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Cognitive behavioral techniques


Tools for Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, is a common form of talk therapy. Unlike some other therapies, CBT is typically intended as a short-term treatment, taking anywhere from a few weeks to a few months to see results.

Although the past is certainly relevant, CBT focuses on providing you with tools to solve your current problems. And there a lot of ways to get there with this type of therapy.

Here’s a look at some of the techniques used in CBT, what types of issues they address, and what to expect with CBT.

The key principle behind CBT is that your thought patterns affect your emotions, which, in turn, can affect your behaviors.

For instance, CBT highlights how negative thoughts can lead to negative feelings and actions. But, if you reframe your thoughts in a more positive way, it can lead to more positive feelings and helpful behaviors.

Your therapist will teach you how to make changes you can implement right now. These are skills you can continue to use for the rest of your life.

Depending on the issue you’re dealing with and your goals, there are several ways to approach CBT. Whatever approach your therapist takes, it will include:

  • identifying specific problems or issues in your daily life
  • becoming aware of unproductive thought patterns and how they can impact your life
  • identifying negative thinking and reshaping it in a way that changes how you feel
  • learning new behaviors and putting them into practice

After speaking with you and learning more about the issue you want help with, your therapist will decide on the best CBT strategies to use.

Some of the techniques that are most often used with CBT include the following 9 strategies:

1. Cognitive restructuring or reframing

This involves taking a hard look at negative thought patterns.

Perhaps you tend to over-generalize, assume the worst will happen, or place far too much importance on minor details. Thinking this way can affect what you do and it can even become a self-fulfilling prophecy.

Your therapist will ask about your thought process in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts so they’re more positive and productive.

For example: “I blew the report because I’m totally useless” can become “That report wasn’t my best work, but I’m a valuable employee and I contribute in many ways.”

2. Guided discovery

In guided discovery, the therapist will acquaint themselves with your viewpoint. Then they’ll ask questions designed to challenge your beliefs and broaden your thinking.

You might be asked to give evidence that supports your assumptions, as well as evidence that does not.

In the process, you’ll learn to see things from other perspectives, especially ones that you may not have considered before. This can help you choose a more helpful path.

3. Exposure therapy

Exposure therapy can be used to confront fears and phobias. The therapist will slowly expose you to the things that provoke fear or anxiety, while providing guidance on how to cope with them in the moment.

This can be done in small increments. Eventually, exposure can make you feel less vulnerable and more confident in your coping abilities.

4. Journaling and thought records

Writing is a time-honored way of getting in touch with your own thoughts.

Your therapist may ask you to list negative thoughts that occurred to you between sessions, as well as positive thoughts you can choose instead.

Another writing exercise is to keep track of the new thoughts and new behaviors you put into practice since the last session. Putting it in writing can help you see how far you’ve come.

5. Activity scheduling and behavior activation

If there’s an activity you tend to put off or avoid due to fear or anxiety, getting it on your calendar can help. Once the burden of decision is gone, you may be more likely to follow through.

Activity scheduling can help establish good habits and provide ample opportunity to put what you’ve learned into practice.

6. Behavioral experiments

Behavioral experiments are typically used for anxiety disorders that involve catastrophic thinking.

Before embarking on a task that normally makes you anxious, you’ll be asked to predict what will happen. Later, you’ll talk about whether the prediction came true.

Over time, you may start to see that the predicted catastrophe is actually not very likely to happen. You’ll likely start with lower-anxiety tasks and build up from there.

7. Relaxation and stress reduction techniques

In CBT, you may be taught some progressive relaxation techniques, such as:

  • deep breathing exercises
  • muscle relaxation
  • imagery

You’ll learn practical skills to help lower stress and increase your sense of control. This can be helpful in dealing with phobias, social anxieties, and other stressors.

