behavioral methods. Cognitive behavioral psychotherapy alone. An example of applying the method of confrontation of behavioral therapy

The foundation of cognitive behavioral therapy (CBT) was laid by the eminent psychologist Albert Ellis and psychotherapist Aaron Beck.

Originating in the 1960s, this technique recognized in academic communities as one of the most effective methods of psychotherapeutic treatment. Cognitive behavioral therapy is a universal method of helping people suffering from various disorders neurotic and mental levels.

The authoritativeness of this concept is added by the dominant principle of the methodology - the unconditional acceptance of personality traits, a positive attitude towards each person while maintaining healthy criticism of the negative actions of the subject.

Methods of cognitive-behavioral therapy have helped thousands of people who suffered from various complexes, depressive states, irrational fears. The popularity of this technique explains the combination of obvious advantages of CBT:

• a guarantee of achieving high results and a complete solution of the existing problem;
• long-term, often life-long persistence of the effect obtained;
• short course of therapy;
• understandability of exercises for an ordinary citizen;
• simplicity of tasks;
• the ability to perform exercises recommended by a doctor, independently in a comfortable home environment;
• a wide range of techniques, the ability to use to overcome various psychological problems;
• no side effects;
• atraumatic and safety;
• using hidden resources of the body to solve the problem.

Cognitive behavioral therapy has shown good results in the treatment of various neurotic and psychotic disorders. CBT methods are used in the treatment of affective and anxiety disorders, neurosis obsessive states, problems in the intimate sphere, anomalies in eating behavior. CBT techniques bring excellent results in the treatment of alcoholism, drug addiction, gambling, and psychological addictions.

general information

One of the features of cognitive-behavioral therapy is the division and systematization of all emotions of a person into two broad groups:

• productive, also called rational or functional;
• unproductive, called irrational or dysfunctional.

The group of unproductive emotions includes destructive experiences of an individual, which, according to the concept of CBT, are the result of irrational (illogical) beliefs and beliefs of a person - “irrational beliefs”. According to supporters of cognitive-behavioral therapy, all unproductive emotions and the dysfunctional model of personality behavior associated with it are not a reflection or result of the subject's personal experience. All irrational components of thinking and the non-constructive behavior associated with them are the result of a person's incorrect, distorted interpretation of their real experience. According to the authors of the methodology, the real culprit of all psycho-emotional disorders is the distorted and destructive belief system present in the individual, which was formed as a result of the wrong beliefs of the individual.

These ideas form the foundation of cognitive-behavioral therapy, the main concept of which is as follows: the emotions, feelings and behavior of the subject are not determined by the situation in which he is, but by how he perceives the current situation. From these considerations comes the dominant strategy of CBT - to identify and identify dysfunctional experiences and stereotypes, and then replace them with rational, useful, realistic feelings, taking full control of your train of thought.

By changing the personal attitude to some factor or phenomenon, replacing a rigid, rigid, non-constructive life strategy with flexible thinking, a person will acquire an effective worldview.

The resulting functional emotions will improve the psycho-emotional state of the individual and ensure excellent well-being under any life circumstances. On this basis, it was formulated conceptual model of cognitive behavioral therapy , presented in an easy-to-understand formula ABC, where:

• A (activating event) - a certain event occurring in reality, which is a stimulus for the subject;
• B (belief) - a system of personal beliefs of an individual, a cognitive structure that reflects the process of a person's perception of an event in the form of emerging thoughts, formed ideas, formed beliefs;
• C (emotional consequences) - final results, emotional and behavioral consequences.

Cognitive-behavioral therapy is focused on the identification and subsequent transformation of distorted components of thinking, which ensures the formation of a functional strategy for the behavior of the individual.

Treatment process

The treatment process using cognitive-behavioral therapy techniques is a short-term course, which includes from 10 to 20 sessions. Most patients visit a therapist no more than twice a week. After a face-to-face meeting, clients are given a small " homework”, including the performance of specially selected exercises and additional acquaintance with educational literature.

Treatment with CBT involves the use of two groups of techniques: behavioral and cognitive.

Let's take a closer look at cognitive techniques. They are aimed at detecting and correcting dysfunctional thoughts, beliefs, ideas. It should be noted that irrational emotions interfere with the normal life of a person, change a person’s thinking, force them to make and follow illogical decisions. Going off scale in amplitude, affective unproductive feelings lead to the fact that the individual sees reality in a distorted light. Dysfunctional emotions deprive a person of control over himself, force him to commit reckless acts.

Cognitive techniques are conditionally divided into several groups.

Group one

The purpose of the techniques of the first group is to track and become aware of one's own thoughts. For this, the following methods are most often used.

Recording your own thoughts

The patient receives the task: to state on a piece of paper the thoughts that arise before and during the performance of any action. In this case, it is necessary to fix thoughts strictly in the order of their priority. This step will indicate the significance of certain motives of a person when making a decision.

Keeping a diary of thoughts

The client is advised to briefly, concisely and accurately write down all the thoughts that arise in a diary for several days. This action will allow you to find out what a person thinks about most often, how much time he spends thinking about these thoughts, how much he is disturbed by certain ideas.

Distance from non-functional thoughts

The essence of the exercise is that a person must develop an objective attitude towards his own thoughts. In order to become an impartial "observer", he needs to move away from emerging ideas. Detachment from one's own thoughts has three components:

• awareness and acceptance of the fact that a non-constructive thought arises automatically, an understanding that the idea that is overcoming now was formed earlier under certain circumstances, or that it is not its own product of thinking, but is imposed from outside by extraneous subjects;
• awareness and acceptance of the fact that stereotyped thoughts are non-functional and interfere with normal adaptation to existing conditions;
• doubt about the truth of the emerging non-adaptive idea, since such a stereotyped construct contradicts the existing situation and does not correspond in its essence to the emerging requirements of reality.

Group two

The task of the technicians from the second group is to challenge existing non-functional thoughts. To do this, the patient is asked to perform the following exercises.

Examining arguments for and against stereotyped thoughts

A person studies his own maladaptive thought and fixes on paper the arguments “for” and “against”. The patient is then instructed to reread their notes daily. With regular exercise in the mind of a person, over time, the “correct” arguments will be firmly fixed, and the “wrong” ones will be eliminated from thinking.

Weighing the advantages and disadvantages

This exercise is not about analyzing your own non-constructive thoughts, but about studying existing solutions. For example, a woman makes a comparison of what is more important for her: to maintain her own safety by not coming into contact with persons of the opposite sex, or to allow a share of risk in her life in order to eventually create a strong family.

Experiment

This exercise provides that a person experimentally, through personal experience, comprehends the result of demonstrating one or another emotion. For example, if the subject does not know how society reacts to the manifestation of his anger, he is allowed to express his emotion in full force, directing it to the therapist.

Return to the past

The essence of this step is a frank conversation with impartial witnesses of past events that left a mark on the human psyche. This technique is especially effective in disorders of the mental sphere, in which memories are distorted. This exercise is relevant for those who have delusions that have arisen as a result of an incorrect interpretation of the motives that move other people.

This step involves giving the patient arguments drawn from the scientific literature, official statistics, and the doctor's personal experience. For example, if a patient is afraid of flying, the therapist points him to objective international reports, according to which the number of accidents when using airplanes is much lower compared to disasters that occur on other modes of transport.

Socratic method (Socratic dialogue)

The doctor's task is to identify and point out to the client logical errors and obvious contradictions in his reasoning. For example, if the patient is convinced that he is destined to die from a spider bite, but at the same time declares that he has already been bitten by this insect before, the doctor points out a contradiction between anticipation and the real facts of personal history.

