Who can benefit from cognitive therapy?

Anxiety and depression, eating disorders and phobias, couple and communication problems — the list of questions that cognitive-behavioral therapy undertakes to answer continues to grow from year to year.

Does this mean that psychology has found a universal «key to all doors», a cure for all diseases? Or are the advantages of this type of therapy somewhat exaggerated? Let’s try to figure it out.

Bring back the mind

First there was behaviorism. This is the name of the science of behavior (hence the second name of cognitive-behavioral therapy — cognitive-behavioral, or CBT for short). The American psychologist John Watson was the first to raise the banner of behaviorism at the beginning of the XNUMXth century.

His theory was a response to the European fascination with Freudian psychoanalysis. The birth of psychoanalysis coincided with a period of pessimism, decadent moods and expectations of the end of the world. This was reflected in the teachings of Freud, who argued that the source of our main problems is outside the mind — in the unconscious, and therefore it is extremely difficult to cope with them.

The American approach, on the contrary, assumed some simplification, healthy practicality and optimism. John Watson believed that the focus should be on human behavior, on how we react to external stimuli. And — to work on improving these very reactions.

However, this approach was successful not only in America. One of the fathers of behaviorism is the Russian physiologist Ivan Petrovich Pavlov, who received the Nobel Prize for his research and studied reflexes until 1936.

It soon became clear that in its quest for simplicity, behaviorism had thrown the baby out with the bath water—in effect, reducing man to a totality of reactions and bracketing the psyche as such. And scientific thought moved in the opposite direction.

In the 1950s and 1960s, psychologists Albert Ellis and Aaron Beck “returned the psyche to its place”, rightly pointing out that between an external stimulus and a reaction to it there is a very important instance — in fact, the person himself who reacts. Or rather, his mind.

If psychoanalysis places the origins of the main problems in the unconscious, inaccessible to us, then Beck and Ellis suggested that we are talking about incorrect «cognitions» — errors of consciousness. Finding which, although not easy, is much easier than penetrating into the dark depths of the unconscious.

The work of Aaron Beck and Albert Ellis is considered the foundation of CBT today.

Errors of consciousness

Errors of consciousness can be different. One simple example is the tendency to view any event as having something to do with you personally. Let’s say the boss was gloomy today and greeted you through his teeth. “He hates me and is probably about to fire me” is a fairly typical reaction in this case. But not necessarily true.

We do not take into account circumstances that we simply do not know about. What if the boss’s child is sick? If he quarreled with his wife? Or has he just been criticized at a meeting with shareholders? However, it is impossible, of course, to exclude the possibility that the boss really has something against you.

But even in this case, repeating “What a horror, everything is gone” is also a mistake of consciousness. It is much more productive to ask yourself if you can change something in the situation and what benefits there might be to leaving your current job.

This example clearly illustrates the «scope» of CBT, which does not seek to understand the mystery that was going on behind the door of our parents’ bedroom, but helps to understand a specific situation.

And this approach turned out to be very effective: “Not a single type of psychotherapy has such a scientific evidence base,” emphasizes psychotherapist Yakov Kochetkov.

He is referring to a study by psychologist Stefan Hofmann confirming the effectiveness of CBT techniques.¹: a large-scale analysis of 269 articles, each of which, in turn, contains a review of hundreds of publications.

The Cost of Efficiency

“Cognitive-behavioral psychotherapy and psychoanalysis are traditionally considered the two main areas of modern psychotherapy. So, in Germany, in order to obtain a state certificate of a specialist psychotherapist with the right to pay through insurance cash desks, 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,” psychologists Alla Kholmogorova and Natalia Garanyan note.². In almost all developed countries, for insurers, psychotherapeutic assistance and cognitive-behavioral psychotherapy are almost synonymous.

For insurance companies, the main arguments are scientifically proven effectiveness, a wide range of applications and a relatively short duration of therapy.

An amusing story is connected with the last circumstance. Aaron Beck said that when he started practicing CBT, he almost went bankrupt. Traditionally, psychotherapy lasted for a long time, but after a few sessions, many clients told Aaron Beck that their problems were successfully solved, and therefore they see no point in further work. The salaries of a psychotherapist have drastically decreased.

Method of use

The duration of the CBT course may vary. “It is used both in the short term (15–20 sessions in the treatment of anxiety disorders) and in the long term (1–2 years in the case of personality disorders),” Alla Kholmogorova and Natalya Garanyan point out.

But on average, this is much less than, for example, a course of classical psychoanalysis. That can be perceived not only as a plus, but also as a minus.

CBT is often accused of superficial work, likening a painkiller pill that relieves symptoms without affecting the causes of the disease. “Modern cognitive therapy starts with symptoms,” explains Yakov Kochetkov. “But working with deep convictions also plays a big role.

We just don’t think it takes many years to work with them. The usual course is 15-20 meetings, not two weeks. And about half of the course is working with symptoms, and half is working with causes. In addition, working with symptoms also affects deep-seated beliefs.

This work, by the way, includes not only conversations with the therapist, but also the exposure method. It lies in the controlled impact on the client of the very factors that serve as a source of problems.

For example, if a person is afraid of heights, then during the course of therapy he will have to climb the balcony of a high-rise building more than once. First, together with a therapist, and then independently, and each time to a higher floor.

Another myth seems to stem from the very name of therapy: as long as it works with consciousness, then the therapist is a rational coach who does not show empathy and is not able to understand what concerns personal relationships.

This is not true. Cognitive therapy for couples, for example, in Germany is recognized as so effective that it has the status of a state program.

Many methods in one

“CBT is not universal, it does not displace or replace other methods of psychotherapy,” says Yakov Kochetkov. “Rather, she successfully uses the findings of other methods, each time verifying their effectiveness through scientific research.”

CBT is not one, but many therapies. And almost every disorder today has its own CBT methods. For example, schema therapy was invented for personality disorders. “Now CBT is successfully used in cases of psychoses and bipolar disorders,” continues Yakov Kochetkov.

— There are ideas borrowed from psychodynamic therapy. And recently, The Lancet published an article on the use of CBT for patients with schizophrenia who have refused to take medication. And even in this case, this method gives good results.

All this does not mean that CBT has finally established itself as the No. 1 psychotherapy. She has many critics. However, if you need quick relief in a particular situation, then 9 out of 10 experts in Western countries will recommend contacting a cognitive-behavioral psychotherapist.

¹ S. Hofmann et al. «The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyzes.» Online publication in the journal Cognitive Therapy and Research from 31.07.2012.

² A. Kholmogorova, N. Garanyan «Cognitive-behavioral psychotherapy» (in the collection «The main directions of modern psychotherapy», Kogito-center, 2000).