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Introduction

1. The essence of A. Beck’s cognitive theory

2. A. Beck’s cognitive approach to psychotherapy: basic principles and history of creation

3. Basic methods and techniques of cognitive psychotherapy by A. Beck

Conclusion

Literature

Introduction

The fact of the ever-increasing need for psychotherapy for millions of our contemporaries is indisputable. At the beginning of the new millennium, our society is witnessing an avalanche-like increase in information that any modern person has to deal with, and the rapid accumulation by humanity of new scientific knowledge, which is acquiring paramount importance in literally all spheres of life. The cult of success that dominates modern culture, the desire for career growth and material well-being with the inability to cope with information overload and other forms of stress lead to a steady increase in emotional, personal and psychosomatic disorders among the population. A highly effective and cost-effective approach to treating a wide range of mental functioning disorders is cognitive psychotherapy (A. Beck, D. Barlow, S. L. Williams, D. M. Clark, J. Falbo, A. Ellis, etc.). Its theoretical and methodological foundations are capable of normalizing public consciousness, primarily in terms of the image of a person and ideas about his well-being - as health-preserving guidelines (A. Beck, A. Freeman, M. Mahoney, A. B. Kholmogorova, etc.).

The relevance of this study of the theoretical and methodological foundations of cognitive psychotherapy is associated with the growing influence of this approach throughout the world and in our country. This determined the topic of this theoretical study: “Cognitive psychotherapy by A. Beck.” cognitive psychotherapy beck decentration

Purpose of the study- study the basic provisions, principles and methods of cognitive psychotherapy by A. Beck.

Research objectives:

Consider the essence of A. Beck's cognitive theory.

Analyze its main provisions and history of creation.

Reveal the main methods and techniques of cognitive therapy by A. Beck.

The research method is theoretical analysis of scientific literature.

1. The essence of A. Beck’s cognitive theory

Cognitive psychotherapy is one of the basic approaches in modern psychotherapy. The founder of this direction is Aaron Beck (1967).

Based on cognitive theories of personality and personality disorders, cognitive psychotherapy by A. Beck is based on the idea that all problems are created by negative thinking - dysfunctional cognitive patterns, automatic thoughts and beliefs, through which the perception of all events and phenomena of the surrounding world is refracted.

It all starts with a person’s interpretation of external events, according to the scheme: external events (stimuli) > cognitive system > interpretation (thoughts) > feelings or behavior.

“A person’s thoughts determine his emotions, his emotions determine his behavior, and his behavior in turn determines our place in the world around us.” “The point is not that the world is bad, but how often we see it this way,” wrote A. Beck.

If interpretations and external events diverge significantly, this can lead to emotional disorders and mental pathology. A. Beck's cognitive approach to emotional and personality disorders suggests that symptoms of depression, anxiety, hostility, etc. are the result of the client's ideas about the world.

Observing patients with neurotic depression, A. Beck drew attention to the fact that themes of defeat, hopelessness and inadequacy constantly sounded in their experiences. The researcher noted that people who are depressed also make serious errors when processing information - they tend to exaggerate the negative and downplay the positive. A. Beck figuratively compared the perception of the surrounding world, himself and his own life by a person suffering from depression to looking through tinted glasses. The researcher, in particular, noted that the thinking of a person suffering from depression is characterized by a negative view of himself (low self-esteem), of his personal future and of his experiences. These manifestations are called “Beck's depressive triad.” A. Beck also found that patients suffering from depression tend to overgeneralize (“Nobody loves me”). Another feature of such patients is selective abstraction, in which one detail is taken out of the situation and then generalized.

Based on all these observations, the researcher proposed his own model of the nature of depression, suggesting that depression develops in people who perceive the world in three negative categories:

Negative assessment of life phenomena and events: no matter what happens, a depressed person is focused on the negative aspects of life, although reality provides an experience that brings pleasure to most people;

Hopelessness about the future: when imagining the future, the depressed patient sees only gloomy events in it;

Reduced sense of self-worth: The depressed patient sees himself as inadequate, unworthy and helpless.

According to Beck, these dysfunctional patterns are acquired in childhood and permanently influence a person's behavior. Children think in global, absolute categories - and/or, while depressants retain these primitive ways of thinking into adulthood, so they adhere to certain primitive, simplified schemes learned at an early age.

In another personality disorder, paranoid disorder, the individual is suspicious of other people and reacts to them negatively and aggressively. This disorder is based on patterns in which such people portray themselves as virtuous and experience bad treatment from others. The latter, in turn, are portrayed by them as suspicious and distrustful, which forces them to be constantly on guard and look for signs of bad attitude and disrespect from others.

2. A. Beck’s cognitive approach to psychotherapy: basic principles and history of creation

A. Beck developed his own method - cognitive psychotherapy, the ultimate goal of which is to identify dysfunctional judgments, see how they “pull the trigger” and cause depressive feelings and behavior, and then try to change them.

