Contents
Authors: A. B. Kholmogorova, Candidate of Psychological Sciences, Head of the Laboratory of Clinical Psychology and Psychotherapy, Moscow Scientific Research Institute of Psychiatry, Ministry of Health of the Russian Federation. Certified specialist in psychodrama, cognitive therapy, systemic family therapy.
N. G. Garanyan, Candidate of Psychological Sciences, Leading Researcher, Moscow Research Institute of Psychiatry, Ministry of Health of the Russian Federation. Certified specialist in psychodrama, cognitive therapy, systemic family therapy.
Book: The main directions of modern psychotherapy. M.: Kogito-center, 2000, pp. 224-265. Source
Cognitive-behavioral psychotherapy and psychoanalysis are traditionally considered the two main areas of modern psychotherapy. So, in Germany, only these two areas are recognized at universities, and in order to receive a state certificate of a psychotherapist with the right to pay through insurance funds, it is necessary to have basic training in one of them. Gestalt therapy, psychodrama, systemic family therapy, despite their popularity, are still recognized only as types of additional specialization.
Cognitive-behavioral, or cognitive-behavioral, psychotherapy is much younger than psychoanalysis. Although behaviorism as a theoretical branch of psychology arose and developed at about the same time as psychoanalysis, that is, since the end of the last century, attempts to systematically apply the principles of learning theory for psychotherapeutic purposes date back to the late 50s and early 60s. At this time in England, in the famous Model Hospital, G. Eysenck first applied the principles of learning theory to the treatment of mental disorders. In clinics in the United States, a technique of positive reinforcement of desired responses in patients with severely disturbed behavior, the so-called «saving tokens» technique, is beginning to be widely used. All positively assessed actions of patients (for example, he washed himself, made a bed, etc.) receive reinforcement in the form of issuing a special token. Then the patient can exchange this token for sweets or get a day off to visit the family, etc. In South Africa, D. Volpe, together with his employees A. Lazarus and Rahman, applies the Pavlovian principle of the formation of a conditioned reflex to treat pathological fears and develops a method of systematic desensitization — destruction of the conditioned reflex reaction of fear by gradually accustoming to a frightening stimulus using imagination and relaxation techniques (Wolpe and Lazarus, 1966).
However, at this time, behaviorism as an explanatory model of human behavior is sharply criticized for its mechanism and ignorance of the inner life of a person. The stimulus-reactive scheme, which described human behavior as the sum of reactions to various stimuli and was the main theoretical paradigm in the work of most American psychologists since the 20s, has clearly exhausted itself as a means of studying the psyche. At this time, a cognitive revolution is taking place in psychology, which has proved the role of the so-called internal variables, or internal cognitive processes, in human behavior, information models of the human psyche appear that describe a person as actively processing information coming from outside and creating various models of reality, and not just passively responding to external stimuli. Behaviorism was significantly modified, and the psychotherapy that arose on its basis was no longer behavioral, but behavioral-cognitive. Today we can only talk about individual techniques based mainly on the stimulus-reactive scheme, which are actively used to this day; these are, first of all, the already mentioned techniques for modifying fear reactions, based on the principle of desensitization, and some others. Currently, we can talk about the existence of various cognitive-behavioral approaches, which are grouped by various authors for various reasons. It seems to us possible to single out three blocks of cognitive-behavioral approaches:
1. Methods closer to classical behaviorism and based primarily on learning theory, that is, on the principles of direct and hidden conditioning. These approaches use systematic desensitization techniques, confrontation with a frightening stimulus, paradoxical intention, positive and negative reinforcement techniques, behavior modeling techniques, that is, learning from observing the behavior of a model. From domestic approaches to this group of methods, Rozhnov’s emotional-stress psychotherapy can be attributed;
2. Methods based mainly on the theory of information, using the principles of the phased construction of internal models for processing information and regulating behavior based on them. These techniques, although they pay more attention to the internal cognitive schemes of action, just like the first group of techniques, consider the patterns of human behavior in a simplified way, reducing them to a computer model. These include various problem-solving therapies (Zurilla, 1988) and coping skills therapies (Rerun and Rokke, 1988);
3. Methods based on the integration of the principles of learning theory and information theory, as well as the principles of reconstruction of the so-called dysfunctional cognitive processes and some principles of dynamic psychotherapy. These are, first of all, rational-emotive psychotherapy by Albert Ellis and cognitive psychotherapy by Aron Beck. This also includes the approaches of V. Guidano (Guidano, 1988) and G. Liotti (Liotti, 1988), as well as M. Mahoney (Machoney, 1993). These integrative cognitive-behavioral approaches, freely using the techniques of the first two blocks, set as the main task the change of dysfunctional ways of thinking, which, according to the authors, are the source of inappropriate painful behavior. At the same time, different authors pay more or less attention to past experience in which representations, beliefs and attitudes were formed that cause the flow of dysfunctional (for example, anxious or depressive) thoughts. It is the latter that makes the methodologists of the cognitive-behavioral approach talk about the lack of theoretical purity of these models and accuse its representatives of sliding towards dynamic psychotherapy (Dobson, 1988). More neutral methodologists speak of the borderline status of this group, calling these approaches «a bridge between behaviorism and psychoanalysis» (Durssen, 1985).
