Future psychologist Aaron Temkin Beck was born in July 1921 in the American city of Providence. Three years before his birth, his older sister died of the flu, which was a big blow for his mother, so Aaron’s childhood was spent in an atmosphere of severe depression. Beck himself was a shy and withdrawn child, often sick and in hospitals. One day he received a serious injury to his hand, and the treatment led to him being haunted by phobias, a panicky fear of getting new injuries and a fear of bleeding. Obviously, it was this circumstance that predetermined his choice of profession. In 1946, he entered the Yale University School of Medicine, where he specialized in neurology, but then went into psychiatry and began studying psychoanalysis. At first, Beck was sure that psychoanalysis was the only system that could help a person to deal with mental problems. However, by the late 1950s, he came to the conclusion that Freudian psychoanalysis was not as effective. In particular, psychoanalysts believed that depression was the result of anger turned inward, however, the psychologist noted that depressed patients did not feel angry, but rather simply considered themselves failures (here, we can indeed see a very simplified understanding of aggression in the concept depth therapy). Beck discovered that it was precisely these assumptions, and the “automatic thoughts” associated with them, such as “I’m always unlucky”, “I’ve always been unsociable”, that were the root of all problems. From here he decided that the transformation of thinking was supposed to help patients correct their illness. He began encouraging patients to focus on negative beliefs in their daily lives rather than conflicts from childhood, and also encouraged people to challenge their assumptions, test them in real life, and collect evidence that supported a positive alternative. This practice contributed to the improvement of patients' conditions. This is how cognitive psychotherapy was born. The ABC Formula The discovery of the fact that the state of depressed patients is determined by their thinking led Aaron Beck to the idea that, firstly, our emotional and behavioral reactions are determined by our thinking, and secondly, that exactly Other mental disorders can be interpreted in the same way. This is how the ABC formula of cognitive therapy was born. In principle, we already discussed it in the previous chapter about rational-emotive therapy by Albert Ellis, but still in cognitive behavioral therapy this formula has some differences. “A”. As in REBT, “A” in the ABC formula means an activating event, i.e. any internal or external event that sets off a chain of mental and behavioral reactions. For example, another person's laughter can become a trigger for the thought “Someone is laughing at me.” Tachycardia in the body can lead to the thought “I’m dying” and trigger a panic attack. My own thought that I am angry with my friend may lead to another thought: “I am a disgusting person for having such feelings.” “B.” At stage “B” some differences with the REBT model already begin, since here Beck introduces the concept of automatic thoughts. At the same time, one must understand that automatic thoughts are not ordinary thoughts, but thoughts that arise instantly, are not the result of reflection and proceed without judgment and without reflection. (Interestingly, representatives of CBT do their best to deny the existence of the unconscious, but at the same time they say that we seem to have thoughts that are initially unconscious, but if we wish, we can pay attention to them. Thus, in fact, unconsciousness is recognized here, but rather not like in psychoanalysis, but closer to what is proposed in Gestalt therapy and. In other humanistic directions, simply put, consciousness and the unconscious are determined by the direction of our attention. Later directions of CBT recognize the unconscious more actively, introducing, for example, such a category as cognitive schemes. But that’s not what we’re talking about here.still about automatic thoughts.) Automatic thoughts are an irrational response to a situation, and therefore a person may well interpret someone else’s laughter as ridicule, and his own anxious sensations in the body as a state of illness. “C”. Finally, “C” is our reactions to certain mental events. For example, interpreting another person's laughter as ridicule can cause us frustration and cause us to act aggressively towards him. And the interpretation of anxiety in the body as a painful state can cause us to have a panic attack. Now this scheme seems fundamentally different from what is proposed in psychoanalysis, however, when we begin to look at it in more detail, it will become clear that, in fact, there is no fundamental difference there are no approaches. Deep Beliefs and Compensatory Strategies To explain why a person has certain maladaptive thoughts, Aaron Beck deployed his scheme not only horizontally, but also vertically, saying that certain maladaptive thoughts are determined by our deepest beliefs. (I’ll say right away, that I will build a scheme based on modern lectures given at the Russian Association of Cognitive Behavioral Therapy, and therefore it will be somewhat