Behavioral behavioral psychotherapy. Behavioral psychotherapy

Behavioral therapy, also called behavioral therapy, is one of the newest trends in modern psychotherapy. However, this does not interfere with the fact that behavior therapy is the leading method. It is behavior that acts as the main and fundamental element of psychotherapeutic direction.

In general terms, behavioral therapy is a special psychotherapy based on changes in human behavior. But when the behavior itself changes, changes necessarily occur in the volitional, cognitive and emotional spheres person. Psychologists believe that this direction is mainly based on behavioral principles and approaches. Here, the principles of learning are used to change three structures - behavioral, emotional and cognitive.

Features of behavioral psychotherapy

In psychology, behavior and its study occupy a significant position in working with patients faced with a wide variety of problems.

It is worth noting that based on the applied behavioral therapy New directions were developed, such as dialectical behavior therapy. Dialectical method widely used in working with patients who suffer from borderline personality disorder.

The behavioral approach includes an extensive list of different techniques. Although initially such a term as “behavior” in psychology was perceived exclusively as an externally observable and manifested characteristic. Now this includes a wide range of manifestations - from emotional-subjective and cognitive, to motivational-affective and more.

Since all these manifestations are united under one concept, this indicates their subordination to the laws of this psychotherapeutic teaching; based on them, a specialist can control a person’s emotions.

The theoretical basis of the behavioral therapy used is psychology, which is called behaviorism.

Behaviorism or behavior therapy also defines the approach to problems of disease and health. A person’s health or illness is a natural result of what a person has learned or failed to learn. Personality is the experience gained by a person during his life. At the same time, neurosis does not act as independent unit, since the nosological approach here, in its essence, has no place to be. The focus of attention is not the disease at all, but rather the symptom.

Basic provisions

The behavioral approach or behavioral direction in psychotherapy is based on certain provisions. These are the characteristics of behavioral psychotherapy:

• First position. A number of cases of pathological behavior, previously considered as diseases or symptoms of a disease, from the perspective of behavioral therapy (BT) are non-pathological problems of life. These are alarming situations, reactions, behavioral disorders and sexual deviations.
• Second position. Pathological behavior is predominantly acquired.
• Third position. The behavioral approach mainly focuses on current human behavior rather than past life patient. The psychological method treatment allows you to better understand the person being studied, describe and evaluate the situation based on specific situation, and not the problems of the past.
• Fourth position. Behavioral therapy techniques require mandatory preliminary analysis issues in order to highlight key points. After this, the identified individual components are subjected to certain effects using appropriate psychotherapeutic procedures.
• Fifth position. In behavioral psychotherapy, intervention techniques are developed individually, depending on the specific problems of an individual patient.
• Sixth position. The behavioral approach allows success in treating the patient's problem without the need for data on etiology.
• Seventh position. All methods of behavioral psychotherapy are based exclusively on scientific approach to consider and study problems. This means that the therapy starts from a basic concept that can be tested through experimentation. Also, the techniques used are described precisely enough for the purpose of their objective measurement and repetition as necessary. An important feature of PT methods is the possibility of experimental evaluation of their concepts.

Application of behavioral therapy

Various methods of behavioral therapy are aimed at helping patients faced with various difficult situations that require intervention from specialists. For example, PT is carried out for autism, social phobia and even obesity.

The behavioral therapy system is used in the following situations:

• at anxiety states;
• in case of chronic mental disorders;
• for sexual disorders;
• to solve emerging marital and interpersonal problems;
• for psychopathologies in children.

Research has clearly proven that PT can effectively help in cases of phobias in a person. In this case, the basic technique used is systematic exposure. The concept of exposure refers to a number of techniques that are based on the presentation of patients’ existing fears. Also, as a supplement for anxiety conditions, the technique is used.

The method of behavioral therapy has been proven to be highly effective in solving problems in the field of sexual relationships.

Many patients prefer this type of psychotherapy, since it allows them to solve the problem of premature ejaculation, vaginismus, impotence, etc.

Couples therapy is a method of training the members of a couple to positively as well as productively achieve desired positive behavioral changes.

In some situations, full-fledged family behavioral psychotherapy is required. The fact is that a number of difficulties and problems experienced by a person can be directly related to members of his family. Therefore, everyone should take part in therapy. This allows you to analyze the situation, determine the role of each family member and solve the current problem.

If we talk about mental disorders, then PT is capable of solving problems exclusively of chronic, but not acute disorders. Behavioral methods of influence are used when working with patients who have significant personality changes or low levels of self-care. PT allows you to solve psychological problems patients in early childhood - This, bad behavior excessive aggression and other violations of norms. In the treatment of hyperactivity, the so-called token technique is widely used. The effectiveness of PT has been clearly proven when it is necessary to improve a child’s academic performance and solve the problem of autism. Autism - current problem lots of children. But it is PT that demonstrates some of the best results to normalize behavioral and. Of course, the percentage is only about 2% of children with autism who have been cured. But among all the methods existing today, only PT has managed to achieve such impressive results.

Basic methods of PT

Cognitive restructuring technique

These methods are based on assumptions about the emergence of emotional disorders as a result of cognitions, that is, maladaptive stereotypes of human thinking. The goal of the method is to change cognitions.

Experts teach how to use calming thoughts when the patient is in stressful situation. One of the most popular techniques is based on stress inoculation training. It involves the need for the patient to imagine being in a stressful situation and apply new skills. The practice of rational emotional behavioral therapy - the emotive method - is widely used.

The practice of rational emotional behavior therapy is characterized by a combination of behavioral and cognitive methods. RET, REBT, or Rational Emotional Behavioral Therapy uses reward factors. The simplest of them are a nod, a smile, or attention. Everyone is looking for a reward or encouragement. And those people from whom we receive them become important and close to us, friendship develops. Those who do not give encouragement, we do not accept or even try to avoid.