Change of mind - reassessment of facts

The purpose of this exercise is to change a person's existing view of an existing situation by testing whether alternative causes of the same event would have the same effect. For example, the client is invited to reflect and discuss whether this or that person could have done the same to him if she had been guided by other motives.

Reducing the significance of the results - decatastrophication

This technique involves the development of a non-adaptive thought of the patient to a global scale for the subsequent devaluation of its consequences. For example, to a person who is terrified of leaving his own home, the doctor asks questions: “In your opinion, what will happen to you if you go outside?”, “How much and for how long will negative feelings overcome you?”, “What will happen next? Are you going to have a seizure? Are you dying? Will people die? The planet will end its existence? A person understands that his fears in a global sense are not worth attention. Awareness of the temporal and spatial framework helps to eliminate the fear of the imagined consequences of a disturbing event.

Softening the intensity of emotions

The essence of this technique is to conduct an emotional reassessment of a traumatic event. For example, the injured person is asked to summarize the situation by saying to herself the following: “It is very unfortunate that such a fact took place in my life. However, I will not allow

this event to control my present and ruin my future. I'm leaving the trauma in the past." That is, the destructive emotions that arise in a person lose their power of affect: resentment, anger and hatred are transformed into softer and more functional experiences.

Role reversal

This technique consists in the exchange of roles between the doctor and the client. The task of the patient is to convince the therapist that his thoughts and beliefs are maladaptive. Thus, the patient himself is convinced of the dysfunctionality of his judgments.

Shelving ideas

This exercise is suitable for those patients who cannot give up their impossible dreams, unrealistic desires and unrealistic goals, but thinking about them makes him uncomfortable. The client is invited to postpone the implementation of his ideas for a long time, while specifying a specific date for their implementation, for example, the occurrence of a certain event. The expectation of this event eliminates psychological discomfort, thereby making a person's dream more achievable.

Drawing up an action plan for the future

The client, together with the doctor, develops an adequate realistic program of actions for the future, which specifies specific conditions, determines the actions of a person, sets step-by-step deadlines for completing tasks. For example, the therapist and the patient agree that in the event of a critical situation, the client will follow a certain sequence of actions. And until the onset of a catastrophic event, he will not exhaust himself with disturbing experiences at all.

Group three

The third group of techniques is focused on activating the sphere of the individual's imagination. It has been established that the predominant position in thinking of anxious people is not occupied by “automatic” thoughts at all, but by obsessive frightening images and exhausting destructive ideas. Based on this, therapists have developed special techniques that act on the correction of the area of ​​​​imagination.

termination method

When a client has an obsessive negative image, he is advised to utter a conditional laconic command in a loud and firm voice, for example: “Stop!”. Such an indication terminates the action of the negative image.

repetition method

This technique involves the repeated repetition by the patient of the settings characteristic of a productive way of thinking. Thus, over time, the formed negative stereotype is eliminated.

Use of metaphors

To activate the sphere of the patient's imagination, the doctor uses appropriate metaphorical statements, instructive parables, quotations from poetry. This approach makes the explanation more colorful and understandable.

Image Modification

The method of modifying imagination involves the active work of the client, aimed at gradually replacing destructive images with ideas of a neutral color, and then with positive constructs.

positive imagination

This technique involves replacing a negative image with positive ideas, which has a pronounced relaxing effect.

constructive imagination

The desensitization technique consists in the fact that a person ranks the probability of an expected catastrophic situation, that is, he establishes and orders the expected events of the future according to their significance. This step leads to the fact that the negative forecast loses its global significance and is no longer perceived as inevitable. For example, a patient is asked to rank the probability of death when meeting with an object of fear.

Group four

Techniques from this group are aimed at increasing the effectiveness of the treatment process and minimizing the resistance of the client.

Purposeful repetition

The essence of this technique is the persistent repeated testing of various positive instructions in personal practice. For example, after reassessing one's own thoughts during psychotherapeutic sessions, the patient is given the task: to independently reassess the ideas and experiences that arise in everyday life. This step will ensure a stable consolidation of the positive skill gained in the course of therapy.

Identification of hidden motives of destructive behavior

This technique is appropriate in situations where a person continues to think and act in an illogical way, despite the fact that all the “correct” arguments are stated, he agrees with them and fully accepts them.

The article will be of interest to CBT specialists, as well as specialists in other areas. This is a full article about CBT in which I shared my theoretical and practical findings. The article provides step-by-step examples from practice that clearly show the effectiveness of cognitive psychology.

Cognitive-behavioral psychotherapy and its application

During consultations, the cognitive therapist helps the patient to change his attitude, formed as a result of the wrong process of learning, development and self-knowledge as a person to the events taking place. Particularly good results are shown by CBT with panic attacks, phobias and anxiety disorders.

The main task of the CPT- find in the patient automatic thoughts of "cognition" (which injure his psyche and lead to a decrease in the quality of life) and direct efforts to replace them with more positive, life-affirming and constructive ones. The task facing the therapist is to identify these negative cognitions, since the person himself refers to them as "ordinary" and "for granted" thoughts and therefore accepts them as "due" and "true".

Initially, CBT was used exclusively as an individual form of counseling, but now it is used in family therapy and group therapy (problems of fathers and children, married couples, etc.).

Consultation by a cognitive-behavioral psychologist is an equal and mutually interested dialogue between a cognitive psychologist and a patient, where both take an active part. The therapist asks such questions, answering which the patient will be able to understand the meaning of their negative beliefs and realize their further emotional and behavioral consequences, and then independently decide whether to maintain them further or modify them.

The main difference of CBT is that a cognitive psychotherapist “pulls out” a person’s deeply hidden beliefs, experimentally reveals distorted beliefs or phobias and checks them for rationality and adequacy. The psychologist does not force the patient to accept the "correct" point of view, listen to "wise" advice, and he does not find the "only true" solution to the problem.

He asks the necessary questions step by step useful information about the nature of these destructive cognitions and allows the patient to draw his own conclusions.

The main concept of CBT is to teach a person to independently correct their erroneous processing of information and find Right way to solve their own psychological problems.

Goals of Cognitive Behavioral Therapy

Goal 2. Teach the patient to control their negative automatic thoughts.

Goal 3. Teach the patient to independently find the connection between cognitions and their further behavior.

Goal 4. So that in the future a person can independently analyze and correctly process the information that has appeared.

Goal 5. A person in the process of therapy learns to independently make a decision to replace dysfunctional destructive automatic thoughts with realistic life-affirming ones.

CBT is not the only tool in the fight against psychological disorders, but one of the most effective and efficient.

Counseling Strategies in CBT

Strategy 1. Empiricism of cooperation

Collaborative empiricism is a partnership process between the patient and the psychologist that brings out the patient's automatic thoughts and either reinforces or refutes them with various hypotheses. The meaning of empirical cooperation is as follows: hypotheses are put forward, various evidence of the usefulness and adequacy of cognitions is considered, a logical analysis is carried out and conclusions are made, on the basis of which alternative thoughts are found.

Strategy 2. Socratic Dialogue

Socratic dialogue is a conversation in the form of questions and answers that allow you to:

• identify the problem;

• find a logical explanation for thoughts and images;

• understand the meaning of the events and how the patient perceives them;

• evaluate events that support cognition;

• evaluate the patient's behavior.

The essence of guided discovery boils down to the following: with the help of cognitive techniques and behavioral experiments, the psychologist helps the patient to clarify problematic behavior, find logical errors and develop new experiences. The patient develops the ability to process information correctly, think adaptively and adequately respond to what is happening. Thus, after the consultation, the patient copes with the problems on his own.

