Basic principles and techniques of cognitive psychotherapy.

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Cognitive-behavioral (or cognitive-behavioral) therapy is a method whose goal is to reduce unpleasant experiences and unwanted behavior by modifying thinking.

Initially, this method was developed to treat depression, then it began to be used to treat anxiety disorders, panic attacks, and OCD in adults. In recent years, the method has been successfully used to help children and adolescents suffering from these diseases or facing life difficulties.

CBT is based on the following principle: a person’s emotions, behavior, and bodily sensations do not arise on their own and are not a direct consequence of the situations that he encounters; At the heart of everything are certain beliefs, interpretations, rules, assessments that a person is guided by in certain situations.

History of therapy

Cognitive behavioral therapy (CBT), also called cognitive behavioral therapy, originated in the 50s and 60s of the twentieth century. The founders of cognitive behavioral therapy are A. Back, A. Ellis and D. Kelly. Scientists studied a person’s perception of various situations, his mental activity and further behavior. This was the innovation - the merging of the principles and methods of cognitive psychology with behaviorist ones. Behaviorism is a branch of psychology that specializes in the study of human and animal behavior. However, the discovery of CBT did not mean that similar methods were never used in psychology. Some psychotherapists used the cognitive abilities of their patients, thus diluting and supplementing behavioral psychotherapy.

It is no coincidence that the cognitive-behavioral direction in psychotherapy began to develop in the United States. At that time, behavioral psychotherapy was popular in the United States - a positive concept that believes that a person can create himself, while in Europe, on the contrary, psychoanalysis, which was pessimistic in this regard, dominated. The direction of cognitive behavioral psychotherapy was based on the fact that a person chooses behavior based on his own ideas about reality. A person perceives himself and other people based on his own type of thinking, which, in turn, is obtained through learning. Thus, the incorrect, pessimistic, negative thinking that a person has learned carries with it incorrect and negative ideas about reality, which leads to inappropriate and destructive behavior.

CBT sessions for children

Because To work in this approach, you need to be able to substantively reflect on specific situations and monitor your own thoughts and actions. CBT is most effective in helping children aged 9 years and older.

To simplify abstract concepts, the therapist uses various pictures and visual materials, dolls, games, and a lot of space is given to the child’s imagination. Of course, to consolidate the results and systematically use the acquired skills, the involvement of parents in the process of helping the child is incredibly important.

The session lasts 50 minutes, during which, together with the therapist, the child or adolescent (depending on his age) discuss specific problem situations that he has encountered, jointly analyze feelings, thoughts and behavior in these situations, perform various exercises, master certain behavioral or thinking skills and be sure to develop an action plan for the coming week to begin practicing the acquired skills.

Therapy model

What is cognitive behavioral therapy and what does it involve? The basis of cognitive behavioral therapy are elements of cognitive and behavioral therapy aimed at correcting a person’s actions, thoughts and emotions in problematic situations. It can be expressed in the form of a unique formula: situation – thoughts – emotions – actions. In order to understand the current situation and understand your own actions, you need to find answers to the questions - what did you think and feel when this happened. After all, in the end it turns out that the reaction is determined not so much by the current situation as by your own thoughts on this matter, from which your opinion is formed. It is these thoughts, sometimes even unconscious ones, that lead to the appearance of problems - fears, anxieties and other painful sensations. It is in them that the key to solving many people's problems lies.

The main task of the psychotherapist is to identify erroneous, inadequate and inapplicable thinking that needs to be corrected or completely changed, instilling in the patient acceptable thoughts and patterns of behavior. For this, therapy is carried out in three stages:

• logical analysis;
• empirical analysis;
• pragmatic analysis.

At the first stage, the psychotherapist helps the patient analyze emerging thoughts and feelings, finds errors that need to be corrected or removed. The second stage is characterized by teaching the patient to accept the most objective model of reality and compare the perceived information with reality. At the third stage, the patient is offered new, adequate life attitudes, based on which he must learn to respond to events.

Behaviorism and cognitive psychology

The terminology of cognitive behavioral therapy is based on the conceptual apparatus of those areas of psychology that lie at its origins - behaviorism and cognitive psychology.

