Cognitive behavioral therapy - effective techniques

In the early 60s. In the 20th century, Aaron Beck, an American professor and psychotherapist, developed a new concept of psychotherapy, called cognitive.

Today, most psychologists and psychotherapists consider it the basis of cognitive behavioral therapy, which is aimed at working with patients on a wide range of problems and disorders of a psychological nature.

The approach is based on various conceptual techniques and methods, including exercises and techniques that help achieve cognitive improvements and change the patient’s mental activity system and behavior in a positive direction.

What is Cognitive Behavioral Therapy?

Modern psychoanalytic specialists consider cognitive behavioral therapy as the most scientifically and technologically sound direction in psychotherapy. Today, many psychotherapists include methods of this concept in their arsenal, and in the practices of many of them this area occupies a leading position.

The very concept of cognitive behavioral psychotherapy can be interpreted as a form of psychoanalysis, including methods and techniques focused on the patient’s specific problem and aimed at results.

In simple words, using this technique, the specialist tries to help the client change his thinking, clear himself of fears, false attitudes and unpleasant life experiences, and make mental activity as adequate as possible.

The main task of the CPT is to detect triggers in the patient who turns to him, thoughts of “cognition” that automatically pop up in his head, which depress his psyche and lead to a decrease in the quality of life, and direct efforts to replace these destructive attitudes with more life-affirming and positive thoughts.

At the same time, it is the psychotherapist who helps the person discover such destructive attitudes, since the patient himself often cannot identify them with destructive thoughts, but perceives them as ordinary, normal, true and self-evident.

Initially, cognitive behavioral therapy was used only in the form of private consultations and was carried out on an individual basis. Now such practices are widely used in group and family therapy and help resolve conflicts between generations, couples and teams.

Goals and objectives of treatment

Cognitive behavioral therapy, the exercises and techniques of which will be discussed later in the article, sets itself the following tasks and goals when working with patients who have obsessive destructive attitudes that interfere with their lives:

teach the patient to take control of negative thoughts and attitudes that pop up in the head automatically;
to form in a person a different attitude towards himself, so that he understands and realizes that he is not a “worthless” and “helpless” creature, and understands that not only he can make mistakes;
help the patient build a cause-and-effect relationship between cognitions and subsequent actions;
teach a person to correctly analyze and process new information (attitudes, rules, actions expected of him by other people), to do this independently, without outside influence;
help a person learn to replace his existing destructive thoughts with others that will give him the opportunity to look at the situation from a different angle.

Techniques

There are a number of basic techniques that Aaron Beck developed and structured.

Writing down thoughts. Regular recording helps the patient to structure his feelings and highlight the main points. They can also be used to retrospectively track the sequence of thoughts and corresponding actions;
Keeping a diary. With its help, you can identify those events or situations to which the patient reacts quite sharply;
"Distancing." Using this technique, the patient can look at his thoughts from the outside and try to give them an objective assessment. It becomes easier to separate productive thoughts and impulses from maladaptive ones, that is, those that cause fear, anxiety and other negative emotions;
Revaluation. The doctor asks the patient to find alternative options for the development of a particular situation;
Purposeful repetition. The patient is asked to replay the situation many times in a row, looking for new options for its development. This exercise allows you to strengthen new affirmations in the patient’s mind.

Indications

Cognitive behavioral psychotherapy, the exercises and techniques of which are used during treatment, can be very effective for a number of diseases:

excessive anxiety;
panic attacks;
depression of various forms;
hypochondriacal disorder;
various kinds of phobias;
migraines;
eating disorders;
when analyzing family problems and conflicts;
for individual personality disorders;
in working with clients with various types of addictions (drug addiction, alcoholism).

In combination with medication, CPT has been successfully used for bipolar disorders and schizophrenia. This technique also shows good results in the treatment of some somatic diseases, such as colitis, hypertension, lumbar pain, and chronic fatigue syndrome.

