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

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

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

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

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

What happens in a cognitive behavioral therapy session:

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

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

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

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

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

Areas of assistance using CBT methods:

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

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Cognitive psychotherapy is a form of structured, short-term, directive, symptom-oriented strategy for stimulating transformations in the cognitive structure of the personal “I” with evidence of transformations at the behavioral level. This direction generally refers to one of the concepts of modern cognitive-behavioral teaching in psychotherapeutic practice.

Cognitive-behavioral psychotherapy studies the mechanisms of an individual’s perception of circumstances and the individual’s thinking, and contributes to the development of a more realistic view of what is happening. Due to the formation of an adequate attitude towards occurring events, more consistent behavior arises. Cognitive psychotherapy, on the other hand, aims to help individuals find solutions to problematic situations. It works in circumstances where there is a need to find new forms of behavior, build the future, and consolidate the result.

Cognitive psychotherapy techniques are constantly used at certain phases of the psychotherapeutic process in combination with other techniques. A cognitive approach to defects in the emotional sphere transforms individuals' point of view on their own personality and problems. This type of therapy is convenient because it can be seamlessly combined with any psychotherapeutic approach and can complement other methods and significantly enhance their effectiveness.

Beck's cognitive psychotherapy

Modern cognitive-behavioral psychotherapy is considered a general name for psychotherapies, the basis of which is the assertion that the factor provoking all psychological deviations are dysfunctional views and attitudes. Aaron Beck is considered the creator of the field of cognitive psychotherapy. He gave rise to the development of the cognitive direction in psychiatry and psychology. Its essence lies in the fact that absolutely all human problems are formed by negative thinking. A person interprets external events according to the following scheme: stimuli influence the cognitive system, which, in turn, interprets the message, that is, thoughts are born that give rise to feelings or provoke certain behavior.

Aaron Beck believed that people's thoughts determine their emotions, which determine the corresponding behavioral reactions, and those, in turn, shape their place in society. He argued that it is not the world that is inherently bad, but people see it that way. When an individual's interpretations diverge greatly from external events, mental pathology appears.

Beck observed patients suffering from neurotic. During his observations, he noticed that the themes of defeatism, hopelessness and inadequacy were constantly heard in the experiences of patients. As a result, I came up with the following thesis that a depressive state develops in subjects who perceive the world through three negative categories:

A negative view of the present, that is, regardless of what is happening, a depressed person concentrates on negative aspects, despite the fact that everyday life gives them certain experiences that most individuals enjoy;

Hopelessness felt about the future, that is, a depressed individual, imagining the future, finds exclusively gloomy events in it;

Low self-esteem, that is, the depressed subject thinks that he is an insolvent, worthless and helpless person.

Aaron Beck in cognitive psychotherapy developed a behavioral therapeutic program that uses mechanisms such as modeling, homework, role-playing games, etc. He mainly worked with patients suffering from various personality disorders.

His concept is described in a work entitled: “Beck, Freeman, cognitive psychotherapy for personality disorders.” Freeman and Beck were convinced that each personality disorder is characterized by the predominance of certain views and strategies that form a specific profile characteristic of a particular disorder. Beck argued that strategies can either compensate for or stem from certain experiences. Deep patterns of correction of personality disorders can be deduced as a result of a quick analysis of an individual’s automatic thoughts. The use of imagination and re-experiencing traumatic experiences can trigger the activation of deep circuits.

Also in the work of Beck and Freeman “Cognitive Psychotherapy of Personality Disorders,” the authors focused on the importance of psychotherapeutic relationships in working with individuals suffering from personality disorders. Since quite often in practice there is such a specific aspect of the relationship built between the therapist and the patient, known as “resistance”.

Cognitive psychotherapy for personality disorders is a systematically designed, problem-solving direction of modern psychotherapeutic practice. It is often limited in time and almost never exceeds thirty sessions. Beck believed that a psychotherapist should be benevolent, empathetic and sincere. The therapist himself must be the standard of what he seeks to teach.

The ultimate goal of cognitive psychotherapy is to identify dysfunctional judgments that trigger depressive attitudes and behavior, and then transform them. It should be noted that A. Beck was not interested in what the patient thinks about, but how he thinks. He believed that the problem is not whether a given patient loves himself, but what categories he thinks in depending on the conditions (“I am good or bad”).

