Among the current mainstream psychotherapy methods, cognitive behavioral therapy (CBT) is recognized as the most effective therapy school confirmed by evidence-based medicine.
In western developed countries, cognitive behavioral therapy has replaced psychoanalytic therapy as the mainstream. In China, although the development and popularization speed is slow, it has been paid more and more attention in recent years, especially in clinical psychiatry.
What kind of therapy is this? How exactly does it work? How can you alleviate mental and psychological barriers? This paper will introduce and analyze this in detail.
It is worth mentioning that the popular "mindfulness therapy" in recent years is actually developed from cognitive behavioral therapy and is called "the third wave of cognitive behavioral therapy", which will also be analyzed below.
What is cognitive behavioral therapy?
Cognitive behavioral therapy (CBT) was not originally named after this name, but divided into behavioral therapy (BT) and cognitive therapy (CT). From the perspective of development, this stage can be regarded as the first generation of cognitive behavioral therapy.
Behavioral therapy emphasizes that some individual behavior habits are adaptive and some are non-adaptive. The so-called non-adaptive behavior habits, to some extent, refer to behaviors different from those of healthy people, such as avoiding social interaction, washing hands repeatedly, and addictive behaviors.
Behavioral therapy believes that non-adaptive behavior habits are acquired and are the cause of individual psychological problems and obstacles, but they can be eliminated through deliberate training and behavioral guidance.
The development of the theory and technical methods of behavioral therapy is inseparable from experiments, such as Pavlov's classical conditioned reflex principle, Skinner's operating conditioned reflex principle and other scholars' systematic desensitization principle and imitation learning principle.
Therefore, behavioral therapy does have scientific theoretical basis and therapeutic effect, and is widely cited in all walks of life. The most common reward and punishment system is a behavioral therapy.
Cognitive therapy emphasizes the role of cognition, including individual specific thoughts, beliefs and ways of thinking.
The picture comes from the internet.
The core of this theory is that cognition affects individuals' emotions, physiological reactions and behaviors. Individual mental disorders or psychological behavior problems are related to their thinking dysfunction. This is a bit like the saying "annoyance comes from the heart".
What does this "thinking disorder" mean? It can be understood as a non-objective distorted cognitive model and concept.
In the bestseller "Burns' New Emotional Therapy" in the field of psychology, the "Top Ten Cognitive Distortions" are listed, including:
The best-selling book in the field of psychology, Burns's New Emotional Therapy, comes from the Internet.
Either-or thinking is also called polarized thinking. For example, when an individual encounters some setbacks and failures, he completely denies himself, "I am an incompetent waste."
Generalize by partiality. For example, when an individual is treated unfairly by a teacher, there will be such a distorted cognition: "Teachers are all bad" and even "human beings are not good things".
"Should" sentence pattern. For example, the individual has high demands on himself and others, and always feels "I should do this, never do that" and "How can he do this? This is unacceptable. " This kind of "should" imposed on others and yourself will make people upset, produce disgust and cause emotional fluctuations.
……
I won't list them here, but briefly introduce the above three typical and common ones.
Therefore, cognitive therapy believes that if we can correct these distorted cognition, we can improve our mood and bad behavior.
Later, the combination of behavioral therapy and cognitive therapy in theory, especially in technical methods, produced the "second generation cognitive behavioral therapy", which not only focused on correcting distorted cognition, but also relied on behavioral therapy technology.
For example, questions and records are used to identify and sort out patients' distorted cognition, guide patients to consciously produce correct cognition, and combine behavioral techniques such as exposure therapy, behavior activation and relaxation techniques to alleviate anxiety, fear and avoidance behavior.
As for the detailed treatment methods and procedures, Li Xianyun, chief physician of huilongguan hospital Psychiatry Department, gave a detailed explanation in an exclusive interview.
Li Xianyun, Chief Physician of Psychiatry Department of huilongguan hospital, Beijing, with pictures from the Internet.
In the early diagnosis and treatment stage of mental and psychological disorders, I also tend to use the second generation cognitive behavioral therapy. For common mental diseases such as depression, bipolar disorder, addiction, etc., the second generation of cognitive behavioral therapy is really effective, among which aversion therapy and exposure therapy can really bring some therapeutic effects.
However, as many scholars have pointed out, the second generation of cognitive behavioral therapy is the product of cognitive therapy+reasonable emotional therapy+behavioral therapy, which is more effective for people with younger age and higher intellectual and cultural level. For those who refuse to change their beliefs and have poor understanding, the effect is not good.
02, the third generation of cognitive behavioral therapy: mindfulness
In 1990s, the third generation of cognitive behavioral therapy appeared, including mindfulness cognitive therapy (MBCT), acceptance and commitment therapy (ACT), mindfulness decompression training (MBSR) and dialectical behavioral therapy (DBT).