Cognitive therapy techniques are successfully used in working with patients of various age categories, from young children to the elderly.

about the author

Robert Leahy is director of the American Institute of Cognitive Therapy in New York and professor of clinical psychology in the department of psychiatry at Weill Cornell Medical College. His research focuses on individual differences in emotional regulation. Dr. Leahy is an Associate Editor for the International Journal of Cognitive Therapy

) and is also a past president of the Association for Behavioral and Cognitive Therapy, the International Association of Cognitive Psychotherapy, and the Academy of Cognitive Therapy.
In 2014, he received the Aaron Beck Award from the Academy of Cognitive Therapy. Dr. Leahy has published a number of books, including Overcoming Resistance in Cognitive Therapy
.
He has also co-authored Treatment Plans and Interventions for Bulimia and Binge -Eating Disorder and
Treatment Plans
and Interventions Depression and Anxiety Disorders, Second Edition
) and Emotion Regulation in
Psychotherapy
.

Contraindications

Cognitive behavioral therapy has the same contraindications as any psychotherapy.

This:

severe depressive states;
severe mental retardation;
psychosis at the acute stage.

These contraindications are not absolute, but rather are related to the fact that, due to the characteristics of his condition, the patient is not able to constructively cooperate with a specialist and the techniques used will not give the desired result.

Acknowledgments

One of the most rewarding parts of writing the book is being able to acknowledge the influence and support I've received over the years. First, I want to thank Jim Nugott, who has been my editor since the very first book I published with The Guilford Press. I am grateful to Jane Keislar and Jenny Tang of Guilford, and to editor Margaret Ryan, whose hard work helped make this book a reality.

At one time, my views were influenced by the work of a large number of specialists, starting with Aaron Beck, the founder of cognitive therapy. I would also like to acknowledge the influence of the ideas of Jill Abramson, Lauren Alloy, Arnud Arntz, David Barlow, Judith Beck, David Burns, David A. Clark, David M. Clark, Frank Dattilio, Keith Dobson, Michael Dugas, Edna Foa, Paul Gilbert, Allison Harvey, Stephen Hayes, Stefan Hofmann, Emily Holmes, Sheri Johnson, Marsha M. Linehan, Doug Mennina, Corey Newman, Christine Purdon, Stanley J. Rahman, John Riskind, Paul Salkovskis, Debbie Sukman, John Tisdale, Dennis Turch, Adrian Wells, Mark Williams, Jeffrey Young and Zindel Segal. I owe a huge debt to my colleagues at the American Institute of Cognitive Therapy: over many years of collaboration, they repeatedly listened to my ideas, which then ended up in my books. I would like to give special thanks to Melissa Horowitz, Laura Oliffe, Susan Paula, Mia Sage, Scott Woodruff, Maren Westphal, and Peggylee Wupperman. I would also like to express my gratitude to my assistant, Sindhu Shivaye, who worked tirelessly and went above and beyond what was required at all stages of collecting information and preparing the text. I would like to thank my friend and colleague at the British Association for Behavioral and Cognitive Psychotherapy, Philip Tata, who has guided and supported me over many years.

And, of course, where would I be, what would I achieve without my sweet, caring, wise wife Helen, who generously shares her sense of humor and support with me? I dedicate this book to her.

Principles, methods and techniques

Cognitive behavioral therapy (exercises and specific techniques will be discussed later in the article) is based on some postulates or principles that define key areas in working with clients:

the principle of minimal intrusion - during therapy, specialists interfere in the patient’s personal life only to the extent necessary to correct his condition;
“here and now” principle — the starting point of therapy is the problem that worries the person who has applied at that particular moment;
the principle of the relativity of the concepts “disease-health” and “deviation-norm” - the psychotherapist does not impose his vision of normal and healthy behavior on the client, the goal of psychocorrectional therapy is the formation of optimal behavior for each specific patient;
the principle of using the help of the patient’s loved ones (family or friends) - this is possible with the consent of all parties and has a positive effect on the motivation of patients, increasing their interest in a favorable outcome of therapy;
the principle of the active and directive role of the psychotherapist - in CBT the technique of “talking out” problems and experiences is not used.

A specialist, as a rule, works according to a specifically developed plan and communication is built in such a way that the patient’s role is quite passive - he must answer questions and diligently carry out recommended practices.