The goal of a cognitive therapist in treating personality disorders is to change these dysfunctional patterns. Many of the techniques used in cognitive therapy to treat depression and anxiety are used when working with personality disorders. However, completely changing these circuits takes a very long time, and the therapeutic strategy is often not to completely destroy them, but to partially change them to make them less dysfunctional. In pranoidal personality disorder, the therapist may encourage the client to learn to trust some people in certain situations or to examine their dysfunctional schemas so as not to be too rigidly guided by them.

There is one new strategy worth noting when working with personality disorders. A. Beck and his colleagues note that sometimes persistent dysfunctional interpersonal patterns cannot be modified without addressing childhood experiences. They do not work with childhood experiences as actively as in psychoanalysis. However, the cognitive therapist may have the client "lose out" the encounter with his father or mother if they are the primary source of his acquisition of dysfunctional schemas. In cognitive therapy, the client does not simply revisit traumatic experiences of early childhood, but through role-playing, tries to use functional adult ways of responding to the person in question. This allows the client to re-evaluate childhood experiences from an adult's perspective and discard old dysfunctional attitudes that arose from these experiences. This strategy can be seen as an extension of the idea of ​​“bright thoughts.”

Usually a person is identified with his automatic thoughts. When he turns over a habitual thought in his mind, for example, “this man is my enemy,” he mechanically equates it with reality. The task of the psychotherapist is to show the unrealisticness of automatic thoughts and to encourage the patient to take part in the formation of a realistic one. In addition, homework can be used with daily recording of automatic thoughts and further discussion of these recordings with the therapist, weighing all the pros and cons, identifying alternative possible schemes, etc.

The main cognitive technique used by the therapist is questioning. Questions are asked to help the client explore and challenge dysfunctional thoughts. It is important to note that A. Beck prefers to ask questions rather than dissuade the client from his dysfunctional thoughts. A. Beck's interview technique mobilizes depressed clients to question their own thoughts.

It is important to note that Beck is not so much interested in what the client is thinking, but in how he thinks. He admits that sometimes depressive cognitions may be correct (for example, someone may ignore you because they don't like you). Beck is not interested in the process of teaching "positive thinking." He considers it as destructive as negative thinking. The question is not whether the client loves himself or not, but whether he thinks in terms of “I am good” or “I am bad” depending on what is happening.

Likewise, life for A. Beck is not a search for happiness. Happiness, in his opinion, is a by-product of activity. Beck wants his clients to learn how to test hypotheses. Even though depressive thoughts may sometimes be correct, depression occurs when there is a depressive triad and people have dysfunctional errors in processing information. A. Beck tries to teach clients to consider these ideas as hypotheses rather than facts, and then test them with evidence. Developing this hypothesis-testing mindset will result in a much more flexible, unobtrusive cognitive system capable of coping with occasional negative thoughts that are supported by evidence.

Cognitive therapy is a systematic, structured, problem-solving approach. It is usually limited in time and rarely exceeds 30 sessions. Each therapy session has a program in which, in contrast to free-form psychoanalysis or client-centered therapy. During the first sessions, A. Beck examines the client’s difficulties and draws up an action plan. The connection between thoughts and feelings is demonstrated to the client through examples. Two main lines of attack are then used to combat the dysfunctional thoughts. These are behavioral and cognitive techniques. But along with individual techniques, an equally important place in the psychotherapeutic process is occupied by the psychotherapeutic relationship between the psychotherapist and the client.

A. Beck believes that the therapist should be friendly, empathic and sincere. However, he does not believe that this is sufficient for therapy. Rather, the therapeutic relationship is important because it is a source of learning. The therapist himself is the model of what he wants to teach. If the therapist is too detailed and can preach, this will simply reinforce the client's initial rationality.

The client and therapist must agree on what problem they will be working on. It is problem solving (!), and not changing the patient’s personal characteristics or shortcomings. The therapist must be very empathic, natural, congruent (principles taken from humanistic psychotherapy); there should be no directiveness.

The principles on which the psychotherapeutic relationship between psychotherapist and client are based are as follows.

1. The therapist and client collaborate in an experimental test of erroneous maladaptive thinking.

Client: “When I walk down the street, everyone turns to look at me.”

Therapist: “Try to walk down the street and count how many people turn to look at you.”

Naturally, automatic thought does not coincide with reality.

The bottom line: there is a hypothesis, it must be tested empirically.

2. Socratic dialogue is a series of questions with the following goals:

Clarify or identify problems;

Help in identifying thoughts, images, sensations;

Explore the meaning of events for the patient;

Assess the consequences of maintaining maladaptive thoughts and behaviors.

3. Guided Cognition: The therapist-guide encourages patients to address facts, evaluate probabilities, gather information, and put it all to the test.

Recently, cognitive therapy has been further developed in the treatment of personality disorders. Beck and his colleagues believe that personality disorders, such as dependent and paranoid disorders, are learned dysfunctional interpersonal strategies or patterns that are triggered in a variety of situations.

