Behavioral therapy. Behavioral therapy methods

It was developed in the 60s of the 20th century by the American psychiatrist Aaron Beck. The main idea of this form therapeutic treatment is the belief that a person's thoughts, emotions and behavior mutually influence each other, creating patterns of behavior that are not always appropriate.

A person, under the influence of emotions, reinforces certain forms of behavior in certain situations. Sometimes copies the behavior of others. Reacts to various phenomena and situations in the way he is used to, often without realizing that he is harming others or himself.

Therapy is needed when behavior or beliefs are not objective and can create problems for normal life. Cognitive behavioral psychotherapy allows you to detect this distorted perception of reality and replace it with the right one.

Cognitive behavioral therapy – for whom

Cognitive behavioral therapy is best suited for treating anxiety and depression based disorders. This therapy is very effective and is therefore most often used in the treatment of patients with phobias, fears, epilepsy, neuroses, depression, bulimia, compulsive disorders, schizophrenia and post-traumatic stress.

Psychotherapy is the most commonly used treatment method mental disorders. May be the only form work on the patient’s psyche or supplement drug treatment. A feature of all types of psychotherapy is personal contact between the doctor and the patient. Various approaches are used in psychotherapy, in particular, psychoanalysis, humanistic-existential therapy, and cognitive behavioral approach. Cognitive behavioral therapy considered one of the most clinically studied forms of therapy. Its effectiveness has been proven by many studies, so doctors often use this proven method of psychotherapy.

Cognitive behavioral therapy course

Cognitive behavioral therapy focuses on current problems - the here and now. In treatment, most often, they do not turn to the past, although there are exceptional situations when this is inevitable.

Duration of therapy – about twenty sessions, once or twice a week. The session itself usually does not last more than one hour.

One of the most important elements successful treatment is the collaboration of the psychotherapist with the patient.

Thanks to cognitive behavioral therapy, it is possible to identify factors and situations that give the effect of distorted perception. In this process it is necessary to highlight:

stimulus, that is, a specific situation that causes the patient to act
specific way of thinking patient in specific situation
feelings and physical sensations, which are a consequence of specific thinking
behavior (actions), which essentially represent the patient.

IN cognitive behavioral therapy the doctor tries to find a connection between the patient's thoughts, emotions and actions. He must analyze complex situations and find thoughts that lead to an incorrect interpretation of reality. At the same time, it is necessary to instill in the patient the irrationality of his reactions and give hope for the possibility of changing the perception of the world.

Cognitive behavioral therapy - methods

This form of therapy uses many behavioral and cognitive techniques. One of them is the so-called Socratic dialogue. The name comes from the form of communication: the therapist asks questions to the patient. This is done in such a way that the patient himself discovers the source of his beliefs and tendencies in behavior.

The role of the doctor is to ask a question, listen to the patient and pay attention to the contradictions that arise in his statements, but in such a way that the patient himself comes to new conclusions and decisions. In the Socratic dialogue, the therapist uses a lot of useful methods, such as paradox, probing, etc. These elements, through appropriate use, effectively influence the change in the patient’s thinking.

In addition to Socratic dialogue, the doctor can use other methods of influence, for example, shifting attention or scattering. During therapy, the doctor also teaches methods to counteract stress. All this is in order to form in the patient the habit of adequately responding to the conditions of a stressful situation.

The result of cognitive behavioral therapy is not only a change in behavior, but also the patient's awareness of the consequences of introducing these changes. All this is so that he forms new habits and reactions.

The patient must be able to respond appropriately to negative thoughts, if such appear. The success of therapy lies in the development in a person of appropriate reactions to these stimuli, which previously led to incorrect interpretation.

Benefits of Cognitive Behavioral Therapy

Cognitive behavioral therapy is supported, first of all, by its high effectiveness, which has already been repeatedly confirmed by clinical studies.

The advantage of this type of treatment is the development of self-awareness of the patient, who after therapy achieves self-control over his behavior.

This potential remains in the patient even after the end of therapy, and allows him to prevent relapses of his disorder.

An additional benefit of therapy is the improvement of the patient's quality of life. He receives an incentive for activity and higher self-esteem.

The basis for behavioral therapy was experimentally based learning theory. Over time, the techniques and concepts of behavioral therapy have improved and now include a variety of practical methods treatments, the essence of which boils down to a logical but controversial theory.

One of the most serious conditions of this therapy is the objective re-verification of treatment results through experiments, which gives the right to include it in the natural science section of psychology, the distinctive feature of which is the application of general laws to a specific individual.

Mental disorders are modeled and tried to be eliminated in laboratory conditions, following a simple scheme: desire (Reiz) - reaction, and therefore behavioral therapy is very accessible and easy to study. So. for example, a phobia, according to behavioral therapy, is a pathological conditioned reaction that arose as a consequence of a threatening situation for a person. Fantasies, repressed desires and defense mechanisms are not taken into account. The cause of the disorder is sought not in childhood, but in the patient’s present. No weight is given to the possible symbolic meaning of the feared object; it is considered as a causative agent of fear, and everything else is considered the consequences of such arousal. The goal of behavioral therapy is to replace the patient’s inappropriate behavior with adequate behavior.