8. Role playing

Role playing can help you work through different behaviors in potentially difficult situations. Playing out possible scenarios can lessen fear and can be used for:

  • improving problem solving skills
  • gaining familiarity and confidence in certain situations
  • practicing social skills
  • assertiveness training
  • improving communication skills

9. Successive approximation

This involves taking tasks that seem overwhelming and breaking them into smaller, more achievable steps. Each successive step builds upon the previous steps so you gain confidence as you go, bit by bit.

In your first session, you’ll help the therapist understand the problem you’re dealing with and what you hope to achieve with CBT. The therapist will then formulate a plan to achieve a specific goal.

Goals should be:

  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Time-limited

Depending on your situation and your SMART goals, the therapist might recommend individual, family, or group therapy.

Sessions generally last about an hour and take place once a week, though this can vary according to individual needs and availability.

Homework is also part of the process, so you’ll be asked to fill out worksheets, a journal, or perform certain tasks between sessions.

Open communication and feeling comfortable with your therapist are key. If you don’t feel completely comfortable with your therapist, try to find a therapist you can connect with and open up to more easily.

Look for a therapist who’s trained in CBT and who has experience treating your specific problem. Check to make sure they’re properly certified and licensed.

You may want to talk to your doctor or other healthcare providers for recommendations. Practitioners may include:

  • psychiatrists
  • psychologists
  • psychiatric nurse practitioners
  • social workers
  • marriage and family therapists
  • other professionals with mental health training

Most of the time, CBT takes a few weeks to a few months to start seeing results.

CBT can help with a variety of everyday problems, such as learning to cope with stressful situations or dealing with anxiety over a certain issue.

You don’t need a medical diagnosis to benefit from CBT.

It can also help with:

  • learning to manage powerful emotions like anger, fear, or sadness
  • dealing with grief
  • managing symptoms or preventing mental illness relapses
  • coping with physical health problems
  • conflict resolution
  • improving communication skills
  • assertiveness training

CBT can be effective for a variety of conditions, either alone or in combination with other therapies or medications. This includes:

  • addictions
  • anxiety disorders
  • bipolar disorders
  • chronic pain
  • depression
  • eating disorders
  • obsessive-compulsive disorder (OCD)
  • phobias
  • post-traumatic stress disorder (PTSD)
  • schizophrenia
  • sexual disorders
  • sleep disorders
  • tinnitus

CBT is not generally considered a risky therapy, though there are some things to keep in mind:

  • It’s a very individual thing, but in the beginning, some people might find it stressful or uncomfortable to confront their problems.
  • Some types of CBT, like exposure therapy, can increase stress and anxiety while you’re working your way through it.
  • It doesn’t work overnight. It takes commitment and willingness to work on new techniques between sessions and after therapy has ended. It’s helpful to think of CBT as a lifestyle change that you intend to follow and improve upon throughout your life.

Cognitive behavioral therapy (CBT) is a well-established, effective type of short-term therapy. It’s based on the connections between your thoughts, emotions, and behaviors, and how they can influence each other.

There are quite a few techniques that are used with CBT. Depending on the type of issue you want help with, your therapist will help figure out which CBT strategy is best suited to your particular needs.

Tools for Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, is a common form of talk therapy. Unlike some other therapies, CBT is typically intended as a short-term treatment, taking anywhere from a few weeks to a few months to see results.

Although the past is certainly relevant, CBT focuses on providing you with tools to solve your current problems. And there a lot of ways to get there with this type of therapy.

Here’s a look at some of the techniques used in CBT, what types of issues they address, and what to expect with CBT.

The key principle behind CBT is that your thought patterns affect your emotions, which, in turn, can affect your behaviors.

For instance, CBT highlights how negative thoughts can lead to negative feelings and actions. But, if you reframe your thoughts in a more positive way, it can lead to more positive feelings and helpful behaviors.

Your therapist will teach you how to make changes you can implement right now. These are skills you can continue to use for the rest of your life.

Depending on the issue you’re dealing with and your goals, there are several ways to approach CBT. Whatever approach your therapist takes, it will include:

  • identifying specific problems or issues in your daily life
  • becoming aware of unproductive thought patterns and how they can impact your life
  • identifying negative thinking and reshaping it in a way that changes how you feel
  • learning new behaviors and putting them into practice

After speaking with you and learning more about the issue you want help with, your therapist will decide on the best CBT strategies to use.