Cognitive Therapy Techniques

Step 1: Identify Automatic Thoughts

Negative destructive cognitions are thoughts that constantly “spin in the head”, do not allow you to adequately respond to what is happening, exhaust you emotionally, cause physical discomfort, destroy a person’s life and knock him out of society.

Technique "Filling the Void"

To identify (identify) cognitions, the cognitive technique "Filling the Void" is widely used. The psychologist divides the past event that caused the negative experience into the following points:

A is an event;

B - unconscious automatic thoughts "emptiness";

C - inadequate reaction and further behavior.

The essence of this method is that with the help of a psychologist, the patient fills in between the event and the inadequate reaction to it, the "emptiness", which he cannot explain to himself and which becomes a "bridge" between points A and C.

Example from practice: The man experienced incomprehensible anxiety and shame in a large society and always tried to either sit unnoticed in the corner or quietly leave. I divided this event into points: A - you need to go to the general meeting; B - inexplicable automatic thoughts; C - feeling of shame.

It was necessary to reveal cognitions and thereby fill the void. After questions asked and the responses received, it turned out that the cognition of a man is “doubts about appearance, the ability to keep up a conversation and an insufficient sense of humor.” The man was always afraid of being ridiculed and looking stupid, and therefore, after such meetings, he felt humiliated.

Thus, after a constructive dialogue-questioning, the psychologist was able to identify negative cognitions in the patient, they discovered an illogical sequence, contradictions and other erroneous thoughts that "poisoned" the patient's life.

Step 2. Correction of automatic thoughts

"Decatastrophization", "Reformulation", "Decentralization" and "Reattribution".

Quite often, people are afraid to look ridiculous and ridiculous in the eyes of their friends, colleagues, classmates, fellow students, etc. However, the existing problem of "looking ridiculous" goes further and extends to strangers, i.e. a person is afraid of being ridiculed by sellers, fellow travelers on the bus, passing passers-by.

Constant fear makes a person avoid people, lock himself in a room for a long time. Such people are knocked out of society and become unsociable loners so that negative criticism does not damage their personality.

The essence of decatastrophization is to show the patient that his logical conclusions are wrong. The psychologist, having received an answer from the patient to his first question, asks the next one in the form “What if ....”. In answering the following similar questions, the patient becomes aware of the absurdity of his cognitions and sees real factual events and consequences. The patient becomes prepared for possible "bad and unpleasant" consequences, but already experiences them less critically.

An example from the practice of A. Beck:

Patient. I have to speak to my group tomorrow and I'm scared to death.

Therapist. What are you afraid of?

Patient. I think I will look stupid.

Therapist. Suppose you really look stupid. What's bad about it?

Patient. I won't survive this.

Therapist. But listen, suppose they laugh at you. Are you going to die from this?

Patient. Of course not.

Therapist. Suppose they decide that you are the worst speaker ever... Will it ruin your future career?

Patient. No... But it's good to be a good speaker.

Therapist. Of course, not bad. But if you fail, will your parents or wife disown you?

Patient. No…they will be sympathetic.

Therapist. So what's the worst thing about it?

Patient. I will feel bad.

Therapist. And how long will you feel bad?

Patient. Day or two.

Therapist. And then?

Patient. Then everything will be in order.

Therapist. You fear that your fate is at stake.

Patient. Right. I feel like my whole future is at stake.

Therapist. So, somewhere along the way, your thinking falters... and you tend to view any failure as if it's the end of the world... You need to actually label your failures as failures in achieving the goal, and not as a terrible disaster and start challenging your false assumptions.

At the next consultation, the patient said that he spoke to an audience and his speech (as he expected) was awkward and upset. After all, the day before he was very worried about her result. The therapist continued to question the patient, paying special attention to how he imagines failure and what he associates with it.

Therapist. How do you feel now?

Patient. I feel better...but was broken for a few days.

Therapist. What do you now think about your opinion that incoherent speech is a disaster?

Patient. Of course, this is not a disaster. It's annoying, but I'll survive.

This moment of the consultation is the main part of the “Decatastrophization” technique, in which the psychologist works with his patient in such a way that the patient begins to change his perception of the problem as an imminent catastrophe.

After some time, the man spoke again to the public, but this time there were much fewer disturbing thoughts and he delivered the speech more calmly with less discomfort. Coming to the next consultation, the patient agreed that he attached too much importance to the reaction of the people around him.

Patient. During the last performance, I felt much better ... I think this is a matter of experience.

Therapist. Have you had any glimpse of the realization that most of the time it doesn't really matter what people think of you?

Patient. If I'm going to be a doctor, I need to make a good impression on my patients.

Therapist. Whether you're a good doctor or a bad one depends on how well you diagnose and treat your patients, not how well you perform in public.

Patient. Okay... I know my patients are doing well, and I think that's what's important.

The following consultation was intended to look more closely at all of these maladaptive automatic thoughts that cause such fear and discomfort. As a result, the patient said the phrase:

“I now see how ridiculous it is to worry about the reaction of complete strangers. I will never see them again. So what does it matter what they think of me?”

For the sake of this positive substitution, the Decatastrophization cognitive technique was developed.

Technique 2: Reframe

Reformulation comes to the rescue in cases where the patient is sure that the problem is beyond his control. The psychologist helps to reformulate negative automatic thoughts. It is rather difficult to make a thought "correct" and therefore the psychologist must ensure that the patient's new thought is concrete and clearly marked from the point of view of his further behavior.

Example from practice: A sick lonely man turned, who was sure that no one needed him. After the consultation, he was able to reformulate his cognitions into more positive ones: “I should be more in society” and “I should be the first to tell my relatives that I need help.” Having done this in practice, the pensioner called and said that the problem disappeared by itself, as his sister began to take care of him, who did not even know about the deplorable state of his health.

Technique 3. Decentralization

Decentralization is a technique that allows the patient to be freed from the belief that he is the center of events taking place around him. This cognitive technique is used for anxiety, depression and paranoid states, when a person's thinking is distorted and he tends to personify even something that has nothing to do with him.

Example from practice: The patient was sure that everyone at work was watching how she was doing her assignments, so she experienced constant anxiety, discomfort and felt disgusting. I suggested that she conduct a behavioral experiment, or rather: tomorrow, at work, do not focus on her emotions, but observe employees.

When she came to the consultation, the woman said that everyone was busy with their own business, someone wrote, and someone was surfing the Internet. She herself came to the conclusion that everyone is busy with their own affairs and she can be calm that no one is watching her.

Technique 4. Reattribution

Re-attribution applies if:

• the patient blames himself "for all the misfortunes" and unfortunate events that occur. He identifies himself with misfortune and is sure that it is he who brings them and that he is the "source of all troubles." Such a phenomenon is called "Personalization" and it is in no way connected with real facts and evidence, just a person says to himself: "I am the cause of all misfortunes and everything else that can be thought about?";

• if the patient is sure that one specific person becomes the source of all troubles, and if it were not for “he”, then everything would be fine, and since “he” is nearby, then do not expect anything good;

• if the patient is sure that the basis of his misfortunes is some single factor (unlucky number, day of the week, spring, wrong T-shirt, etc.)

Treatment of an anxious patient at a consultation with a cognitive psychologist

In order to visually show the work of a cognitive psychologist and the effectiveness of behavioral techniques, we will give an example of the treatment of an anxious patient, which took place during 3 consultations.

Consultation #1

Stage 1. Acquaintance and familiarization with the problem

A student of the institute before exams, important meetings and sports competitions fell asleep hard at night and woke up often, during the day he stuttered, felt trembling in his body and nervousness, he felt dizzy and had a constant feeling of anxiety.