Unlike behavior therapy, psychoanalysis places great emphasis on unconscious mental processes. The subject of psychoanalysis is the person himself, therefore all therapeutic methods of psychoanalysis are based on a complex and sophisticated psychoanalytic theory of personality.

Despite major differences, behavior therapy and psychoanalysis have much in common. Both methods are intended for understanding complex mental phenomena, both are of no small importance for improving social relations, recognize the inevitability of errors that arise during the research process, and accept them as necessary condition rechecking the results obtained. It should, however, be recognized that the necessity of the latter condition was postulated in psychoanalysis only recently.

Many psychoanalysts, in particular Hans-Volker Wertmann, in his article published in the Journal psychosomatic medicine and psychoanalysis" (Zeitschrift fuer psychosomatische Medizin und Psychoanalyse) l . point to sharp contradictions between behavior therapy and psychoanalysis, but a growing number of scientists are trying to find ways to synthesize the two methods. A combination of these two approaches proposed by Reiner Krause 2 is very effective, for example. in the treatment of stuttering. Representatives of behavioral therapy are also not standing still. Psychologist Eva Jaeggi 3 in the context of cognitive therapy, developed on the basis of behavioral therapy, considers mental disorders not only as specific “thinking errors” (Denkfehler), but also as a consequence of irrational thoughts and internal contradictions that are not realized by patients.

To an even greater extent, E. Hand builds his conclusions on the similarities between behavioral therapy and psychoanalysis (E. Hand 1986). He conducts a sequential analysis of individual human needs, functions, motivations and behavioral disorders, distinguishing between conscious and so-called “unconscious” (“nicht-bewusste”) functions (see Rosenbaum & Merbaum), the significance of which becomes obvious in the course of therapy.

Thus Hand. avoiding the use of psychoanalytic terminology, in essence repeats a truth long known in psychoanalysis. However, adherents of behavioral therapy are in no hurry to admit this. “The hypothesis or, more precisely, the recognition of the existence of unconscious or unconscious (nichtgewusster) intentions by a person does not contain a transition to an analytical structure postulating the unconscious motivation of actions, but is only a practical means that allows the use of a speculative, abstract analysis of functions for therapeutic purposes” ( Hand 1986. p.289).

Paul Wachtel, on the contrary, is not afraid to acknowledge psychoanalytic “constructs,” as evidenced by his book “Psychoanalysis and Behavioral Therapy. A Speech in Defense of Their Integration" (Paul Wachtel 1981), in which he synthesizes the largely weak theory of the emergence of phobias from behavior therapy and psychoanalysis, introducing into behavior therapy the concept of the unconscious meaning of the feared object.

Nevertheless, psychoanalysts should take into account that behavioral therapy also pays off in practice, therefore, in the case when the detected disorders of the unconscious do not contribute to the cure of a patient suffering, for example, from stuttering, the psychoanalyst, without any doubt, should refer him to a psychologist practicing behavioral therapy . Such cooperation can only be welcomed.

1.2. Conversational psychotherapy

The basis for conversational psychotherapy, as in the case of behavioral therapy, was experimental psychology. In conversational psychotherapy, the description of clinical phenomena is practiced, and attention is paid to great attention monitoring the results of treatment and, first of all, identifying a specific goal of therapy. Revealing unconscious contents is not part of the therapist's plans. Great importance have three basic conditions (Basisvariablen), developed by Carl R. Rogers (Carl R. Rogers 1957):

1. Authentic, human response.

2. Kind attitude and understanding of the patient.

3. Verbalization of the patient's feelings.

In conversational psychotherapy, as in psychoanalysis, an essential factor is recognized personal experience therapist. According to conversational psychotherapy, in order to fully understand the hidden meaning of the patient's feelings, it is necessary to achieve the so-called “behavior modification” (“Verhaltensmodifikation”). Unlike behavioral therapy, directive treatment methods are not practiced here, since it is believed that the patient himself understands perfectly well what he needs and in what direction the therapeutic process should develop. The function assigned to the psychotherapist is, therefore, to accompany the patient on this path and verbalize, i.e. verbally designate his feelings.

In this regard, psychotherapeutic interventions in the patient’s monologue are of no small importance. The latter may be asked various leading questions, for example: “How do you feel at the moment?”, “Is something bothering you?”, “Do you feel abandoned by everyone?” At the same time, the therapist always trusts the patient’s answers. The revival of early relational patterns, the inevitability of which is emphasized in the psychoanalytic concept of transference, is avoided or its significance is completely denied. No attempt is made to penetrate into the unconscious meaning of behavior and thereby determine whether a person has one or another unconscious conflict. By adhering to such principles, the creators of conversational psychotherapy were able to get rid of the “bogeyman” * “sacred cow” of psychoanalysis - the concepts of resistance, repetition compulsion, transference and counter-transference. From a psychoanalytic point of view, 4 conversational psychotherapy, “which has at its disposal neither a theory of mental disorders nor a specific disease-oriented therapeutic technique,” appears to be only a psychological method of conversation.

