Cognitive behavioral psychotherapy. Cognitive psychotherapy

This method of psychotherapy addresses the conscious mind and helps to free ourselves from stereotypes and preconceived ideas that deprive us of freedom of choice and push us to act according to a pattern. The method allows, if necessary, to correct the patient’s unconscious, “automatic” conclusions. He perceives them as truth, but in reality they can greatly distort real events. These thoughts often become the source of painful emotions, Not adequate behavior, depression, anxiety disorders and other diseases.

Operating principle

Therapy is based on working together therapist and patient. The therapist does not teach the patient how to think correctly, but works with him to figure out whether the habitual type of thinking helps him or hinders him. The key to success - active participation a patient who will not only have to work during sessions, but also do homework.

If at the beginning therapy focuses only on the patient’s symptoms and complaints, then gradually it begins to affect unconscious areas of thinking - deep-seated beliefs, as well as childhood events that influenced their formation. The principle is important feedback- the therapist constantly checks how the patient understands what is happening in therapy and discusses possible errors with him.

Work progress

The patient, together with the psychotherapist, finds out under what circumstances the problem manifests itself: how “automatic thoughts” arise and how they affect his ideas, experiences and behavior. In the first session, the therapist only listens carefully to the patient, and in the next they discuss in detail the patient’s thoughts and behavior in numerous everyday situations: what does he think about when he wakes up? And at breakfast? The goal is to make a list of moments and situations alarming.

The therapist and patient then outline a program of work. It includes tasks that must be completed in places or circumstances that cause anxiety - riding an elevator, having dinner at public place… These exercises allow you to reinforce new skills and gradually change behavior. A person learns to be less rigid and categorical, to see different facets of a problem situation.

The therapist constantly asks questions and explains points that will help the patient understand the problem. Each session is different from the previous one, because each time the patient moves forward a little and gets used to living in accordance with new, more flexible views without the support of a therapist.

Instead of “reading” other people’s thoughts, a person learns to distinguish between his own, begins to behave differently, and as a result, his emotional state. He calms down, feels more alive and free. He begins to be friends with himself and stops judging himself and other people.

In what cases is this necessary?

Cognitive therapy is effective in treating depression, panic attacks, social anxiety, obsessive-compulsive disorder and disorders eating behavior. This method is also used to treat alcoholism, drug addiction and even schizophrenia (as a supportive method). At the same time, cognitive therapy is also suitable for working with low self-esteem, relationship difficulties, perfectionism and procrastination.

It can be used both in individual work and in working with families. But it is not suitable for those patients who are not ready to take an active part in the work and expect the therapist to give advice or simply interpret what is happening.

How long should therapy last? How much does it cost?

The number of meetings depends on the client’s willingness to work, the complexity of the problem and his living conditions. Each session lasts 50 minutes. The course of therapy ranges from 5–10 sessions 1–2 times a week. In some cases, therapy may last longer than six months. A consultation with a cognitive psychologist costs from 2,000 to 4,000 rubles.

History of the method

1913. American psychologist John Watson publishes his first articles on behaviorism. He encourages his colleagues to focus exclusively on studying human behavior, on studying the connection “ external stimulus- external reaction (behavior).”

1960s The founder of rational-emotive psychotherapy, American psychologist Albert Ellis, states the importance of the intermediate link in this chain - our thoughts and ideas (cognitions). His colleague Aaron Beck begins to study the field of cognition. Having assessed the results various methods therapy, he came to the conclusion that our emotions and our behavior depend on the style of our thinking. Aaron Beck became the founder of cognitive behavioral (or simply cognitive) psychotherapy.

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

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

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

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

What is cognitive psychotherapy?

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

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

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

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

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

Beck's cognitive psychotherapy

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

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

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

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

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

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

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

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

Ultimate Goal Cognitive psychotherapy is the identification of destructive thoughts and personality transformation by eliminating them. What is important is not what the client thinks, but how he thinks, reasons, and what mental patterns he uses. They should be transformed.

Methods of cognitive psychotherapy

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

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

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

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

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

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

Cognitive psychotherapy exercises

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

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

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

Exercise "Fifth Column".

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

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

Cognitive psychotherapy techniques

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

Cognitive psychotherapy aims to teach the client the following:

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

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

Bottom line

You can even use the services of a cognitive psychotherapist healthy person. Absolutely all people have some personal problems which he cannot cope with on his own. The result of unresolved problems is depression, dissatisfaction with life, dissatisfaction with oneself.

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

People's experiences often include themes of hopelessness, a gloomy perception of the world, and dissatisfaction with oneself. Cognitive psychotherapy helps to identify established stereotypes by working with thinking and replacing “automatic” negative thoughts with positive ones. The patient is an active participant in the therapy process.