The young man said that he grew up in a family where his father told him from childhood that he needed to be "the best and first in everything." Competition was encouraged in their family, and since he was the first child, they expected him to win academically and in sports so that he would be a "role model" for his younger brothers. The main words of instruction were: "Never let anyone be better than you."

To date, the guy has no friends, since he takes all fellow students for competitors, and there is no girlfriend. Trying to attract attention to himself, he tried to appear "cooler" and "more solid" by inventing fables and stories about non-existent exploits. He could not feel calm and confident in the company of children and was constantly afraid that the deceit would be revealed, and he would become a laughingstock.

Consultations

Questioning the patient began with the therapist identifying his negative automatic thoughts and their effect on behavior, and how these cognitions could drive him into a depressive state.

Therapist. What situations upset you the most?

Patient. When I fail in sports. Especially in swimming. And also when I'm wrong, even when I'm playing cards with the guys around the room. I get very upset if a girl rejects me.

Therapist. What thoughts go through your head when, say, something is not working out for you in swimming?

Patient. I think about the fact that people pay less attention to me if I'm not on top, not a winner.

Therapist. What if you make mistakes when playing cards?

Patient. Then I doubt my intellectual abilities.

Therapist. What if a girl rejects you?

Patient. This means that I am ordinary ... I lose value as a person.

Therapist. Do you see the connection between these thoughts?

Patient. Yes, I think my mood depends on what other people think of me. But it's so important. I don't want to be lonely.

Therapist. What does it mean to you to be single?

Patient. It means that something is wrong with me, that I am a loser.

At this point, the questions are temporarily suspended. The psychologist begins, together with the patient, to build a hypothesis that his value as a person and his personal self is determined by strangers. The patient fully agrees. Then they write on a piece of paper the goals that the patient wants to achieve as a result of the consultation:

• Reduce the level of anxiety;

• Improve the quality of night sleep;

• Learn to interact with other people;

• Become morally independent from your parents.

In the morning, not getting enough sleep, he goes to the exam, begins to worry, and he develops all the above described symptoms of neurosis. Then the psychologist asked to answer one question: “What is the benefit of having you constantly think about the exam, day and night?”, To which the patient replied:

Patient. Well, if I don't think about the exam, I might forget something. If I keep thinking, I'll better prepare.

Therapist. Have you ever been in a situation where you were "worse prepared"?

Patient. Not in an exam, but one day I took part in a big swimming competition and was with friends the night before and didn't think. I returned home, went to bed, and in the morning I got up and went swimming.

Therapist. Well, how did it happen?

Patient. Wonderful! I was in shape and swam pretty well.

Therapist. Based on this experience, don't you think there is reason to worry less about your performance?

Patient. Yes, probably. It didn't hurt that I didn't worry. In fact, my anxiety only frustrates me.

As can be seen from the final phrase, the patient independently, by logical reasoning, came to a reasonable explanation and refused the “mental chewing gum” about the exam. The next step was the rejection of maladaptive behavior. The psychologist suggested progressive relaxation to reduce anxiety and taught how to do it. The following dialogue followed:

Therapist. You mentioned that when you worry about exams, you get anxious. Now try to imagine that you are lying in bed the night before an exam.

Patient. Okay, I'm ready.

Therapist. Imagine that you are thinking about an exam and decide that you didn't prepare enough.

Patient. Yes, I did.

Therapist. What do you feel?

Patient. I feel nervous. My heart starts pounding. I think I need to get up and do some more work.

Therapist. Okay. When you think you're not prepared, you get anxious and want to get up. Now imagine that you are lying in bed on the eve of an exam and thinking about how well you prepared and knew the material.

Patient. Okay. Now I feel confident.

Therapist. Here! See how your thoughts affect feelings of anxiety?

The psychologist suggested that the young man write down his cognitions and recognize distortions. It was necessary to write down in a notebook all the thoughts that visit him before an important event, when he had nervousness and he could not sleep peacefully at night.

Consultation #2

The consultation began with a discussion of homework. Here are some interesting thoughts the student wrote down and brought to the next consultation:

• “Now I will think about the exam again”;

• “No, now thoughts about the exam no longer matter. I'm prepared";

• “I saved time in reserve, so I have it. Sleep is not important enough to worry about. You need to get up and read everything again ”;

• "I need to sleep now! I need eight hours of sleep! Otherwise, I will be exhausted again.” And he imagined himself swimming in the sea and fell asleep.

The result of the first consultation: the first 2 goals were achieved (reduce anxiety and improve the quality of night sleep).

Stage 2. Research part

Therapist. If someone is ignoring you, could there be other reasons besides the fact that you are a loser?

Patient. No. If I can't convince them that I'm important, I won't be able to attract them.

Therapist. How do you convince them of this?

Patient. To tell the truth, I exaggerate my successes. I lie about my grades in class or say I won a competition.

Therapist. And how does it work?

Patient. Actually not very good. I feel embarrassed and they are embarrassed by my stories. Sometimes they don't pay special attention, sometimes they leave me after I talk too much about myself.

Therapist. So, in some cases, they reject you when you draw their attention to you?

Patient. Yes.

Therapist. Does it have something to do with whether you're a winner or a loser?

Patient. No, they don't even know who I am inside. They just turn away because I talk too much.

Therapist. It turns out that people react to your style of conversation.

Patient. Yes.

The psychologist stops the questioning, seeing that the patient begins to contradict himself and he needs to point it out, so the third part of the consultation begins.

Stage 3. Corrective action

The conversation started with "I'm insignificant, I can't attract" and ended with "people react to the style of the conversation." In this way, the therapist shows that the problem of inferiority has smoothly turned into a problem of social inability to communicate. In addition, it became obvious that the most relevant and painful topic for a young person seems to be the topic of a “loser” and this is his main conviction: “Nobody needs and is not interested in losers.”

There were clearly visible roots from childhood and constant parental teaching: "Be the best." After a couple more questions, it became clear that the student considers all his successes solely the merit of parental upbringing, and not his personal ones. It pissed him off and robbed him of his confidence. It became clear that these negative cognitions needed to be replaced or modified.

Stage 4. Ending the conversation (homework)

It was necessary to focus on social interaction with other people and understand what was wrong with his conversations and why he ended up alone. Therefore, the next homework was as follows: in conversations, ask more questions about the affairs and health of the interlocutor, restrain yourself if you want to embellish your successes, talk less about yourself and listen more about the problems of others.

Consultation No. 3 (final)

Stage 1. Discussion of homework

The young man said that after all the tasks completed, the conversation with classmates went in a completely different direction. He was greatly surprised how other people sincerely admit their mistakes and resent their mistakes. That many people simply laugh at mistakes and openly admit their shortcomings.

Such a small “discovery” helped the patient to understand that there is no need to divide people into “successful” and “losers”, that everyone has their own “minuses” and “pluses” and this does not make people “better” or “worse”, they just the way they are and that's what makes them interesting.

The result of the second consultation: achievement of the 3rd goal "Learn to interact with other people."

Stage 2. Research part

It remains to complete the 4th point "Become morally independent from parents." And we started a dialogue-questioning:

Therapist: How does your behavior affect your parents?

Patient: If my parents look good, then that says something about me, and if I look good, then it does them credit.

Therapist: List the characteristics that distinguish you from your parents.

The final stage

The result of the third consultation: the patient realized that he was very different from his parents, that they were very different, and he said the key phrase, which was the result of all our joint work:

“Realizing that my parents and I are different people leads me to the realization that I can stop lying.”

The final result: the patient got rid of the standards and became less shy, learned to cope with depression and anxiety on his own, he made friends. And most importantly, he learned to set himself moderate realistic goals and found interests that had nothing to do with achievements.