However, Carl R. Rogers put forward in 1959 not only a personality theory of talk psychotherapy, but also a theory of the therapy itself. In his work, he talks, in particular, about the use for therapeutic purposes of contradictions between real and ideal images present in the patient’s psyche. Despite the fact that this statement can rightfully be called completely psychoanalytic, the creators of conversational psychotherapy tend to deny any resemblance to the inconvenient neighbor.

1.3. Other psychotherapeutic methods

From the extensive list of various psychotherapeutic methods currently used to treat mental disorders, the following should be noted:

* The above expression was first heard at the seminar “Psychoanalysis and Behavioral Therapy. Commonality and differences”, conducted jointly with K. Heinerth - in the winter semester 1976/77.

Transactions-Analysis, developed by Eric Berne (1974). According to Berne, there are three states of the human self: the child self, the adult self, and the parent self. Berne considers human conflicts as a kind of “game” (“Spiele”), the essential condition of which he considers the provocative behavior of one of the conflicting parties. A person’s behavior may thus have as its goal the motivation of another person to take certain actions. Berne notes, in particular, such provocations as “rush at me” or “kick me out,” etc. In transactive analysis, just as in psychoanalysis, typical patterns of relationships and behavior are taken into account, in addition, it contributes to the patient’s awareness of his own t n. “unconscious life plan” (unbewusster Lebensplan), i.e. i.e. a kind of unconscious “instruction” (Skript) that controls certain human actions. Thus, transactive analysis turns out to be an adapted analogue of psychoanalysis. The theory and methods of transactional analysis are described in detail by Leonhard Schlegel in the fifth volume of his “Fundamentals of Depth Psychology” (Leonhard Schlegel “Grundriss der Tiefenpsychologie” Band 5. 1979).

Image therapy (Gestalttherapy). According to the theory of imagery therapy, blocked internal reserves appear in the process of a person’s contact with hidden images, visions, etc. And if the phenomena of resistance (WiderstancJsphaenomene), as in psychoanalysis, are subject to interpretation, then interpretation of the unconscious content is not given (see. Hartmann-Kottek-Schroederl986).

Bioenergetics (Bio-Energetik) is a method of treating mental disorders based on the understanding of certain bodily symptoms. In his book covering the current state of bioenergy. Alexander Lowen (1979), following Wilhelin Reich, whose work devotes much of its attention, in particular, to the consideration of various physical manifestations of mental disorders, emphasizes the need for a thorough study of body language. The kinship of the above theory with psychoanalytic concepts, in particular with the character analysis (Charakteranalyse) of Wilhelm Reich (1933), is recognized and perceived by representatives of bioenergetics as a positive factor in many respects.

The so-called psychoanalysis has a lot in common with psychoanalysis. “primal cry therapy” (“Urschreitheraple”). better known as primary therapy (Primaertherapie, Arthur Janovs 1970).

The main tool of this therapy is regression, in which the patient plunges into unconscious areas of pain, fear, suffering, despair and anger, inaccessible to him under other circumstances due to existence defense mechanisms. Through this, the “primary pain” (“Urschmera”) is revealed. associated with dramatic experiences early childhood. Re-revival of unpleasant emotions or. in other words, "primrose" (Primein) allows the patient to openly express the suppressed "primary cry" ("Urschrei"). that is, without any embarrassment, cry, complain, get angry, etc. This in turn leads to the disappearance of the symptoms that bother him *.

In a certain sense, primary therapy is an undertaking even more daring than psychoanalysis itself. Long-term group sessions conducted in a darkened room as part of primary therapy make it possible to achieve deeper and longer-lasting regression and, in some sense, even more effective results than psychoanalytic sessions.

However, it must be emphasized once again that all of the above types of therapy are not entirely satisfactory: behavioral therapy misses the unconscious meaning of human behavior, the problem of transference and counter-transference; conversational psychotherapy, taking into account the possibility of transference reactions, nevertheless perceives them as something harmful; and only within the framework of transactive analysis, focused primarily on bioenergetics, and to an even greater extent in primary therapy, is the psychoanalytic concept recognized, according to which mental disorders are the consequence of dramatic experiences in a person’s early relationships and cannot be overcome without their re-vitalization. The last statement essentially contains the definition of the most important psychoanalytic principle.

* As for the commonality between psychoanalysis and primary therapy, proof of this can be found, in particular, in the example of psychologist and psychoanalyst Albert Goerres. who practiced primary therapy along with psychoanalysis at the Munich University Clinic.

2. Conditions necessary for the successful application of psychoanalytic methods

2.1. From the psychoanalyst's perspective

The most important factor in the successful application of the psychoanalytic method, along with external conditions therapy, the personality of the psychoanalyst himself is presented. Unfortunately, this fact is rather sparingly covered in the literature on psychoanalysis. The lack of this kind of information has been somewhat compensated for by a recently published collection, which includes works on this topic written by famous psychoanalysts (Kutter et al., 1988). The main idea of this collection can be formulated as follows: the psychoanalyst must perceive himself as important subjective factor therapy and strive for self-knowledge. It is in this regard that educational analysis becomes an integral part of psychoanalytic education. The latter provides the novice therapist with the opportunity to study himself, understand his own conflicts and thus achieve a fairly high level of self-knowledge. At the same time, there are serious reasons to believe that high level knowledge of one’s own personality guarantees a more successful understanding of other people, that is, in our case, patients.