Some of the techniques that are most often used with CBT include the following 9 strategies:

1. Cognitive restructuring or reframing

This involves taking a hard look at negative thought patterns.

Perhaps you tend to over-generalize, assume the worst will happen, or place far too much importance on minor details. Thinking this way can affect what you do and it can even become a self-fulfilling prophecy.

Your therapist will ask about your thought process in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts so they’re more positive and productive.

For example: “I blew the report because I’m totally useless” can become “That report wasn’t my best work, but I’m a valuable employee and I contribute in many ways.”

2. Guided discovery

In guided discovery, the therapist will acquaint themselves with your viewpoint. Then they’ll ask questions designed to challenge your beliefs and broaden your thinking.

You might be asked to give evidence that supports your assumptions, as well as evidence that does not.

In the process, you’ll learn to see things from other perspectives, especially ones that you may not have considered before. This can help you choose a more helpful path.

3. Exposure therapy

Exposure therapy can be used to confront fears and phobias. The therapist will slowly expose you to the things that provoke fear or anxiety, while providing guidance on how to cope with them in the moment.

This can be done in small increments. Eventually, exposure can make you feel less vulnerable and more confident in your coping abilities.

4. Journaling and thought records

Writing is a time-honored way of getting in touch with your own thoughts.

Your therapist may ask you to list negative thoughts that occurred to you between sessions, as well as positive thoughts you can choose instead.

Another writing exercise is to keep track of the new thoughts and new behaviors you put into practice since the last session. Putting it in writing can help you see how far you’ve come.

5. Activity scheduling and behavior activation

If there’s an activity you tend to put off or avoid due to fear or anxiety, getting it on your calendar can help. Once the burden of decision is gone, you may be more likely to follow through.

Activity scheduling can help establish good habits and provide ample opportunity to put what you’ve learned into practice.

6. Behavioral experiments

Behavioral experiments are typically used for anxiety disorders that involve catastrophic thinking.

Before embarking on a task that normally makes you anxious, you’ll be asked to predict what will happen. Later, you’ll talk about whether the prediction came true.

Over time, you may start to see that the predicted catastrophe is actually not very likely to happen. You’ll likely start with lower-anxiety tasks and build up from there.

7. Relaxation and stress reduction techniques

In CBT, you may be taught some progressive relaxation techniques, such as:

  • deep breathing exercises
  • muscle relaxation
  • imagery

You’ll learn practical skills to help lower stress and increase your sense of control. This can be helpful in dealing with phobias, social anxieties, and other stressors.

8. Role playing

Role playing can help you work through different behaviors in potentially difficult situations. Playing out possible scenarios can lessen fear and can be used for:

  • improving problem solving skills
  • gaining familiarity and confidence in certain situations
  • practicing social skills
  • assertiveness training
  • improving communication skills

9. Successive approximation

This involves taking tasks that seem overwhelming and breaking them into smaller, more achievable steps. Each successive step builds upon the previous steps so you gain confidence as you go, bit by bit.

In your first session, you’ll help the therapist understand the problem you’re dealing with and what you hope to achieve with CBT. The therapist will then formulate a plan to achieve a specific goal.

Goals should be:

  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Time-limited

Depending on your situation and your SMART goals, the therapist might recommend individual, family, or group therapy.

Sessions generally last about an hour and take place once a week, though this can vary according to individual needs and availability.

Homework is also part of the process, so you’ll be asked to fill out worksheets, a journal, or perform certain tasks between sessions.

Open communication and feeling comfortable with your therapist are key. If you don’t feel completely comfortable with your therapist, try to find a therapist you can connect with and open up to more easily.

Look for a therapist who’s trained in CBT and who has experience treating your specific problem. Check to make sure they’re properly certified and licensed.