Self-control

The method requires the patient to directly participate in determining the goals of his treatment and strict implementation of the therapy program. For these purposes, various self-control procedures are used.

Self-control is the basis for successful self-regulation of problem behavior. By using this method a person better understands the essence of his problem and his own actions. The therapist's task is to help the patient almost independently determine the goal or establish certain standards that govern behavior. An example is the treatment of obesity, where the amount of calories for each day is jointly prescribed as part of the therapy.

The clearer and shorter-term the goals set, the higher the likelihood of developing successful self-control. If you just tell yourself, “I won’t eat much with tomorrow", success will not be achieved. You need to say, “Starting tomorrow, I will eat no more than 1 thousand calories.” Unclear goals lead to failure, which negatively affects self-esteem. If the goal is achieved, the patient has an incentive to develop success.

Disgust technique

A technique aimed at inducing disgust is called aversive psychotherapy. A striking example This method is the treatment of alcohol addiction, when the patient is offered small portions of alcohol, but at the same time he uses substances that can cause discomfort(nausea, vomiting, etc.).

Enuresis, tremors in the hands, stuttering and other similar disorders can be cured with electric shocks.

Method of punishment

Unlike the previous method, here the patient receives punishment after an undesirable behavioral situation. For example, a patient performed an undesirable action and subsequently received an electric shock. Writer's cramp of the tremor and spastic form is treated with these methods.

Punishment training encourages a person to relax necessary groups muscles, thereby coping with the problem.

Positive reinforcement

This method is based on establishing a connection between the patient’s current behavior and the resulting consequences of his behavior. The most popular method of positive reinforcement is the so-called token system. It is widely used both in working with withdrawn and uncommunicative children or adults, and in treating people with severe personality or mental retardation.

The essence of the token technique is to reward the patient for the actions they perform. For example, they are tasked with speaking clearly, doing homework, clean the room or wash the dishes after yourself. At the same time, there must be a price list system, which indicates how many conditional tokens a person will receive if he completes certain tasks or achieves certain goals.

Self-confidence

The technique was developed to work with people who lack self-confidence. They are unable to express their emotions or defend their rights, own opinion. Such people are often exploited, they do not respect themselves. What can we say about respect from the people around us.

Similar psychotherapy trainings are conducted in groups. Through exercise, patients develop self-confidence, develop a model of self-affirming behavior and try to change the reaction towards themselves from the environment. This technique helps to raise self-esteem, gain confidence and the ability to defend one’s opinion, beliefs or rights.

Also, this method of PT is capable of developing in a person the appropriate ability to communicate, the ability to listen to others and establish trusting relationships.

Systematic Desensitization (SD)

Here the focus is on the anxiety that a person faces in certain situations. Anxiety is a persistent response from the outside nervous system, which is acquired through classical conditioning. The author of this method has developed a technique that allows you to extinguish these autonomous conditioned reactions - systematic desensitization or SD.

Practice has shown that the most effective stimulus for getting rid of anxiety is muscle relaxation. After mastering this relaxation technique, the second stage begins - a hierarchical composition of the situation, which provokes anxiety or fear. Then the patient, who is already in a relaxed state, should vividly imagine a situation occupying the lowest level of the constructed hierarchy. This is the level that is least associated with anxiety or fear.

SD or systemic behavioral psychotherapy is also carried out by actually immersing a person or patient in the situation of their phobia. Moreover, psychotherapists claim that this approach gives the highest effect.

Modeling technique

It is not uncommon for specialists to resort to the modeling method. It involves teaching the patient the required behavior by modeling or visually demonstrating it.

The simplest example is that a psychotherapist uses his own example to show his patient how to behave in a given situation that can provoke fear or anxiety.

Let's say you are very afraid of cockroaches. The specialist clearly demonstrates that they are not dangerous and are very easy to kill. First, training is carried out through a visual demonstration, then the patient trains on some models or rubber insects. Gradually, a person independently reacts to his fear without screaming, panic or fear.

Extinction methods

Such techniques are called immersion or immersion. The peculiarity of the technique is that a person faces his fear directly without the condition of prior relaxation. There are several methods that are based on the phenomenon of immersion, that is, extinction.

• Flood. The patient and the specialist are immersed in situations that provoke fear and remain there until the moment when the feeling of fear subsides. At the same time, you should not try to distract yourself in order to reduce the intensity of anxiety.
• Intention (paradoxical). If we talk in simple language, then this is a method of detaching from neurosis. Therapy involves deliberately evoking the symptom and dealing with it with humor. Having laughed at his own fear, he will cease to be such.
• Implosion. Based on the hierarchy of fear. Therapy begins from the lowest levels, gradually increasing the patient’s anxiety level more and more. The main task is to achieve the maximum level of fear within 30-60 minutes.

Behavioral therapy can help manage symptoms or the disease itself, but this psychotherapeutic method is not intended to eliminate the causes. Therefore, unwanted behavior sometimes appears again after completion of treatment. In such situations, the method of exposure is changed or a repeat course is carried out.

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

A person, under the influence of emotions, consolidates certain forms behavior in certain situations. Sometimes copies the behavior of others. Reacts to various phenomena and situations in the way they are used to it, often without realizing that they are harming others or themselves.