The above applies equally to psychoanalysts who have received psychological education and to those. who graduated from medical school.

The analyst’s self-knowledge is also facilitated by group-dynamic workshops. The group atmosphere allows future specialists to get a clear picture of their own behavior. Participant

* Previously there was an opinion that medical education, which implies instilling a sense of responsibility for the patient’s life, is the best guarantor of truly psychoanalytic behavior, but ten years of teaching at the University of Frankfurt convinced me personally that purely psychological education has its undeniable advantages. Psychology is, simply put, the science of human experiences. Therefore, students studying psychology deal primarily with this issue, which is, in a sense, the key to self-knowledge. Of course, one cannot fail to mention in the context of psychology the danger of turning a person into an abstract object of statistical or any other study. Modern medicine has proven the reality of such a threat. Concentrating their attention on pathology and chemical drugs, doctors seem to have completely forgotten about the human person.

Participants in the group dynamic workshop openly express their opinions about their colleagues, opening their eyes to aspects of their personality that are unknown to them. In this case, the criterion for the objectivity of the expressed opinion can be its support by the majority of the workshop participants. Maximum information 6 of your own positive and negative qualities The insight provided by such sessions makes it easier for the future psychoanalyst to understand the patient's reaction, which in many respects is nothing more than a reaction to the analyst's behavior. It, in turn, must comply with the main rule of psychoanalytic therapy - “restraint” (Abstinenz). The psychoanalyst needs to learn to control his feelings towards the patient.

2.2. From the patient's side

Ideal patient not only complains about certain symptoms, but also associates them with specific mental experiences, therefore, he is ready to actively participate in the analysis process. On the success of the collaboration between the analyst and the patient or, in other words, on the degree of participation of the latter in the so-called “therapeutic alliance” (Arbeitsbuendnis), which implies a non-voicism. the rational and reasonable attitude of the analysand towards the analyst largely depends on the effectiveness of the therapy itself (Greenson 1967). Cooperation is understood, first of all, as the patient’s willingness to freely associate, that is, to talk about everything. whatever comes to his mind, regardless of feelings of shame, embarrassment, fear or guilt. Such frankness implies a high degree of trust, which cannot arise immediately at the beginning of analysis, but is built up gradually.

A short example will give the reader an idea. How does a psychoanalyst determine whether a patient is ready to cooperate?

Analyst. I'm trying to understand you. I would really like to collaborate with you. This would help us better understand the cause of your suffering.

Patient. But why then don’t you help me?

Analyst. I’m already helping you, I just don’t make any hasty conclusions. I'm not interested in the symptoms at all, I'm interested in the mental problems that the symptoms cause. Why don't you become interested in this too?

Patient. Fine. But I doubt whether I can help you. It seems to me that the reasons are unknown to me.

Analyst. I am ready to help you understand them. The main thing is our joint work, and it will become possible under one condition. You need to tell me everything you feel. So, what do you think your suffering may be related to?

Patient. Most likely with my married life.

Analyst. This is quite likely. We will look into this issue. However, something else is more important: you yourself understand that you are unhappy in your marriage, which means that it will be easier to understand the causes of unhappiness.

Psychotherapy. Study guide Team of authors

General characteristics behavioral therapy

Behavioral therapy is characterized by two main provisions that distinguish it from other therapeutic approaches (G. Terence, G. Wilson, 1989). First, behavioral therapy is based on a learning model—a psychological model that is fundamentally different from the psychodynamic model of mental illness. Second point: commitment to the scientific method. From these two main provisions the following follow:

1. Many cases of pathological behavior, which were previously considered as diseases or as symptoms of disease from the point of view of behavior therapy, represent non-pathological “life problems”. Such problems include, first of all, anxiety reactions, sexual deviations, and behavioral disorders.

2. Pathological behavior is largely acquired and is maintained in the same ways as normal behavior. It can be treated using behavioral treatments.

3. Behavioral diagnosis focuses more on the determinants of present behavior than on past life analysis. The hallmark of behavioral diagnosis is its specificity: a person can be better understood, described and assessed by what he does in a particular situation.

4. Treatment requires a preliminary analysis of the problem, identifying its individual components. These specific components are then subjected to systematic behavioral treatments.

5. Treatment strategies are developed individually various problems in different individuals.

6. Understanding the origin of a psychological problem (psychogenesis) is not essential for the implementation of behavioral changes; success in changing problem behavior does not imply knowledge of its etiology.

7. Behavioral therapy is based on a scientific approach. This means, firstly, that it starts from a clear conceptual basis that can be tested experimentally; secondly, the therapy is consistent with the content and method of experimental clinical psychology; third, the techniques used can be described with sufficient precision to allow them to be measured objectively or to be repeated; fourth, therapeutic methods and concepts can be evaluated experimentally.