To solve clients' problems, cognitive behavioral psychotherapy uses the following techniques and methods:

Written recording of thoughts	The psychotherapist suggests writing down what exactly prevents you from performing this or that action. As a rule, this will be the first thought that you should focus on while working.
Distance technique	It consists in developing an objective attitude towards one’s own thoughts, when first comes the awareness of the automatism of the emerging thought-attitude, then the understanding that this thought brings fear, irritation, anger or other unpleasant emotions and, in the end, the client himself questions the truth of such false cognitions .
Keeping a journal to record thoughts	Helps to understand exactly what thoughts a person spends his time on, and which of them are toxic to his consciousness.
Special cognitive rehearsal	When, while working with a specialist, the patient consciously reproduces destructive thoughts in his imagination and describes to him his emotions and sensations.
Repressing negative emotions	This technique helps victims of various crimes and people who have suffered various traumatic situations, when, instead of constantly replaying the details of what happened in their head, a person sets himself not to live in the past, and not to drag this burden into the present and future, and lets go of these events.
Decentration and decatastrophization	It is used to combat various types of phobias and patients with anxiety disorders.
Obsessive repetition of correct settings	This is the practice of repeating positive instructions that are written down on paper and read over and over again, leading to increased self-efficacy.
Channeling imagination in the right direction	For some patients, discomfort is caused not only by emerging events from the past and some incorrect attitudes, but also by a wild imagination. In this case, you should direct the coercive mental force to block the negative fantasies being played out in your head.
Replacing roles	The patient is asked to imagine that he needs to comfort a person who has the same problems as him.

Signs and history of the concept

Initially, it was believed that the main signs of acceleration were the main physical parameters of development - weight and height, head circumference and chest volume. However, after some time, many scientists began to be of the opinion that acceleration should be characterized by the following factors:

Body proportions.
Level of skeletal ossification.
Vital volume of the lungs.
The appearance of baby teeth and their replacement by permanent teeth.
Level of maturity.
Muscle strength.

And recently, the concept of acceleration has changed a lot. It has become much broader and can be applied both to children and adolescents, and to adults, if we are talking about such a phenomenon as the “growing up” of menopause, although the predominant meaning of the word “acceleration” is still a teenager characterized by faster pace of development.

If we consider the history of acceleration, it is not that long. For the first time this phenomenon manifested itself very clearly in the 60s of the last century. For example, children's body weight began to double earlier, and baby teeth began to be replaced by permanent ones earlier.

Cognitive psychology did not emerge overnight. This section first appeared in the 60s in response to the now popular behaviorism movement. Ulrik Neisser is considered the founder of behavioral psychology. His monograph “Cognitive Psychology” became the beginning of the development and popularization of this branch of science.

A huge breakthrough in the field of studying cognitive processes was the development of a holographic model of not just the human brain, but the functioning of the psyche. Its authors were neurophysiologist Karl Pribram and physiologist Karl Spencer Lashley. It is material evidence that an individual’s memory is preserved even after resection of certain parts of the brain. With the help of this invention, scientists received confirmation that memory and other cognitive processes are not “fixed” to a separate area.

Currently, cognitive psychology is quite successfully practiced by clinical psychologist Yakov Kochetkov. He organized a huge psychological center that uses cognitive therapy methods to treat many disorders. He is the author of many articles on the topic of rational treatment of panic attacks, obsessive-compulsive disorder, depression and many other problems.

Cognitive psychology in modern science is closely related to neurobiology. Many cognitive processes cannot be studied without understanding the subtlest matters of neurophysiology. This connection gave birth to the experimental science of cognitive neuroscience.

Treatment process

Cognitive-behavioral psychotherapy, the exercises of which are based on the methods described above, in practice is a short-term course during which the patient goes through the treatment process and includes from 10 to 20 sessions.

Moreover, during the treatment, both direct classes with a psychotherapist are provided (at least 1-2 times a week), and the completion of “homework”, consisting of exercises selected for each specific patient.

To work through false attitudes that interfere with a person’s life, cognitive techniques are used, which are divided into several groups.

Group one

The purpose of using Group 1 techniques in practice when working with patients is to help them track and become aware of their own destructive thoughts.