Cognitive therapy - what is it?

Aaron Beck, an American psychotherapist, one of the founders of the movement in 1954, studying depression within the framework of psychoanalysis, did not receive any encouraging reliable results. This is how a new direction of psychotherapeutic assistance appeared in panic attacks, depression, various dependencies. Cognitive therapy is short term method, aimed at recognizing negative thought patterns that lead a person to suffering and replacing them with constructive thoughts. The client learns new perceptions, begins to believe in himself and think positively.

Methods of cognitive psychotherapy

The psychotherapist initially negotiates and establishes a collaborative relationship with the patient. A list of target problems is generated in order of importance of elaboration for the patient, and automatic negative thoughts. Methods of cognitive- behavioral therapy cause positive changes at a fairly deep level, include:

• struggle with negative thoughts (“this is pointless”, “this is useless”, “nothing good will come of this”, “I don’t deserve to be happy”);
• alternative ways of perceiving the problem;
• rethinking or living through a traumatic experience from the past, which affects the present and does not allow the patient to adequately assess reality.

Cognitive psychotherapy techniques

The psychotherapist encourages the patient to actively participate fully in therapy. The therapist’s goal is to convey to the client that he is unhappy with his old beliefs; there is an alternative to start thinking in a new way, to take responsibility for his thoughts, state, and behavior. Homework is required. Cognitive therapy for personality disorders contains a number of techniques:

1. Tracking and recording negative thoughts and attitudes when you need to do something important action. The patient writes down on paper in order of priority the thoughts that come to him while making a decision.
2. Journaling. During the day, the thoughts that arise most often in the patient are recorded. A diary helps you track thoughts that affect your well-being.
3. Examination negative attitude in action. If the patient claims that “he is not capable of anything,” the therapist encourages him to first take small successful actions, then complicates the tasks.
4. Catharsis. A technique for experiencing emotions from a state. If the patient is sad or in self-disagreement, the therapist suggests expressing sadness, for example, by crying.
5. Imagination. The patient is afraid or unsure of his abilities to take action. The therapist encourages you to imagine and try.
6. Three Column Method. The patient writes in the columns: situation-negative thought-corrective (positive) thought. The technique is useful for learning the skill of replacing a negative thought with a positive one.
7. Recording the day's events. The patient may believe that people are aggressive towards him. The therapist suggests keeping a list of observations, where to put “+” “-”, throughout the day with each interaction with people.

Cognitive therapy - exercises

Lasting results and success in therapy are ensured by the consolidation of new constructive attitudes and thoughts. The client completes homework and exercises that the therapist will prescribe: relaxation, tracking pleasant events, learning new behavior and self-change skills. Cognitive psychotherapy and self-confidence exercises are necessary for patients with high anxiety and in a state of depression from dissatisfaction with oneself. In the course of developing the desired “self-image,” a person tries on and tries different options behavior.

Cognitive therapy for social phobia

Fear and high, unreasonable anxiety prevent a person from performing his or her duties normally. social functions. Social phobia is a fairly common disorder. Cognitive psychotherapy for social phobia helps to identify the “benefits” of such thinking. Exercises are selected for the patient’s specific problems: fear of leaving the house, and so on.

Cognitive therapy for addictions

Alcoholism and drug addiction are diseases caused by genetic factor, sometimes this is a pattern of behavior of people who do not know how to solve problems and see stress relief in using psychoactive substances without solving the problems themselves. Cognitive behavioral psychotherapy for addictions is aimed at identifying triggers (situations, people, thoughts) that trigger the mechanism of use. Cognitive therapy successfully helps a person cope with bad habits through awareness of thoughts, working through situations and changing behavior.

Cognitive behavioral therapy - the best books

People cannot always turn to a specialist for help. Techniques and methods of well-known psychotherapists can help you independently move towards solving some problems, but they will not replace the psychotherapist himself. Cognitive behavioral therapy books:

1. “Cognitive therapy for depression” A. Beck, Arthur Freeman.
2. “Cognitive psychotherapy for personality disorders” A. Beck.
3. “Psychotraining according to the Albert Ellis method” A. Ellis.
4. “The practice of rational-emotional behavioral psychotherapy” A. Ellis.
5. “Methods of behavioral therapy” V. Meyer, E. Chesser.
6. “Guide to cognitive behavioral therapy” by S. Kharitonov.

Today, correction of any psychological problems is carried out using the most different methods. One of the most progressive and effective is cognitive behavioral psychotherapy (CBT). Let's figure out how this technique works, what it consists of, and in what cases it is most effective.