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Behavioral psychotherapy

Behavioral psychotherapy is based on techniques for changing pathogenic reactions (fear, anger, stuttering, enuresis, etc.). It is important to remember that behavioral psychotherapy is based on the “aspirin metaphor”: if a person has a headache, then it is enough to give aspirin, which will relieve the headache. This means that you don’t need to look for the cause of the headache - you need to find remedies that eliminate it. Obviously, the cause of the headache is not a lack of aspirin, but, nevertheless, its use is often sufficient. Let us describe specific methods and the sanogenic mechanisms inherent in them.

At the core method of systematic desensitization lies the idea that pathogenic reactions (fear, anxiety, anger, panic disorders, etc.) are a maladaptive response to some external situation. Let's say a child is bitten by a dog. He was afraid of her. Subsequently, this adaptive reaction, which forces the child to be careful around dogs, is generalized and extends to all types of situations and to all types of dogs. A child begins to be afraid of a dog on TV, a dog in a drawing, a dog in a dream, a small dog that has never bitten anyone and sits in the arms of its owner. As a result of such generalization, the adaptive response becomes maladaptive. The goal of this method is to desensitize a dangerous object - the child should become insensitive and resistant to stressful objects, in this case, dogs. Becoming desensitized means not reacting with fear.

The mechanism for eliminating maladaptive reactions is the mechanism of mutual exclusion of emotions, or the principle of reciprocity of emotions. If a person experiences joy, then he is closed to fear; if a person is relaxed, then he is also not susceptible to fear reactions. Therefore, if a person is “immersed” in a state of relaxation or joy, and then shown stressful stimuli (in this example, different types of dogs), then the person will not have fear reactions. It is clear that stimuli that have a low stress load should initially be presented. The stressogenicity of the stimuli should increase gradually (from a drawing of a small dog with a pink bow named Pupsik to a large black dog named Rex). The client must progressively desensitize stimuli, starting with weak ones and gradually moving to increasingly stronger ones. Therefore, a hierarchy of traumatic stimuli should be constructed. The step size in this hierarchy should be small. For example, if a woman has an aversion to male genitals, then the hierarchy can start with a photograph of a naked 3-year-old child. If immediately after this you present a photograph of a naked teenager of 14–15 years old, then the step will be very large. In this case, the client will not be able to desensitize male genitals upon presentation of the second photograph. Therefore, the hierarchy of stressful stimuli should include 15–20 objects.

It is equally important to organize incentives correctly. For example, a child has a fear of exams. You can build a hierarchy of teachers from less “scary” to more “scary” and consistently desensitize them, or you can build a hierarchy of traumatic stimuli based on the principle of temporary proximity to exams: woke up, washed, did exercises, had breakfast, packed my briefcase, got dressed, went to school, came to school, went to the classroom door, entered the classroom, took a ticket. The first organization of stimuli is useful in the case when the child is afraid of the teacher, and the second - in the case when the child is afraid of the exam situation itself, while treating teachers well and not being afraid of them.

If a person is afraid of heights, then he should find out in what specific situations in his life he encounters heights. For example, these could be situations on the balcony, on a chair while screwing in a light bulb, in the mountains, on cable car etc. The client’s task is to remember as many situations as possible in his life in which he has encountered and is faced with a fear of heights, and arrange them in order of increasing fear. One of our patients first experienced respiratory discomfort, and then increasingly increasing sensations of suffocation when leaving the house. Moreover, the further the client moved from the house, the more this discomfort was expressed. Beyond a certain point (for her it was a bakery) she could only walk accompanied by someone and with constant feeling suffocation. The hierarchy of stressful stimuli in this case was based on the principle of distance from home.

A universal resource that allows you to cope with many problems is relaxation. If a person is relaxed, then it is much easier for him to cope with many situations, for example, approaching a dog, moving away from the house, going out onto the balcony, taking an exam, getting closer to a sexual partner, etc. In order to put a person into a state of relaxation, used progressive muscle relaxation technique according to E. Jacobson.

The technique is based on a well-known physiological pattern, namely that emotional stress is accompanied by tension in the striated muscles, and calm is accompanied by their relaxation. Jacobson suggested that muscle relaxation entails a decrease in neurological muscle tension.

In addition, while recording objective signs of emotions, Jacobson noticed that different types of emotional responses correspond to the tension of a certain muscle group. Thus, a depressive state is accompanied by tension in the respiratory muscles, fear – by a spasm of the muscles of articulation and phonation, etc. Accordingly, removing, through differentiated relaxation, the tension of a particular muscle group can selectively influence negative emotions.

Jacobson believed that each region of the brain is connected to the peripheral neuromuscular apparatus, forming the cerebroneuromuscular circle. Voluntary relaxation allows you to influence not only the peripheral, but also the central part this circle.

Progressive muscle relaxation begins with a conversation, during which the therapist explains the mechanisms to the client therapeutic effects muscle relaxation, emphasizing that the main goal of the method is to achieve voluntary relaxation of striated muscles at rest. Conventionally, there are three stages in mastering the progressive muscle relaxation technique.