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

Cognitive behavioral therapy – for whom

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

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

Cognitive behavioral therapy course

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

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

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

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

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

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

Cognitive behavioral therapy - methods

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

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

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

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

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

Benefits of Cognitive Behavioral Therapy

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

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

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

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

Behavioral psychotherapy

Behavioral therapy; behavioral therapy(from English behavior- “behavior”) is one of the leading areas of modern psychotherapy. Behavioral psychotherapy is based on Albert Bandura's learning theory, as well as the principles of classical and operant conditioning. This form of psychotherapy is based on the idea that the symptoms of psychological disorders are due to incorrectly formed skills. Behavioral psychotherapy aims to eliminate unwanted behaviors and develop behavioral skills that are useful for the client. Behavioral therapy is most successfully used to treat phobias, behavioral disorders and addictions, that is, those conditions in which it is possible to identify a specific symptom as a “target” for therapeutic intervention. The scientific basis of behavioral psychotherapy is the theory of behaviorism. Behavioral therapy can be used either independently or in combination with cognitive psychotherapy (Cognitive-Behavioral Psychotherapy). Behavioral psychotherapy is a directive and structured form of psychotherapy. Its stages are: analysis of behavior, determination of the stages necessary for behavior correction, gradual training of new behavioral skills, development of new behavioral skills in real life. The main goal of behavioral therapy is not to understand the causes of the patient's problems, but to change his behavior.

Story

Although behavioral therapy is one of the the latest methods Treatments in psychiatry, the techniques that are used in it, existed already in ancient times. It has long been known that people’s behavior can be controlled using positive and negative reinforcements, that is, rewards and punishments (the “carrot and stick” method). However, only with the advent of the theory of behaviorism did these methods receive scientific justification.

Behaviorism as theoretical direction psychology arose and developed at about the same time as psychoanalysis (that is, from the end of the last century). However, the systematic application of the principles of behaviorism for psychotherapeutic purposes dates back to the late 50s and early 60s.

Behavioral therapy methods are largely based on the ideas of Russian scientists Vladimir Mikhailovich Bekhterev (1857-1927) and Ivan Petrovich Pavlov (1849-1936). The works of Pavlov and Bekhterev were well known abroad, in particular, Bekhterev’s book “ Objective psychology» provided big influence on J. Watson. All the major behaviorists in the West call Pavlov their teacher.

Already in 1915-1918, V. M. Bekhterev proposed the method of “combination-reflex therapy.” I.P. Pavlov became the creator of the theory of conditioned and unconditioned reflexes and reinforcement, with the help of which behavior can be changed (due to the development of desirable conditioned reflexes or the “extinction” of unwanted conditioned reflexes). Conducting experiments with animals, Pavlov found that if feeding a dog is combined with a neutral stimulus, for example, the ringing of a bell, then this sound will subsequently cause salivation in the animal. Pavlov also described phenomena associated with the development and disappearance of conditioned reflexes:

Thus, Pavlov proved that new forms of behavior can arise as a result of establishing a connection between innate forms of behavior (unconditioned reflexes) and a new (conditioned) stimulus. Pavlov's method was later called classical conditioning.

Pavlov's ideas were further developed in the works of the American psychologist John Watson. John B. Watson, 1878-1958). Watson concluded that classical conditioning, which Pavlov observed in animals, also exists in humans, and is the cause of phobias. In 1920, Watson conducted an experiment with an infant (en: Little Albert experiment). While the child was playing with a white rat, the experimenters induced fear in him using a loud sound. Gradually, the child began to be afraid of white rats, and later also of any furry animals.

In 1924, Watson's assistant, Mary Cover Jones (en: Mary Cover Jones, 1896-1987). used a similar method to cure a child of a phobia. The child was afraid of rabbits, and Mary Jones used the following techniques:

1. The rabbit was shown to the child from afar, while the child was feeding.
2. At the moment when the child saw the rabbit, the experimenter gave him a toy or candy.
3. The child could watch other children playing with rabbits.
4. As the child got used to the sight of the rabbit, the animal was brought closer and closer.

Thanks to the use of these techniques, the child’s fear gradually disappeared. Thus, Mary Jones created a method of systematic desentification, which has been successfully used to treat phobias. Psychologist Joseph Wolpe (1915-1997) called Jones "the mother of behavior therapy."

The term "behavioral therapy" was first mentioned in 1911 by Edward Thorndike (1874-1949). In the 1940s the term was used research group Joseph Volpe.

Volpe conducted the following experiment: placing cats in a cage, he subjected them to electric shocks. The cats very soon developed a phobia: they began to be afraid of the cage; if they were brought close to this cage, they tried to break free and run away. Then Wolpe began to gradually reduce the distance between the animals and the cage and give the cats food the moment they were near the cage. Gradually, the animals' fear disappeared. Wolpe suggested that using a similar method, phobias and fears in people could be eliminated. Thus, the systematic desensitization method, also sometimes called the systematic desensitization method, was created. Wolpe used this method mainly to treat phobias, social phobias and sexual disorders associated with increased anxiety.

Further development Behavioral therapy is primarily associated with the names of Edward Thorndike and Frederick Skinner, who created the theory of operant conditioning. In classical Pavlovian conditioning, behavior can be changed through modification initial conditions, in which this behavior is manifested. In operant conditioning, behavior can be changed by stimuli that follow for behavior (“rewards” and “punishments”). Edward Thorndike (1874-1949), conducting experiments with animals, formulated two laws that are still used in behavioral psychotherapy:

• "The Law of Exercise" Law of exercise), which states that the repetition of a certain behavior contributes to the fact that in the future this behavior will be manifested with an increasingly higher probability.
• "Law of Effect" Law of effect): if the behavior has positive result for an individual, it will be repeated with a higher probability in the future. If an action leads to unpleasant results, in the future it will appear less and less often or disappear altogether.

The ideas of behavioral therapy became widespread thanks to the publications of Hans Eysenck (German). Hans Eysenck; 1916-1997) in the early 1960s. Eysenck defined behavior therapy as the application modern theory training for the treatment of behavioral and emotional disorders. In 1963, the first journal devoted exclusively to behavioral psychotherapy (Behavior Research and Therapy) was founded.

In the 1950-1960s, the theory of behavior therapy developed mainly in three research centers:

Behavioral psychotherapy was established as an independent field around 1950. The popularity of this method was facilitated by the growing dissatisfaction with psychoanalysis, due to the insufficient empirical basis analytical methods, and also due to the duration and high cost analytical therapy while behavioral techniques have proven their effectiveness, and the effect was achieved in just a few therapy sessions.