In conclusion, I would like to note that cognitive-behavioral psychotherapy is an opportunity to replace ingrained dysfunctional beliefs with functional, irrational thoughts for rational, rigid cognitive-behavioral connections with more flexible ones and teach a person to independently adequately process information.

Behavioral therapy is a psychological approach based on the need to study only overt behavior and denying the significance of unconscious behavior. This assumption strongly contradicts depth psychotherapy (especially psychoanalysis), whose proponents argue that mental illness is the result of internal conflicts in a person.

The founder of behavioral therapy (behaviorism) is the American psychologist John Watson. From the point of view of behaviorism, the object of psychology is human behavior. Behavior is a response to certain stimuli. Proponents of behavioral psychotherapy study the external factors under which a particular behavior of a person is formed. They argue that human behavior can be changed by changing these factors.

Behavior Therapy Methods

The specialists of this psychotherapeutic method believe that the patient must be taught new forms of behavior, suppressing or completely getting rid of the old, incorrect behavior. may be applied depending on the situation. different method treatment:

Conditioning

Conditioning is a method of developing new behavioral skills by modifying stimulus/response associations. It's pretty effective method, in the application of which the correct (desired) command is rewarded, and undesirable behavior is suppressed or eliminated altogether. The wrong command is suppressed with the help of punishments, and the right one is stimulated with the help of rewards, which can be praise, gifts, etc.

Modeling

Simulation is a method by which a person gets used to a behavior by observing another person. It is useful for the patient to learn new rules of command.

Aversion therapy

Another method is aversion therapy. In this case, the unwanted behavior is repeated many times, for example, smokers are forced to smoke until it disgusts them.

Aversive therapy

Aversive therapy has a similar effect, aimed at developing aversion to unwanted behavior, which causes a person to change behavior or habits.

Desensitization

Desensitization is a technique used in behavioral therapy to treat the condition of a phobia. An object that the patient considers dangerous is very slowly brought into contact with him (at first only mentally, and then in reality). For example, if a person is terribly afraid of spiders, then during the sessions he should imagine spiders and do this until the sight of an insect ceases to cause him panic fear. At this stage, a spider can be shown to a person, once again convincing him that he is absolutely not dangerous.

Family Therapy

Family therapy is based on the fact that some of the difficulties experienced by a person are related to his family and the interactions between its members. Therefore, in order to find out what role this or that family member plays, what are the features of communication, etc. all family members are encouraged to participate in therapy sessions.

Most often, parents raise a child with the help of punishments and rewards. However, parents should know that the child should be punished immediately after he was guilty. Otherwise, untimely punishment may be misunderstood and cause a protest.

When is behavioral therapy used?

Behaviorism is used to treat mental disorders, various phobias, obsessive-compulsive disorder, depression, hysteria, mental illness, nicotine and alcohol addiction. In addition, behavioral therapy is effectively used to treat various defects and behavioral disorders in children, such as stuttering, as well as for the treatment of mentally retarded children and children with learning difficulties.

Behaviorism treats the disease itself or the symptoms of disorders, but does not eliminate their causes. Therefore, after some time, unwanted behavior may reappear. In this case, it is necessary to undergo a second course of therapy or apply another therapeutic method.

Behavioral Psychotherapy

Behavioral therapy; behavioral therapy(from English. behavior- "behavior") - one of the leading areas of modern psychotherapy. Behavioral psychotherapy is based on the learning theory of Albert Bandura, as well as the principles of classical and operant conditioning. This form of psychotherapy is based on the idea that the symptoms of psychological disorders owe their appearance to malformed skills. Behavioral therapy aims to eliminate unwanted behaviors and develop behavioral skills that are beneficial to the client. Behavioral therapy has been most successfully used to treat phobias, behavioral disorders and addictions, that is, those conditions in which it is possible to isolate a particular symptom as a "target" for therapeutic intervention. The scientific basis of behavioral psychotherapy is the theory of behaviorism. Behavioral therapy can be used both independently and in combination with cognitive psychotherapy (Cognitive Behavioral Psychotherapy). Behavioral psychotherapy is a directive and structured form of psychotherapy. Its stages are: analysis of behavior, determination of the stages necessary for behavior correction, gradual training of new behavioral skills, development of new behavioral skills in real life. The main goal of behavioral therapy is not to understand the causes of the patient's problems, but to change his behavior.

History

Despite the fact that behavioral therapy is one of the newest methods of treatment in psychiatry, the techniques that are used in it have already existed in ancient times. It has long been known that people's behavior can be controlled with the help of positive and negative reinforcements, that is, rewards and punishments (the "carrot and stick" method). However, only with the advent of the theory of behaviorism, these methods received scientific justification.

Behaviorism as a theoretical direction of psychology arose and developed at about the same time as psychoanalysis (that is, since the end of the last century). However, the systematic application of the principles of behaviorism for psychotherapeutic purposes dates back to the late 50s and early 60s.

Methods of behavioral therapy are largely based on the ideas of Russian scientists Vladimir Mikhailovich Bekhterev (1857-1927) and Ivan Petrovich Pavlov (1849-1936). The works of Pavlov and Bekhterev were well known abroad, in particular, Bekhterev's book "Objective Psychology" had a great influence on J. Watson. Pavlov is called his teacher by all the major behaviorists of the West.

Already in 1915-1918, V. M. Bekhterev proposed the method of "combination-reflex therapy." I. P. Pavlov became the creator of the theory of conditioned and unconditioned reflexes and of reinforcement, with the help of which behavior can be changed (due to the development of desirable conditioned reflexes or the “extinction” of undesirable conditioned reflexes). While conducting experiments with animals, Pavlov found that if a dog's feeding is combined with a neutral stimulus, for example, with the ringing of a bell, then in the future this sound will cause the animal to salivate. Pavlov also described the phenomena associated with the development and disappearance of conditioned reflexes:

Thus, Pavlov proved that new forms of behavior can arise as a result of establishing a connection between innate forms of behavior (unconditioned reflexes) and a new (conditioned) stimulus. Later, Pavlov's method was called classical conditioning.

Pavlov's ideas were further developed in the works of the American psychologist John Watson. John B Watson, 1878-1958). Watson came to the conclusion that the classical conditioning that Pavlov observed in animals also exists in humans, and it is this that is the cause of phobias. In 1920, Watson conducted an experiment with an infant (en: Little Albert experiment). While the child was playing with a white rat, the experimenters aroused fear in him with a loud sound. Gradually, the child began to be afraid of white rats, and later also of any furry animals.

In 1924, Watson's assistant, Mary Cover Jones (en: Mary Cover Jones, 1896-1987). used a similar method to cure a child of a phobia. The child was afraid of rabbits, and Mary Jones used the following tricks:

1. The rabbit was shown to the child from afar, while the child was being fed.
2. At the moment when the child saw the rabbit, the experimenter gave him a toy or candy.
3. The child could watch other children play with rabbits.
4. As the child got used to the sight of the rabbit, the animal was brought closer and closer.

Thanks to the use of these techniques, the child's fear gradually disappeared. Thus, Mary Jones created a method of systematic desentization, which is successfully used to treat phobias. Psychologist Joseph Wolpe (en: Joseph Wolpe, 1915-1997) called Jones "the mother of behavior therapy."

The term "behavioral therapy" was first mentioned in 1911 by Edward Thorndike (1874-1949). In the 1940s, the term was used by Joseph Wolpe's research group.

Wolpe did the following experiment: placing cats in a cage, he subjected them to blows electric current. The cats developed a phobia very soon: they began to be afraid of the cage, if they were brought closer to this cage, they tried to break free and run away. Wolpe then began to gradually reduce the distance between the animals and the cage and feed the cats the moment they were near the cage. Gradually, the fear of the animals disappeared. Wolpe suggested that people's phobias and fears could be eliminated by a similar method. Thus the method of systematic desensitization was created, also sometimes called the method of systematic desensitization. Wolpe used this method primarily to treat phobias, social phobia, and anxiety-related sexual disorders.