Characterization of the three main blocks of cognitive-behavioral approaches
Cognitive-behavioral psychotherapy is often viewed simply as a set of effective techniques, divorced from a theoretical foundation. As one of the authors of the latest manual on psychotherapy, G. Reinicker (Reinicker, 1998), notes, many who want to learn the cognitive-behavioral approach emphasize technological effectiveness as its important advantage. However, excessive enthusiasm for technology threatens with insufficient attention to the psychological models of various diseases and conditions, their holistic conceptual understanding. Excessive enthusiasm for technology leads to a simple snatching of various symptoms and problems that correspond to certain techniques from a holistic picture of violations, which inevitably reduces work efficiency and may even lead to the opposite negative effect. Therefore, knowledge of the norm and pathology, various syndromes and psychological mechanisms corresponding to them is a necessary basis for every psychotherapist.
After this important, in our opinion, warning, we will briefly present the most famous techniques from the first block of cognitive-behavioral approaches, namely those based on learning theory. In the theory of learning, different types of it were distinguished as the views of behaviorists developed. The model of classical learning, which goes back to the fathers of behaviorism I. P. Pavlov and J. Watson, is based on the principle of a conditioned reflex: a certain reaction to a certain stimulus is fixed as a result of a positive or negative reinforcement combined with it (Schultz, Schultz, 1998). J. Watson showed how, as a result of such learning, a child develops a reaction of fear to a neutral object (a white rat), which was shown to him simultaneously with the unexpected presentation of a sharp, frightening sound. Thus, the presentation of a rat is accompanied by a reaction of fear, and the child develops a reaction of avoiding the rat itself, which at first was perceived neutrally or even positively. A well-known follower of Watson, Mary Jones, showed that children can be relieved of fears by gradually accustoming them to objects that cause fear, presenting these objects at a safe distance, gradually reducing it, and accompanying the presentation of objects with other stimuli that cause positive emotions. Many years later, these experiments were repeated under strictly controlled conditions on rats and on humans by Wolpe and his collaborators, thereby laying the foundation for confrontation techniques in the fight against anxiety. The same principle is used in play therapy for children with phobic reactions, when frightening situations are played out in a psychotherapy room with a positive emotional background, and the child plays other forms of behavior in these initially terrible situations. The reframing method, the “anchor” technique in NLP, is also based on the same principle of classical learning.
Perhaps the confrontation techniques are among the most famous and widely used of the first block. Their main principle is to change dysfunctional reactions to a certain stimulus by purposefully confronting this stimulus. As we have already mentioned, the most well-known of these techniques is the technique of systematic desensitization. According to Wolpe, the inhibition of fear reactions has three stages;
1) compiling a list of frightening situations or stimuli with an indication of their significance or hierarchy;
2) training in any method of muscle relaxation in order to form the skill to create a physical state opposite to the state with the emotion of fear, that is, the skill to inhibit the reaction of fear;
3) gradual presentation of a frightening stimulus or situation in combination with the use of the muscle relaxation method. An example would be dealing with a traffic phobia. The patient is taught, for example, the method of autogenic training. Then the patient is taught to imagine himself in the subway, keeping even breathing and relaxed muscles. Then the instructor can go down with him to the subway, helping to control breathing and muscle condition. Then the instructor can drive with the patient together one stop. The next day, the patient is invited to go down the subway alone, controlling breathing and muscle condition, the next day — to drive one stop, and so on until the fear reaction disappears.