A. Beck calls his biography the clearest example that his psychotherapy really works. His journey from a timid, stuttering boy, the son of poor Russian emigrants, to one of the five richest and most influential psychologists in the world is the best proof of this. He was born in 1921 into a family of Jewish emigrants from Russia. Three years earlier, during a flu epidemic, his parents had lost their only daughter, causing him to painfully observe his mother's depressive state from childhood. After receiving his medical education, he began his professional career in the Department of Psychiatry at the University of Pennsylvania. In the early 60s, he revised the psychoanalytic concept and developed the foundations of cognitive psychotherapy.

Gradually, having started practice as a psychoanalyst, A. Beck switched to cognitive psychotherapy - his own technique, the foundations of which began to take shape precisely then. Compared to psychoanalysis, which usually lasted five to ten years, his sessions (taking a maximum of 12 months) seemed incredibly fast.

In an interview, Beck admitted: “Having refused counseling according to Freud’s method, the first thing I felt was anxiety for my material well-being. If I had remained a psychoanalyst, it would have been enough for me to have two or three regular clients to sign bills without looking at the numbers. When I started practicing cognitive therapy, my financial situation deteriorated sharply. After ten sessions, clients told me: “Doctor, thank you! I began to look at life differently, to think differently about myself and those around me. I feel that I no longer need your help, all the best, doctor!” And, satisfied, they left. And my income was melting before our eyes.”

However, cognitive therapy, which helped people in the shortest possible time go from depression to a positive solution to most problems, made A. Beck so popular that the method he created began to spread rapidly.

Initially, A. Beck studied and treated only depression, but then extended his psychotherapeutic approach to a wide range of psychological problems, including anxiety disorders and personality disorders.

3. Basic methods and techniques of cognitive psychotherapy by A. Beck

Cognitive psychotherapy in Beck's version is structured training, experiment, mental and behavioral training designed to help the patient master the following operations:

Identify your negative automatic thoughts;

Find connections between knowledge, affect and behavior;

Find facts for and against these automatic thoughts;

Look for more realistic interpretations for them;

Learn to identify and change disorganizing beliefs that lead to distortion of skills and experience.

Specific methods for identifying automatic thoughts:

1. Empirical testing (“experiments”). This process of helping the patient identify and correct his cognitive distortions requires the application of some principles of epistemology, that is, the science of knowledge and its nature, limitations and criteria of knowledge. Directly or indirectly, the therapist conveys certain principles to the patient:

1) The perception of reality is not reality itself. The image of reality that arises in the patient is subject to natural limitations on the part of his sensory functions - vision, hearing, smell, etc.

2) Our interpretations of sensory experiences depend on cognitive processes such as stimulus integration and differentiation. These interpretations may be erroneous, since physiological and psychological processes can change the perception and assessment of reality

Methods of empirical verification:

Find arguments for and against;

Constructing an experiment to test a judgment;

The therapist turns to his experience, fiction and academic literature, and statistics.

The therapist "convicts" - points out logical errors and contradictions in the patient's judgments and teaches the patient to recognize his own automatic thoughts and ideational processes that are incompatible with the ability to cope with life, violate internal harmony and produce inappropriate, excessively intense and painful emotional reactions. Emotional reactions, motives and external behavior are controlled by thinking. A person may not be fully aware of those automatic thoughts that largely determine his actions, feelings and reactions to what happens to him. With some training, however, he can increase his awareness of these thoughts and learn to focus his attention on them. One can learn to perceive a thought, focus attention on it, and evaluate it in a similar way to how a sensation (such as pain) or an external stimulus (such as a verbal statement) is reflected.

During cognitive therapy, the patient focuses on thoughts or images that create discomfort, distress, or self-blame. In using the term "maladaptive" it is important for the therapist to beware of transferring his own value system onto the patient. As a rule, the term can be legitimately used if both the patient and the therapist are unanimous that these automatic thoughts interfere with the patient's well-being and the achievement of important goals. Ideation processes may be considered maladaptive if they interfere with effective functioning. Distortions or unjustified self-accusations are usually so obvious that they can rightfully be called maladaptive.

Automatic maladaptive thoughts are “internal statements”, “statements to ourselves”, “what we tell ourselves”. Maladaptive thoughts are voluntary and can be changed or consciously switched from these thoughts to others. Recognizing the practical usefulness of this terminology, A. Beck called these thoughts automatic, pointing to the subjective form of experiencing these cognitive processes. In human perception, these thoughts arise reflexively - without previous reflection or reasoning. They give the impression of being believable or valid. They can be compared to statements that parents make to a trusting child. Often the patient can be taught to stop these thoughts. However, in severe cases, especially psychosis, physiological intervention such as medication or electroconvulsive therapy is required to stop maladaptive thoughts. The intensity and severity of maladaptive thoughts increase in proportion to the severity of the disorders observed in the patient. In cases of deep disturbances, these thoughts are usually obvious (they simply catch the eye) and may in fact occupy a central place in the ideational sphere (in cases of acute and profound depression, anxiety or paranoid state). On the other hand, patients with obsessive disorders (not of a deep or acute nature) may be very aware of repeated statements of a certain type in the mind. Continuous rumination of this kind serves as a diagnostic criterion for this disorder. Preoccupation with any thoughts can also be observed in people who do not suffer from neuroses.