You may want to talk to your doctor or other healthcare providers for recommendations. Practitioners may include:

  • psychiatrists
  • psychologists
  • psychiatric nurse practitioners
  • social workers
  • marriage and family therapists
  • other professionals with mental health training

Most of the time, CBT takes a few weeks to a few months to start seeing results.

CBT can help with a variety of everyday problems, such as learning to cope with stressful situations or dealing with anxiety over a certain issue.

You don’t need a medical diagnosis to benefit from CBT.

It can also help with:

  • learning to manage powerful emotions like anger, fear, or sadness
  • dealing with grief
  • managing symptoms or preventing mental illness relapses
  • coping with physical health problems
  • conflict resolution
  • improving communication skills
  • assertiveness training

CBT can be effective for a variety of conditions, either alone or in combination with other therapies or medications. This includes:

  • addictions
  • anxiety disorders
  • bipolar disorders
  • chronic pain
  • depression
  • eating disorders
  • obsessive-compulsive disorder (OCD)
  • phobias
  • post-traumatic stress disorder (PTSD)
  • schizophrenia
  • sexual disorders
  • sleep disorders
  • tinnitus

CBT is not generally considered a risky therapy, though there are some things to keep in mind:

  • It’s a very individual thing, but in the beginning, some people might find it stressful or uncomfortable to confront their problems.
  • Some types of CBT, like exposure therapy, can increase stress and anxiety while you’re working your way through it.
  • It doesn’t work overnight. It takes commitment and willingness to work on new techniques between sessions and after therapy has ended. It’s helpful to think of CBT as a lifestyle change that you intend to follow and improve upon throughout your life.

Cognitive behavioral therapy (CBT) is a well-established, effective type of short-term therapy. It’s based on the connections between your thoughts, emotions, and behaviors, and how they can influence each other.

There are quite a few techniques that are used with CBT. Depending on the type of issue you want help with, your therapist will help figure out which CBT strategy is best suited to your particular needs.

Cognitive Behavioral Therapy (CBT) or Cognitive Behavioral Psychotherapy (CBT)

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DIRECTION GUIDE

Contents

Behaviorism and cognitivism

Basic concepts

Techniques and exercises

When will CBT help?

Course duration

Evidence-based medicine and CBT

Medical therapy and CBT

Case studies

What to read

What is CBT?


Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions.

From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.

Behaviorism and cognitivism


The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee. As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved.

Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect.

“Cognitions are basically all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs. Dysfunctional and maladaptive views make it difficult to adequately assess life situations. Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems.

Anastasia Afanasyeva, Psychotherapist KPT:

Historically, the development of KPT is divided into 4 waves:

The first wave
(1910s-1950s)

Behavioral therapy

Second wave
(1960s)

Classical approach of CBT and rational-emotive psychotherapy

Third wave
(1990s)

Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)

The fourth wave
(2010s)

The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications

In 1913, the American psychologist John Watson publishes the first articles on behaviorism. He urges his colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process.

In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.

Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.

Historical reference

Basic concepts: automatic thoughts, cognitive distortions

Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment. Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel.

“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear. Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career.

Anastasia Afanasyeva, psychotherapist CBT:

Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:

Generalization

“I never have relationships”, “I always ruin everything”, “I always have bad luck”. A person carries over the characteristics of a single incident for life.

Catastrophe

“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.

Duty

“I owe”, “They owe me”, “Everything should have turned out this way and not otherwise. ” Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account.

Conformity

“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.

The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.

Techniques and exercises


One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.

An example of what columns a CBT diary can contain. Each therapist offers his own diary system.

“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.”

Anastasia Afanasyeva, CBT psychotherapist:

Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.

For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it.

When will CBT help?


The effectiveness of the CPT is proved for the following states:

All types of phobia

Alarm

Panic disorder and panic attacks

Depression

Occupation and compulsive disorders (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals

Psychosomatic disorders

irritable intestine, headaches and another

post -traumatic stress disorder

Eating disorders

Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations

Dependencies 9000,0003

Physical and physical mental

Aggressive behavior

CBT in panic attacks

Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.