By the end of the 60s, behavioral psychotherapy was recognized as an independent and effective form psychotherapy. Currently, this area of ​​psychotherapy has become one of the leading methods of psychotherapeutic treatment. In the 1970s, methods of behavioral psychology began to be used not only in psychotherapy, but also in pedagogy, management and business.

Initially, behavioral therapy methods were based exclusively on the ideas of behaviorism, that is, on the theory of conditioned reflexes and on learning theory. But currently there is a tendency towards a significant expansion of the theoretical and instrumental base of behavioral therapy: it can include any method whose effectiveness has been proven experimentally. Lazarus called this approach "Broad Spectrum Behavioral Therapy" or "Multimodal Psychotherapy." For example, behavioral therapy currently uses relaxation techniques and breathing exercises (in particular, diaphragmatic breathing) . Thus, although behavioral therapy is based on evidence-based methods, it is eclectic in nature. The techniques that are used in it are united only by the fact that they are all aimed at changing behavioral skills and abilities. According to the American Psychological Association, " Behavioral psychotherapy includes, first of all, the use of principles that were developed in experimental and social psychology... The main goal of behavioral therapy is to build and strengthen the ability to act, increase self-control» .

Methods similar to those of behavioral therapy were used in the Soviet Union starting in the 1920s. However, in domestic literature for a long time instead of the term “behavioral psychotherapy” the term “conditioned reflex psychotherapy” was used

Basic principles

Behavioral therapy scheme

Assessing the client's condition

This procedure in behavior therapy is called "functional analysis" or "applied behavior analysis" (eng. Applied behavior analysis). At this stage, the first step is to compile a list of behavior patterns that have negative consequences for the patient. Each behavior pattern is described according to the following scheme:

• How often?

• How long does it last?

• What are its consequences in the short and long term?

Then situations and events that cause neuroticism are identified behavioral response(fear, avoidance, etc.). . Using self-observation, the patient must answer the question: what factors can increase or decrease the likelihood of a desired or undesirable behavior pattern? You should also check whether the undesirable behavior pattern has any “secondary gain” for the patient, that is, hidden positive reinforcement this behavior. The therapist then determines for himself what strengths in the patient's character can be used in the therapeutic process. It is also important to find out what the patient's expectations are regarding what psychotherapy can give him: the patient is asked to formulate his expectations in specific terms, that is, to indicate which behavioral patterns he would like to get rid of and what forms of behavior he would like to learn. It is necessary to check whether these expectations are realistic. In order to obtain the most complete picture of the patient's condition, the therapist gives him a questionnaire, which the patient must fill out at home, using, if necessary, the method of self-observation. Sometimes a stage initial assessment takes several weeks because in behavioral therapy it is extremely important to obtain a complete and accurate description of the patient's problem.

In behavior therapy, the data obtained during the preliminary analysis stage is called " basic level"or "starting point" (eng. baseline). These data are subsequently used to evaluate the effectiveness of therapy. In addition, they allow the patient to realize that his condition is gradually improving, which increases motivation to continue therapy.

Drawing up a treatment plan

In behavioral therapy, it is necessary for the therapist to adhere to a specific plan when working with the patient, so after assessing the patient's condition, the therapist and patient draw up a list of problems that need to be solved. However, it is not recommended to work on several problems at the same time. Multiple problems must be addressed sequentially. You should not move on to the next problem until you have made significant improvement on the previous problem. If there is a complex problem, it is advisable to break it down into several components. If necessary, the therapist creates a “problem ladder,” which is a diagram that shows the order in which the therapist will work with the client's problems. The behavior pattern that should be changed first is selected as a “target”. The following criteria are used for selection:

• The severity of the problem, that is, how much great damage this problem brings the patient (for example, prevents him professional activity) or poses a danger to the patient (for example, severe alcohol dependence);

• What causes the most unpleasant sensations (for example, panic attacks);

In case of insufficient motivation of the patient or lack of self-confidence, therapeutic work can not begin with the most important issues, but from easily achievable goals, that is, from those behavior patterns that are easiest to change, or that the patient wants to change first. Move to more complex tasks is carried out only after simpler problems have been solved. During therapy, the therapist constantly checks the effectiveness of the methods used. If the initially chosen techniques are ineffective, the therapist should change the therapy strategy and use other techniques.

The priority in choosing a goal is always consistent with the patient. Sometimes therapeutic priorities may be revised during therapy.

Behavioral therapy theorists believe that the more specific the goals of therapy are formulated, the more effective the therapist's work will be. At this stage, you should also find out how great the patient's motivation is to change a particular type of behavior.

In behavior therapy it is extremely important factor success is how well the patient understands the meaning of the techniques the therapist uses. For this reason, usually at the very beginning of therapy, the basic principles of this approach are explained to the patient in detail, and the purpose of each specific method is explained. The therapist then uses questions to check how well the patient has understood his explanations and answers questions if necessary. This not only helps the patient correctly perform the exercises recommended by the therapist, but also increases the patient's motivation to perform these exercises daily.

In behavioral therapy, the use of self-observation and the use of “homework” are widespread, which the patient must complete daily, or even, if necessary, several times a day. For self-observation, the same questions that were asked to the patient at the preliminary assessment stage are used:

• When and how does it appear? this type behavior?

• How often?

• How long does it last?

• What are the triggers and reinforcing factors for this behavior pattern?

When giving a patient “homework,” the therapist must check whether the patient correctly understands what he is supposed to do and whether the patient has the desire and ability to complete this task every day.