First stage (preparatory). The client lies on his back, bends his arms at the elbow joints and sharply tenses the arm muscles, thereby causing a clear sensation of muscle tension. Then the arms relax and fall freely. This is repeated several times. At the same time, attention is fixed on the sensation of muscle tension and relaxation.

The next exercise is contraction and relaxation of the biceps. Muscle contraction and tension should first be as strong as possible, and then weaker and weaker (and vice versa). During this exercise, you need to fix your attention on the feeling of the slightest muscle tension and their complete relaxation. After this, the client practices the ability to tense and relax the flexor and extensor muscles of the torso, neck, shoulder girdle, and finally the muscles of the face, eyes, tongue, larynx and muscles involved in facial expressions and speech.

The second stage (actually differentiated relaxation). The client in a sitting position learns to tense and relax muscles that are not involved in supporting the body in vertical position; further - relax the muscles that are not involved in these acts when writing, reading, speaking.

Third stage (final). The client, through self-observation, is asked to establish which muscle groups tense during various negative emotions (fear, anxiety, excitement, embarrassment) or painful conditions(for pain in the heart area, increased blood pressure, etc.). Then, through relaxation of local muscle groups, you can learn to prevent or stop negative emotions or painful manifestations.

Progressive muscle relaxation exercises are usually learned in a group of 8–12 people under the guidance of an experienced psychotherapist. Group classes take place 2-3 times a week. In addition, clients conduct self-training sessions on their own 1-2 times a day. Each session lasts from 30 minutes (individual) to 60 minutes (group). The entire training course takes from 3 to 6 months.

After the technique of progressive muscle relaxation has been mastered and a new reaction has arisen in the client’s behavioral repertoire - the differentiated relaxation reaction, desensitization can begin. There are two types of desensitization: imaginal (in the imagination, in vitro) and real (in vivo).

During imaginal desensitization, the therapist is located next to the sitting (lying) client. The first step is for the client to enter a state of relaxation.

The second step is that the therapist asks the client to imagine the first object from the hierarchy of psychogenic stimuli (a small dog, the genitals of a 3-year-old child, going outside, etc.). The patient's task is to go through the imaginary situation without tension or fear.

The third step is that as soon as any signs of fear or tension arise, the patient is asked to open his eyes, relax again and enter the same situation again. The transition to the next stressful object occurs if and only if desensitization of the first object in the hierarchy is completed. In some cases, the patient is asked to inform the therapist about the occurrence of anxiety and tension index finger right or left hand.

In this way, all objects of the identified hierarchy are consistently desensitized. When in the imagination the patient is able to go through all the objects, i.e., leave the house, walk to the bakery and go further, climb onto a chair, calmly look at the male genitals, desensitization is considered complete. The session lasts no more than 40–45 minutes. Typically, 10–20 sessions are required to desensitize fear.

Relaxation is not the only resource that allows you to cope with a stressful object. Moreover, in some cases it is contraindicated. For example, one 15-year-old girl, a fencing athlete, developed a syndrome of anxious anticipation of losing after two defeats in a row. In her imagination, she constantly played out frightening situations of defeat. In this case, relaxation, which immerses her in a losing situation, could make the patient calmer, but would not help her win. In this case, the resource experience can be confidence.

Concept resource experience or state used in neurolinguistic programming (NLP) and is not specific to behavioral or any other psychotherapy. At the same time, behavioral psychotherapy is associated with the possibility of using a positive (resource) state to change the reaction to a traumatic stimulus. In the above case, confidence can be found in the athlete's past - in her victories. These victories were accompanied by a certain psycho-emotional uplift, confidence and special sensations in the body. The most important thing in this case is to help the client restore these forgotten sensations and experiences, on the one hand, and to be able to quickly access them, on the other. The client was asked to tell in detail about her most important victory recent years. Initially, she talked about this in a very detached manner: she talked about external facts, but did not report anything about her experiences of joy and the corresponding sensations in her body. This means that positive experiences and positive feelings are dissociated and there is no direct access to them. In the process of remembering her own victory, the client was asked to remember as many details as possible related to external events: how she was dressed, how she was congratulated on her victory, what the coach’s reaction was, etc. After this, it became possible to “go into” internal experiences and sensations in the body - straight back, elastic, springy legs, light shoulders, easy, free breathing, etc. Desensitization of traumatic situations - defeats - consisted in the fact that the client was consistently immersed in the memory of each of these situations, while being in positive experiences and bodily sensations. After the memories of the situations of defeat ceased to traumatize her and did not find a response in the body (tension, anxiety, feelings of powerlessness, difficulty breathing, etc.), it could be stated that past traumas ceased to have a negative impact on the present and future.

The next step in psychotherapy was the desensitization of the traumatic image of a future defeat, which had developed under the influence of past defeats. Due to the fact that these past defeats no longer support the negative image of the future (expectation of defeat), its desensitization became possible. The client was asked to imagine her future opponent (and she knew her and had experience fighting with her), the strategy and tactics of her performance. The client imagined all this while in a positive state of confidence.