Initially, behaviorism was understood as the science of behavior, which studied only those of its obvious acts that can be observed and studied objectively (Watson J., 1913). Watson derived his concept of psychology from the philosophical traditions of objectivism, mechanism, zoopsychology and functional psychology (Schultz D., Schultz S., 1965).

In historical development, radical biobehaviorism was replaced by neobehaviorism , the main representatives of which are considered to be Tolman, Guthrie, Hull and Skinner. Since, from their point of view, most acts of behavior can be explained by the laws of conditioned reflexes, the main goal of psychology was the study of learning processes. These processes were to be studied guided by the principle of operationism , according to which any concept could be described in precise terms relating to the set of procedures or operations underlying it.

Proponents of behaviorism believed that the individual’s psyche is a collection of complex but individual reactions, and the main reason for its formation is the influence of environmental factors. Changes in the stimulus-response chains cause changes in human behavior, and this behavior can be assessed and explained only by considering the objective relationship between stimulus and response. In other words, human behavior is reactive and is controlled by external stimuli.

At the first stage of the development of behaviorism, its main theoretical basis was the theory of conditioned reflexes by I.P. Pavlov, according to which the formation of conditioned reflexes occurs in the presence of contiguity, coincidence in time of indifferent and unconditioned stimuli and repetition. Extinction of conditioned reactions , in turn, occurs in the absence of their reinforcement by an unconditioned stimulus. Reinforcement schemes with a variable time interval, in which reinforcement was given randomly, and also with a variable ratio, where the magnitude of the unconditioned stimulus - the reinforcing stimulus - changed in an unpredictable way, were considered to be the most resistant to the extinction process.

At the second stage of the development of behaviorism, the main role began to be played by the theory of instrumental or operant conditioning , according to which the formation of conditioned reactions occurs through trial and error, being the result of choice, selection of the desired stereotype of behavior with its subsequent consolidation, subject to certain laws.

At the third stage of the development of behaviorism, there was a rapprochement with the rapidly developing cognitive psychology and the emergence of A. Bandura’s theory of social learning.

“behavior” narrowly understood by behaviorists as an external manifestation of the “stimulus-response” chain. Activities, formally divided into external and internal, have a “common structure”, and the internal, as it were, fills the external (Kurpatov A.V., 1999). Discussing the topic of activity, Vygotsky noted that consciousness is a reflex of reflexes; it turns out to be a very complex structure of behavior, in particular the doubling of behavior.

Biobehaviorists have focused on learning processes and physiological mechanisms associated with conditioning and reflexes. Behaviorists argued that skills can be acquired, directly or indirectly, through learning, the main mechanism by which individual experience is formed. In this context, skills were considered as actions that, as a result of repetition, acquired an automatic nature; the physiological mechanism of skills was considered the so-called. dynamic stereotype .

An important concept in behaviorism is the concept of “conditioning,” which denotes the process of the emergence of new conditions as a result of planned or spontaneous learning, for example, the emergence of a new “stimulus-response” connection or a “reaction-expectation” connection. There are different types of conditioning:

• classic,
• operant,
• hidden,
• hidden non-directive, etc.

The basic principles of classical conditioning were developed by Pavlov based on his experiments on the formation of conditioned reflexes in animals. Conditioned reflexes mean those reflexes that are conditioned or depend on the conditions for the formation of an associative connection between a stimulus and a response. Conditioned reflexes are formed on the basis of reinforcement. Positive reinforcement or rewarding is the use of stimuli that reinforce the outcome of a desired response. Negative reinforcement , in turn, is understood as the process of strengthening desired behavior through the withdrawal and removal of negative stimuli (pain, heat, cold, etc.).

According to the theory of stimulus generalization, the same type of behavior can be detected in various situations and not only in those in which it was formed. If a conditioned reaction has already been formed, then due to the phenomenon of generalization , it can already be caused by stimuli that are similar to those stimuli that participated in the process of formation of this conditioned reaction. In this case we are talking about the so-called . stimulus equivalence (Devany J., Hayes S., Nelson R., 1986), in which a network of two-way relationships between stimuli is easily formed, and the relationships between stimuli, in turn, move in this network. So, in particular, when describing this or that event in words, the patient begins to react not to the real situation, but only to its similarity.