We should not forget that behavioral therapy is not limited to eliminating unwanted behavior patterns. From the point of view of the theory of behaviorism, any behavior (both adaptive and problematic) always performs some function in a person’s life. For this reason, when problem behavior disappears, a vacuum of sorts is created in a person's life, which may be filled by new problem behavior. To prevent this from happening, when drawing up a behavioral therapy plan, the psychologist provides for what forms of adaptive behavior should be developed to replace problematic behavior patterns. For example, therapy for a phobia will not be complete unless it is established what forms of adaptive behavior will fill the time that the patient devotes to phobic experiences. The treatment plan should be written in positive terms and indicate what the patient should do rather than what he should not do. This rule is called the “living person rule” in behavior therapy - since the behavior of a living person is described in positive terms (what he is capable of doing), while the behavior dead person can only be described in negative terms(for example, a dead person cannot have bad habits, experience fear, show aggression, etc.).

Completion of therapy

As Judith S. Beck emphasizes, therapy focused on behavior change does not eliminate the client's problems once and for all. The goal of therapy is simply to learn how to cope with difficulties as they arise, that is, to “become your own therapist.” Renowned behavioral psychotherapist Mahoney Mahoney, 1976) even believes that the client should become a “research scientist” self and his behavior, which will help him solve problems as they arise (in behavioral therapy this is referred to as “self-management”). For this reason, at the final stage of therapy, the therapist asks the client what techniques and techniques turned out to be The therapist then recommends using these techniques independently, not only when the problem arises, but also for preventive purposes. The therapist also teaches the client to recognize the signs of the problem occurring or returning, as this will allow the client to take early action to cope with the problem. or at least reduce the negative effect of this problem.

Behavioral therapy methods

• Biological Feedback(Main article: Biofeedback) is a technique that uses equipment to monitor signs of stress in a patient. As the patient achieves a state of muscle relaxation, he receives positive visual or auditory reinforcement (for example, pleasant music or an image on a computer screen).

• Unlearning methods (aversive therapy)
• Systematic desensitization
• Shaping (behavior modeling)
• Auto-instruction method

Problems that arise during therapy

• The client's tendency to verbalize at length what he is thinking and feeling, as well as to try to find the causes of his problems in what he has experienced in the past. The reason for this may be the idea of ​​psychotherapy as a method that “allows you to speak out and understand yourself.” In this case, you should explain to the client that behavioral therapy consists of performing specific exercises, and its goal is not to understand the problem, but to eliminate its consequences. However, if the therapist sees that the client needs to express his feelings or find the underlying cause of his difficulties, then cognitive or humanistic psychotherapy techniques can be added to behavioral methods, for example.

• The client's fear that correcting his emotional manifestations will turn him into a “robot.” In this case, you should explain to him that thanks to behavioral therapy, his emotional world will not become poorer, just that negative and maladaptive emotions will be replaced by pleasant emotions.

• The client's passivity or fear of the effort required to perform the exercises. In this case, it is worth reminding the client what consequences such an installation may lead to in the long term. At the same time, you can review the treatment plan and start working with more simple tasks, breaking them down into separate stages. Sometimes in similar cases Behavioral therapy uses the help of the client's family members.

Sometimes the client has dysfunctional beliefs and attitudes that interfere with his involvement in the therapeutic process. These settings include:

• Unrealistic or inflexible expectations about the methods and results of therapy, which may be a form of magical thinking (suggesting that the therapist can fix any problem the client has). In this case, it is especially important to find out what the client's expectations are, and then create a clear treatment plan and discuss this plan with the client.

• The belief that only the therapist is responsible for the success of therapy, and that the client cannot and should not make any effort (external locus of control). This problem not only significantly slows down progress in treatment, but also leads to relapses after stopping meetings with the therapist (the client does not consider it necessary to do his “homework” and follow the recommendations that were given to him at the time of completion of therapy). In this case, it is helpful to remind the client that in behavior therapy, success is not possible without the active cooperation of the client.

• Dramatizing the problem, for example: “I have too many difficulties, I will never cope with this.” In this case, it is useful to start therapy with simple tasks and exercises that allow you to achieve quick results, which increases the client’s confidence that he is able to cope with his problems.

• Fear of judgment: The client is embarrassed to tell the therapist about some of his problems, and this prevents the development of an effective and realistic plan for therapeutic work.

If such dysfunctional beliefs exist, it makes sense to use cognitive psychotherapy methods to help the client reconsider his attitudes.

One of the obstacles to achieving success is the client's lack of motivation. As stated above, strong motivation is a necessary condition success of behavioral therapy. For this reason, motivation to change should be assessed at the very beginning of therapy, and then, in the course of working with the client, its level should be constantly checked (we should not forget that sometimes the client’s demotivation takes hidden forms. For example, he may stop therapy, assuring that his problem has been solved. In behavioral therapy this is called “escape to recovery”). To increase motivation:

• It is necessary to provide clear and precise explanations about the importance and usefulness of the techniques used in therapy;

• You should choose specific therapeutic goals, coordinating your choice with the desires and preferences of the client;

• It has been noticed that clients often focus on problems that have not yet been resolved and forget about problems that have already been solved. achievements achieved. In this case, it is useful to periodically evaluate the client's condition, visually showing him the progress achieved due to his efforts (this can be demonstrated, for example, using charts).

• A feature of behavioral therapy is its focus on quick, specific, observable (and measurable) results. Therefore, if there is no significant progress in the client's condition, then the client's motivation may disappear. In this case, the therapist must immediately reconsider the chosen tactics of working with the client.

• Because in behavior therapy the therapist works collaboratively with the client, it should be explained that the client is not obligated to blindly follow the therapist's recommendations. Objections on his part are welcome, and any objection should be immediately discussed with the client and, if necessary, changes to the work plan.

• To increase motivation, it is recommended to avoid monotony in working with a client; It is useful to use new methods that arouse the greatest interest in the client.