For this, the following methods are used:

written recording of one’s own thoughts – the patient’s task is to express his thoughts before and after performing any action in writing, and this must be done consistently and not chaotically. This will help analyze and better understand a person’s motives when making significant decisions;
daily journaling - the client is asked to briefly and clearly express all his thoughts for some time. This will allow you to understand exactly what thoughts occupy a person most of the time;
blocking dysfunctional thoughts - this exercise includes 3 stages:

a clear understanding and acceptance of the fact that unconstructive thoughts arise automatically, the awareness that this attitude is imposed by someone from the outside, and is not a product of one’s own mental activity;
the patient’s understanding that this stereotypical thought is dysfunctional and interferes with normal adaptation to life conditions;
the patient questions the truth of the maladaptive obsessive judgment.

Group two

The purpose of the selection of exercises from the 2nd group of CBT is to challenge the controversial dysfunctional thoughts existing in the patient’s mind and head.

To do this, the practicing psychotherapist suggests the client perform the following exercises:

determining the advantages and disadvantages of unnecessary cognitions - in this case, it is not the maladaptive thought itself that is analyzed, but possible options for the development of events;
elaboration of arguments for and against dysfunctional thoughts - in this case, such arguments are recorded on paper, and the patient is recommended to regularly read these notes, which will help on a subconscious level to form the right attitude towards unnecessary attitudes;
release of emotions - destructive thoughts often cause “indecent” feelings in people, which they suppress in themselves, for fear of being misunderstood by society. During CBT, the therapist invites the patient to fully express these emotions and address them to him;
analysis of the past – together with a specialist, the patient works through the traumatic situations that happened to him and gets rid of distorted memories;
role change - the patient is asked to imagine that the psychotherapist has similar problems and needs help with advice. Thus, with the help of this technique a person convinces himself.

Group three

The next 3rd group of techniques is aimed at working with the imagination of those individuals who are prone to anxiety. In such people, it is not obsessive automatic cognitions that predominate, but rather exhausting and frightening images.

To adjust the area of imagination in these patients, the following techniques are used:

repetition - the patient is asked to take out negative images and forcefully replay productive positive attitudes in his head. Thanks to this technique, the formed negative stereotype is gradually erased;
cessation - when frightening images appear in the head, the patient should aloud prohibit himself from thinking about it. This should be done in a loud, clear and well-produced voice;
repression due to a modified and positive image - in this case, the active work of the client’s imagination is important, with the help of which he first neutralizes disturbing images and then completely replaces them with positive ideas;
a practical-constructive approach (desentification technique) - the patient is asked to realistically assess the likelihood of the occurrence of a particular alarming event that his imagination depicts.

Group four

The techniques of this group are aimed at enhancing the effectiveness of the treatment process and neutralizing the resistance provided by the patient.

determination of the implicit (hidden) motives of the patient’s destructive behavior - is used to identify the reasons for the patient’s illogical behavior when he accepts and understands the “correct” arguments, but still continues to think destructively;
regular repetition - the patient is instructed to apply positive attitudes in everyday life and independently re-evaluate experiences and ideas.

Main goals

Cognitive psychology views a person as an object whose activity is aimed at searching and processing new information. All cognitive processes (perception, memory, rational thinking, decision making) are involved at different stages of information processing. Scientists draw an analogy between the work of the brain and the work of a computer process. Psychologists even borrowed the term “information processing” from programmers and successfully use it in their scientific works.

For practical applications, the information processing model is often used. With its help, the memorization process is directly decomposed into several separate components. Thus, you can study the entire process: from receiving information to issuing a specific reaction to it.

Practitioners, using methods of cognitive psychology, try to prove that knowledge primarily influences the behavior and reaction of an individual to surrounding stimuli. The difference in the perception of verbal and non-verbal stimuli, the duration and strength of the effect of a particular image are also studied.

This is what cognitive therapy is based on. It is based on the opinion that the causes of all disorders of mental processes, as well as a number of diseases of the nervous system, lie in erroneous processes of thinking and perception.