A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.

“Panic attacks can occur in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist.

Anastasia Afanasyeva, psychotherapist CBT:

The exposure technique mentioned above is very well the main tool for dealing with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.

“First, there is a stage of psycho-education: we tell what happens in the patient's body at the time of the attack. We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears.

Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.

The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition. "

Anastasia Afanasyeva, psychotherapist CBT:

Duration of the course

CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work.

Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.

« Terms are always individual and depend on the severity of the condition. For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder.

As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.

Anastasia Afanasyeva, CBT psychotherapist:

Evidence-based medicine and CBT

Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy. In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here.

1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).

Medication and CBT

There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression. However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression.

« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.

If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.”

Anastasia Afanasyeva, psychotherapist CBT:

Case reports


“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite . In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be".

During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.

Anastasia Afanasyeva, psychotherapist CBT:

What to read?

Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning

This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT. The authors dwell on techniques and exercises that help to cope with the manifestations of anxiety and symptoms of panic attacks.

Cognitive Behavioral Therapy for Dummies. Rena Branch, Rob Wilson

A book from practicing therapists that explains CBT principles, concepts and how to deal with various disorders in simple language. In addition to practical advice and exercises, you will find many examples from the practice of the authors in it.

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Cognitive Behavioral Therapy (CBT) or Cognitive Behavioral Psychotherapy (CBT)

FIND A PSYCHOLOGIST

We tell you how one of the most popular psychotherapy techniques works, which allows you to correct thinking and emotional reactions.

alter

DIRECTION GUIDE

Contents

Behaviorism and cognitivism

Basic concepts

Techniques and exercises

When will CBT help?

Course duration

Evidence-based medicine and CBT

Medical therapy and CBT

Case studies

What to read

What is CBT?


Cognitive Behavioral Therapy (or CBT) is a technique that highlights a person's unconscious motivations, transfers them to a conscious level, helps to change beliefs and behavior that cause neurotic and other pathological conditions.

From the name it is clear that CBT combines two scientific psychological approaches: cognitive and behavioral (behavioristic). The first states that psychological problems and neuropsychiatric disorders are caused by thoughts and beliefs, stereotypes of thinking acquired during life. The second argues that human (as well as animal) behavior can be changed by encouraging desirable forms of action and not reinforcing undesirable behavior.

Behaviorism and cognitivism


The theory of behaviorism (from the English behavior - behavior) was developed in the early twentieth century. It considers behavior as a set of reactions (reflexes) to environmental stimuli. One of the basic concepts of behaviorism is positive and negative reinforcement. Positive reinforcement, or encouragement, is applied when the individual has done the right thing, and helps to reinforce the desired form of behavior. Negative reinforcement implies a negative reaction to the undesirable behavior of the trainee. As a rule, the first form of reinforcement is used in CBT: it works faster, clearly indicates what needs to be achieved.

Cognitivism is a scientific movement that originated in the 1960s. It focuses on mental processes: how people perceive, think, remember, learn, solve problems, where they direct their attention. Cognitions are any thoughts and ideas that become the fruits of our thinking. According to the cognitive approach, it is inefficient to work only with a person’s behavior to solve his psychological problems: first, you need to identify beliefs, ideas and thoughts that make him act destructively or feel discomfort, get rid of them, and only then work on the behavioral aspect.

“Cognitions are basically all mental processes, both adequate and dysfunctional. When children are born, they don't know anything about the world yet. Over time, they begin to encounter people and their ideas about the environment. Parents and society help them formulate both adequate and dysfunctional beliefs. Dysfunctional and maladaptive views make it difficult to adequately assess life situations. Fears, complexes are formed, the child has a feeling that he is doing something wrong. It is this feeling that in the future leads to neurotic and other psychological problems.