The further development of behavioral therapy is associated primarily with the names of Edward Thorndike and Frederick Skinner, who created the theory of operant conditioning. In classical Pavlovian conditioning, behavior can be changed by modifying baseline that exhibit this behavior. In the case of operant conditioning, behavior can be changed by stimuli that follow for behavior ("rewards" and "punishments"). Eduard Thorndike (1874-1949), while conducting experiments on animals, formulated two laws that are still used in behavioral psychotherapy today:

• "The Law of Exercise" Law of exercise), stating that the repetition of a certain behavior contributes to the fact that in the future this behavior will be manifested with an increasing probability.
• "Law of Effect" law effect): if a behavior has a positive outcome for an individual, it will be repeated with a higher probability in the future. If the action leads to unpleasant results, in the future it will appear less often or disappear altogether.

The ideas of behavioral therapy were widely disseminated through the publications of Hans Eysenck (German. Hans Eysenck; 1916-1997) in the early 1960s. Eysenck defined behavioral therapy as the application of modern learning theory for the treatment of behavioral and emotional disorders. In 1963, the first journal devoted exclusively to behavioral psychotherapy (Behavior Research and Therapy) was founded.

In the 1950s and 1960s, the theory of behavioral therapy developed mainly in three research centers:

Formation of behavioral psychotherapy as an independent direction occurred around 1950. The popularity of this method was facilitated by the growing dissatisfaction with psychoanalysis, due to the insufficient empirical base of analytic methods, and also because of the length and high cost of analytic therapy, while behavioral methods have proven to be effective, and the effect was achieved in just a few therapy sessions.

By the end of the 1960s, behavioral psychotherapy was recognized as an independent and effective form of psychotherapy. Currently, this direction of psychotherapy has become one of the leading methods of psychotherapeutic treatment. In the 1970s, the methods of behavioral psychology began to be used not only in psychotherapy, but also in pedagogy, management and business.

Initially, the methods of behavioral therapy were based solely on the ideas of behaviorism, that is, on the theory of conditioned reflexes and on the theory of learning. But at present there is a tendency towards a significant expansion of the theoretical and instrumental base of behavioral therapy: it can include any method, the effectiveness of which has been proven experimentally. Lazarus called this approach Behavioral Therapy. a wide range"or" multimodal psychotherapy ". For example, currently in behavioral therapy methods of relaxation and breathing exercises(particularly diaphragmatic breathing). Thus, although behavioral therapy is based on evidence-based methods, it is eclectic in nature. The techniques that are used in it are united only by the fact that they are all aimed at changing behavioral skills and abilities. According to the American Psychological Association, " Behavioral psychotherapy includes, first of all, the use of principles that have been developed in experimental and social psychology ... The main goal of behavioral therapy is to build and strengthen the ability to act, increase self-control» .

Techniques similar to behavior therapy techniques have been used in the Soviet Union since the 1920s. However, in the domestic literature for a long time instead of the term "behavioral psychotherapy" the term "conditioned reflex psychotherapy" was used.

Basic principles

Behavior Therapy Schema

Assessment of the client's condition

This procedure in behavioral therapy is called "functional analysis" or "applied behavioral analysis". Applied behavior analysis). At this stage, first of all, a list of behavior patterns is compiled that have negative consequences for the patient. Each behavior pattern is described as follows:

• How often?

• How long does it last?

• What are its implications in the short and long term?

Then the situations and events that trigger the neurotic behavioral response (fear, avoidance, etc.) are identified. . With the help of self-observation, the patient must answer the question: what factors can increase or decrease the likelihood of a desired or undesirable pattern of behavior? It should also be checked whether the undesirable behavior pattern has any "secondary gain" for the patient (English secondary gain), that is, hidden positive reinforcement of this behavior. The therapist then determines for himself what strengths in the patient's character can be used in the therapeutic process. It is also important to find out what the patient's expectations are about what psychotherapy can give him: the patient is asked to formulate his expectations in concrete terms, that is, to indicate which behavioral patterns he would like to get rid of and what forms of behavior he would like to learn. It is necessary to check whether these expectations are realistic. In order to get the most complete picture of the patient's condition, the therapist gives him a questionnaire, which the patient must complete at home, using, if necessary, the method of self-observation. Sometimes the initial assessment phase takes several weeks, because in behavioral therapy it is extremely important to get a complete and accurate description of the patient's problem.

In behavioral therapy, the data obtained during the preliminary analysis phase is called " base level" or "starting point" (eng. baseline). In the future, these data are used to evaluate the effectiveness of therapy. In addition, they allow the patient to realize that his condition is gradually improving, which increases the motivation to continue therapy.

Drawing up a therapy plan

In behavioral therapy, it is considered necessary that the therapist adhere to a certain plan in working with the patient, so after assessing the patient's condition, the therapist and the patient make a list of problems to be solved. However, it is not recommended to work on several problems at the same time. Multiple problems must be dealt with sequentially. You should not move on to the next problem until a significant improvement in the previous problem has been achieved. If there is a complex problem, it is advisable to break it down into several components. If necessary, the therapist draws up a "problem ladder", that is, a diagram that shows in what order the therapist will work with the client's problems. As a "target" a pattern of behavior is chosen, which should be changed in the first place. The following criteria are used for selection:

• Severity of the problem, that is, how much harm the problem brings to the patient (for example, interferes with his professional activities) or poses a danger to the patient (for example, severe alcohol dependence);

• What causes the most discomfort(for example, panic attacks);

In case of insufficient motivation, the patient or disbelief in one's own strength therapeutic work you can start not with the most important problems, but with easily achievable goals, that is, with those patterns of behavior that are easiest to change, or that the patient wants to change first. The transition to more complex problems is made only after the simpler problems are solved. During therapy, the psychotherapist constantly checks the effectiveness of the methods used. If the initially chosen techniques were ineffective, the therapist should change the therapy strategy and use other techniques.

The priority in choosing a goal is always consistent with the patient. Sometimes therapeutic priorities may be reassessed during therapy.

Behavioral theorists believe that the more specific goals of therapy are formulated, the more effective the therapist's work will be. At this stage, you should also find out how great the patient's motivation is to change this or that type of behavior.

In behavior therapy, an extremely important success factor is how well the patient understands the meaning of the techniques that the therapist uses. For this reason, usually at the very beginning of therapy, the basic principles of this approach are explained to the patient in detail, as well as the purpose of each specific method. The therapist then uses questions to check how well the patient has understood his explanations and, if necessary, answers questions. This not only helps the patient to perform the exercises recommended by the therapist correctly, but also increases the patient's motivation to do these exercises daily.

In behavioral therapy, the use of self-observation and the use of "homework" is widespread, which the patient must complete daily, or even, if necessary, several times a day. For self-observation, the same questions that were asked to the patient at the preliminary assessment stage are used:

• When and how does this type of behavior manifest itself?

• How often?

• How long does it last?

• What is the “trigger” and reinforcers of this pattern of behavior?

Giving the patient "homework", the therapist must check whether the patient understood correctly what he should do, and whether the patient has the desire and ability to do this task every day.