In some cases, it is quite difficult to teach a client relaxation, since he may refuse any independent work necessary to master this technique. Therefore, we use a modified desensitization technique: the patient sits in a chair or lies on a couch, and the therapist gives him a “massage” of the collar area. The purpose of such a massage is to relax the client and ensure that he rests his head in the therapist’s hands. Once this happens, the therapist asks the client to talk about the traumatic situation. At the slightest sign of tension, the client is distracted by asking him extraneous questions that lead him away from traumatic memories. The client must relax again, and then he is again asked to talk about the trauma (bad sexual experience, fears about upcoming sexual contact, fear of entering the subway, etc.). The therapist's task is to help the client talk about trauma without leaving a relaxed state. If the client is able to talk repeatedly about the trauma while remaining calm, then the traumatic situation can be considered desensitized.

Children use the emotion of joy as a positive experience. For example, to desensitize darkness in case of fear of it (being in dark room, go through a dark corridor, etc.) the child is offered to play blind man's buff in the company of friends. The first step of psychotherapy is that children are asked to play blind man's buff in a lighted room. As soon as a child suffering from a fear of the dark gets carried away with the game, feels joy and emotional upsurge, the illumination of the room begins to gradually decrease until the child plays in the dark, rejoicing and completely not noticing that it is dark around. This is an option gaming desensitization. Famous child psychotherapist A.I. Zakharov (Zakharov, p. 216) describes play desensitization in a child who was afraid of loud sounds from neighboring apartments. The first stage is the actualization of the situation of fear. The child was left alone in a closed room, and his father knocked on the door with a toy hammer, at the same time frightening his son with cries of “Uh-uh!”, “Ah-ah!”. On the one hand, the child was scared, but on the other hand, he understood that his father was playing around with him and playing with him. The child was overwhelmed mixed feelings joy and alertness. Then the father opened the door, ran into the room and began to “beat” his son on the butt with a hammer. The child ran away, again experiencing both joy and fear. At the second stage, roles were exchanged. The father was in the room, and the child “scared” him by knocking on the door with a hammer and making menacing sounds. Then the child ran into the room and chased his father, who, in turn, was demonstratively frightened and tried to dodge the blows of the toy hammer. At this stage, the child identified himself with the force - knocking and at the same time saw that its impact on the father only caused a smile and was an option fun game. At the third stage, a new form of reaction to knocking was consolidated. The child, as in the first stage, was in the room, and the father “scared” him, but now this only caused laughter and a smile.

There is also picture desensitization fears, which, according to A.I. Zakharov, is effective for children aged 6–9 years. The child is asked to draw a traumatic object that causes fear - a dog, fire, a subway turnstile, etc. Initially, the child draws a big fire, a huge black dog, large black turnstiles, but the child himself is not in the picture. Desensitization consists of reducing the size of the fire or the dog, changing their ominous color, so that the child can draw himself on the edge of the sheet. By manipulating the size of the traumatic object, its color (a big black dog is one thing, a white dog with a blue bow is another), the distance in the drawing between the child and the traumatic object, the size of the child himself in the drawing, the presence of additional figures in the drawing (for example, a mother), names of objects (the dog Rex is always more feared than the dog Pupsik), etc., the psychotherapist helps the child cope with the traumatic object, master it (in a normal situation we always control fire, but a child who has survived a fire feels uncontrollable, fatality of fire) and thereby desensitize.

There are various modifications of the desensitization technique. For example, NLP offers techniques of overlay and “swinging” (described below), a technique of viewing a traumatic situation from end to beginning (when the habitual obsessive cycle of memories is disrupted), etc. Desensitization as a direction of psychotherapeutic work is present in one form or another in many techniques and approaches of psychotherapy. In some cases, such desensitization becomes independent equipment, for example, F. Shapiro's eye movement desensitization technique.

One of the most common methods of behavioral psychotherapy is flood technique. The essence of the technique is that long-term exposure to a traumatic object leads to extreme inhibition, which is accompanied by a loss of psychological sensitivity to the effects of the object. The patient, together with the therapist, finds himself in a traumatic situation that causes fear (for example, on a bridge, on a mountain, in a closed room, etc.). The patient is in this situation of being “flooded” with fear until the fear begins to subside. This usually takes an hour to an hour and a half. The patient should not fall asleep, think about strangers, etc. He should be completely immersed in fear. The number of flood sessions can vary from 3 to 10. In some cases, this technique is also used in group form.

There is also a flood technique in story form called implosion. The therapist composes a story that reflects the patient's main fears. For example, one client, after breast removal surgery, developed a fear of returning cancer, and in connection with this - the fear of death. A woman had obsessive thoughts about developing cancer symptoms. This individual mythology reflected her naive knowledge of the disease and its manifestations. The story must use this individual mythology of cancer because it is what creates fear. During the story, the patient may experience dying, cry, or shake. In this case, it is important to take into account the patient's adaptive capabilities. If the trauma presented in the story exceeds the patient’s ability to cope, then he may develop quite deep mental disorders that require urgent therapeutic measures. It is for this reason that flooding and implosion techniques are used extremely rarely in domestic psychotherapy.