These four therapies are closely related to Oriental Buddhism, and they are cognitive behavioral therapies based on mindfulness, which are popular in China and the West in recent years.
So, what is mindfulness therapy?
The concept of "mindfulness" originally originated from Buddhist meditation, developed from meditation, meditation and enlightenment, and is a method of self-adjustment. Some scholars define it as a method of spiritual training.
The picture comes from the internet.
In this kind of mental training, the emphasis is on conscious awareness and attention to the present, instead of judging and analyzing all the concepts of the present, just paying attention to and paying attention to it.
For example, in mindfulness-based decompression therapy, patients first choose an object that can be noticed, which can be a voice, words, their own breathing, feelings and so on. Then sit relaxed, close your eyes, practice breathing and relax, and then focus on the selected attention object. After the training, take a rest and engage in other normal work and life.
In mindfulness cognitive therapy, cognitive therapy is combined with mindfulness decompression therapy. For example, when depressed patients have negative thoughts and emotions, they can adopt an open and acceptable attitude to deal with them. Through meditation, retreat or meditation, they can concentrate on perceiving their physical and emotional state, and let nature take its course without making any judgment, analysis or depression.
There is also dialectical cognitive therapy, which was originally used to treat borderline personality disorder, and then gradually applied to psychotherapy of depression, addiction, bulimia and eating disorder.
According to this therapy, the biggest defect of the first and second generation cognitive behavioral therapy is that it emphasizes "change" too much, which is difficult for many patients to do. Therefore, dialectical cognitive therapy emphasizes confirmation and acceptance, not change.
Therefore, the core of treatment is to enable patients to endure the pressure of life, learn to accept themselves, and let them realize that every thought and behavior is the result of joint efforts to achieve a new state of balance. This involves the fundamental acceptance principle of Buddhist philosophy and the idea that everything is a combination of cause and effect.
It can be seen that the biggest difference between mindfulness therapy and traditional cognitive therapy is that traditional cognitive therapy focuses on discovering patients' irrational thinking or dysfunctional thinking, and then helping patients consciously identify and change these thinking.
The core of mindfulness therapy is not to change these negative thoughts, but to observe and accept these thoughts with a more peaceful and patient attitude and coexist with them; Never take an attitude of rejection and disgust towards these ideas.
This is also the progress of the third generation of cognitive behavioral therapy compared with the second generation of cognitive behavioral therapy. It is reasonable for the second generation of cognitive behavioral therapy to suppress and criticize irrational thinking, but it is not easy to do so. If it is not successful, it will easily become reinforcement.
"I know my idea is wrong, but the more I suppress it and criticize it, the more it jumps, and finally the whole person falls in, which is even more helpless." This is the feeling of many patients who have received the second generation cognitive behavioral therapy but the effect is not good.
Therefore, the genius of mindfulness therapy lies in accepting and paying attention to the present rather than the past. This method of non-confrontation and retreat is a weakening.
In addition, mindfulness therapy is usually carried out through meditation, meditation and spiritual training. It has been confirmed by scientific research that meditation can relax the brain and produce endorphins and cannabinol. And the mood is relatively calm, even with a hint of pleasure. When you realize your thoughts and feelings in this state, you may further weaken negative emotions and thinking.
03. Advantages and disadvantages of cognitive behavioral therapy.
From the above development process, generation after generation of cognitive behavioral therapy is the perfection of the theory and technology of the previous generation, and it is very worthy of recognition.
Moreover, CBT is the most effective psychotherapy method confirmed by evidence-based medicine. No matter at home or abroad, it is regarded as the first choice of psychotherapy for most mental and psychological diseases, and is recognized as a scientific psychotherapy method, which is widely used in the psychotherapy of depression, bipolar disorder and addictive diseases. The clinical contribution of CBT is worthy of recognition.
The picture comes from the internet.
However, from the perspective of MDT, combined with the latest scientific psychology theory, especially the theory of memory reconsolidation and pathological memory, and our many years of interdisciplinary clinical practice experience, the limitations of cognitive behavioral therapy are also obvious.
In clinical practice, we find that the main psychological root of most mental disorders is pathological memory formed by the superposition of psychological trauma and pathological positive emotional experience. Under the influence of this pathological memory, patients will show emotional fluctuations, cognitive biases, behavioral problems, physiological reactions and physical feelings.
CBT changes patients' cognition and behavior from the perspectives of cognition and behavior, thus changing patients' emotions, physiological reactions and physical feelings. This angle has scientific basis, but obviously it doesn't touch the root and is not comprehensive.