different from the one that Beck originally proposed. In particular, there will be somewhat more deep-seated beliefs, and we are considering intermediate beliefs. as identical to cognitive distortions, which, to me, is much more logical than the initial piling up of meaningless structures). Aaron Beck argued that our automatic thoughts are distorted by our deepest beliefs. All these beliefs have three vectors: about oneself, about others and about the world. At the same time, Beck, in the process of his practice, first identified two categories of deep-seated beliefs, and then added a third. In Russia, they also use the fourth, but we will talk about the three classic ones. Worthlessness. The first group of deep-seated beliefs are beliefs about one’s worthlessness. Such beliefs usually sound like “I’m worthless” and are based on assumptions about activities in the style of “If I don’t do something perfectly or achieve something, then I’m worthless.” Unattractiveness. The second group of beliefs sounds like “I am unattractive” and is associated with relationships with people based on the assumption “If I don’t please people, they will reject me.” Helplessness. The third group of beliefs sounds like “I am helpless”, it is based on the assumption “If I don’t control everything, then something terrible will happen and I won’t be able to cope with it.” All these beliefs can be described according to the three vectors indicated earlier, then exists as a belief about oneself, about others and about the world. For example, the belief of helplessness can be described as “I am helpless, and others and the whole world in general are dangerous.” According to Beck, we can somehow fit all maladaptive thoughts into these categories. For example, the thought “I’m dying” during a panic attack can be attributed to helplessness, and the thought “They’re laughing at me” to unattractiveness. It is also interesting that in this model there is a direct reflection of the idea of ​​psychoanalysis about a person’s desire to compensate for these beliefs. Thus, CBT also considers a number of strategies with the help of which an individual seeks to compensate for these beliefs. Worthlessness - Perfectionism. Worthlessness is compensated by perfectionism; the individual strives to set inflated goals for himself and wants to increase his productivity so as not to face his own worthlessness. And from here distortions arise when a person devalues ​​the results of his work, for example, declaring that he could have done it better. Unattractiveness - Conformism. A person strives to compensate for his own unattractiveness with conformity, constantly adapting to other people and paying excessive attention to the social environment, hence all sorts of thoughts arise that someone is making fun of him or about his own loneliness. Helplessness - Hypercontrol. Helplessness is compensated by hypercontrol, when the individual is unable to let go of the control lever (this isby the way, one of the main problems with hypnotization). It is with this compensation that catastrophizing often occurs, in the style of “I don’t control what happens to me, and this means that something terrible will happen.” Actually, while the compensatory mechanisms are more or less working, the person still feels comfortable, however , as soon as the ideal picture is violated, he experiences frustration, and from the perspective of schema therapy, which we will consider with you later, one could say that he has a neurotic mode of functioning. The second position of CBT, associated with deep-seated beliefs, also reflects the ideas of psychoanalysis . In particular, it is assumed that deep beliefs change little throughout life and are almost impossible to change with the help of psychotherapy, and by the way, they are largely associated with various borderline disorders. Deep beliefs are rigid and strive for self-confirmation, and therefore use cognitive distortions, distorting our perception and thoughts. Cognitive distortions Cognitive behavioral therapy also explores how deep beliefs are connected to our thoughts, and it is cognitive distortions that connect them. At the same time, in cognitive therapy the lists of cognitive distortions differ from those offered in cognitive psychology, and there are quite a lot of these lists themselves, so I will give you the classification that seems to me most adequate. Selective filtering is focusing on purely negative aspects of the situation and devaluation of the positive. For example, a client may say: “I have been promoted and now I will have to work twice as hard,” without noticing that he will be paid twice as much. Black-and-white thinking is viewing the world in exclusively polar terms: “everything or nothing”, without the ability to see intermediate options. So, a person thinks, “Either I pass the entrance exam, or I will forever remain poor and unemployed” or “Either we never quarrel, or we break off relations.” Overgeneralization is the formulation of global conclusions based on isolated events and cases, without taking into account the entire possible sample of situations . For example, a man may claim that he will not be able to find a girlfriend simply because his two attempts