2. Filling the gap. When automatic thoughts are at the center of awareness, there is no problem in identifying them. In cases of neuroses of minor or moderate severity, a program of instruction and practice is required to train the patient to catch automatic thoughts. Sometimes the patient is able to catch these thoughts simply by imagining the traumatic situation. The main procedure to help the patient identify his own automatic thoughts is to teach him the ability to establish the sequence of external events and his reactions to them. The patient can talk about many circumstances in which he became upset for no reason. Ellis describes the following techniques to explain this procedure to the patient. He introduces the concept of the sequence “A, B, C”. “A” is an activating stimulus, “C” is an excessive, inadequate conditioned reaction. “B” is a gap in the patient’s consciousness, by filling which he can create a bridge between “A” and “C”. Filling the gap becomes a therapeutic task.

The “filling the gap” technique provides significant assistance to patients suffering from excessive shyness, anxiety, irritability, melancholy, and fears with specific content. In many cases, maladaptive ideational processes occur in figurative or verbal form

3. Revaluation technique. Checking the probability of alternative causes of an event.

4. Distancing and decentering. Some patients who have been trained to identify automatic thoughts spontaneously become aware of their maladaptive nature, which distorts reality. So, with social phobia, patients feel like the center of everyone’s attention and suffer from it. Empirical testing of these automatic thoughts is also needed here. As these thoughts are successfully identified, patients' ability to address them objectively increases. The process of looking at automatic thoughts objectively is called distancing. The concept of "distancing" is used to refer to patients' ability (eg, Rorschach inkblot test) to maintain a distinction between the configuration of inkblots and the fantasies or associations stimulated by the configuration.

A person who views automatic thoughts as a psychological phenomenon, and not as identical realities, is endowed with the ability to distance. Concepts such as “distancing”, “reality check”, “checking the reliability of observations”, “validating inferences” are associated with epistemology. Distancing involves the ability to differentiate between “I believe” (an opinion that must be validated) and “I know” (an irrefutable fact). The ability to make such discrimination is particularly important when attempting to modify those types of patient responses that are associated with distortions.

5. Self-expression. Depressed, anxious, etc. patients often think that their illness is controlled by higher levels of consciousness, constantly observing themselves, they understand that the symptoms do not depend on anything, and attacks have a beginning and an end. Conscious self-observation.

6. Decatastrophizing. For anxiety disorders. Therapist: “Let's see what would happen if...”, “How long will you experience such negative feelings?”, “What will happen then? You will die? Will the world collapse? Will this ruin your career? Will your loved ones abandon you? etc. The patient understands that everything has a time frame and the automatic thought “this horror will never end” disappears.

7. Establishing the reliability of inferences. After the patient has acquired the ability to clearly distinguish between internal mental processes and the external world that generates them, he still needs to be taught the procedures required to obtain accurate knowledge. People consistently formulate hypotheses and draw conclusions. They have a tendency to identify their own conclusions with reality and accept a hypothesis as a fact. Under normal circumstances, they can function adequately, since their ideational processes coincide with the outside world and are not a significant obstacle to adaptation.

To determine the inaccuracy and unfoundedness of the patient’s conclusions, the psychotherapist can use special techniques. Since the patient is accustomed to distorting reality, therapeutic procedures consist primarily of examining his conclusions and testing them with reality. The therapist works with the patient to explore how the patient's inferences work. This work initially consists of checking observations and gradually focuses on drawing conclusions.

8. Change of rules. “Rules” here mean attitudes, concepts, and constructs. Such deep ideas as ideas about the world, about oneself, about others, as a rule, are not irrational, but too broad, absolute, taking thought to the extreme, or too personalized. They are used too arbitrarily, which prevents the patient from coping with critical life situations. Such rules need to be reconstructed and made more precise and flexible. Erroneous, dysfunctional and destructive rules must be eliminated from the behavioral repertoire. In such cases, the therapist and patient collaborate to develop more realistic and adaptive rules.

Here are examples of some attitudes that predispose to the experience of melancholy or depression:

1) To be happy, I must be lucky in everything.

2) To feel happy, I must be accepted (or I must be loved, I must be admired) by everyone and always.

3) If I didn't reach the top, I failed.

4) How wonderful it is to be popular, famous, rich; It's terrible to be unknown, mediocre.

5) If I make a mistake, it means I'm stupid.

6) My worth as a person depends on what others think of me.

7) I can not live without love. If my spouse (lover, parents, child) does not love me, I am good for nothing.

8) If someone doesn't agree with me, it means they don't love me.

9) If I don't take every chance to advance myself, I'll regret it later. The above attitudes lead to a person feeling unhappy. It is impossible for a person to be loved without any criticism, all the time. The degree of love and acceptance varies greatly from person to person. However, in the light of these attitudes, every sign of diminishing love is regarded as rejection.

9. Cognitive rehearsal. Clients suffering from major depression often struggle with challenging tasks because they have difficulty concentrating and thinking. As a result, they may harm themselves. To anticipate difficulties that may be encountered when performing a task, the therapist makes the client rehearse it, that is, go through it step by step. In this case, difficulties are detected in advance, and the client manages to take measures to overcome them. In addition, the therapist can give the client appropriate recommendations.