For a long time, systematic desensitization has been the queen of techniques for dealing with anxiety. However, at present, Wolpe’s ideas about the three stages of inhibition of fear reactions are used rather isolatedly, and the techniques for working with anxiety have somewhat changed. For example, the technique of confrontation with the suppression of an anxious reaction (exposure/response prevention) has become widespread. Confrontation means placing the client in a frightening situation. Usually, the client has a pronounced fear reaction, accompanied by avoidance behavior. According to learning theory, avoidance behavior was reinforced by negative reinforcement, as it led to a decrease in the fear response. The main purpose of this method is to prevent the avoidance reaction. The prohibition against avoidance can be, for example, in the form of a contract with the client to conduct an experiment, the purpose of which is to make sure that their own fears are unfounded. For example, you can offer a client with social fears and the expectation of hostile reactions from others to ask passers-by walking towards the street what time it is. As such an experiment is carried out and the bulk of the responses are benevolent or calmly indifferent, the client becomes convinced of the groundlessness of his fears (the reaction of fear does not find reinforcement) and his tension on the street subsides, that is, as a result of a confrontation with a frightening situation, behavior changes: expectations and expectations change. learning takes place.
The «flooding» technique, popular in the USA, is simply the most brutal variant of the confrontation technique, mass confrontation, so to speak.
The client is offered an immediate confrontation with the most unpleasant stimulus, and, accordingly, he must experience the most pronounced reaction of fear, anger, etc. The use of this technique requires the client to be very motivated and quite stress resistant. Being in a situation in spite of fear and direct real experience of the groundlessness of one’s fears usually leads to a noticeable breakthrough and a sharp overcoming of old reactions. An important advantage of this technique is a high preventive effect. In practice, avoidance behavior stops in other situations as well, since it is not reinforced as a life strategy, but, on the contrary, confrontation receives reinforcement. Usually the technique of mass confrontation is applied in vivo, that is, by placing the patient in a real problem situation. However, in some cases it is also possible to work with imaginary situations. The main thing is to remain immersed in the situation until the fear or anger reaction gradually decreases. As a rule, repeated repetition of a massive confrontation is necessary for learning.
In contrast to classical learning, based on the principles of the formation or extinction of a conditioned reflex, techniques based on operant learning mainly use the techniques of positive or negative reinforcement following the desired and, accordingly, undesirable reaction. Moreover, both types of techniques usually complement each other and are used in combination. In operant learning, the desired behavior is systematically reinforced, and the undesirable behavior is inhibited. The formation of the desired behavior can occur on the basis of shaping, a step-by-step reinforcement of the very first elements of the desired behavior, as is the case with the reinforcement of the pronunciation of individual sounds by a child who is learning to speak. Another example where the use of shaping reinforcement is adequate is arriving on time or following time frames during a session with a patient who has serious problems with setting and boundaries. Receiving chaining (chaining) means reinforcing the entire chain of actions aimed at a specific goal. This technique is good when the task is to develop self-reliance — withholding help when trying to find the right solution, but generous reinforcement after reaching it. Finally, there are operant strategies to stabilize or reinforce the desired behavior. According to this strategy, all the skills formed in the office or hospital should be transferred to life. Here, a system of homework can be used, followed by a discussion of the difficulties and reinforcement of the successful application of skills outside the clinic. For example, a patient with a social phobia, which is often based on a cult of strength and success, for the first time decides to admit his problems and weaknesses to a psychotherapist. However, his communication with people is still constrained by the desire to appear super-prosperous. Therefore, the next step of the psychotherapist is to help the patient to more openly and calmly admit his problems. That is, the strategy of stabilizing more open and trusting communication with people should be a conscious goal of the psychotherapist if he wants the results of psychotherapy to be sustainable. Reinforcement may be the therapist’s expression of joy, praise, changing the observation mode, moving to the next stage of work. But the main reinforcement is the positive changes in life and relationships that follow the change in behavior. Typically, the decrease in the frequency of sessions occurs as the ability to cope with problems is consolidated.
Finally, A. Bandura in the 60s singled out another type of learning — social learning or learning based on observation or behavior modeling (Bandura, 1969). Bandura actually works in the behavioral-cognitive paradigm and emphasizes the role of attitudes and motivation in learning.
A good example of psychotherapeutic work that uses almost all of the above principles of learning and their corresponding techniques is social skills training, which arose on the basis of Bandura’s concept of social learning. Encouraging the client to act in a difficult situation for him, modeled in the training, you remove anxiety and fear of this situation on the basis of confrontation and desensitization. The system of rewarding successful behavior in the form of positive feedback is combined with learning based on behavior modeling by others and analysis of one’s own and others’ mistakes, which is especially facilitated by video training. Many social skills trainers are poorly aware that they are using certain principles of learning theory (like Molière’s character did not know that he was speaking in prose). However, knowledge of the principles creates the prerequisites for a more free and meaningful application of techniques, as well as for more creative work with each individual situation.