At the same time, the therapist should not forget that the failure of therapy may be associated not with the client’s dysfunctional attitudes, but with the hidden dysfunctional attitudes of the therapist himself and with errors in the application of behavioral therapy methods. For this reason, it is necessary to constantly use self-observation and the assistance of colleagues to identify which distorted cognitive attitudes and problematic behaviors prevent the therapist from achieving success in his work. The following errors are common in behavioral therapy:

• The therapist gives the client homework or a self-monitoring questionnaire, but then forgets about it or does not take the time to discuss the results. This approach can significantly reduce the client's motivation and reduce his trust in the therapist.

Contraindications to the use of behavioral psychotherapy

Behavioral psychotherapy should not be used in the following cases:

• Psychoses in the acute stage.

• Severe depressive states.

• Profound mental retardation.

In these cases, the main problem is that the patient is unable to understand why he should do the exercises that the psychotherapist recommends.

If the patient has personality disorders, behavioral therapy is possible, but it may be less effective and take longer because it will be more difficult for the therapist to gain active cooperation from the patient. Not enough high level intellectual development is not an obstacle to behavioral therapy, but in this case it is preferable to use simple techniques and exercises, the purpose of which the patient is able to understand.

Third generation behavioral psychotherapy

New directions in behavioral psychotherapy are united under the term “third generation behavioral therapy.” (See for example Acceptance and Commitment Therapy and Dialectical Behavior Therapy).

see also

Notes

1. Psychological Encyclopedia
2. Psychological Dictionary
3. Chaloult, L. La thérapie cognitivo-comportementale: théorie et pratique. Montréal: Gaëtan Morin, 2008
4. PSI FACTOR LIBRARY
5. Meyer W., Chesser E. Behavioral therapy methods, St. Petersburg: Rech, 2001
6. Garanyan, N. G. A. B. Kholmogorova, Integrative psychotherapy for anxiety and depressive disorders based on the cognitive model. Moscow Psychotherapeutic Journal. - 1996. - No. 3.
7. Watson, J.B. and Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3, 1, pp. 1-14
8. Cover Jones, M. (1924). A Laboratory Study of Fear: The Case of Peter. Pedagogical Seminary, 31, pp. 308-315
9. Rutherford, A Introduction to " A Laboratory Study of Fear: The Case of Peter", Mary Cover Jones(1924) (Text). Archived from the original on December 14, 2012. Retrieved November 9, 2008.
10. Thorndike, E.L. (1911), "Provisional Laws of Acquired Behavior or Learning", Animal Intelligence(New York: The McMillian Company)
11. Wolpe, Joseph. Psychotherapy by Reciprocal Inhibition. California: Stanford University Press, 1958

Behavioral therapy is psychological approach, based on the fact that it is necessary to study only overt behavior and denies the significance of unconscious behavior. This assumption strongly contradicts depth psychotherapy (especially psychoanalysis), whose proponents argue that mental illness is a consequence of a person’s internal conflicts.

The founder of behavioral therapy (behaviorism) is American psychologist John Watson. From the point of view of behaviorism, the object of psychology is human behavior. Behavior is a response to certain stimuli. Proponents of behavioral psychotherapy study the external factors that shape a person’s behavior. They argue that human behavior can be changed by changing these factors.

Behavioral therapy methods

Specialists of this psychotherapeutic method believe that the patient must be taught new forms of behavior, suppressing or completely getting rid of old, incorrect behavior. Depending on the situation, they can be applied different method treatment:

Conditioning

Conditioning is a method of developing new behavioral skills by modifying stimulus/response associations. It's pretty effective method, when applied, the correct (desired) command is rewarded, and unwanted behavior is suppressed or eliminated altogether. An incorrect command is suppressed with the help of punishment, and a correct command is stimulated with the help of rewards, which can be praise, gifts, etc.

Modeling

Modeling is a method by which a person becomes accustomed to a behavior by observing another person. It is useful for the patient to master new rules of command.

Aversion therapy

Another method is aversion therapy. In this case, the unwanted behavior is repeated many times, for example, smokers are forced to smoke until they feel disgusted by it.

Aversive therapy

Aversive therapy, aimed at developing aversion to unwanted behavior, has a similar effect, which forces a person to change their behavior or habits.

Desensitization

Desensitization is a technique used in behavioral therapy to treat the condition of a phobia. An object that the patient considers dangerous is very slowly brought into contact with it (at first only mentally, and then in reality). For example, if a person is terribly afraid of spiders, then during sessions he should imagine spiders and do this until the sight of an insect no longer causes him panic fear. At this stage, you can show the spider to the person, once again convincing him that it is absolutely not dangerous.

Family therapy

At the core family therapy lies in the fact that some of the difficulties a person experiences are related to his family and the interactions between its members. Therefore, in order to find out what role this or that family member plays, what are the features of communication, etc. All family members are encouraged to participate in therapy sessions.

Most often, parents raise their children with the help of punishments and rewards. However, parents should know that the child should be punished immediately after he has done something wrong. Otherwise, untimely punishment may be misunderstood and cause protest.

In what cases is behavioral therapy used?

Behaviorism is used to treat mental disorders, various phobias, and neuroses obsessive states, depression, hysteria, mental illness, nicotine and alcohol addiction. In addition, behavioral therapy has been used effectively to treat various defects and behavioral disorders in children, such as stuttering, as well as for the treatment of mentally retarded children and children with learning difficulties.

Behaviorism treats the disease itself or the symptoms of disorders, but does not eliminate their causes. Therefore, after some time, the unwanted behavior may reappear. In this case, it is necessary to undergo a second course of therapy or use another therapeutic method.

With behavioral therapy, improvement often occurs earlier than with other types of psychotherapy and is more specific. Rapid improvement can manifest itself even in disorders that have lasted for many years (for example, with long-term alcohol addiction, eating disorders, phobias).

Encyclopedic YouTube

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Cognitive-behavioral psychotherapy (narrated by psychotherapist Dmitry Kovpak)

Behavioral psychotherapy

Treatment of phobias in cognitive behavioral therapy.