In operant conditioning, reinforcement is given based on the outcome of a response.

Latent conditioning is built on the principles of operant conditioning. It is distinguished by the purposeful formation of behavior, for example, training of emotional reactions in response to a proposed situation. Latent conditioning, as a rule, is non-directive and refers to the process of learning at the hidden psychological (thoughts, images and feelings) and physiological level (activity of internal organs) (Cautela J., Kearney A., 1986). Based on latent conditioning, behavioral therapy techniques such as sensitization, reinforcement, isolation, negative reinforcement and modeling have been created.

Currently, the following training options :

• classical learning , developed on the basis of a series of repeated combinations of any unconditioned reflexes with conditioned stimuli (Pavlov I.P., 1897);
• operant conditioning (instrumental) learning, in which an emerging reaction causes an event that becomes a reinforcing stimulus for this reaction (Skinner B., 1945).
• vicarious learning , which is the consolidation of a response to a specific stimulus associated with the observable consequences of the behavior of a person or model (vicarious learning may fall under the general category of instrumental reactions); there is a type of learning based on observation of the model - vicarious assimilation of classically conditioned emotional reactions; this learning appears when the observer not only experiences emotional reactions similar to the reactions of the model, but also reacts emotionally to the stimuli that provoked these reactions (Bandura A., 1969). Learning by imitation is used in behavior therapy - the patient observes the behavior of other people or independently models the performance of a certain role in a problem situation (observation of a model), the correct implementation of this technique is ensured by: choosing a model situation similar or similar in parameters, choosing a person to imitate who has common features with the patient (age, gender, social status, etc., the attractiveness and positive character of the model, the positive result of the model’s action; learning with the help of a model is usually of a two-phase nature, distinguished: the assimilation phase (repeated observation or independent behavior in an artificially simulated situations) and the implementation phase (gradually increasing complexity of action in a real situation);
• perceptual learning, based on the selective perception of certain objects;
• retrospective learning, based on positive and negative experiences of the past;
• psychomotor learning caused by a purposeful change in motor activity;
• social learning, according to which personality changes occur due to the influence of social processes;
• discriminative learning, during which a response (pattern of behavior) is punished or rewarded depending on the specifics of the situation, and the response (behavior) in this case is under “stimulus control”; discrimination (discrimination) of stimuli makes it possible to learn which behavior is adaptive (reinforced) and which is maladaptive - inappropriate in a given situation;
• cognitive learning , which involves a set of techniques and procedures such as: self-control, self-observation, self-reinforcement, controlled self-esteem; drawing up a contract; work in the patient rules system, etc.

The basic laws of conditioned reflexes include:

1. The law of exercise, which establishes the relationship between the reaction and the situation - the more often an action or reaction occurs in a certain situation, the stronger the associative connection between the action and the situation (Torndike E., 1905).
2. The law of primary reinforcement states that if the connection between a stimulus and a response (pattern of behavior) is accompanied by a decrease in the severity of the need, then the probability increases that the subsequent appearance of the same stimulus will result in the same reaction (pattern of behavior) (Hull C., 1951).
3. Law of acquisition , according to which the strength of operant behavior increases if the behavior is accompanied by a reinforcing stimulus (Skinner B., 1953). In this definition we encounter the adjective “operant”. The term operant was proposed by Skinner to denote such a specific response that affects the environment, changing it. Changes in the environment, in turn, influence the subsequent occurrence of the reaction (Skinner B., 1945). Achieving a goal causes a positive emotion in the form of a feeling of effectiveness. This provision corresponds to the concept of effect motivation . Having achieved the expected result, a person receives reinforcement in the form of a positive emotion, thus creating a need to complete the intended plan, making it easier to achieve the goal, in accordance with a certain standard of a certain level of complexity. The law of acquisition or the law of effect is the basic law of instrumental or operant conditioning, it states that behavior is reinforced or controlled by its results and consequences, and behavior leading to the achievement of a positive result, to satisfaction, is reinforced, and vice versa, behavior that does not lead to a positive result , — is erased or weakened.