The second large block of cognitive-behavioral approaches that we have identified is based on information models of the psyche and attempts to present any morbid behavior or state as a problem. Identification of a problem together with the patient, its concretization is the first necessary step towards changes. For example, the problem of overeating is reformulated as the problem of coping with a difficult emotional state that is accompanied by overeating. At the same time, questions are discussed: what is the problem, how severe is it, what resources are available to solve it, what are the potential ways to solve it? etc.
The client then focuses on producing different options for solving it, followed by evaluation and selection. In the case of disturbed eating behavior, this may be a detailed analysis of the circumstances that contribute to overeating, the circumstances in which the patient manages to refrain from overeating, the resources that can be attracted to solve this problem (increased sources of pleasure, active activities, etc.). To develop coping skills, the therapist focuses on ways in which the client can deal with problems more effectively. For example, in stress coping training (Meichenbaum, 1977), the emphasis is on the need to teach the client how to approach a problem step by step, how to analyze problems associated with it, and how to teach self coping instructions. Problem solving training and coping skills training are usually used together. The main task is to teach a person adequate ways of processing information and making a decision. Here one can clearly see the direct transfer of information models from cognitive psychology to work with psychological problems and mental disorders. Techniques can be useful where there is a clear deficit in problem solving and decision making skills. This deficit is typical of many mental disorders; therefore, these techniques can be successfully integrated into work with sick and healthy people.
Of the third block of integrative approaches, Ellis’ rational-emotive therapy (RET) and Beck’s cognitive psychotherapy are the most well-known. Let us briefly characterize Ellis’s approach. According to this approach, excessively strong (and therefore, according to Ellis, destructive) feelings are based on irrational beliefs. Ellis considers the tendency to think irrationally as an innate feature of a person. On the other hand, as the second biological feature of a person, he singles out his ability to comprehend his own thinking (that is, reflection, although Ellis himself does not use this term) and, on this basis, change his own irrational ideas to more constructive and realistic ones. Rational-emotive psychotherapy is based on this second feature.
Here is the famous Ellis formula of behavior «ABC», where
A — an activating event, or, from a strictly phenomenological position, its perception;
B — personal beliefs or ways of evaluating perceived events,
C — emotional and behavioral patterns, determined by B.
Thus, the beliefs in this formula are central both in place and in functional load. Ellis notes the interactive nature of beliefs and the leading role of the social environment in their formation. The universal cause of irrational thinking is, according to Ellis, «the tyranny of duty,» when a person rigidly forces himself and others to obligatory adherence to certain standards. Any possibility of deviation from these standards leads to such cognitive assessments of the situation as catastrophization, curses and self-abasement, denial of one’s tolerance.
The main difference between RET and other cognitive approaches Ellis formulates as follows: “RET emphasizes the importance of identifying dogmatic unconditional “shoulds”, separating them from one’s desires and preferences, and learning how to abandon the former and take into account the latter” (Ellis, 1999). One of the most common misconceptions about cognitive psychotherapy is that cognitive therapists have a serious and overly intellectual style of dealing with clients. RET, on the other hand, considers psychological disorders as the result of an overly serious attitude to life and recommends the use of humor as a treatment method (Dryden, Ellis, 1986). Ellis recommends an informal, humorous active-directive style, but emphasizes the need to be flexible depending on the specific situation and the specific client. So, with hysterical accentuations, it is recommended to avoid overly friendly, emotional communication, it is not recommended to be overly intellectual with obsessive-compulsive clients, a directive style is not recommended with those who show an increased need for autonomy, and finally, one should not be very active with clients passivity.
So, the «philosophy of duty» is considered by Ellis as the cause of most psychological disorders. Accordingly, the philosophy of relativism is considered as a philosophy of health, according to which “people have a large number of needs, desires and preferences, but if they do not turn these non-absolute values into grandiose dogmas and demands, then they will not be mentally ill” (Dryden, Ellis, 1986, p.227). Ellis’s approach is, in a sense, a system of education for rational thinking, which he actively popularizes (Ellis, 1993). And it is not for nothing that Ellis refers to Adler’s concept as one of the sources of RET. “While Freud is a researcher and interpreter, Adler is mainly an educator” (Jung, 1993, p. 26). And further in Jung: “It must not be overlooked that false neurotic pathways become ingrained habits and that, despite all understanding, they do not disappear until they are replaced by other habits that can only be acquired through training” (ibid. , p. 27).