Anxiety disorders are a scourge modern civilization. Dmitry Kovpak

Webinar "Cognitive-behavioral psychotherapy of depressive disorders" - Dmitry Viktorovich Kovpak

Subtitles

Story

Despite the fact that behavioral therapy is one of the newest methods of treatment in psychiatry, the techniques that it uses have existed since ancient times. It has long been known that people’s behavior can be controlled using positive and negative reinforcements, that is, rewards and punishments (the “carrot and stick” method). However, only with the advent of the theory of behaviorism did these methods receive scientific justification.

Behaviorism as a theoretical direction in psychology arose and developed at about the same time as psychoanalysis (that is, with late XIX century). However, the systematic application of the principles of behaviorism for psychotherapeutic purposes dates back to the late 50s and early 60s.

Behavioral therapy methods are largely based on the ideas of Russian scientists Vladimir Mikhailovich Bekhterev (1857-1927) and Ivan Petrovich Pavlov (1849-1936). The works of Pavlov and Bekhterev were well known abroad, in particular, Bekhterev’s book “Objective Psychology” had a great influence on John Watson. All the major behaviorists in the West call Pavlov their teacher. (See also: reflexology)

The term "behavioral therapy" was first mentioned in 1911 by Edward Thorndike (1874-1949). In the 1940s, the term was used by Joseph Wolpe's research group (English) Russian .

The further development of behavioral therapy is associated primarily with the names of Edward Thorndike and Frederick Skinner, who created the theory of operant conditioning. In classical Pavlovian conditioning, behavior can be changed through modification initial conditions, in which this behavior is manifested. In operant conditioning, behavior can be changed by stimuli that follow for behavior (“rewards” and “punishments”).

1. "The Law of Exercise"(eng. Law of exercise), which states that the repetition of a certain behavior contributes to the fact that in the future this behavior will manifest itself with an increasingly higher probability.
2. "Law of Effect"(eng. Law of effect): if a behavior has a positive outcome for the individual, it will be repeated with a higher probability in the future. If an action leads to unpleasant results, in the future it will appear less and less often or disappear altogether.

By the end of the 60s, behavioral psychotherapy was recognized as an independent and effective form of psychotherapy. Currently, this area of ​​psychotherapy has become one of the leading methods of psychotherapeutic treatment. In the 1970s, methods of behavioral psychology began to be used not only in psychotherapy, but also in pedagogy, management and business.

Initially, behavioral therapy methods were based exclusively on the ideas of behaviorism, that is, on the theory of conditioned reflexes and on the theory of learning. But currently there is a tendency towards a significant expansion of the theoretical and instrumental base of behavioral therapy: it can include any method whose effectiveness has been proven experimentally. Arnold Lazarus (English) Russian called this approach "Broad Spectrum Behavioral Therapy" or "Multimodal Psychotherapy". For example, relaxation techniques and breathing exercises (in particular, diaphragmatic breathing) are currently used in behavioral therapy. Thus, although behavioral therapy is based on evidence-based methods, it is eclectic in nature. The techniques that are used in it are united only by the fact that they are all aimed at changing behavioral skills and abilities. According to the definition of the American Psychological Association, “ Behavioral psychotherapy includes, first of all, the use of principles that were developed in experimental and social psychology... The main goal of behavioral therapy is to build and strengthen the ability to act, increase self-control» .

Methods similar to those of behavioral therapy were used in the Soviet Union starting in the 1920s. However, in the domestic literature for a long time, instead of the term “behavioral psychotherapy,” the term “conditioned reflex psychotherapy” was used.

Indications

Behavioral psychotherapy is used for a wide range of disorders: mental and so-called psychosomatic disorders, as well as purely somatic diseases. It is especially useful in the treatment of anxiety disorders, in particular panic disorders, phobias, obsessions, as well as the treatment of depression and other affective disorders, eating disorders, sexual problems, schizophrenia, antisocial behavior, sleep and attention disorders, hyperactivity, autism, difficulties in learning and other developmental disorders in childhood, as well as language and conversation problems.

In addition, behavioral psychotherapy can be used to cope with stress and treat clinical manifestations of high blood pressure, headaches, asthma and some gastrointestinal diseases, in particular enteritis and chronic pain.

Basic principles

Behavioral therapy scheme

Assessing the client's condition

This procedure in behavior therapy is called “functional analysis” or “applied behavior analysis”. At this stage, the first step is to compile a list of behavior patterns that have negative consequences for the patient. Each behavior pattern is described according to the following scheme:

Then situations and events are identified that cause a neurotic behavioral reaction (fear, avoidance, etc.). Using self-observation, the patient must answer the question: what factors can increase or decrease the likelihood of a desired or undesirable behavior pattern? You should also check whether the undesirable behavior pattern has any “secondary benefit” (English) Russian"for the patient, that is, hidden positive reinforcement of this behavior. The therapist then determines which strengths in the patient's character can be used in the therapeutic process. It is also important to find out what the patient's expectations are regarding what psychotherapy can give him: the patient is asked to formulate his expectations in specific terms, that is, to indicate which behavioral patterns he would like to get rid of and what forms of behavior he would like to learn. It is necessary to check whether these expectations are realistic. In order to obtain the most complete picture of the patient's condition, the therapist gives him a questionnaire, which the patient must fill out at home, using, if necessary, the method of self-observation. Sometimes the initial assessment phase takes several weeks because it is critical in behavior therapy to obtain a complete and accurate description of the patient's problem.

In behavior therapy, the data obtained at the preliminary analysis stage is called the “baseline” or “starting point” (English baseline). These data are subsequently used to evaluate the effectiveness of therapy. In addition, they allow the patient to realize that his condition is gradually improving, which increases motivation to continue therapy.