Anastasia Afanasyeva, Psychotherapist KPT:

Historically, the development of KPT is divided into 4 waves:

The first wave
(1910s-1950s)

Behavioral therapy

Second wave
(1960s)

Classical approach of CBT and rational-emotive psychotherapy

Third wave
(1990s)

Development of new currents within CBT: dialectical-behavioral psychotherapy, schema therapy, mindfulness therapy, acceptance and obligation therapy (ACT)

The fourth wave
(2010s)

The emerging stage associated with the use of modern technologies in therapy: augmented reality gadgets and software applications

In 1913, the American psychologist John Watson publishes the first articles on behaviorism. He urges his colleagues to focus exclusively on the study of human behavior, the study of the connection "external stimulus - external reaction (behavior)". Instead of analyzing the structural components of consciousness, behaviorists looked for reproducible connections between observed events, in particular between stimuli (environment) and responses (observed and measured reactions of people or animals to stimuli). Learning theories were the main model in the psychology of that time. Behaviorists have tried to formulate an explanation for how an organism establishes new connections between stimulus and response. Despite its early and sustained success, the behavioral approach placed many limitations on the therapy process.

In 1955, the founder of rational-emotional psychotherapy, Albert Ellis, announced the influence of our thoughts and ideas (cognitions) on mental processes. His colleague Aaron Beck begins to study the field of knowledge. After evaluating the results of various methods of therapy, he comes to the conclusion that our emotions and behavior depend on the way we think.

Despite attempts by behavioral therapists to maintain their position in the late 1950s and early 1960s, the ideas of cognitivism became increasingly influential. Publication of the book by A.T. Beck on Cognitive Therapy for Depression (Beck et al., 1979), as well as studies showing that cognitive therapy treats depression as effectively as antidepressants (Rush, Beck, Kovacs & Hollon, 1977), changed psychotherapy forever. In subsequent years, behavioral and cognitive therapy developed together and influenced each other so strongly that they eventually merged into a single cognitive-behavioral approach.

Historical reference

Basic concepts: automatic thoughts, cognitive distortions

Search and awareness automatic thoughts - the basis of the CBT method. About 20 thousand of such quick thoughts arise in our head per day, which are a response to what is happening to us. They are always appreciated. Evolutionarily automatic thoughts are necessary so that we can quickly respond to changes in the environment. Most of them we do not have time to realize. These thoughts trigger our emotional response. In order to understand why our state has changed (anxiety, fear appeared, mood fell), it is necessary to identify what kind of thought caused this change. CBT suggests looking for quick thoughts in order to process them and translate your judgments into a rational channel.

“There is always a situation that triggers a state change. For example, a person is walking in the dark and hears something rustling in the bushes. He becomes anxious. Most likely, the thought flashed that there was a danger nearby. In response to this thought and feeling of anxiety, the person decides to leave quickly. However, a quick thought and a reaction to it are not always rational. For example, you are doing a work task and realize that you do not have time to complete it on time. A neurotic person may have automatic thoughts: I am not responsible enough, I will be fired. The emotional response to them is anxiety, fear. Although if you think rationally, it is unlikely that one missed deadline will negatively affect your entire career.

Anastasia Afanasyeva, psychotherapist CBT:

Cognitive Behavioral Therapy works on cognitive distortions (or errors) that arise from automatic thoughts. Cognitive distortions are erroneous conclusions, irrational ideas that ultimately lead a person to psychological problems. There are over 100 types of cognitive distortions. Here are just a few examples:

Generalization

“I never have relationships”, “I always ruin everything”, “I always have bad luck”. A person carries over the characteristics of a single incident for life.

Catastrophe

“Everything is very bad”, “This is a failure”, “Irreparable happened”. Under the influence of negative judgments and emotions, the feeling of the situation is pumped up to complete hopelessness.

Duty

“I owe”, “They owe me”, “Everything should have turned out this way and not otherwise. ” Social roles and responsibilities become immutable truths, neither the specifics of the situation, nor the state of the person, nor the complexity of relationships are taken into account.