Beck’s Cognitive Psychotherapy
In this article, for a number of reasons, we decided to focus on Beck’s cognitive therapy (CT) in the most detail.
First, in our opinion, it is cognitive psychotherapy that integrates the most important achievements of other cognitive-behavioral approaches. Moreover, the two-level scheme of cognitive processes proposed by Beck allows the integration of cognitive principles with the psychodynamic approach. In this scheme, Beck singles out the actually dynamic (mobile, changing) and structural (more stable and permanent) components of the cognitive process. Dynamic components are the flow of thoughts or, in the language of behaviorism, internal behavior. Structural components are stable cognitive formations that represent beliefs, beliefs and attitudes. These components determine the nature and content of the dynamic components or the flow of thoughts about oneself and about the world. Thoughts, in turn, determine the emotional state and behavior of a person. Thus, in order to change behavior and inadequate emotional states, it is necessary to modify thinking. The difficulty lies in the fact that many thoughts are semi-conscious and cannot be directly detected and controlled (Beck calls them automatic thoughts). Also, beliefs and beliefs formed in previous experience can be unconscious. Therefore, the techniques developed by Beck are aimed primarily at identifying, understanding and modifying the so-called dysfunctional thoughts and beliefs that lead to painful states and inadequate reactions. These fundamental ideas of cognitive psychotherapy clearly conflict with one of the main theses of behaviorism about the external determination of behavior. Finally, the study of the sources of the formation of structural components inevitably leads to the concept of early experience in which they were formed, which means a direct connection with the psychodynamic approach, where the concept of early experience is one of the central ones. The integrating function of the two-level model of cognitive processes proposed by Beck is illustrated by the following diagram.
Cognitive Behavioral Psychotherapy
In our opinion, the integrative nature of cognitive psychotherapy is its most important advantage, which makes it possible to string a variety of techniques and approaches on the core idea of modifying dysfunctional thoughts and beliefs. Another advantage of the two-level scheme is that it sets a clear strategy for psychotherapeutic work — from more superficial situationally unfolding thoughts (a dynamic component of the cognitive process) to deep, stable structural formations.
Another no less important advantage of cognitive psychotherapy compared to other cognitive-behavioral approaches is the presence of a detailed theory of mental pathology: psychological models have been developed for almost all major mental disorders and the main targets of psychotherapeutic influence have been identified, as well as the most appropriate techniques and techniques for these targets have been described.
The undoubted advantage of cognitive psychotherapy in comparison with psychodynamic approaches is its short duration and economy. At the same time, numerous controlled studies have proven the high effectiveness of cognitive psychotherapy for a wide variety of disorders.
In Russia, cognitive psychotherapy has not yet become widespread, which is partly due to the lack of a flow of cognitively oriented “missionary trainers” from the West. At one time, the spread of psychoanalysis, psychodrama, Gestalt therapy, neurolinguistic programming in Russia became possible thanks to a series of training programs brought here by Western experts. Compensating for the gap that has arisen in relation to cognitive psychotherapy seems to be very important, since this approach has proven to be highly effective in the treatment of various disorders and has a close relationship with modern scientific psychology. Cognitive psychotherapy, with its structured nature, can greatly contribute to compensating for the chaos that is often characteristic of a Russian client. At the same time, the central link in the process of cognitive psychotherapy is reflection, which leads to the realization of basic, initial ideas about oneself and the world, which is consonant with the existentially oriented Russian mentality. The particularly high efficiency of this approach in the treatment of emotional disorders, the incidence of which, according to epidemiologists, has increased significantly (which is indirectly confirmed by the expansion of the corresponding clusters in the modern ICD-IO, DSM-IVr classifications), makes, in our opinion, the popularization of CT in Russia expedient.
Brief history and main methodological principles of CT
The creation of a new psychotherapeutic system and the departure from psychoanalysis of A. Beck led to disappointment in the traditional types of psychological assistance to depressive patients: “In different periods of my work, I applied most of the approaches described in modern literature to patients with depression. It seemed that individual methods sometimes help, sometimes backfire. I openly expressed warmth and sympathy, evoked anger, encouraged patients to express feelings of guilt and sadness intensely, interpreted their ‘need for suffering’, tried to increase their self-acceptance. However, talking about how helpless and pitiful the patient is and encouraging him to openly express his anger often only aggravated the depressive state, and the increased adoption of a derogatory self-image and pessimism as a result of therapy simply increased sadness, passivity and self-blame» (Beck, 1, p. 1976). These failures served as an impetus for A. Beck to many years of creative research in the study and treatment of emotional disorders, to the creation of an original cognitive model of this pathology and special highly effective psychotherapy techniques.