Examples of exercises, description, practice

Cognitive behavioral therapy recognizes that neurotic disorders and psychological problems develop due to a person's incorrect thoughts and beliefs, as well as the behavior that results from following these destructive attitudes.

Based on this approach, practical work with patients is built, corrective methods and exercises are selected. When choosing a specific technique, psychotherapists should proceed from the client’s personal situation and the goals of the corrective sessions.

Problem solving and skill development

The essence of this technique is that the psychotherapist works with the patient on ways to solve emerging life problems. Sometimes it happens that people who have false attitudes generally do not cope well with the difficulties that arise in life.

In this case, the specialist conducts a conversation in which:

finds out what problems the patient had to face over the past week;
what difficulties may await him in the near future (again, in the next 7 days);
tries to find out how the client previously resolved similar issues;
offers to give advice to another person who finds himself in a similar situation;
if necessary, suggests ways to solve the problem.

Making decisions

Patients with various types of anxiety and depressive disorders often find it very difficult to independently make decisions regarding their lives. Thus, they may believe that someone else should decide for them whether to change jobs, start a family, or have children. At the same time, they are characterized by infantilism and in case of failures they shift responsibility to others.

The fear of making an independent decision is associated only with a negative vision of the consequences of its adoption. Such patients are asked to make a list of the pros and cons of the position being taken and, together with a specialist, evaluate the importance of each position, and then make a final decision.

Refocusing

This technique involves the patient switching his attention to another type of activity every time automatic thoughts appear.

This technique helps people who have obsessive thoughts and have difficulty evaluating them rationally. The specialist’s task is to teach patients to categorize their own obsessive thoughts and accept them as a fact that has a bad effect on their mood and learn to switch to something else.

Assessing mood and behavior using an activity graph

For some types of disorders and behavioral deviations, psychotherapists recommend that patients draw graphs and record the anxiety that arises on a scale rated at 10 points. This will help you track your mood swings and detect patterns and patterns of anxiety, anger, and irritability.

A similar technique for assessing the condition is used in patients with:

compulsive overeating;
smoking;
gambling addiction;
squandering;
drug and alcohol addiction;
tendency to sudden outbursts of rage.

Cognitive errors

Cognitive errors

is what makes our cognitions incorrect. Again, not every cognition is erroneous, but those that are not are not of interest to us and, accordingly, will not be considered.

Here are examples of some common cognitive errors. Firstly, this is, of course, catastrophization

, which consists in the fact that the subject, based on one bad experience, makes the conclusion that “
everything is bad and we will all die
.” For example, a student who has failed one exam during the session may not be thinking about how to get a retake, but imagining a terrible future for himself, where he will be drafted into the army, he will go to war, he will be captured there, etc. Such thoughts will be absolutely disorganizing and obviously will not help you get out of the situation.

A second interesting and common mistake is overgeneralization.

(overgeneralization). In this case, a person, ignoring the knowledge gained in terver and matstat courses, makes assumptions about the general population from one fact. And this totality often turns out (in his head, of course) to be hostile, unpleasant and in every possible way threatening the subject. The testers found one non-critical bug for the programmer, and he is already thinking about leaving his profession, since he is a redneck coder and a bug-dealer - this is it.

One of my favorite cognitive errors is the so-called. " The tyranny of the should"

”, which is based on three pillars: “
I owe
”, “
they owe me
”, “
the whole world owes me
”. Let's look at examples to make it clearer.

The company's employee regularly participates in the inventory of goods, even when there is no direct order from the director, but only an insistent demand from the head of the logistics department. Why? Because he feels that he must do this, although in reality there is no relationship of obligation: this is not stated in the contract, there is no order from the manager, there is only a cognitive distortion: “ I must, otherwise I will be fired.”

».

Another example: the subject demands something that was not agreed upon. The mother demands that her son enter the specialty of her choice (“ you must become a doctor

"), the boss demands that his subordinate clean the office premises, very surprised and indignant that the latter himself did not think of this. “But this is elementary, he should have guessed!”

An example of the third type of obligation: a girl experiences extreme distress because a bus has arrived at the stop on the wrong route for her (“ How can this be, everything should be my way!”

»).