According to the theory of learning, many pathological conditions are, as it were, learned, fixed reactions, for example, fear - could be considered a fixed emotional reaction. Various theories have developed within the framework of bioheveorism. So, in particular, according to the associative-reflex theory of learning , based on the basic patterns of conditioned reflex activity, the assimilation of knowledge, skills, and abilities can be imagined as a process of formation in the consciousness of various associations. This process includes the following components: perception, understanding, fixation in memory and application of acquired knowledge in practice. The central link of this process is comprehension (understanding).

Social learning theory (Bandura A., 1967) suggested that personality changes occur through the influence of cognitive processes or schemas. According to Bandura, all effective psychological interventions change a certain component of the “I-schema”, namely subjective personal effectiveness . According to the basic principles of social learning theory, four sources of information can be identified that provide the possibility of personality change: verbal persuasion, arousal of emotions, vicarious experience and successful task completion. Research in the field of social learning theory shows the importance of mediated regulatory processes (Kanfer F., Phillips J., 1970).

In the theory of social learning, there are terms that, in our opinion, are quite significant for psychotherapeutic work with a patient. These are the concepts of internal and external locus of control (Rotter J., 1966), which are a reflection of a person’s worldview, faith or belief in what determines the result of his behavior, on which the success of his activities depends. From the point of view of psychotherapy, patients with an internal locus of control try to take responsibility for their lives and make every effort to change the situation around them. If the patient believes that the result of treatment depends on external factors (the behavior of others, the activity of the psychotherapist, spontaneous changes in the situation, etc.), then we can talk about the presence of an external locus of control . With an external locus of control, the patient makes minimal effort to change the situation.

According to the theory of conflict behavior in human behavior, the tendency to move towards a goal becomes more pronounced as it approaches the goal it has set (Miller N., Dollard J., 1941). This phenomenon is called the “ approximation gradient.” The term “avoidance gradient ,” in turn, corresponds to the tendency to avoid those negative stimuli that an individual approaches. Increasing approach or avoidance drive increases the overall level of the gradient. The avoidance gradient curve is generally steeper than the approach gradient curve. Drive , is understood as a motivational component that encourages or activates behavior, but does not determine its direction. Primary drives include pain, hunger, thirst and sex. If a drive is caused by a learned response to previously neutral stimuli, it is identified as an acquired or secondary drive. Some authors propose to consider the concept of “dominant” as equivalent to the concept of “secondary drive” (Kurpatov A.V., 1998).

Solving certain problems independently and solving the same problems under the guidance of someone are processes of different complexity. Thus, in particular, the discrepancy in the level of difficulty of tasks solved by a child independently (current level of development) and under the guidance of an adult is characterized by the concept of “zone of proximal development” (Vygotsky L.S., 1934) and reflects the concept of the relationship between the learning process and mental development. According to Vygotsky’s views, learning, by creating a zone of proximal development, leads to development; and only that learning becomes effective that is ahead or “runs ahead” of development.

How does a person’s condition and the situation surrounding him influence the formation of a conditioned reflex? To clarify this issue, concepts such as reciprocal inhibition have been proposed.

Reciprocal inhibition as a mechanism according to which an emotional state incompatible with a feeling of fear or anxiety can inhibit the action of a stimulus (irritant) that causes this feeling. The concept of “reciprocal inhibition” is similar to Pavlov’s concept of “ negative induction ” or “external inhibition”. The idea of ​​reciprocal inhibition underlies a number of behavioral therapy techniques (Wolpe J., 1958). Reciprocal inhibition corresponds to the principle of reciprocal inhibition , which states that when a stimulus that causes a feeling of anxiety is combined with its response inhibition, the connection between this stimulus and anxiety weakens (Wolpe J., Lazarus A., 1966). By observing a person's behavior in a certain situation or asking detailed questions about it, it is possible to identify and rank various stimuli in varying degrees of activity that influence this behavior. However, in order to change this behavior, it is not enough to work with stimuli alone; it is necessary to pay attention to the intermediate variables in the “stimulus-response” chain, and to understand complex internal processes. What is learned is not a simple stimulus-response sequence, but a picture, internal representation of the stimulus situation - a cognitive map (Tolman E., 1932).