Thus, initially CT was a short-term approach to the treatment of depression, in which cognitive and behavioral techniques were combined (Beck, 1967). This, according to Ferris (Ferris, 1988), explains the current misconceptions about this approach as a short-term version of psychotherapy designed exclusively for emotional disorders. Currently, the field of application of CT has expanded significantly: cognitive psychotherapists work effectively with a whole range of psychopathological disorders and psychological problems: with depression of various nosologies (Beck et al., 1979), anxiety disorders (phobias, panic disorders, generalized anxiety) (Beck, Emery , 1985), eating disorders (McPherson, 1988), hypochondria (Warwick, 1991), personality disorders (Beck, Freeman, 1990), schizophrenia (Ferris, 1988), PTSD (Beck, 1993), family dysfunctions (Epstein, Baucom, 1988), psychological problems of athletes, etc. CT is used in various conditions (outpatient and clinical) and forms (individual, group, marital, family). CT is used both in the short term (for example, 15-20 sessions in the treatment of anxiety disorders) and in the long term (1-2 years in the case of personality disorders).
CT is being studied in almost all centers for teaching cognitive behavioral therapy as one of the most important modern approaches to the treatment of various disorders. There are also centers that teach exclusively A. Beck’s cognitive psychotherapy. Specialists who have already received basic training in any of the areas of psychotherapy can be trained in such centers. The most famous teaching center is the Beck Institute for Cognitive Therapy and Research in Philadelphia. The president of the center is Professor A. Beck, the director of the Institute is his daughter J. Beck, the author of one of the most popular practical manuals on psychotherapy. In 1999, the Academy of Cognitive Psychotherapy was established, the members of which are the most authoritative experts in this field.
The founders of CT recognized the complex biopsychosocial determination of mental disorders (Ferris, 1988). However, in the system of psychological factors, the cognitive model of mental disorders assigns a central role to the processes of information processing: how people think determines how they feel and how they act. From this point of view, pathological emotional states and dysfunctional behavior are the result of «maladaptive» cognitive processes.
According to the methodologists of CT (Ferris, 1988), the following teachings should be attributed to the philosophical foundations of CT:
a) the teaching of the philosophers of the Late Stoa (Cicero, Seneca, Epictetus) about the role of subjective opinion and judgments of the mind in the occurrence of spiritual discomfort and longing: “Everything depends on subjective opinion … We suffer thanks to our opinions …” (From a letter from Seneca to Lucilius. Quoted from : Ferris, 1988);
b) deductive dialogue technique developed by Socrates;
c) the teaching of Francis Bacon about the limitations of the human mind and its inherent distortions;
d) the rationalist doctrine of Spinoza about emotions as derivatives of thinking and the ability to change a feeling by modifying the belief associated with it.
In the psychological foundations of CT, one should single out theories of information processing by a person, emphasizing a special place for cognitive theories of emotions, which showed the role of cognitive variables in the emergence of emotions of different signs and modalities (Schachter, 1964; Lazarus, 1968).
However, it should not be assumed that the cognitive approach develops the cult of «rationalism» and classifies as adapted only those people who think rationally, logically and share generally accepted views. Irrational thoughts and fantasies with an idiosyncratic, that is, a purely personal element that do not coincide with the opinions of others, are found in most people. The term «maladaptive» applies only to those ideational processes «which are incompatible with the ability to cope with life, disrupt internal harmony and produce an inadequate, overly intense and painful emotional reaction» (Kovack, Beck, 1976, p. 381). Moreover, modern versions of CT dispute the central role of cognitive processes in the secondary nature of emotional processes and put forward the thesis of their simultaneity (Mahoney, 1993). For practice, the following provision remains fundamentally important: the vicious circle of negative emotions, non-adaptive thought processes and dysfunctional behavior can be broken in the cognitive link. Thus, a change in perception and thinking entails a modification of painful experiences and behavioral responses. The practice of CT requires from the psychotherapist knowledge of the phenomenology of cognitive processes in various mental disorders. The most developed are cognitive models of depression and anxiety disorders (phobias, panic disorders and generalized anxiety). In what follows, we will mainly rely on these models.