Conformity

“Everyone does/behaves like this. Those who do otherwise are bad/inferior, etc.” Ideas about norms received from outside cause one to stigmatize the slightest deviation in oneself and others.

The task of the CBT therapist is to identify cognitive distortions that negatively affect the client's quality of life and help develop rational, constructive thought patterns in their place.

Techniques and exercises


One of the main techniques of the method is keeping a CBT diary . Usually it is a table in which you need to enter daily events that caused a strong emotional reaction, and analyze them according to the proposed scheme. Further cases are discussed with the therapist at the session.

An example of what columns a CBT diary can contain. Each therapist offers his own diary system.

“After the client has learned to identify his automatic thoughts, he begins to keep a diary for a week. We look at what thoughts most often arise in different situations. This may be the fear that the person will look in someone's eyes as optional (that is, bad), or a feeling that he is not successful, or a feeling that he is vulnerable and will not cope. From the automatic thoughts we recognize, core beliefs begin to emerge. Not quick, superficial thoughts, but the foundation on which the human psyche is based. We are working on changing this array of beliefs in a rational direction.”

Anastasia Afanasyeva, CBT psychotherapist:

Another important technique for CBT is exposure . It is especially useful in all kinds of phobias. Exposure helps the client learn not to avoid disturbing situations, but to experience them.

For example, a person is afraid to enter an elevator. When using the exposure technique, the client and therapist approach the booth, stop, and begin to observe the client's reaction. When the anxiety rises, they do exercises with the therapist to help them cope with the anxiety. If the reaction is managed, the client and therapist move on to the next step: they enter the elevator together. The level of anxiety rises again, the therapist again works out with the client his condition. The intensity of the situation gradually increases until the client receives all the necessary skills in order to be aware and rationally assess his condition, to cope with it.

When will CBT help?


The effectiveness of the CPT is proved for the following states:

All types of phobia

Alarm

Panic disorder and panic attacks

Depression

Occupation and compulsive disorders (OKR)
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 thoughts, actions, rituals

Psychosomatic disorders

irritable intestine, headaches and another

post -traumatic stress disorder

Eating disorders

Difficulties with communication, building contacts and their maintenance, constancy in the work and family relations

Dependencies 9000,0003

Physical and physical mental

Aggressive behavior

CBT in panic attacks

Panic attacks are spontaneous panic attacks that are accompanied by rapid breathing, palpitations, dizziness, tremor, nausea, sweating and other somatic manifestations.

A panic attack may be the result of other psychiatric disorders rather than a single illness. Recurrent panic attacks without other symptoms may be manifestations of panic disorder. Cognitive behavioral therapy is the proven and most effective treatment for it.

“Panic attacks can occur in depressive disorders, generalized anxiety disorder, and hypochondriacal disorders. This is a very non-specific symptom, such as fever. It is found in various diseases. To make an accurate diagnosis, before starting treatment, you need to be diagnosed by a psychiatrist or psychotherapist.

Anastasia Afanasyeva, psychotherapist CBT:

The exposure technique mentioned above is very well the main tool for dealing with panic attacks. The psychotherapist teaches the patient to recognize what is happening to him at the time of the attack, how and to what his body reacts. Gradually, the patient learns to cope with his condition.

“First, there is a stage of psycho-education: we tell what happens in the patient's body at the time of the attack. We analyze cycles, thoughts, emotions, behavior, we are looking for the reason that starts the process. Further work is based on the fact that in the office we learn to cause symptoms: dizziness, palpitations, hyperventilation. We practice techniques to endure the anxiety that these symptoms cause. Thus, gradually we build tolerance. Anxiety decreases and eventually disappears.

Shortness of breath can be caused by hyperventilation - rapid shallow breathing. Dizziness - spinning in place. Palpitations - squats or running up the stairs. All exercises are performed together with the therapist. We say that it is not dangerous, the person understands this. When during the session I breathe with the patient, he sees that I normally endure this state. In doing so, he observes what happens to his own sensations.