The most surprising phenomenon in the development of psychology in the last quarter of the twentieth century is the rapid rise of interest in cognitive psychology (Boneau D., 1992). Its origins include statistical studies of the learning process, information theory, and attempts at computer modeling of thinking. Before moving on to the conceptual apparatus of cognitive therapy, it is necessary to say a few words about the terminology of cognitive psychology.

According to one of the founders of cognitive psychology, Miller, when choosing the term “cognitive,” he deliberately contrasted it with behaviorism, and not a single person at that time could clearly explain what the word “cognitive” means and what follows from all this (Schultz D., Schultz S., 1998).

Currently, cognitive psychology is understood as a direction (concept) in psychology that focuses on the process of cognition, on the entire set of components of this complex phenomenon, including purposeful activity of consciousness, perception, attention, memory, language, concept formation, and especially thinking. Consciousness as awareness of events and stimuli in the surrounding world and of cognitive phenomena such as memories, thoughts and bodily sensations (Solso R., 1988).

The term perception describes the process of detecting and interpreting sensory stimuli. Attention is the concentration of mental effort on sensory or mental events. Thinking refers to the general process of mentally solving a specific issue, as a result of which a new mental representation is formed (Solso R., 1988).

Neisser, the author of the first textbook on cognitive psychology, believed that cognition is a process by which “incoming sensory data undergoes transformation, reduction, processing, accumulation, reproduction” (Neisser U., 1967). In the process of intellectual development or adaptation , the ability to learn is formed, effectively coping with environmental conditions. Adaptation, according to Piaget, includes two types of activities: assimilation and accommodation (Piaget J., 1952). During assimilation, new information is included in the cognitive system in the same way as nutrients are absorbed at the physiological level; accommodation , in turn, is an intellectual activity during which a restructuring of mechanisms occurs so that new information that is not sufficiently consistent with them can be assimilated by the cognitive system. system. Cognition is a creative process, one of its stages is verification , reflecting the hypothetical stage of developing or testing a solution to a problem. The historical paradox of the development of psychology and psychotherapy is the fact that cognitive psychology was to some extent formed as an alternative to behaviorism, but in practical psychotherapy, these two concepts of psychology, on the contrary, merged together. Although already in the 50s, the representative of behaviorism Guthrie believed that in order to assess the true meaning of certain stimuli, they must be described in terms of perception (Guthrie E., 1959). Any direction of psychology has its own methods; probably, the main method of cognitive psychology should be considered introspection, which gives meaning to any operational analysis. In rational-emotive therapy, descriptive and evaluative cognitions are distinguished (Ellis A., 1952). Descriptive cognitions represent specific information

In rational-emotive therapy, descriptive and evaluative cognitions are distinguished (Ellis A., 1952). Descriptive cognitions represent specific information about reality and contain what a person has directly perceived from the world around him. In evaluative cognitions , on the contrary, a certain attitude towards reality is reflected and its generalized assessment is given. Most evaluative cognitions turn out to be related to descriptive ones. A variant of this connection would be mapping , a form of symbolic representation supposedly describing the cognitive relationships between the physical and conceptual worlds.

Sequence of constructing a cognitive map

1. Listing your main ideas
2. Determining similarities and differences between thoughts
3. Determining the sequence of occurrence of thoughts
4. Finding out the nature of the connection between different thoughts
5. Drawing up a cognitive map.

An important term in cognitive psychology is the concept of “cognitive pattern.” Literally, a pattern means a complex combination of sensory stimuli in order to determine their belonging to a certain class of objects (Solso R., 1996). Approximate Russian equivalents of this term are such concepts as: “image”, “structure”, “structure”, “picture”, “method”, “model”, “sample”. However, there is no exact equivalent covering all these meanings in the Russian language (Zinchenko V.P. et al., 1996).

Cognitive errors

The behavioral approach considers inappropriate, painful and negatively directed thoughts as cognitive errors. Such errors are quite typical and can occur to different people in different situations. These include, for example, arbitrary conclusions. In this case, a person draws conclusions without having evidence or even in the presence of facts contradicting these conclusions. There is also overgeneralization - generalization based on several incidents, implying the identification of general principles of action. However, what is abnormal here is that such overgeneralization is also applied in situations in which it should not be done. The next mistake is selective abstraction, in which certain information is selectively ignored, and information is also taken out of context. Most often this happens with negative information to the detriment of positive information.