10. Purposeful repetition and role play. Playing out the desired behavior, repeatedly trying out various positive instructions in practice, which leads to increased self-efficacy.

11 . Using the imagination. In anxious patients, it is not so much “automatic thoughts” that predominate as “obsessive images”, that is, it is not thinking that maladapts, but imagination (fantasy).

Types of techniques using imagination:

Stopping technique: loud command “stop!” - the negative image of the imagination is destroyed.

Repetition technique: we mentally scroll through the fantasy image many times - it is enriched with realistic ideas and more probable contents.

Metaphors, parables, poems.

Modifying imagination: the patient actively and gradually changes the image from negative to more neutral and even positive, thereby understanding the possibilities of his self-awareness and conscious control.

Positive imagination: a positive image replaces a negative one and has a relaxing effect.

Constructive imagination (desensitization): the patient ranks the expected event, which leads to the fact that the forecast loses its globality.

Thus, having examined the main methods and techniques used in cognitive psychotherapy, we see that A. Beck compiled a psychotherapeutic program that uses self-control, role-playing, modeling, homework, etc.

Behavioral techniques are used primarily with clients who are severely depressed. Such clients may have difficulty processing information and therefore cognitive interventions are often ineffective for them.

A. Beck uses several behavioral interventions. For example, a list of daily activities is an hourly record by the client of his actions, no matter how trivial they may be. This helps combat dysfunctional thoughts such as “I never get anything done.”

Beck also uses another behavioral intervention when working with clients with depression: a series of graded tasks. A client for whom getting out of bed is an accomplishment may be tasked with brushing his teeth and shaving. Once he has mastered this, he may be tasked with preparing his own breakfast and going for a walk. Next week, his assignment might include reading the newspaper and looking at job advertisements. The strategy is to select tasks that gradually return the depressed client to full functioning. However, at the same time, it is important to select tasks that clients can do. Beck emphasizes that the purpose of an action is to complete it, and not to complete it.

A. Beck does not believe that depression can be cured using behavioral methods alone. You also need to deal with the underlying negative thoughts that caused the depression, otherwise it will come back again. Behavioral interventions help relieve the client's depression. Getting the client to take action means teaching him to resist thoughts like “I can’t do anything” or “I’m a moron.” In addition, the therapist can get the client to begin testing dysfunctional thoughts during actual acts of behavior. Once the depression has subsided and the client is open to cognitive intervention, the therapist can begin to focus on cognitive techniques.

First, it is necessary to ensure that the client understands the connection between his thoughts and feelings. To do this, he is given the task of keeping a daily record of unconscious thoughts. Each time the client notices the onset of depression, he should try to recall the thoughts that preceded the onset of depressive feelings. In addition to daily recording of dysfunctional thoughts and feelings, the client is asked to note alternative, less dysfunctional ways of perceiving the situation. As a result, the client understands that he is limiting himself to one way of perceiving the situation, when there are many of them.

Based on Beck's cognitive approach, it can be determined that the main features of cognitive therapy are the following characteristics.

First, activity. Therapy proceeds with the patient’s full understanding of the plan, goals, and techniques; a relationship is established, in the words of A. Beck, “experiential cooperation,” in which the therapist mobilizes the client to activity and active participation.

Secondly, structure. This therapy is based on a two-level structure of the organization of cognitive processes.

Thirdly, short-termism. The session lasts 40-50 minutes. In total, on average, from 6 to 25 sessions are conducted, depending on the type of psychological disorder.

Fourthly, symptom-oriented cognitive psychotherapy. This psychotherapy is aimed specifically at a specific symptom.

Thus, the goal of cognitive therapy is to adapt the information process to initial positive changes in all systems through actions within the cognitive system

Conclusion

Based on the theoretical analysis of the scientific and methodological literature available to us on the research problem, we were able to establish that cognitive psychotherapy by Aaron Beck is a structured training, experiment, mental and behavioral training designed to help the patient detect his negative automatic thoughts; find connections between knowledge, affect and behavior; find facts for and against these automatic thoughts; look for more realistic interpretations for them; teach to identify and change disorganizing beliefs that lead to distortion of skills and experience.

The main task of cognitive therapy is to make the patient's attitudes explicit and help him understand whether they are self-destructive. It is also important that the patient be convinced from his own experience that, due to his own attitudes, he is not as happy as he could be if he were guided by more moderate or realistic rules. The therapist's role is to offer alternative rules for the patient's consideration.

Based on the considered cognitive approach of A. Beck, it can be summarized that the main features of cognitive therapy are:

Activity;

Structuring;

Short-term (a session lasts 40-50 minutes. From 6 to 25 sessions depending on the type of psychological disorder);

Symptom-oriented

Thus, the goal of cognitive therapy is to adapt the information process to initial positive changes in all systems through actions within the cognitive system. And A. Beck suggested ways of these changes.