Methods of cognitive psychotherapy

The methods of cognitive psychotherapy include the fight against negative thoughts, alternative strategies for perceiving the problem, secondary experience of situations from childhood, and imagination. These methods are aimed at creating opportunities for forgetting or new learning. In practice, it was revealed that cognitive transformation depends on the degree of emotional experience.

Cognitive psychotherapy for personality disorders involves the use in combination of both cognitive methods and behavioral techniques that complement each other. The main mechanism for a positive result is the development of new schemes and the transformation of old ones.

Cognitive psychotherapy, used in its generally accepted form, counteracts the individual’s desire for a negative interpretation of events and themselves, which is especially effective for depressive moods. Since depressed patients are often characterized by the presence of thoughts of a certain type of negative orientation. Identifying such thoughts and defeating them is of fundamental importance. For example, a depressed patient, recalling the events of last week, says that then he could still laugh, but today it has become impossible. A psychotherapist practicing a cognitive approach, instead of accepting such thoughts unquestioningly, encourages studying and challenging the course of such thoughts, asking the patient to remember situations when he overcame a depressive mood and felt great.

Cognitive psychotherapy is aimed at working with what the patient tells himself. The main psychotherapeutic step is the patient's recognition of certain thoughts, as a result of which it becomes possible to stop and modify such thoughts before their results lead the individual very far. It becomes possible to change negative thoughts to others that can obviously have a positive effect.

In addition to counteracting negative thoughts, alternative coping strategies also have the potential to transform the quality of the experience. For example, the general feeling of a situation is transformed if the subject begins to perceive it as a challenge. Also, instead of desperately trying to succeed by doing things that the individual cannot do well enough, one should set oneself as the immediate goal of practice, as a result of which one can achieve much greater success.

Cognitive psychotherapists use the concepts of challenge and practice to confront certain unconscious assumptions. Recognizing the fact that the subject is an ordinary person with inherent flaws can minimize the difficulties created by an attitude of absolute striving for perfection.

Specific methods for detecting automatic thoughts include: writing down similar thoughts, empirical testing, reappraisal techniques, decentering, self-expression, decatastrophizing, targeted repetition, use of imagination.

Cognitive psychotherapy exercises combine activities to explore automatic thoughts, analyze them (which conditions provoke anxiety or negativity) and perform tasks in places or conditions that provoke anxiety. Such exercises help reinforce new skills and gradually modify behavior.

Cognitive psychotherapy techniques

The cognitive approach to therapy is inextricably linked with the formation of cognitive psychology, which places the main emphasis on the cognitive structures of the psyche and deals with personal elements and logical abilities. Cognitive psychotherapy training is widespread today. According to A. Bondarenko, the cognitive direction combines three approaches: direct cognitive psychotherapy by A. Beck, the rational-emotive concept of A. Ellis, and the realistic concept of V. Glasser.

The cognitive approach involves structured learning, experimentation, mental and behavioral training. It is designed to assist the individual in mastering the operations described below:

Discovering your own negative automatic thoughts;

Finding connections between behavior, knowledge and affects;

Finding facts “for” and “against” identified automatic thoughts;

Finding more realistic interpretations for them;

Learning to identify and transform disorganizing beliefs that lead to disfigurement of skills and experiences.

Training in cognitive psychotherapy, its basic methods and techniques helps to identify, dismantle and, if necessary, transform negative perceptions of situations or circumstances. People often begin to fear what they have prophesied for themselves, as a result of which they expect the worst. In other words, the individual’s subconscious warns him of possible danger before he gets into a dangerous situation. As a result, the subject becomes afraid in advance and tries to avoid it.

By systematically monitoring your own emotions and trying to transform negative thinking, you can reduce premature thinking, which can be modified into a panic attack. With the help of cognitive techniques, it is possible to change the fatal perception characteristic of such thoughts. Thanks to this, the duration of a panic attack is shortened and its negative impact on the emotional state is reduced.

The technique of cognitive psychotherapy consists of identifying the attitudes of patients (that is, their negative attitudes should become obvious to patients) and helping them to understand the destructive impact of such attitudes. It is also important that the subject, based on his own experience, make sure that, due to his own beliefs, he is not happy enough and that he could be happier if he were guided by more realistic attitudes. The role of the psychotherapist is to provide the patient with alternative attitudes or rules.