Daniel Kahneman, a professor of psychology at Princeton University in the United States, believes that the operation of the brain is divided into two systems:
The operation of "system 1", which is dominated by the limbic system, is unconscious and fast, and it is in a state of autonomous control, mainly responsible for emotional functions such as emotion and conditioned reflex, which is equivalent to the short path of brain operation;
Previously, the operation of "System 2" based on frontal lobe was based on logic. It processes information in consciousness and is mainly responsible for rational functions such as thinking and calculation, which is equivalent to the long path of brain operation.
The picture comes from the internet.
In the brain operation of most patients with mental and psychological disorders, there is something wrong with "system 1", which is characterized by irrational and intense emotional fluctuations, leading to disastrous or overly optimistic one-way thinking, which in turn leads to emotional deterioration or mania and enters a vicious circle.
CBT mainly deals with these problems at the level of "system 2", guiding patients to use the rational function of the brain, that is, the long path of the brain to detect these problems and find ways to make them disappear.
This requires repeated practice and reinforcement, and it takes a long time. As Dr. Li Xianyun of Huilongguan said, "Slow work leads to fine work" requires constant reminder and guidance from "coaches" (that is, psychotherapists or psychological counselors), which is relatively inefficient.
In the operation of "system 1", the first is extreme emotion, and then the wrong cognition and thinking. These two are like twins, and they are very closely related.
To put it bluntly, severe patients are almost completely controlled by pathological emotions caused by pathological memory, and there are many distorted and wrong cognition. Some patients even have paranoid personality changes. At this time, it is actually very difficult for them to change their minds by changing their ideas.
Therefore, if we don't deal with emotions first and correct them from a cognitive point of view, treatment is extremely difficult; The risk of illness fluctuation is also great, and the progress is good. However, when it encounters a big stimulus, pathological emotions prevail and the patient's rationality may disappear.
In clinical practice, we found that if the pathological memory repair technology (TPMIH) under deep hypnosis is used to deal with the problem of "system 1", that is, after the pathological memory is activated under deep hypnosis, the treatment difficulty is greatly reduced.
In addition, the theoretical basis of CBT is limited. The development of cognitive therapy mainly originated from Baker and Alice. Both of them were trained in psychoanalysis at first. Although they later questioned it, the cognitive therapy theory they founded obviously had some psychoanalytic shadow.
For example, according to the theoretical basis of cognitive therapy, functional bad thoughts or beliefs will cause negative emotions and behaviors, so where do these bad thoughts and beliefs come from? This mainly comes from bad childhood experiences.
It is very similar to psychoanalysis to attribute all the reasons to childhood experiences. But clinically, we find that family background and his childhood experience do have a profound influence on individuals, but not all the reasons.
Some patients have a lively and cheerful childhood and a harmonious family, and have never experienced a traumatic event. But after entering adolescence, I met school bullying, or absorbed some bad information from the Internet, and gradually formed a superimposed psychological trauma.
In addition, in today's internet age, information is developed, and many children can easily receive negative information through the internet, which will bring them adverse effects.
Therefore, the theoretical basis of CBT is not comprehensive. Fortunately, however, CBT has not paid special attention to finding the root cause in practical application.
In addition, CBT can't achieve accurate psychotherapy, and can't find the corresponding pathological memory through the symptoms of patients. At the same time, it is difficult for CBT to deal with implicit memory. After all, how can cognitive behavioral therapy work if patients can't figure it out and can't say it themselves?
As for the third generation of cognitive behavioral therapy, that is, mindfulness therapy, its advantages have been affirmed above. However, because it is closely related to the thought of Oriental Buddhism, not everyone can accept it or realize it, especially for people with low perception and westerners with strong critical thinking.
In a word, for the vast number of mental patients, cognitive behavioral therapy has more advantages than disadvantages, and it is still being improved and developed.
Although the effect of cognitive behavioral therapy on patients with severe mental disorders is limited, it is obvious for patients with mild or early diseases. This also reminds patients and their families that mental and psychological disorders must be found early and treated early!
For the public, CBT has strong repeatability and operability, and the collection cost is low. For most patients and their families, on the basis of psychiatric medication, combined with continuous and professional cognitive behavioral therapy, it should be the most practical and economical treatment scheme at present.
refer to
1, Shen Yucun's Psychiatry 6th Edition, edited by Lu Lin footballer.
2. Burns's New Emotional Therapy, by David Burns, translated by Li Yaping, Science and Technology Literature Publishing House, 20 18.
3. The latest progress of dialectical behavior therapy and its clinical application, Chen et al., Sichuan Mental Health, Vol.29, No.5, 20 16.
4. Mindfulness therapy-a new psychotherapy, Xiong et al., Medicine and Society, Vol. 24,No. 1 issue, 20 1 1 year.
5. Effect of mindfulness therapy on anxiety, depression and adjustment disorder of adolescents, Dong Yingying et al., 20 19.