Literature

Ivy, A. E. Psychological counseling and psychotherapy: methods, theories and techniques [Text]: practical guide / A. E. Ivy, M. B. Ivy, L. Syman-Downing. - M.: Psychotherapeutic College, 2000. - 487 p.

Beck, A. Techniques of cognitive psychotherapy [Text] / A. Beck // Moscow Psychiatric Journal. - 1996. - No. 3. - pp. 40-49.

Beck, A. Techniques of cognitive psychotherapy [Text] / A. Beck // Psychological counseling and psychological therapy: a reader: in 2 volumes - T.1 / ed. A. B. Fenko. - M.: Rech, 2009. - 760 p.

Beck, A. Cognitive therapy for depression [Text] / A. Beck, A. Rush, B. Shaw, G. Emery. - St. Petersburg. : Peter, 2003.

Beck, A. Cognitive psychotherapy for personality disorders [Text] / A. Beck, A. Freeman. - St. Petersburg. : Peter, 2002. - 496 m.

Beck, A. Cognitive therapy: a complete guide [Text] / A. Beck, S. Judith. - M.: “Williams”, 2006. - P. 400.

Kassinov, G. Rational-emotional-behavioral therapy as a method of treating emotional disorders [Text] / G. Kassinov // Psychotherapy: from theory to practice: materials of the 1st Congress of the Russian Psychotherapeutic Association. - St. Petersburg. : Publishing house of the Psychoneurological Institute named after. V. M. Bekhtereva, 1995. - 310 p.

Cognitive psychotherapy for personality disorders [Text] / Ed. A. Beck and A. Freeman. - St. Petersburg: Peter, 2002. - 544 p.

Cognitive-behavioral approach to psychotherapy and counseling [Text]: reader / Comp. T. V. Vlasova. - Vladivostok: State Institute of Moscow State University, 2002. - 110 p.

McMullin, R. Workshop on cognitive therapy [Text] / R. McMullin. - St. Petersburg: Rech, 2001. - 560 p.

Moscow Psychotherapeutic Journal [Text]: special issue on cognitive therapy / Ed. A. V. Kholmogorova. - 1996. - No. 3.

Moscow Psychotherapeutic Journal [Text]: special issue on cognitive therapy / Ed. A. V. Kholmogorova. - 2001. - No. 4.

Nelson-Jones, R. Theory and practice of counseling [Text] / R. Nelson-Jones. - St. Petersburg. : Peter, 2000. - 464 p.

Sokolova, E. T. General psychotherapy [Text] / E. T. Sokolova. - M.: Prospekt, 2001. - 652 p.

Todd, J. Fundamentals of clinical and counseling psychology [Text] / J. Todd, A. Bogart - M.: Eksmo-Press, 2001. - 768 p.

Fedorov, A. P. Cognitive psychotherapy [Text] / A. P. Fedorov. - St. Petersburg. : MAPO, 1991.

Fedorov, A. P. Cognitive-behavioral psychotherapy [Text] / A. P. Fedorov. - St. Petersburg. : Peter, 2002. - 352 p.

Festinger, L. Theory of cognitive dissonance [Text] / L. Festinger. - St. Petersburg. : Yuventa, 1999. - 318 p.

Kholmogorova, A. V., Garanyan N. Emotional disorders and modern culture using the example of somatoform, depressive and anxiety disorders [Text] / A. V. Kholmogorova, N. D. Garanyan // Moscow Psychotherapeutic Journal. - 1999. - No. 2. - P. 61-90.

Shaverdyan, G. M. Basics of psychotherapy [Text] / G. M. Shaverdyan. - St. Petersburg: Peter, 2007. - 208 p.

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Aaron Beck and cognitive therapy

The focus of cognitive therapy is the influence of cognition on human emotions. Its theoretical roots are intertwined with common sense and naturalistic introspective observation of the human mind at work, typically in a psychotherapeutic setting. Apart from its emphasis on cognition, cognitive therapy has little in common with the theories and methods of cognitive psychology discussed in the previous section. Practical in its interests, cognitive therapy aims to modify and regulate the negative impact of certain cognitive processes on a person's emotional well-being. As one of the major approaches to psychotherapy today, cognitive therapy owes its basic theory and therapeutic techniques to the pioneering work of Aaron Beck.

Beck's discovery

Aaron Beck received psychoanalytic training and for several years practiced psychoanalysis in a traditional manner, asking patients to verbalize their free associations(free associations) and communicate whatever comes to their mind. But one day something happened that changed his approach. One patient, in the process of making free associations, severely criticized Beck. After a pause, Beck (1976) asked the patient what he was feeling now, and he replied: “I feel a strong feeling of guilt.” There was nothing unusual about this. But then the patient spontaneously added that when he made sharp criticisms of his analyst, self-critical thoughts simultaneously arose in his mind. Thus, there was a second stream running parallel to the thoughts of anger and hostility that he reported during his free associations. The patient described this second stream of thought as follows: “I said the wrong thing... I shouldn’t have said it... I’m wrong to criticize him... I’m doing wrong... He will think badly of me” (p. 31).