It should not be forgotten that behavioral therapy is not limited to eliminating unwanted patterns of behavior. From the point of view of the theory of behaviorism, any behavior (both adaptive and problematic) always performs some function in a person's life. For this reason, when the problem behavior disappears, a kind of vacuum is created in a person's life, which can be filled with new problem behavior. To prevent this from happening, when drawing up a plan for behavioral therapy, the psychologist provides what forms of adaptive behavior should be developed to replace problematic behavior patterns. For example, therapy for a phobia will not be complete unless it is established which forms of adaptive behavior will fill the time the patient devotes to phobic experiences. The treatment plan should be written in positive terms and indicate what the patient should do, not what he should not do. This rule has been called in behavioral therapy the "rule of the living person" - since the behavior of a living person is described in positive terms (what he is able to do), while the behavior of a dead person can only be described in negative terms (for example, a dead person is not may have bad habits, experience fear, show aggression, etc.).

Completion of therapy

As Judith S. Beck emphasizes, behavior change therapy does not fix the client's problems once and for all. The goal of therapy is simply to learn how to deal with difficulties as they arise, that is, "become your own psychotherapist." Renowned behavioral therapist Mahoney Mahoney, 1976) even believes that the client should become a "scientist-researcher" of his own personality and his behavior, which will help him solve problems as they arise (in behavioral therapy this is referred to as "self-management" - en "Self-management). According to this reason, at the end of therapy, the therapist asks the client what techniques and techniques have been most helpful to him.Then the therapist recommends using these techniques on his own, not only when a problem occurs, but also as a preventive measure.The therapist also teaches the client to recognize the signs of occurrence or returning the problem as this will allow the client to take early action in order to deal with the problem or at least reduce the negative impact of the problem.

Behavior Therapy Methods

• biological Feedback(Main article: Biofeedback) is a technique that uses equipment that monitors for signs of stress in a patient. As the patient manages to achieve a state of muscle relaxation, he receives positive visual or auditory reinforcement (for example, pleasant music or an image on a computer screen).

• Methods of weaning (aversive therapy)
• Systematic desentation
• Shaping (behavior modeling)
• Autoinstruction Method

Problems arising during therapy

• The client's tendency to verbalize what he thinks and feels, and to seek to find the causes of his problems in what he has experienced in the past. The reason for this may be the idea of ​​psychotherapy as a method that "allows you to speak out and understand yourself." In this case, it should be explained to the client that behavioral therapy consists of performing specific exercises, and its goal is not to understand the problem, but to eliminate its consequences. However, if the therapist sees that the client needs to express his feelings or find the root cause of his difficulties, then behavioral methods can be supplemented, for example, with cognitive or humanistic psychotherapy techniques.

• The client's fear that the correction of his emotional manifestations will turn him into a "robot". In this case, it should be explained to him that thanks to behavioral therapy, his emotional world will not become poorer, just positive emotions will replace negative and maladaptive emotions.

• Passivity of the client or fear of the effort required to perform the exercises. In this case, it is worth reminding the client what consequences such an installation can lead to in the long run. At the same time, you can revise the therapy plan and start working with simpler tasks, breaking them down into separate stages. Sometimes in such cases, behavioral therapy uses the help of family members of the client.

Sometimes the client has dysfunctional beliefs and attitudes that interfere with his involvement in the therapeutic process. These settings include:

• Unrealistic or inflexible expectations about the methods and results of therapy, which may be a form of magical thinking (it is suggested that the therapist is able to solve any problem of the client). In this case, it is especially important to find out what the client's expectations are, and then to develop a clear treatment plan and discuss this plan with the client.

• The belief that only the therapist is responsible for the success of therapy, and the client cannot and should not make any effort (external locus of control). This problem not only significantly slows down progress in treatment, but also leads to relapses after the termination of meetings with the therapist (the client does not consider it necessary to do "homework" and follow the recommendations that were given to him at the time of completion of therapy). In this case, it is helpful to remind the client that in behavioral therapy success is impossible without the active cooperation of the client.

• Dramatization of the problem, for example: "I have too many difficulties, I will never cope with this." In this case, it is useful to start therapy with simple tasks and with exercises that achieve quick results, which increases the client's confidence that he is able to cope with his problems.

• Fear of judgment: The client is embarrassed to tell the therapist about some of their problems, and this prevents the development of an effective and realistic plan for therapeutic work.

In the presence of such dysfunctional beliefs, it makes sense to apply methods of cognitive psychotherapy that help the client to reconsider their attitudes.

One of the barriers to success is the client's lack of motivation. As stated above, strong motivation is a necessary condition for the success of behavioral therapy. For this reason, the motivation to change should be assessed at the very beginning of therapy, and then, in the course of working with the client, its level should be constantly checked (we should not forget that sometimes the client’s demotivation takes hidden forms. For example, he can stop therapy, assuring that his problem is solved. In behavioral therapy, this is called "flight to recovery"). To increase motivation:

• It is necessary to give clear and clear explanations about the importance and usefulness of the techniques used in therapy;

• You should choose specific therapeutic goals, coordinating your choice with the desires and preferences of the client;

• It is noticed that often clients focus on problems that have not yet been solved, and forget about the successes already achieved. In this case, it is useful to periodically assess the state of the client, clearly showing him the progress achieved thanks to his efforts (this can be demonstrated, for example, using diagrams).

• A feature of behavioral therapy is the focus on a quick, specific, observable (and measurable) result. Therefore, if there is no significant progress in the client's condition, then the client's motivation may disappear. In this case, the therapist should immediately reconsider the chosen tactics of working with the client.

• Because in behavioral therapy the therapist works in collaboration with the client, it should be explained that the client is not obligated to blindly follow the therapist's recommendations. Objections from his side are welcome, and any objection should be immediately discussed with the client and, if necessary, amend the work plan.

• To increase motivation, it is recommended to avoid monotony in working with a client; it is useful to use new methods that cause the greatest interest in the client.

At the same time, the therapist should not forget that the failure of therapy may be associated not with the client's dysfunctional attitudes, but with the latent dysfunctional attitudes of the therapist himself and with errors in the application of behavioral therapy methods. For this reason, it is necessary to constantly use self-observation and the help of colleagues, identifying which distorted cognitive attitudes and problematic behaviors prevent the therapist from succeeding in his work. Behavioral therapy is characterized by the following errors:

• The therapist gives the client "homework" or self-observation questionnaire, but then forgets about it or does not take the time to discuss the results. This approach can significantly reduce the client's motivation and reduce their trust in the therapist.

Contraindications to the use of behavioral psychotherapy

Behavioral psychotherapy should not be used in the following cases:

• Psychosis in the acute stage.

• Severe depression.

• Profound mental retardation.

In these cases, the main problem is that the patient is unable to understand why he should do the exercises that the therapist recommends.

In the case of a personality disorder, behavioral therapy is possible, but it may be less effective and longer because it will be more difficult for the therapist to obtain active cooperation from the patient. An insufficiently high level of intellectual development is not an obstacle to conducting behavioral therapy, but in this case it is preferable to use simple techniques and exercises, the purpose of which the patient is able to understand.

Third Generation Behavioral Therapy

New trends in behavioral psychotherapy are grouped under the term "third generation behavioral therapy". (See for example Acceptance and Commitment Therapy and Dialectical Behavior Therapy.)

see also

Notes

1. Psychological Encyclopedia
2. Psychological Dictionary
3. Chaloult, L. La therapie cognitivo-comportementale: theorie et pratique. Montreal: Gaëtan Morin, 2008
4. PSI FACTOR LIBRARY
5. Meyer W., Chesser E. Behavior Therapy Methods, St. Petersburg: Speech, 2001
6. Garanyan, N. G. A. B. Kholmogorova, Integrative psychotherapy of anxiety and depressive disorders based on a cognitive model. Moscow Psychotherapeutic Journal. - 1996. - No. 3.
7. Watson, J.B. and Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3, 1, pp. 1-14
8. Cover Jones, M. (1924). A Laboratory Study of Fear: The Case of Peter. Pedagogical Seminary, 31, pp. 308-315
9. Rutherford, A Introduction to " A Laboratory Study of Fear: The Case of Peter", Mary Cover Jones(1924) (Text). Archived from the original on December 14, 2012. Retrieved November 9, 2008.
10. Thorndike, E.L. (1911), ""Provisional Laws of Acquired Behavior or Learning"", animal intelligence(New York: The McMillian Company)
11. Wolpe, Joseph. Psychotherapy by Reciprocal Inhibition. California: Stanford University Press, 1958

Depression, anxiety, phobias and others mental disorders hard enough to heal traditional methods forever.