to do so turned out to be failures. Exaggeration is an excessive exaggeration of the complexity and scale of a problem situation. For example, a client might state, “My speaking in public has been an absolute nightmare,” or “My disorder is keeping me from living a normal life.” Negative predictions are the unreasonable prediction of a negative outcome without considering the probabilities of other outcomes. Well, for example, a client may tell the therapist: “You still won’t help me,” or a person may assume before any exam or competition that he will not succeed. Catastrophizing is an excessive exaggeration of the negative meaning of a particular event. So, if in the previous case we were talking about a possible real outcome, here we are rather talking about what this outcome can lead to. For example, “If I panic again, I will die” or “If she leaves me, I will be alone forever.” Low frustration tolerance is a belief in one’s inability to cope with negative states and an exaggeration of their significance. For example, a client may state that he is unable to bear his anxiety or a quarrel with his partner. Labeling involves a global assessment of a personality based on its individual manifestations. For example, a client may state “Well, you’re just a psychologist, all you care about is money” or “He’s a typical dork and can’t understand me.” Mind reading is an unfounded assumption about what other people think about a person, as well as the belief that that others should know his own thoughts. For example, a woman may say that she gives obvious hints to men, but for some reason they still do not approach her, or a man may say that he knows how much his mother-in-law hates him. Painful comparison - involves comparison with other people, when onlyBased on a particular area, a general conclusion is drawn. For example, the client may say: “I’m not worth anything because other people my age already have families and children” or “Most of the people I know earn more than me, which means I haven’t achieved anything.” Obligation - making unreasonable demands to yourself, to others and to the world. The distortion is often formed from parental attitudes and can sound like “A man must pay his debt to his homeland” or “A man must provide for his family” or “People have a responsibility to show compassion.” Emotional argumentation is the elevation of an assumption to the rank of reality based on its emotional significance. For example: “I go to a healer and get better because I feel better with each session” or “This situation will be bad because I will feel bad in it.” Personalization - the belief that the reason for other people's behavior and everything that happens around lies precisely in you. For example, “If I had not behaved this way, she would not have left me” or “If I had helped her then, she would have remained alive.” Magical thinking is the belief that a person is able to influence others and events in the world in an indirect way contrary to cause-and-effect relationships. Well, for example, “I think I set him up for this with my thoughts” or “I will teach you to attract money to yourself” or “I got rid of my diseases with the help of orgone energy and can treat others with it.” Once again about ABC Now that we We know all the components of the ABC formula, we can build it completely and usually it is drawn like this. However, in fact, it looks like this: certain situations activate a deep belief in us, which activates one or another cognitive distortion, and it, in turn, leads to one or another maladaptive thoughts. And if you remember my formula for deep therapy , and also think a little, you will understand that in this form the theory of cognitive behavioral therapy is no different from the same psychoanalysis or any other deep direction, especially if we replace deep-seated beliefs with complexes, and cognitive distortions with mental defense mechanisms. But this there was a little off-topic in order to bring cognitive therapists down to earth a little. Well, we continue. Vicious circles An interesting model of CBT is also the model of vicious circles of neurosis. Honestly, I don’t know whether it was developed independently by Aaron Beck or taken from existential psychotherapy (or Morita therapy), but its essence boils down to a description of how the mechanism of self-reinforcement of our maladaptive reactions and deep-seated beliefs works. In essence, this model also reflects this the so-called Rosenthal effect, which states that we unconsciously strive to reinforce our beliefs. And one of the most famous vicious circles you have probably heard of is the vicious circle of a panic attack, which consists of the following stages. First, for one reason or another, you experience a release of stress hormones and experience a number of bodily symptoms such as increased heart rate and sweating. Then you pay attention to them, and since you have a belief in helplessness, you begin to catastrophize. This leads to increased fear, which leads to increased symptoms until a panic attack occurs. But in addition to panic attacks, many other disorders can be described in this way. For example, depression suggests that you feel worthless and unable to do