Drawing up a treatment plan

In behavioral therapy, it is necessary for the therapist to adhere to a specific plan when working with the patient, so after assessing the patient's condition, the therapist and patient draw up a list of problems that need to be solved. However, it is not recommended to work on several problems at the same time. Multiple problems must be addressed sequentially. You should not move on to the next problem until you have made significant improvement on the previous problem. If there is a complex problem, it is advisable to break it down into several components. If necessary, the therapist creates a “problem ladder,” which is a diagram that shows the order in which the therapist will work with the client's problems. The behavior pattern that should be changed first is selected as a “target”. The following criteria are used for selection:

If the patient is insufficiently motivated or lacks self-confidence, therapeutic work can begin not with the most important problems, but with easily achievable goals, that is, with those behavior patterns that are easiest to change, or that the patient wants to change first. The transition to more complex problems is made only after simpler problems have been solved. During therapy, the therapist constantly checks the effectiveness of the methods used. If the initially chosen techniques are ineffective, the therapist should change the therapy strategy and use other techniques.

The priority in choosing a goal is always consistent with the patient. Sometimes therapeutic priorities may be revised during therapy.

Behavioral therapy theorists believe that the more specific the goals of therapy are formulated, the more effective the therapist's work will be. At this stage, you should also find out how great the patient's motivation is to change a particular type of behavior.

In behavior therapy, a critical success factor is how well the patient understands the meaning of the techniques the therapist uses. For this reason, usually at the very beginning of therapy, the basic principles of this approach are explained to the patient in detail, and the purpose of each specific method is explained. The therapist then uses questions to check how well the patient has understood his explanations and answers questions if necessary. This not only helps the patient correctly perform the exercises recommended by the therapist, but also increases the patient's motivation to perform these exercises daily.

In behavioral therapy, the use of self-observation and the use of “homework” are widespread, which the patient must complete daily, or even, if necessary, several times a day. For self-observation, the same questions that were asked to the patient at the preliminary assessment stage are used:

When giving a patient “homework,” the therapist must check whether the patient correctly understands what he is supposed to do and whether the patient has the desire and ability to complete this task every day.

We should not forget that behavioral therapy is not limited to eliminating unwanted behavior patterns. From the point of view of the theory of behaviorism, any behavior (both adaptive and problematic) always performs some function in a person’s life. For this reason, when problem behavior disappears, a vacuum of sorts is created in a person's life, which may be filled by new problem behavior. To prevent this from happening, when drawing up a behavioral therapy plan, the psychologist provides for what forms of adaptive behavior should be developed to replace problematic behavior patterns. For example, therapy for a phobia will not be complete unless it is established what forms of adaptive behavior will fill the time that the patient devotes to phobic experiences. The treatment plan should be written in positive terms and indicate what the patient should do rather than what he should not do. This rule is called the "living person rule" in behavior therapy - because the behavior of a living person is described in positive terms (what he is capable of doing), while the behavior of a dead person can only be described in negative terms (for example, a dead person does not may have bad habits, experience fear, show aggression, etc.).

Completion of therapy

Behavioral therapy methods

Problems that arise during therapy

• The client's tendency to verbalize at length what he is thinking and feeling, as well as to try to find the causes of his problems in what he has experienced in the past. The reason for this may be the idea of ​​psychotherapy as a method that “allows you to speak out and understand yourself.” In this case, you should explain to the client that behavioral therapy consists of performing specific exercises, and its goal is not to understand the problem, but to eliminate its consequences. However, if the therapist sees that the client needs to express his feelings or find the underlying cause of his difficulties, then cognitive or humanistic psychotherapy techniques can be added to behavioral methods, for example.
• The client's fear that correcting his emotional manifestations will turn him into a “robot.” In this case, you should explain to him that thanks to behavioral therapy, his emotional world will not become poorer, just that negative and maladaptive emotions will be replaced by pleasant emotions.
• The client's passivity or fear of the effort required to perform the exercises. In this case, it is worth reminding the client what consequences such an installation may lead to in the long term. At the same time, you can review the treatment plan and start working with simpler tasks, breaking them down into separate stages. Sometimes in such cases, behavioral therapy uses the help of the client's family members.

Sometimes the client has dysfunctional beliefs and attitudes that interfere with his involvement in the therapeutic process. These settings include:

• Unrealistic or inflexible expectations about the methods and results of therapy, which may be a form of magical thinking (assuming that the therapist can solve any client problem). In this case, it is especially important to find out what the client's expectations are, and then create a clear treatment plan and discuss this plan with the client.
• The belief that only the therapist is responsible for the success of therapy, and that the client cannot and should not make any effort (external locus of control). This problem not only significantly slows down the progress of treatment, but also leads to relapses after stopping meetings with the therapist (the client does not consider it necessary to do his “homework” and follow the recommendations that were given to him at the time of completion of therapy). In this case, it is helpful to remind the client that in behavior therapy, success is not possible without the active cooperation of the client.
• Dramatizing the problem, for example: “I have too many difficulties, I will never cope with this.” In this case, it is useful to begin therapy with simple tasks and exercises that provide quick results, which increases the client's confidence in his ability to cope with his problems.
• Fear of judgment: The client is embarrassed to tell the therapist about some of his problems, and this prevents the development of an effective and realistic plan for therapeutic work.

In the presence of such dysfunctional beliefs, it makes sense to use methods of cognitive psychotherapy that help the client reconsider his attitudes.

One of the obstacles to achieving success is the client's lack of motivation. As stated above, strong motivation is a prerequisite for the success of behavior therapy. For this reason, motivation for change should be assessed at the very beginning of therapy, and then, in the course of working with the client, its level should be constantly checked (we should not forget that sometimes the client’s demotivation takes hidden forms. For example, he may stop therapy, assuring that his problem has been solved. In behavioral therapy this is called “escape to recovery”). To increase motivation.