Technique aversions is another option for behavioral psychotherapy. The essence of the technique is to punish a maladaptive reaction or “bad” behavior. For example, in case of pedophilia, a man is asked to watch a video that shows objects of desire. In this case, electrodes are applied to the patient's penis. When an erection occurs due to watching a video, the patient receives a weak electric shock. With several repetitions, the connection between the object of desire and the erection is disrupted. Demonstration of the object of attraction begins to cause fear and expectation of punishment.

When treating enuresis, electrodes of a special device are applied to the child so that when urinating during night sleep, a circuit is closed and the child receives an electric shock. When using such a device for several nights, enuresis disappears. As noted in the literature, the effectiveness of the technique can reach up to 70%. This technique is also used in the treatment of alcoholism. A group of alcoholics is given vodka with an emetic added to it to drink. The combination of vodka and an emetic is supposed to lead to aversion towards alcohol. However, this technique has not proven its effectiveness and is currently practically not used. However, there is a domestic option for treating alcoholism using the aversion technique. This is the well-known method of A.R. Dovzhenko, which is a variant of emotional stress psychotherapy, when the patient is intimidated by all sorts of dire consequences for continued alcohol abuse and, against this background, a sober lifestyle program is offered. Using the aversion technique, stuttering, sexual perversions, etc. are also treated.

Techniques for developing communication skills considered one of the most effective. Many human problems are determined not by some deep, hidden reasons, but by a lack of communication skills. In the technique of teaching structural psychotherapy by A.P. Goldstein, it is assumed that mastering specific communication skills in a particular area (family, professional, etc.) allows one to solve many problems. The technique consists of several stages. At the first stage, a group of people interested in solving a communication problem gathers (for example, people who have problems in their marital relationships). Group members fill out a special questionnaire, based on which specific communication deficits are identified. These deficits are considered as the lack of certain communication skills, for example, the skill of giving compliments, the skill of saying “no,” the skill of expressing love, etc. Each skill is broken down into components, thus forming a certain structure.

In the second stage, group members are encouraged to identify the benefits they will receive if they learn the relevant skills. This is the motivation stage. As group members begin to understand the benefits they will receive, their learning becomes more focused. At the third stage, group members are shown a model of a successful skill using a video recording or a specially trained person (for example, an actor) who fully possesses this skill. At the fourth stage, one of the trainees tries to repeat the demonstrated skill with one of the group members. Each approach should take no more than 1 minute, since otherwise the rest of the group members begin to get bored, and a positive attitude is necessary for work. The next stage is the feedback stage. Feedback must have the following qualities:

1) be of a specific nature: you cannot say “it was good, I liked it”, but should say, for example, “you had a good smile”, “you had a great tone of voice”, “when you said “no”, you didn’t he left, but, on the contrary, touched his partner and showed his affection,” etc.;

2) be positive. The positive should be celebrated rather than focusing on what was bad or wrong.

Feedback is given in the following order: group members–co-actors–coach. At the sixth stage, trainees receive homework. They must real conditions demonstrate the appropriate skill and write a report about it. If the trainees have completed all stages and consolidated the skill in real behavior, then the skill is considered mastered. In a group, no more than 4–5 skills are mastered. The good thing about this technique is that it does not focus on unclear and incomprehensible changes, but is aimed at mastering specific skills. The effectiveness of a technique is measured not by what the trainees liked or disliked, but by the specific result. Unfortunately, in the current practice of psychological groups, effectiveness is often determined not by the real result, but by those pleasant experiences that to a large extent are caused not by the depth of change, but by security and surrogate satisfaction of infantile needs (found support, praise - received positive feelings that may not be oriented towards real changes).

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Today, correction of any psychological problems is carried out using a variety of techniques. 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. The behavior then creates a 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. The skill of changing one’s negative behavior and thinking stereotype becomes available to a person, which has a positive effect on emotional condition, and to the physical.

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 therapy 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 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, which 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:

A person's awareness of the problem.
Formation of an alternative pattern of actions and actions.
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 is their coordinated work that will allow us to 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 only important to remember that cognitive behavioral therapy has a 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 severe mental illnesses, for example, schizophrenia, this technique is not used.

Types of therapy

Methods of cognitive behavioral psychotherapy depend on the specific situation and problem of the patient and pursue a specific goal. 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:

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.
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.
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.
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.
“Stop tap” technique and anxiety control. At the same time, the person himself says “Stop” to his negative thoughts and actions.
Relaxation. This technique is often used in combination with others to completely relax the patient, create a trusting relationship with a specialist, and more productive work.
Self-instructions. This technique consists in creating a series of tasks for oneself and independently solving them in a positive way.
Introspection. At the same time, a diary can be kept, which will help in tracking the source of the problem and negative emotions.
Research and analysis threatening consequences. A person with negative thoughts changes them to positive ones, based on the expected results of the development of the situation.
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.
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 therapy can be done independently or as homework after a session with a specialist. 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 change the patient’s stereotypes in a positive direction;
examples from literature, when the doctor talks and gives specific examples of 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 experimental testing 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. A person also begins to understand where his destructive behavior and mental messages are leading, together with a doctor or independently collecting the necessary information and testing 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 monitoring 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 that can help the patient further act and develop in a positive direction independently.