anything. Because of this belief, you immediately refuse this or that action, and this further strengthens your belief that you are incapable of anything. In general, this is how all types of deep-seated beliefs are described. For example, worthlessness compensated by perfectionism works like this. You have the conviction that you are not capable of anything, and therefore, in order to compensate for this conviction, you set yourself inflated goals and demands, which, obviously, you do not achieve. Moreover, you don’t achieve it rather subjectively, because even if you objectively achieve the goal, then most likely you will still devalue it.This leads to reinforcement of the idea of ​​your helplessness, to attempts to set even higher goals and to be disappointed in them. In the case of unattractiveness, the individual usually tries to prove that he is attractive and please everyone, and because of his excessive assertiveness, he himself destroys social contact, making sure that no one needs him. Well, in case of helplessness, the individual begins to try to control everything, and since it is impossible to control everything and sooner or later, something goes out of his control, he again becomes convinced of his helplessness. Process and setting CBTCognitive-behavioral psychotherapy is distinguished by its formalization, and therefore each time it follows the same algorithm, consisting of several stages. Review of the condition. At the first stage, the therapist checks the client's current state and invites him to share the events of the past week, which helps, on the one hand, to outline a new agenda, and, on the other hand, to identify difficulties that may have arisen when doing homework. Repetition. At the second stage, the conclusions of the previous session or all past work are repeated. The client's successes are celebrated. This ensures continuity of knowledge as well as reinforcing customer loyalty.Agenda. Next, the agenda is determined and usually this can happen together with the therapist, either based on current life circumstances, or based on the targets of influence identified in past sessions. Discussion of the problem. Next, the work phase itself begins. Here, the client’s problem is either discussed, or new techniques are demonstrated to him, which he will also later perform independently. Homework. At the fifth stage, the client is given new homework based on what was done in the session. Summary. The session ends with a brief summary of what was done in the session. This entire process takes about 40 minutes, while the session itself and the execution of the techniques in it last about 15-20 minutes. In this case, the therapist acts as a coach or teacher who provides the client with the tools and techniques he needs. Of course, there is no talk of any deep contact here, as in other types of therapy, however, it is not particularly required here. In essence, CBT is a symptom-centered approach, where the therapist starts from the symptom, and not from the client’s understanding of this symptom. Depending on the symptom, CBT uses different protocols. So you can find treatment protocols for insomnia, depression, panic disorder, borderline disorder, etc., which are a fixed sequence of steps from individual diagnostic methods and therapeutic techniques. For example, in the case of anxiety-phobic disorders, the exposure therapy technique will be used, in the case of depression, a diary of successes and achievements will be used, and in the case of stress and insomnia, the progressive relaxation technique will be used. In this sense, CBT has a great advantage over other types of therapy, such as the same psychoanalysis, where, despite large classifications and theories, the technique for any disorder, problem or internal conflict remains approximately the same. CBT techniques Since CBT is also a technology-centered approach, there are a huge number of techniques in it, and today they are so many that probably no cognitive therapist will be able to list them for you, let alone perform them correctly. I’m also unlikely to be able to give you the entire list of modern techniques, as well as the entire list of Aaron Beck’s classic techniques, so we will consider only the main ones. Psychoeducation. The first technique is to instill in the client a model of cognitive psychotherapy, which involves constantly teaching the client how thoughts can cause certain feelings and demonstrating this. Actually, this stage is necessary to increase client loyalty, since if he does not believe in the ABC scheme, as, for example, I personally do not believe, then it will not work despite all itsscientific nature. Diaries. The second group of techniques is aimed at identifying automatic thoughts. And the first thing the client is offered here is keeping an ABC diary, which in Russian translation bears the specious name SMER. In this diary, the client writes situations - thoughts - reactions in accordance with the ABC scheme, thus learning to independently identify his thoughts and specify his request. Keeping a diary occurs throughout the entire process of psychotherapy, and during the sessions themselves, the therapist constantly helps the client to identify his