Cognitive psychotherapy exercises for relaxation, stopping the flow of thoughts, and controlling impulses are used in conjunction with the analysis and regulation of daily activities in order to increase the subjects’ skills and focus on positive memories.

Doctor of the Medical and Psychological Center "PsychoMed"

Cognitive psychotherapy for personality disorders Beck Aaron

Cognitive, behavioral and emotional avoidance

In addition to social avoidance, many avoidant patients also exhibit cognitive, behavioral, and emotional avoidance. They avoid think about the issues that cause dysphoria and act in ways that maintain this avoidance. The following typical pattern appears.

Avoidant patients are aware of feelings of dysphoria. (They may or may not be fully aware of the thoughts that precede or accompany the emotion.) Their tolerance for dysphoria is low, so they take a “dose” to distract themselves and feel better. They may give up on something they started or be unable to start something they had planned. They may turn on the TV, grab something to read, have a snack or light a cigarette, get up and walk around the room, etc. In short, they try to distract themselves in order to push uncomfortable thoughts out of their minds. This pattern of cognitive and behavioral avoidance, reinforced by a decrease in dysphoria, eventually becomes ingrained and automatic.

Patients are at least to some extent aware of their behavioral avoidance. They constantly criticize themselves indiscriminately and categorically: “I’m lazy,” “I’m incurable,” “I’m passive-aggressive.” Such statements reinforce beliefs in one's inadequacy or defectiveness and lead to hopelessness. Patients do not understand that their avoidance is a way of overcoming unpleasant emotions. They are generally unaware of their cognitive and behavioral avoidance until the pattern becomes clear to them.

Attitudes regarding overcoming dysphoria

Avoidant patients may have certain dysfunctional attitudes toward experiencing dysphoric emotions: “It’s bad to feel bad,” “I shouldn’t worry,” “I should always feel good,” “Other people rarely experience fear, are confused, or feel bad.” Avoidant patients believe that if they allow themselves to experience dysphoria, they will be overwhelmed by the feeling and will never recover from it: “If I give in to my feelings, it will destroy me,” “If I feel a little anxious, I will reach a point,” “If I feel worse, it will get out of control and I will be unable to act.” Unlike anorexics who fear the behavioral consequences of losing control (overeating), avoidant patients fear the overwhelming emotion they believe will arise if they lose control. They are afraid that they will get stuck in dysphoria and always feel bad about themselves.

Justifications and rationalizations

Avoidant patients are eager to achieve their long-term goal of establishing close relationships. In this they differ from schizoid patients, for whom a lack of intimacy with others is consistent with their self-image. Avoidant patients feel empty and lonely and want to change their lives, make close friends, find a better job, etc. They understand what it takes, but they do not dare to experience negative emotions. They come up with thousands of explanations for why they don’t do anything to achieve their goals: “I will feel bad,” “It’s tiring,” “I’ll do it later,” “I don’t want to do it now.” When “later” comes, they always make the same excuses, continuing the behavioral avoidance. In addition, avoidant patients are confident that they will not achieve their goals anyway. Typical assumptions are: “I can’t change anything,” “What’s the point of trying? I won’t succeed anyway.”

Wishful thinking

Avoidant patients may engage in wishful thinking when thinking about their future. They believe that one day the perfect relationship or the perfect job will appear on its own, without any effort on their part. This is due to the fact that they do not believe that they can achieve this on their own: “One day I will wake up and everything will be fine”, “I cannot make my life better on my own”, “Everything can become better, but it will not depend on me". This distinguishes avoidant patients from obsessive patients, who truly do not believe that they will ever get rid of their problems.

Case from practice

Jane, the patient described above, worked without fully realizing her abilities. However, she avoided taking steps that could have led to getting a better position: talking to her boss about a promotion, looking for another job, sending out a resume. She constantly hoped that something would happen and the situation would change. She came to psychotherapy with the same attitudes. Jane expected her therapist to “cure” her with little or no effort from herself. In fact, Jane believed that the “cure” had to come from outside, since her attempts to change on her own were unsuccessful.