The essence of a panic attack is that it always goes away. The fear that it will start, most often becomes the trigger for its start. It brings other problems as well, such as avoiding certain situations or carefully checking one's condition. "

Anastasia Afanasyeva, psychotherapist CBT:

Duration of the course

CBT is considered a short-term therapy, but the duration of the course depends on many factors. For a specific request, such as a phobia or difficulty falling asleep, about 10 sessions are needed. However, this format involves solving only one problem. For multiple problems and more complex conditions, the course will last from a few months to a year. Treating personality disorders will require even longer work.

Therapy involves a meeting once a week, at a pre-selected time. The duration of the session is 50 minutes. Outside of sessions, the client does homework.
Each session has a structure: agenda, checking homework, discussing specific requests, working through them, debriefing, receiving homework, feedback.

« Terms are always individual and depend on the severity of the condition. For panic attacks or depression, this is six months to a year. For complex diseases or personality disorders, therapy can be very long. In addition to the form and severity of the disease, the ability and desire of a person to get involved in work play a role. There are people who are more prone to reflection, it is easier for them to realize their own mental processes. There are people who find it harder.

As with any therapy, one should not expect miracles from CBT. You cannot change in a couple of months, and even in six months. But you can learn to see the relationship between your thoughts, emotions and behavior, and this will allow you to weed out unnecessary thoughts, change reactions, not be led by your beliefs left by your parents and the outside world, and not let anxiety and fear rule your life.

Anastasia Afanasyeva, CBT psychotherapist:

Evidence-based medicine and CBT

Cognitive Behavioral Therapy (CBT) is one of the most researched methods of psychotherapy. In 2012, a Boston University Department of Psychology Working Group released a seminal systematic review of meta-analyses (1) of various studies, which is the most comprehensive scientific paper on the effectiveness of CBT to date. Based on 269 papers, the researchers concluded that the referral was extremely effective in dealing with anxiety and mood disorders, highly effective in treating phobias, insomnia, and significantly effective in reducing workplace stress. The full text of the review in English can be found here.

1 Meta-analysis is a type of data analysis in which the results of a number of randomized clinical trials are combined and analyzed as a single large study. In evidence-based medicine, meta-analysis is assigned the highest level of evidence (IA).

Medication and CBT

There are a number of conditions that can be treated with non-medicated CBT, such as mild generalized anxiety disorder, panic disorder, mild OCD, mild depression. However, in a number of conditions, it is recommended to combine psychotherapy with pharmacotherapy. These include moderate depression and severe depression.

« Fear of pharmacotherapy is quite common and I deal with it regularly. I can say that many fears are unfounded. There is a myth that antidepressants are addictive. According to all studies, no antidepressant causes either mental or physical dependence.

If you have a fear of medication, see a qualified doctor who is trained in psychotherapy and pharmacotherapy. He will conduct a medical diagnosis, decide whether it is really necessary to carry out drug therapy, and help work through your fear using CBT techniques.”

Anastasia Afanasyeva, psychotherapist CBT:

Case reports


“A young man asked for help: after breaking up with a girlfriend, he suffered from depressed mood, anxiety, difficulty falling asleep, obsessive thoughts before going to bed, loss of appetite . In the course of therapy, we uncovered the hidden beliefs that generated these reactions. He believed that if he could not "keep" the relationship, then this indicates his unreliability, if he failed to choose an "adequate" partner, this indicates weakness. Also, the client could not understand what he needed, he relied on ideas about how "should be".

During three months of work, the client has learned to be aware of his needs, desires, track thoughts and engage in polemics with them. The young man was able to emotionally distance himself from obsessive thoughts, the mood background leveled off. He built his schedule in accordance with his own goals and values, acquired awareness skills.

Anastasia Afanasyeva, psychotherapist CBT:

What to read?

Cognitive Behavioral Therapy for Anxiety, Fear, Worry and Panic. Michelle Skin, Matthew McKay, Patrick Fanning

This book is for those who are already in therapy and want to understand the basics of the method and get the most out of CBT.

Learn more