inadequate cognitions , and then demonstrates how they can be written down in a diary. Moreover, since the client often cannot identify the thought that is disturbing him, the therapist uses additional techniques to identify it. For example, he uses a fill-the-blank technique, filling in only the event and reaction columns in the diary, leaving a void in the thought column so that the client can think about what can be put there. The therapist may ask: “And so that another person could think in your place or your friend?" and thus reveal the thought. He can offer to play out a problematic situation, so that it is easier for the client to reproduce the thought that is problematic for him. In addition, the differentiation technique is used when a column is added to the table with a division into fact or opinion. This is how the client learns to distinguish factual descriptions of events from their distorted interpretation. As a result, when the client learns to identify his thoughts, he and the therapist are already filling out more complex tablets. This is how a stress diary is used, in which the client notes not specific, but generalized situations and reactions. Such a diary makes it possible to identify deeper distortions and beliefs, which are also later entered into the extended ABC diary. At the same time, the therapist also has his own diary, in which he performs the so-called conceptualization of the client, that is, he also writes down his beliefs, thoughts, reactions, and In the process of therapy, the Falling Arrow develops and changes this scheme under the influence of new information. Another technique aimed at identifying thoughts and, to a greater extent, deep-seated beliefs is the falling arrow technique. Many have heard about it, but in fact it is not formalized and is the same deepening dialogue that, for example, psychoanalysts have with clients. So, for example, a client may state his inadequate proposal: “I will definitely fail the exam.” Then we ask, “What exactly will happen?” The client responds, “Well, if I don’t pass the exam, I’ll never find a job.” We ask again, “So what does this mean for you?” - “Well, this will mean that I let my parents down and they will abandon me.” "And then what?" - “Then I will be completely alone and no one will need me.” That is, as a result of such questioning, we have already received a set of thoughts, each of which is written separately in the diary. Moreover, we should not think that this technique will immediately lead us to deep-seated beliefs, and the survey itself can continue indefinitely, so we select exactly those phrases to which the client reacts most emotionally. Socratic dialogue. Next come techniques for challenging thoughts and here, first of all, we are talking about Socratic dialogue, which in fact has nothing in common with the dialogues that Socrates himself conducted, except for the idea that with our questions we lead a person to the thought we need The technique of Socratic dialogue comes down to the fact that the therapist first asks himself why the client’s given thought is incorrect, and after giving himself the answer, he comes up with an appropriate question for the client. For example, a client states that during his speech someone in the audience laughed, which means that they laughed at him. Hence, the therapist first asks himself: “Why might this thought be incorrect?” and concludes that, for example, “The person could have laughed at something other than the client.” Therefore, you can ask the client: “Could there be other reasons for that person’s laughter?” or “Could it be that helaughed not at you, but at a joke that was sent to him on social networks during a speech.” Gradually, the client himself learns to challenge his thoughts in this way and expands his ABC diary, now it not only indicates irrational thoughts and beliefs, but also rational ones answers to them. Arguments for and against. Here a plate is drawn, where in different columns the arguments “for” and “against” a given thought or belief are indicated, which are also sometimes given weight. The idea is to show the client that his dysfunctional judgment is simply not beneficial to him. Behavioral experiment. This technique involves asking the client to test his thought. For example, if he thinks that everyone will laugh at him at a performance, we can invite him to perform. In most cases, certain thoughts are refuted, or their consequences are refuted, since the individual is most often afraid not of facts, but of their outcomes. For example, a person might be afraid that if they laughed at him at a performance, he would die of shame, but when they actually laughed at him, he realized that it didn’t mean anything and calmed down. Skills training. Most often we are talking about social skills, when the client is taught to correctly express their feelings or defend their boundaries. For example, the client is given the following refusal formula: if you don’t like something, you must indicate the specific behavior that does not suit you, your feelings about it, as well as the desired reaction. So, instead of immediately hitting the child on the head, the father can instead tell him: “You make a lot of noise