It was the second stream of thought that was the link between the patient's expression of anger and his feelings of guilt. The patient felt guilty because he criticized himself for being angry with the analyst. Perhaps, being an analogue of Freud's preconscious(preconscious), this flow has to do with what people say to themselves rather than with what they might say in conversation with another person. Apparently, this is a kind of self-monitoring system that functions in conjunction with the thoughts and feelings expressed in conversation. Thoughts that are associated with self-monitoring tend to occur quickly and automatically, like a reflex (Beck, 1991). They are usually followed by some unpleasant emotion. Sometimes patients, either spontaneously or prompted by the therapist, express this emotion. But they almost never report the automatic feelings that precede the emotion. In fact, they are usually only vaguely aware of these feelings, if at all.

Automatic thoughts provide ongoing commentary to accompany what people do or experience. These thoughts occur in both healthy and emotionally anxious people. The difference has to do with the type of messages that thoughts contain and the extent to which they interfere with a person's life. For example, people suffering from depression talk to themselves in very harsh terms, judging themselves for every mistake, expecting the worst and feeling that they deserve all the misfortunes that befall them because they are worthless anyway. People who are severely depressed tend to talk to themselves in an even louder voice. For them, negative thoughts are not just a whisper heard on the periphery of consciousness, but loud, repeated screams that can absorb a lot of energy and distract a person from some other activity.

The combination of automatic thinking and unpleasant physical or emotional symptoms creates a vicious cycle that maintains and intensifies symptoms, sometimes leading to serious emotional distress. Beck gives the example of a person suffering from symptoms of anxiety, including palpitations, sweating and dizziness. The patient's thoughts about death lead to increased anxiety, manifested in physiological symptoms; these symptoms are then interpreted as signs of imminent death (1976, p. 99).

Cognitive therapy and common sense

The discovery of the existence of automatic thoughts marked a change in Beck's approach to therapy, as well as in his view of human personality. The content of these thoughts “was not usually associated with some esoteric topics, such as castration anxiety or psychosocial complexes (fixations), as classical psychoanalytic theory might suggest, but related to extremely important social issues, such as as success or failure, approval or rejection, respect or contempt” (Beck, 1991, p. 369).

An important feature of automatic thoughts is that a person can be aware of them and that they enable introspection. Although these thoughts may be difficult to notice at first, with some preparation, Beck discovered, they can be brought to consciousness. Consequently, both the source and the solution to emotional problems are within the sphere of human awareness, within the limits accessible to its knowledge.

“The manner in which a person monitors and instructs himself, praises and criticizes himself, interprets events and makes predictions, not only illuminates normal behavior but also sheds light on the internal mechanisms of emotional disorders” (Beck, 1976, p. 38).

This principle underlies Beck's cognitive approach to therapy. The core of this approach is respect for the abilities of human beings to heal themselves and the triumph of common sense, which embodies the wisdom through which people have developed these abilities over generations. Beck draws attention to the everyday feats of our cognitive abilities:

“If it were not for man’s ability to so skillfully filter and attach appropriate labels to an avalanche of external stimuli, his world would be chaotic and one crisis would follow another. Moreover, if he could not control his highly developed imagination, he would periodically fall into a kind of twilight region, unable to distinguish between the reality of a situation and the images and personal intentions that it initiates. In his interpersonal relationships, he can usually find hidden clues that enable him to separate his enemies from his friends. He makes subtle adjustments to his behavior that help him maintain diplomatic relations with people who are unsympathetic to him or who are unsympathetic to him. He can usually see through other people's social masks, distinguish sincere messages from insincere ones, and see the difference between friendly pretense and disguised antagonism. It tunes in to meaningful messages in the loudest noise so that it can organize and modulate its own responses. These psychological operations appear to operate automatically, without evidence of any intense cognition, deliberation, or reflection” (Beck, 1976, pp. 11–12).

It is an eloquent expression of Beck's belief in the fundamental human ability to heal and remain whole. His praise of our natural ability to maintain mental health is reminiscent of person as scientist Kelly. Both valued the powers of the human mind, which led them to respect the common man and to believe that the gap between the expert (scientist or therapist) who has knowledge, and the layman who supposedly does not, is much narrower and more easily bridged than is commonly thought. Beck and his followers openly shared their findings with therapists as well as the general public.

Cognitive therapy and self-help techniques

Based on Beck's approach, many techniques have been developed that focus on specific problems and require relatively short-term therapy (Beck, Rush, Shaw, & Emery, 1979; Emery, 1981; McMullin, 1986). Their goal is to modify negative or self-destructive automatic thought processes or perceptions that appear to contribute to the persistence of symptoms of emotional disorders. Either directly or indirectly, these techniques deny, challenge, or restructure clients' perceptions or understandings of themselves and their life situations.

In cognitive therapy, a collaborative, almost collegial relationship is established between therapist and client. The therapist does not pretend to know the client's thoughts and feelings, but invites the client to explore and critically examine them for himself. In cognitive therapy, clients resolve their own problems; they have direct access to the patterns of perception and thinking that intensify maladaptive feelings and behavior patterns, and they are able to change these patterns.