Cognitive errors also include inadequate perception of the significance of an event. As part of this error, both exaggeration and understatement can occur, which, in any case, is not true. Such a deviation as personalization also does not bring anything positive. People who are prone to personalization perceive the actions, words or emotions of other people as related to them, when in fact they had nothing to do with them. Maximalism, also called black and white thinking, is also considered abnormal. With it, a person differentiates what happened into completely black or completely white, which makes it difficult to see the essence of the actions.

Chapter 4. General principles of cognitive psychotherapy

Many patients, such as those recovering from depression, no longer blame themselves for any failure, stop making negative predictions about the future, and are less likely to think that they are bad or inadequate. Some patients, however, continue to exhibit these qualities and claim that they have “always” thought this way. However, they are no longer clinically depressed.

Patients return to their premorbid cognitive style after the Axis I disorder resolves. The modus operandi of Axis II disorders differs from that of Axis I disorders in a number of ways. The frequency and intensity of dysfunctional automatic thoughts observed during the acute disorder decreases as patients return to their usual level of cognitive functioning. Although patients may readily identify and test their dysfunctional automatic thoughts during the “normal neurotic period,” exaggerated or distorted interpretations and associated destructive affect are noted in certain situations. One highly intelligent and competent woman, for example, had the automatic thought “I can't do this” whenever she was offered a position that required a higher level of intellectual performance.

The most likely explanation for the difference between Axis I disorders and personality disorders is that the pronounced misbeliefs and interpretations that characterize symptomatic disorders are relatively malleable and actually become milder as depression subsides, even without any psychotherapeutic intervention. But the more persistent dysfunctional beliefs in personality disorders are “structured,” that is, embedded in “normal” cognitive organization. Consequently, it takes significantly more time and effort to make some of the structural changes needed to treat a personality disorder than it does to change the dysfunctional thinking of, say, a mood disorder.

The therapist typically uses “standard” cognitive psychotherapies for acute episodes of Axis I disorders (American Psychiatric Association, 1987) such as depression (Beck, Rush, Shaw, & Emery, 1979) or generalized anxiety disorder (Beck & Emery with Greenberg, 1985). This approach is effective in addressing dysfunctional automatic thoughts and helps to make a cognitive shift from a depressive (or anxious) way of processing information to a “normal” one. Checking your automatic thoughts and beliefs when your depression or anxiety is worse can help you work on your cognitive processes during a relatively calm period. Patients observed during this period were previously defined in the psychiatric literature and colloquial terminology as "neurotic". When describing the characteristics of the “neurotic personality,” labels such as “immaturity” or “childishness” were typically used; emotional lability, exaggerated reactions to rejection or failure, unrealistically low or high self-image and, above all, pronounced egocentrism were noted.

Dysfunctional beliefs operate because they form the basis for patients' orientation to reality. Because people rely on their beliefs to interpret events and choose how to respond to those events, they cannot give up these beliefs until they have learned new adaptive beliefs and strategies. When patients return to premorbid levels of functioning, they rely on the strategies they normally use. In general, core beliefs at this stage are less dysfunctional than in depression or generalized anxiety disorder, but they are less amenable to further modification than in the acute phase.

Both patient and therapist must recognize that these deep-seated, residual beliefs (schemas) are deeply ingrained and not easily treated by the methods used in standard treatment for depression or anxiety. Even when patients are convinced that their core beliefs are dysfunctional or irrational, they cannot get rid of them simply by questioning them or “wishing” them to go away.

Changing the character structure of these patients requires a long, sometimes tedious process. The “characterological phase” of treatment tends to be prolonged and does not produce dramatic improvements.

Basic principles of therapy

If you want to get rid of negative attitudes, you should remember and understand some of the rules on which CBT is based. The most important thing is that your negative feelings are primarily caused by your assessment of what is happening around you, as well as yourself and everyone around you. The significance of the situation should not be exaggerated; you need to look inside yourself, in an effort to understand the processes driving you. Assessing reality is usually subjective, so in most situations you can radically change your attitude from negative to positive.