The cognitive approach is based on the assumption that all psychological problems are caused by the thoughts and beliefs of the person himself.

Cognitive-behavioral psychotherapy is a direction that originates in the middle of the 20th century and today is only being improved every day. The basis of CBT is the opinion that it is human nature to make mistakes when passing life path. That is why any information can cause certain changes in a person’s mental or behavioral activity. The situation gives rise to thoughts, which in turn contribute to the development of certain feelings, and these already become the basis of behavior in a particular case. Behavior then generates new situation and the cycle repeats.

A striking example would be a situation in which a person is confident in his insolvency and powerlessness. In each difficult situation he experiences these feelings, becomes nervous and despairs, and, as a result, tries to avoid making a decision and cannot realize his desires. Often the cause of neuroses and other similar problems becomes an intrapersonal conflict. Cognitive-behavioral psychotherapy helps to determine the original source of the current situation, the patient’s depression and experiences, and then resolve the problem. A person becomes aware of the skill of changing his negative behavior and thinking patterns, which has a positive effect on both his emotional and physical state.

Intrapersonal conflict is one of the common reasons occurrence of psychological problems

CBT has several goals:

• stop and permanently get rid of the symptoms of a neuropsychic disorder;
• achieve a minimum probability of recurrence of the disease;
• help improve the effectiveness of prescribed medications;
• eliminate negative and erroneous stereotypes of thinking and behavior, attitudes;
• resolve problems of interpersonal interaction.

Cognitive behavioral psychotherapy is effective for a wide variety of disorders and psychological problems. But most often it is used when the patient needs to receive quick help and short-term treatment.

For example, CBT is used for deviations in eating behavior, problems with drugs and alcohol, inability to restrain and experience emotions, depression, increased anxiety, various phobias and fears.

Contraindications to the use of cognitive behavioral psychotherapy can only be severe mental disorders that require the use of medications and other regulatory actions and seriously threaten the life and health of the patient, as well as his loved ones and others.

Experts cannot say exactly at what age cognitive-behavioral psychotherapy is used, since this parameter will vary depending on the situation and the methods of working with the patient selected by the doctor. However, if necessary, such sessions and diagnostics are possible in both childhood and adolescence.

Use of CBT for severe mental disorders unacceptable, special drugs are used for this

The following factors are considered the main principles of cognitive behavioral psychotherapy:

1. A person's awareness of the problem.
2. Formation of an alternative pattern of actions and actions.
3. Consolidating new stereotypes of thinking and testing them in everyday life.

It is important to remember that both parties are responsible for the result of such therapy: the doctor and the patient. It's them coordinated work will achieve maximum effect and significantly improve a person’s life, take it to a new level.

Advantages of the technique

The main advantage of cognitive behavioral psychotherapy can be considered visible result, affecting all areas of the patient’s life. The specialist finds out exactly what attitudes and thoughts negatively affect a person’s feelings, emotions and behavior, helps to critically perceive and analyze them, and then learn to replace negative stereotypes with positive ones.

Based on the skills developed, the patient creates a new way of thinking, which corrects the response to specific situations and the patient’s perception of them, and changes behavior. Cognitive behavioral therapy helps to get rid of many problems that cause discomfort and suffering to the person himself and his loved ones. For example, in this way you can cope with alcohol and drug addiction, some phobias, fears, part with shyness and indecisiveness. The duration of the course is most often not very long - about 3-4 months. Sometimes it may take much longer, but in each specific case this issue is resolved individually.

Cognitive behavioral therapy helps to cope with a person’s anxieties and fears

It is important to remember that cognitive behavioral therapy has positive effect only when the patient himself has decided to change and is ready to trust and work with a specialist. In other situations, as well as in particularly difficult mental illness, for example, in schizophrenia, this technique is not used.

Types of therapy

Methods of cognitive behavioral psychotherapy depend on specific situation and the patient's problems have a specific purpose. The main thing for a specialist is to get to the root of the patient’s problem and teach the person positive thinking and ways of behavior in such a case. The most commonly used methods of cognitive behavioral psychotherapy are the following:

1. Cognitive psychotherapy, in which a person experiences uncertainty and fear, perceives life as a series of failures. At the same time, the specialist helps the patient develop a positive attitude towards himself, will help him accept himself with all his shortcomings, gain strength and hope.
2. Reciprocal inhibition. During the session, all negative emotions and feelings are replaced by other more positive ones. Therefore, they cease to have such a negative impact on human behavior and life. For example, fear and anger are replaced by relaxation.
3. Rational-emotive psychotherapy. At the same time, a specialist helps a person realize the fact that all thoughts and actions must be reconciled with the realities of life. And unrealizable dreams are the path to depression and neurosis.
4. Self-control. When working with this technique, reactions and human behavior in certain situations is fixed. This method works for unmotivated outbursts of aggression and other inappropriate reactions.
5. “Stop tap” technique and anxiety control. At the same time, the person himself says “Stop” to his negative thoughts and actions.
6. Relaxation. This technique is often used in combination with others to complete relaxation patient, creating a trusting relationship with a specialist, more productive work.
7. Self-instructions. This technique consists in creating a series of tasks for oneself and independently solving them in a positive way.
8. Introspection. At the same time, a diary can be kept, which will help in tracking the source of the problem and negative emotions.
9. Research and analysis threatening consequences. When a person has negative thoughts, he changes them to positive ones, based on the expected results of the situation.
10. A method for finding advantages and disadvantages. The patient himself or in pairs with a specialist analyzes the situation and his emotions in it, analyzes all the advantages and disadvantages, draws positive conclusions or looks for ways to solve the problem.
11. Paradoxical intention. This technique was developed by the Austrian psychiatrist Viktor Frankl and consists in the fact that the patient is asked to experience a frightening or problematic situation over and over again in his feelings and does the opposite. For example, if he is afraid to fall asleep, then the doctor advises not to try to do this, but to stay awake as much as possible. In this case, after a while a person stops experiencing negative emotions associated with sleep.

Some of these types of cognitive-behavioral psychotherapy can be carried out independently or act as a homework» after a specialist session. And when working with other methods, you cannot do without the help and presence of a doctor.

Self-observation is considered a type of cognitive behavioral psychotherapy

Cognitive Behavioral Psychotherapy Techniques

Cognitive behavioral psychotherapy techniques can be varied. Here are the most commonly used ones:

• keeping a diary where the patient will write down his thoughts, emotions and situations preceding them, as well as everything exciting during the day;
• reframing, in which, by asking leading questions, the doctor helps to change positive side patient stereotypes;
• examples from literature when a doctor talks and gives specific examples literary characters and their actions in the current situation;
• the empirical path, when a specialist offers a person several ways to try certain solutions in life and leads him to positive thinking;
• a change of roles, when a person is invited to stand “on the other side of the barricades” and feel like the one with whom he has a conflict situation;
• evoked emotions, such as anger, fear, laughter;
• positive imagination and analysis of the consequences of a person’s choices.

Psychotherapy by Aaron Beck

Aaron Beck- American psychotherapist who examined and observed people suffering from neurotic depression, and concluded that depression and various neuroses develop in such people:

• having a negative view of everything that happens in the present, even if it can bring positive emotions;
• having a feeling of powerlessness to change something and hopelessness, when when imagining the future a person pictures only negative events;
• suffering from low self-esteem and decreased self-esteem.

Aaron Beck used the most different methods. All of them were aimed at identifying a specific problem both from the specialist and from the patient, and then a solution to these problems was sought without correcting the specific qualities of the person.

Aaron Beck - an outstanding American psychotherapist, creator of cognitive psychotherapy

In Beck's cognitive behavioral therapy for personality disorders and other problems, the patient and therapist collaborate in an experimental test of the patient's negative judgments and stereotypes, and the session itself is a series of questions and answers to them. Each of the questions is aimed at promoting the patient to understand and understand the problem, and find ways to solve it. Also, a person begins to understand where they are leading him destructive behavior and mental messages, together with a doctor or independently collects the necessary information and verifies it in practice. In a word, cognitive behavioral psychotherapy according to Aaron Beck is a training or structured training that allows you to detect negative thoughts in time, find all the pros and cons, and change your behavior pattern to one that will give positive results.

What happens during the session

The choice of a suitable specialist is of great importance in the results of therapy. The doctor must have a diploma and documents permitting his activity. Then a contract is concluded between the two parties, which specifies all the main points, including details of the sessions, their duration and quantity, conditions and time of meetings.

The therapy session must be conducted by a licensed professional

This document also prescribes the main goals of cognitive behavioral therapy and, if possible, the desired result. The course of therapy itself can be short-term (15 one-hour sessions) or longer (more than 40 one-hour sessions). After completing the diagnosis and getting to know the patient, the doctor draws up an individual plan for working with him and the timing of consultation meetings.

As you can see, the main task of a specialist in the cognitive-behavioral direction of psychotherapy is considered to be not only observing the patient and finding out the origins of the problem, but also explaining your opinion on the current situation to the person himself, helping him to understand and build new mental and behavioral stereotypes. To increase the effect of such psychotherapy and consolidate the result, the doctor can give the patient special exercises and “homework”, use various techniques, which can help the patient to further act and develop in a positive direction independently.