Drug treatment relieves only the symptoms, not allowing a person to become completely mentally healthy. Psychoanalysis can bring an effect, but it will take years (from 5 to 10) to obtain a sustainable result.

Cognitive-behavioral direction in therapy is young, but really working for healing by psychotherapy. It allows people to a short time(up to 1 year) get rid of despondency and stress by replacing destructive patterns of thinking and behavior with constructive ones.

What is human cognitive development? Learn about it from ours.

concept

Cognitive methods in psychotherapy work with the patient's mindset.

The goal of cognitive therapy is awareness and correction of destructive patterns (mental patterns).

The result of treatment is a complete or partial (at the request of the patient) personal and social adaptation of a person.

People, faced with unusual or painful events for themselves in different periods of life, often react negatively, creating tension in the body and brain centers responsible for receiving and processing information. In this case, hormones are released into the blood, causing suffering and mental pain.

In the future, such a scheme of thinking is reinforced by the repetition of situations, which leads to. A person ceases to live in peace with himself and the world around him, creating your own hell.

Cognitive therapy teaches you to respond more calmly and relaxed to the inevitable changes in life, translating them into a positive direction with creative and calm thoughts.

Advantage of the method- work in the present tense, not focusing on:

• events in the past;
• the influence of parents and other close people;
• feelings of guilt and regret for lost opportunities.

Cognitive therapy allows take fate into your own hands freeing yourself from harmful addictions and the undesirable influence of others.

For successful treatment, it is desirable to combine this method with behavioral, that is, behavioral.

What is cognitive therapy and how does it work? Learn about it from the video:

Cognitive Behavioral Approach

Cognitive-behavioral therapy works with the patient in a complex way, combining the creation of constructive mental attitudes with new behaviors and habits.

This means that each new mental attitude must be backed up by concrete action.

Also, this approach allows you to identify destructive patterns of behavior, replacing them with healthy or safe for the body.

Cognitive, behavioral and combination therapy can be used both under the supervision of a specialist and independently. But still, at the very beginning of the journey, it is advisable to consult a professional to develop the right treatment strategy.

Applications

The cognitive approach can be applied to all people who feel unhappy, unsuccessful, unattractive, insecure etc.

Self-torture can happen to anyone. Cognitive therapy in this case can reveal the thought pattern that served as a trigger for creating bad mood replacing it with a healthy one.

This approach is also used for the treatment of the following mental disorders:

Cognitive therapy can remove difficulties in relationships with family and friends, as well as teach how to establish and maintain new connections, including with the opposite sex.

What does the science of cognitive science study? find out right now.

Aaron Beck's opinion

American psychotherapist Aaron Temkin Beck (professor of psychiatry at the University of Pennsylvania) is the author of cognitive psychotherapy. He specializes in the treatment of depression, including suicidal.

Based on the approach of A.T. Beck took the term (process of information processing by consciousness).

The decisive factor in cognitive therapy is the correct processing of information, as a result of which an adequate program of behavior is fixed in a person.

Patient in the process of treatment according to Beck must change the way you look at yourself, their life situation and tasks. This requires three steps to be taken:

• admit your right to make a mistake;
• abandon erroneous ideas and worldviews;
• correct thought patterns (replace inadequate ones with adequate ones).

A.T. Beck believes that correcting erroneous thought patterns can create life with more high level self-realization.

The creator of cognitive therapy himself effectively applied its techniques to himself when, after successfully curing patients, his income level dropped significantly.

Patients recovered quickly without recurrence, returning to a healthy and happy life which adversely affected the state of the doctor's bank account.

After analyzing the thinking and correcting it, the situation changed for the better. Cognitive therapy suddenly became fashionable, and its creator was asked to write a series of books for a wide range of users.

Aaron Beck: goals and objectives of cognitive psychotherapy. Practical examples in this video:

Cognitive Behavioral Psychotherapy

After this work, methods, techniques and exercises of cognitive-behavioral therapy are applied, which cause positive changes in a person's life.

Methods

Methods in psychotherapy are called ways to achieve the goal.

In the cognitive-behavioral approach, these include:

1. Removal (erasing) of fate-destroying thoughts(“I won’t succeed”, “I am a loser”, etc.).
2. Creating an adequate worldview(“I will do it. If it doesn’t work out, then it’s not the end of the world,” etc.).

When creating new thought forms, it is necessary really look at the problems. This means that they may not be resolved as planned. A similar fact should also be calmly accepted in advance.

1. Revision of painful past experience and assessment of the adequacy of its perception.
2. Fixing new thought forms with actions (the practice of communicating with people for a sociopath, good nutrition- for anorexic, etc.).

The methods of this type of therapy are used to solve real problems in the present. An excursion into the past is sometimes necessary only to create an adequate assessment of the situation in order to creating healthy patterns of thinking and behavior.

More details about the methods of cognitive-behavioral therapy can be found in the book by E. Chesser, V. Meyer "Methods of Behavioral Therapy".

Techniques

A distinctive feature of cognitive-behavioral therapy is the need to active participation of the patient in your healing.

The patient must understand that his suffering creates wrong thoughts and behavioral reactions. It is possible to become happy by replacing them with adequate thought forms. To do this, you need to perform the following series of techniques.

You can learn about what the cognitive sphere of personality is from ours.

A diary

This technique will allow you to track the most frequently repeated phrases that create problems in life.

1. Identification and recording of destructive thoughts when solving any problem or task.
2. Testing a destructive installation with a specific action.

For example, if a patient claims that “he will not succeed,” then he should do what he can and write it in a diary. The next day is recommended perform a more complex action.

Why keep a diary? Find out from the video:

Catharsis

In this case, the patient needs to allow himself the manifestation of feelings that he previously forbade himself, considering them bad or unworthy.

For example, cry, show aggression(in relation to the pillow, mattress), etc.

Visualization

Imagine that the problem has already been solved and remember emotions that appeared at the same time.

The techniques of the described approach are discussed in detail in the books:

1. Judith Beck Cognitive Therapy. The Complete Guide »
2. Ryan McMullin "Workshop on Cognitive Therapy"

Methods of cognitive-behavioral psychotherapy:

Cognitive dissonance - what is it in simple words? is on our website.

Exercises for self-fulfillment

To correct your thinking, behavior and solve problems that seem insoluble, it is not necessary to immediately contact a professional. You can try the following exercises first:

The exercises are detailed in the book. S. Kharitonova"Guide to Cognitive Behavioral Therapy".

Also, in the treatment of depression and other mental disorders, it is advisable to master several relaxation exercises, using auto-training techniques and breathing exercises for this.

additional literature

Cognitive Behavioral Therapy - young and very interesting approach not only for the treatment of mental disorders, but also for creating a happy life at any age, regardless of the level of well-being and social success. For a more in-depth study or study on your own, books are recommended:

Cognitive Behavioral Therapy is based on on the correction of the worldview, which is a series of beliefs (thoughts). For successful treatment, it is important to recognize the incorrectness of the formed thinking model and replace it with a more adequate one.