The examples may seem exaggerated, but they are all taken from real life, and none of them are fictitious. By the way, if you haven’t read the Wikipedia article about cognitive distortions, I recommend it.

Relaxation and Mindfulness

Many people benefit from various relaxation techniques for behavioral disorders. These can be relaxation exercises including breathing control, muscle relaxation and imaginative (related to imagination and fantasy) techniques.

The therapist’s task is to teach the patient such exercises and observe his reaction. Sometimes, in some clients, relaxation exercises cause an inexplicable opposite effect - paradoxical arousal.

Mindfulness techniques can help patients with rumination (obsessive thoughts) to observe and come to terms with their experiences impartially, without trying to repress or change them.

This approach is described in detail by the American psychologist Robert Leahy. It involves re-evaluating real life experiences and challenging destructive ideas, which is the key to defeating anxiety.

Successive approximation technique

Due to cognitive triggers, patients feel that desired goals are not achievable. They literally focus on the remoteness of the desired result, instead of focusing on the immediate step that needs to be taken to achieve their cherished goal.

The specialist’s task is to explain that the path to the goal consists of many steps and it is important to concentrate on the nearest one. To better influence the patient, together with him, the psychotherapist develops a plan diagram in the form of steps, which most transparently displays the path ahead of the patient and has a calming effect on him.

Exposition

People with problems with depressive and anxiety disorders often choose avoidant behavior. It can be either obvious, when a person does not leave the house at all and avoids any contact, or hidden, when, experiencing social anxiety, a person does not look other people in the eyes, is afraid to express his opinion and communicate with other people.

This behavior in psychology is designated as protective, since patients feel that they are protecting themselves from anxiety. However, this line of behavior does not help solve the problem.

In this case, experts recommend the “exposure” exercise to overcome anxiety, when existing fears are not masked by the patient, but on the contrary, he tries to feel what will happen if he does what he is afraid of.

The patient is recommended to gradually enter into moderate discomfort and at the same time analyze his emotions by filling out special coping cards. On such cards, on one side, the patient’s fear is written down, and on the other side, motivators to encourage him to perform actions that cause fear.

Role-playing games

Used to achieve a variety of therapeutic goals and are very useful for teaching and practicing social skills. It often happens that people experience various communication fears - they are afraid to speak with someone (higher in position or just a stranger), or they are afraid to express their opinion, for fear of being misunderstood or of offending someone.

Psychological role-playing game helps the patient to experience in advance the emotions that frighten him and overcome his own fears.

Pie technique

This technique helps patients clearly and visually see how unbalanced their lives are and what exactly does not suit them. To do this, they use a graphical method - the drawn circle is divided like a pie, dividing it into shares - different areas of life.

Each lobe will have its own size, depending on how important it is to the patient and what role it actually plays in his life. Thus, it often turns out that the bias towards family or work deprives people of the opportunity to enjoy both at the same time.

Such a pie chart is applicable when analyzing completely different situations and helps patients clearly see the essence of the problem.

Distribution of Responsibility

This is another type of psychological influence that helps to visualize the outcome of an event in graphic form. Some people with anxiety disorders and a heightened sense of responsibility tend to blame only themselves when they fail and attribute failures to their own negative thinking.

The specialist invites the patient to draw up a pie chart and critically evaluate the influence of various factors on the outcome of the situation, rather than placing all the blame on themselves. So, for example, low earnings may not only be the fault of the person himself, but may be partly due to the unfavorable situation in the country and company, bad luck, or biased attitude of his superiors.

Comparison with yourself and lists of achievements

Patients with mental disorders are characterized by negative distortion of information when assessing themselves. They usually form a negative opinion about themselves, and forget and devalue their good traits and actions.

They are also characterized by dysfunctional comparisons - they can compare themselves with people who do not have mental disorders, as well as with an ideal image of themselves or with the person they were before the onset of disorders.

However, this approach is unproductive and even destructive for them, since it only causes a worsening of mood and maintains dysphoria - a form of low mood characterized by gloominess, irritability and hostility towards others.

The specialist’s task in this case is to conduct a conversation with the patient, the purpose of which is to eliminate his close attention to the painful comparison of himself with other people or with his more successful image.