Not surprisingly, cognitive therapy has contributed to the proliferation of self-help publications. In fact, much of the popular literature on how to assert yourself, increase your self-esteem, calm your anger, overcome depression, save your marriage or relationship, and simply feel good comes from the work of cognitive therapists (Burns, 1980; Ellis & Harper, 1975; McMullin & Casey, 1975).

Perhaps Albert Ellis (1962, 1971, 1974) did more than anyone else to popularize cognitive therapy methods. His assertive tactics of confrontation and persuasion have won him supporters among therapists and lay people. Ellis's approach is known as rational emotive therapy(rational-emotive therapy) (RET). Based on the idea that irrational thoughts cause emotional distress and behavioral problems, RET uses logic and rational argumentation to highlight and combat the irrational thoughts that support unwanted emotions and behavior patterns. Although more confrontational than other types of cognitive therapy, Ellis's approach is characterized by the sound logic inherent in all cognitive methods.

The logic of the cognitive approach(logic of the cognitive approach) can be expressed using the following four principles (Burns, 1980, pp. 3–4): 1) when people experience depression or anxiety, they think in an illogical, negative manner and perform involuntary actions to their own detriment ; 2) with a little effort, people learn how to get rid of harmful thinking patterns; 3) when their painful symptoms disappear, they become happy and energetic again and begin to respect themselves; 4) these goals are achieved, as a rule, within a relatively short period of time through the use of simple methods.

The first step is to become aware of your automatic thoughts and identify any distorting patterns. Burns (1980, pp. 40–41) describes the following ten types of distortions that commonly characterize the thinking of depressed people:

"1. All or nothing thinking. A person sees everything in black and white. For example, failure to achieve perfection is seen as a complete failure.

2. Overgeneralization(overgeneralization). Viewing a one-time negative event as confirmation of a pattern of never-ending defeats.

3. Mental filter. Focusing solely on one negative detail until the entire experience appears in a negative light.

4. Derogation of the positive. The person insists that positive experiences are for some reason of little significance, and thereby maintains a negative view, despite all evidence to the contrary.

5. Wrongful conclusions. A person makes negative conclusions, despite the fact that there are no concrete facts to support them. This happens, for example, when a person arbitrarily concludes that someone else is reacting negatively to him, without trying to find out whether this conclusion is true. Or a person is so afraid that events will take a bad turn that he begins to believe that this is exactly what will happen.

6. Exaggeration (viewed as a disaster)(catastrophizing) or understatement. Exaggerating the significance of some incidents (for example, your own mistakes) or downplaying their importance (for example, your positive qualities).

7. Emotive reasoning. The assumption that one’s own negative emotions certainly reflect the true state of affairs: “It seems so to me, therefore it is so.”

8. Calls “must”. Prompting oneself to do something with the words “should” and “don’t”, as if a person is unable to act without psychological self-coercion. When the “should” is directed at oneself, a feeling of guilt may arise; when it is directed at others, the person may experience anger, frustration, or resentment.

9. Labeling and mislabeling. Using negative labels when a mistake is made, instead of describing what happened. For example, instead of saying, “I lost my keys,” a person puts a negative label on himself: “I’m a bungler.” If a person is unhappy with someone's behavior, a negative label may be attached to the other person, such as "He's a jerk." Mislabeling refers to describing an event in emotionally loaded language that is not accurate.

10. Personalization. Viewing oneself as the cause of some external event for which one is not actually primarily responsible."

When distortions in a person's habitual, automatic thinking are discovered and correctly identified, it becomes possible to change thoughts, replacing the distorting ideas with rational and realistic ones. For example, a person who has been let down by a friend may cling to the thought: “I am a real simpleton and a complete fool.” This reaction is an example of mislabeling and all-or-nothing thinking. Rational, realistic thoughts that more accurately describe what is happening might include: “I made a mistake by trusting this friend” and “I don’t always know when I should or shouldn’t trust a person, but over time I will get better at it.” " Cognitive therapists believe that if the client focuses and works hard enough with the help of the therapist, automatic thoughts and their associated distortions can be eliminated. These can be replaced by rational, precise thoughts, leading to a happier, healthier lifestyle.

For thought. Negative Thinking Patterns

Try the following experiment to gain a deeper understanding of your negative thinking patterns.

When you feel anxious, depressed, upset, or just a little sad, observe the thoughts that spontaneously arise and disappear in your mind. Allow thoughts to come and go without judging, suppressing, or trying to change them in any way. Just track them for a few minutes.

Take a piece of paper and divide it into the following three columns: automatic thoughts, cognitive distortions, and rational responses. In the first column (automatic thoughts), write down thoughts or recurring themes in the order they appear. Then look through your list and, in the second column, identify the distortions contained in each thought in the first column. Create and list in the third column for each thought a rational replacement, using objective, neutral descriptions.

The next time you feel anxious, depressed or upset about anything, try to get rid of all the distorted thoughts by first noticing them and then replacing them with rational thoughts.

Cognitive Interpretation Many of the theoretical perspectives on BPD presented above share the idea that a person's suspicions about other people and thoughts about being persecuted and mistreated by others are just rationalizations.