It is important to recognize this subjectivity even when you are confident in the veracity and correctness of your conclusions. This frequent phenomenon of discrepancy between internal attitudes and reality disturbs your peace of mind, so it is better to try to get rid of them.

It is also very important for you to understand that all this - incorrect thinking, inadequate attitudes - can be changed. The typical thinking you have developed can be corrected in the case of small problems, and in the case of serious ones, it can be completely corrected.

Training in new thinking is carried out with a psychotherapist in sessions and independent studies, which subsequently ensures the patient’s ability to adequately respond to emerging events.

Therapy methods

The most important element of CBT in psychological counseling is teaching the patient to think correctly, that is, to critically evaluate what is happening, use available facts (and search for them), understand probability and analyze the collected data. This analysis is also called pilot testing. The patient carries out this check independently. For example, if a person thinks that everyone is constantly turning to look at him on the street, he should just take it and count how many people will actually do this? This simple check allows you to achieve serious results, but only if you do it and do it responsibly.

Therapy for mental disorders involves the use of other techniques by psychotherapists, for example, reappraisal techniques. When using it, the patient checks for the likelihood of a given event occurring due to other reasons. The most complete possible analysis of the many possible causes and their influence is carried out, which helps to soberly assess what happened as a whole. Depersonalization is used in cognitive behavioral therapy for those patients who feel constantly in the center of attention and suffer from this.

With the help of tasks, they understand that those around them are most often passionate about their own affairs and thoughts, and not about the patient. An important area is also the elimination of fears, for which conscious introspection and decatastrophizing are used. Using these methods, the specialist gets the patient to understand that all bad events come to an end, and that we tend to exaggerate their consequences. Another behavioral approach involves repeating the desired result in practice and constantly consolidating it.

Homework in cognitive behavioral therapy

Homework is very important: the client receives direct help from a psychotherapist for only 1-2 hours a week, and the remaining 166-167 hours a week is left to himself. And at this time, his beliefs and his problems still influence him. The key to success in CBT is doing your homework.

Homework helps the client be his or her own therapist. If a client conscientiously approaches homework, he speeds up the process of psychotherapy, achieves the desired changes faster, and also saves his money and time :).

In this matter, the main thing is the process, not the result. There may not be a result (that is, the exercise may not work out) - and this is still wonderful! Because, once again, the main thing is to try to do at least something.

What is this post even for? Yes, because not everyone has the opportunity to see a psychotherapist, but everyone can, if they wish, do some real psychotherapeutic exercises at home. You will surely find something interesting for yourself.

Features of homework selection

Homework is selected individually for each client. Of course, there are types of homework, for example, behavioral experiments or collecting opinions, more about them below. How should you select homework assignments?

❗️ Tasks must be related to the client’s problem. If he is working on social anxiety, for example, or trying to get rid of depression, then giving assignments on a topic about relationships is a pointless waste of time.

❗️The task should include testing one or two hypotheses.

For example, there was such a case. The client was convinced that all women who cook well (and also sew, knit, embroider, in a word, are good housewives) are happy in marriage. She herself could not find a soul mate, of course, she was looking for an explanation for this, and one of them was this: “I am not able to build a long-term relationship, because, among other things, I’m a bad cook and I don’t like to do it.” This is the number one hypothesis worth testing. And hypothesis number two is the link between good cooking skills and marital happiness. We tested them with two different homework assignments. Result: none of them were confirmed.

❗️For cases of eating disorders, homework is simply the pillars on which everything rests. If the client does not do the work once, of course, we discuss both resistance and motivation. However, if PD is not done systematically, this is a sign and basis for stopping psychotherapy. Because in these cases the psychotherapeutic effect will be more likely to be zero.

Types and examples of homework

Homework varies, but as a rule, so-called “ behavioral experiments ” occupy a large share of them. What it is? During a consultation with a psychologist, the client and the psychotherapist jointly identify an idea or several ideas that greatly influence the client, but it is definitely impossible to establish the truth of these ideas. For example: “The figure of a woman is the only and decisive one for men.” How can this be checked? Only after finding out the opinion of men on this topic. It is enough to collect 10 opinions to get some picture of how men evaluate women. There are other experiments that are aimed at testing the client's ideas.