The patient should concentrate on comparing himself with his current self and note any positive actions or changes for which he would like to praise himself.

To do this, it is proposed to keep lists of achievements for some time, which will list such merits. If you want to compare yourself with someone, the patient is recommended to re-read these to-do lists that he himself created and understand that these achievements are very valuable and required effort from him.

Cognitive-behavioral psychotherapy does not rely on drugs and medications, but on various psychological methods, techniques and exercises.

In some cases, depending on the initial condition of the patient, treatment can last quite a long time, but, nevertheless, even in such situations, clients almost always show significant improvements and are able to significantly change the quality of their life.

After undergoing therapy, most patients manage to maintain the achieved results thanks to mastering the methods and techniques of self-regulation in practice.

Basics of CBT

As its name suggests, cognitive behavioral therapy is built around two things: how the client thinks and how he behaves.

CBT is based on the assumption that what happens to a person depends largely on how he structures the world. And this is determined by the way he thinks. CBT, unlike many other psychotherapeutic approaches, postulates that a person's thoughts cause emotions

, and not vice versa.

The most important role here is played by the so-called. automatic thoughts

- these are, oddly enough, thoughts that appear automatically.
Let us explain with an example: while writing this article, the author had to take a few days off to solve some everyday problems. When he learned about this, a whole series of involuntary and, as further analysis showed, destructive thoughts arose in his brain, such as “ I’m a loser
,” “
I won’t succeed
,” “
I’ll be kicked out of GeekTimes
,” and the like.

Automatic thoughts are not always destructive, and moreover, they are not always wrong. But you should treat them with suspicion - as a rule, they are products of the principle of saving resources: the brain is “lazy” to fully calculate the situation and produces the first solution/judgment that comes across. And it often happens that the same brain, if forced to think carefully, will give a completely different assessment or make a completely different decision.

For example, a person who has accumulated minuses in his karma may automatically consider himself defective, but, after thinking carefully, he will understand that he simply made a too harsh and erroneous statement (a one-time mistake does not prove the inferiority of the one who made it).

A synonym for the term “automatic thought” is the word “ cognition

”, which Beck defined as follows: “Cognition is a thought or image that may go unnoticed by you unless you concentrate on it.”[9].

Actually, that part of CBT that is cognitive is about teaching the client to catch his cognitions, become aware of them, check for adequacy and (if necessary) replace them with more adequate thoughts. Those. argue with yourself. And no, this is in no way schizophrenia, this is part of the therapeutic process in CBT called disputation.

Some of the cognitions are disputed by the therapist, some (it must be said - b o

most of it) the client himself.

But in CBT there is also a second part - behavioral. A directive approach works here, where the therapist forces the client to behave in a healthy way, for example, a depressed client who lies in bed most of the day will be tasked with creating (and then implementing) a certain daily routine, including a certain level of activity, and the client with agoraphobia (after appropriate training, of course) will be forced to visit crowded places.

Speaking of “appropriate preparation”. Within the framework of behaviorism (on which the behavioral part of CBT is based), various techniques are possible, but two of them deserve special attention and inclusion in this article.

The first is systematic desensitization

. It is especially good for various kinds of phobias. At the first stage, the client is taught some kind of relaxation technique (muscle relaxation, breathing exercises, etc.), after which he is presented with a stimulus that causes fear.

If we imagine that our hypothetical client is afraid of spiders, then he will be shown a photo of a spider and asked to use a previously learned technique to relax. When the photograph ceases to make an impression, he will be presented with a spider in a jar at a considerable distance and asked to relax. As therapy progresses, the stimulus will increase in intensity until the client becomes desensitized to it.

The second technique is the so-called. flood technique

. It is essentially the opposite of the first: a person is immediately presented with a very high-strength stimulus and waits until he is so sick that he “gets tired of being afraid.”

That, in fact, is the whole essence of CBT. Of course, there are many interesting technical points, but their consideration is clearly beyond the scope of our review article, and instead of going into this jungle, understandable only to professionals, let’s talk a little more about cognition, and then consider an example of working with them.