

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

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

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

Cognitive psychotherapy exercises

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

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

All people from childhood are taught to think unambiguously. For example, “If I can’t do anything, then I’m a failure.” In fact, such thinking limits the behavior of a person who is now not even going to try to refute it.

Exercise "Fifth Column".

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

After identifying automatic thoughts, it is suggested to perform various exercises, where a person will be able to change his attitudes by performing actions other than those he did previously. Then it is proposed to perform these actions in real conditions to see what result will be achieved.

Cognitive psychotherapy techniques

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

Cognitive psychotherapy aims to teach the client the following:

• Identifying negative automatic thoughts.
• Discovering connections between affect, knowledge, and behavior.
• Finding arguments for and against automatic thoughts.
• Learning to identify negative thoughts and attitudes that lead to incorrect behavior and negative experiences.

Most people expect a negative outcome of events. That's why he has fears, panic attacks, negative emotions, which force him not to act, to run away, to fence himself off. Cognitive psychotherapy helps in identifying attitudes and understanding how they affect a person’s behavior and life. The individual is to blame for all his misfortunes, which he does not notice and continues to live unhappily.

Bottom line

You can even use the services of a cognitive psychotherapist healthy person. Absolutely all people have some kind of personal problems that they cannot cope with on their own. Bottom line unresolved problems– depression, dissatisfaction with life, dissatisfaction with oneself.

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

To avoid any confusion, let me clarify right away that cognitive behavioral therapy (CBT) and cognitive behavioral therapy (CBT) are the same thing. Actually, the first option is just a more complete translation from English. "cognitive behavioral therapy" (behavior - behavior). And they call it as it is more familiar to someone.

What is it and what does it look like?

Probably everyone imagines what a hypnosis session or a session with a psychoanalyst looks like. And what a group psychotherapy session looks like, everyone has also seen it in movies or on television. The person is in a trance, under the control of a psychotherapist, or lies on the couch and talks about his associations and dreams. Or he sits in a circle of people with problems and everyone talks about painful things, and the psychotherapist directs the conversation in the right way.

Appointment with a psychotherapist professing cognitive behavioral therapy , takes place in the form of an active interview - in a clear mind, sitting opposite each other. It's pretty active process, as a result of which I try to come with my patient to certain findings, to identify conscious and unconscious causes of neurosis (negative beliefs and attitudes - cognitions). And, as a result, it is imperative to develop tactics for correcting symptoms, negative experiences and behavior.

For example, if a person cannot use the subway because of fear of panic attacks, we not only identify the causes and mechanisms of fear, not only understand how attacks are triggered, but also create a specific strategy for overcoming fear and controlling the attack. We are planning steps for tomorrow, for the following days. First in some kind of experiments, training, and then in real life. And these are steps not only to control the symptoms of neurosis, but also to identify and control the causes that caused significant nervous tension, causing a development deadlock. The result is getting rid of panic attacks and metro phobia, and the formation of effective, useful, developmental behavior in a person’s life.

During the session, we create a system of tasks: what needs to be done before our next meeting, how exactly to explore our “cognitive errors,” control and correct them, changing our mood and behavior. It is correct to consider this method of psychotherapy as a kind of training. I teach you to control your negative thoughts and their consequences - anger, fears, depression and addictive behavior.

The tasks vary: from keeping special psychotherapeutic diaries to performing step by step instructions in a frightening situation, from training internal optimistic dialogue to using relaxation and breathing exercises.

Even from this it became clear to you that cognitive behavioral psychotherapy, this is a method of ACTIVEly finding and fixing the problem . While other directions are non-directive, “passive”. Therefore, today, in world practice, cognitive behavioral therapy occupies a leading position. It is more short-term. And it's more effective. She is results-oriented. This style of psychotherapy may not appeal to everyone. It looks much simpler when you come to a session and they do something to you, after which you recover. But, as a rule, this is a fantasy.

By the way, cognitive behavioral therapy is the only method, direction of psychotherapy in general, the effectiveness of which scientifically proven. Whereas other methods, even psychoanalysis (it seemed a method with unquestioned centuries-old authority), do not show reliable effectiveness. Yes, the client is cured of neurosis by visiting a psychotherapist-analyst for a long time, sometimes for years. You can't argue with that. And problems are solved. But they are solved, apparently, for other reasons, but the impact of the treatment process has not been proven. Critics of psychoanalysis, humanistic methods and Gestalt therapy believe that neurotic conditions can go away on their own, also influenced by the attitude towards healing, motivation by the desire to justify their efforts, including material ones. And, a person changes over time, finds resources within himself. I only know that a person is definitely capable of much. And global scientific research has to be trusted by definition.

Cognitive behavioral psychotherapy is easily integrated into psychoanalysis, transactional analysis, Gestalt and NLP. The theory and practice of CBT do not contradict the leading directions of psychotherapy, but become a strong unifying core of analysis and all applied techniques. Therefore, I often use elements of other areas in my work - for example, logotherapy and transactional analysis. This helps a lot in my work.

Cognitive behavioral psychotherapy was created by the works of such great scientists as Ivan Petrovich Pavlov, John Watson, Burres Skinner, Albert Bandura, Aaron Beck and Albert Ellis.

The theory of modern CBT is based on a special understanding of the origin of all human reactions, emotions and behavior. We consider our reactions as the result of the triggering (sometimes instantaneous, automatic, learned) of stereotypical attitudes, learned beliefs, and painful attitudes. Since this relates to the system of thinking, it is very difficult for a person to change them. But by changing, he gets the opportunity to learn other reactions. Cognition- these are “automatic” thoughts that are a reaction to an event that psychologically traumatizes a person.

In the process of psychotherapy, we treat situations and events in a special way. Any difficult situation that provokes a person to negative reactions is such only because of a catastrophic assessment. Habitual for each specific person. Catastrophic assessments and attitudes force one to react to events with resentment, guilt, fear, hopelessness or anger. This is what we are trying to change, and nothing is impossible. Our task is to find cognitive errors and create a system of optimistic rational thinking and behavior.

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