at night, I’m irritated by this, it would be nice if you would stop.” Such communication usually not only sounds more plausible, but also more often achieves its goal. Moreover, in addition to social ones, the client can be taught the skills of relaxation, coping with stress, and many others. Role reversal. In CBT, as in REBT, role-playing games are used, when the therapist and the client change places and the client tries to convince the therapist that his own thoughts and beliefs are incorrect, thereby convincing himself. Decatastrophization. Separately, for catastrophic assumptions, the decatastrophization technique is used. This technique assumes that we develop a series of events that the individual stops at when catastrophizing. For example, a girl declares that if she defends her opinion in front of a guy, he will leave her. Then we ask, “What happens next?” - “Then I will feel bad and I will cry” - “What will happen next?” - “Well, I’ll be left alone, I’ll be lonely” - “Well, a month, two, a year will pass, what’s next?” - “Well, I think by then I’ll have already found someone new.” Thus, the client understands that the situation is not so catastrophic and that it does not end with a breakup with the guy. Reframing. Reframing involves replacing the client's inadequate thought with a more rational and adaptive one, implying specific behavior. For example, if a client states that “He will never be able to start a family,” you can reformulate this into the following thought: “If I don’t try, then I definitely won’t succeed, but if I try to get acquainted, then at least I will have a chance.” Decentration . The technique assumes that we invite the client to accept his own problem, and then simply transfer his attention to something else. Well, for example, this is how a client can accept his anxiety: “Yes, I have anxiety, and, most likely, a panic attack will begin soon, but nothing can be done about it, so I’ll just be distracted by my own affairs.” Actually, an example of such a technique is counting to yourself during a panic attack. Back to the past. CBT also uses the “Back to the Past” technique, when we invite the client to describe a particular situation from the perspective of an objective observer. For example, if the client himself believes that he made himself a laughing stock when he slipped on the ice, then from a third-person perspective, he may perceive it more coolly: “Well, yes, it was funny, but nothing more.” Often this techniqueused in working with trauma. For example, if a girl feels guilty about being seduced by her father, an outside observer may note that it was the father who seduced his daughter and it was not her fault. Trauma Diary. Another technique used to work with trauma is the ABC Trauma Diary. This is, in fact, the same ABC diary, only here significant events from life and the conclusions that the individual made from them are recorded, and then rational responses to these conclusions are written down. The “Stop!” technique. Also, to work with maladaptive thoughts, the “Stop!” technique is used, when the client, when such thoughts arise, must loudly tell them: “Stop!” and they must disappear. (This is probably the most ineffective CBT technique, but despite all the declared scientificity, for some reason they continue to teach it). Systematic disensitization and exposure. Actually, we will combine disensitization and exposure into one group of techniques, since we have already talked quite a lot about them. The essence comes down to the fact that a person encounters an object that frightens him and relives the emotions associated with it, so that, according to the law of the verbal reflex, they come to extinction. Coaching. I have combined another group of techniques under the name coaching and, in fact, it is related to planning and any other work with goals. So, within the framework of CBT, the client is helped to clarify his goals and clearly plan them, setting deadlines and options for his behavior. If certain goals are not achieved, the therapist helps the client set more adequate goals and objectives. Setting limits. I combined another series of techniques into one group and called setting limits. This includes everything that involves limiting a particular behavior and its exposure. For example, this applies to limiting the number of calories eaten per week; the number of times the client seeks help in trying to compensate for his loneliness; the amount of time after which an OCD patient begins to perform his rituals. Scaling and the cognitive continuum. In the case of black-and-white thinking, the cognitive continuum technique is often used, when the client is asked to rate a particular situation on a scale from one to one hundred, which allows one to avoid polar and catastrophic assessments. These are the basic CBT techniques, but one must understand that they and their modifications exists today many times more. You also need to understand that today REBT and CBT are essentially the same in their techniques and differ rather only in the principles of conducting therapy, and therefore the techniques that we discussed in the chapter on REBT apply here. Conclusion In conclusion, I see no point in talking about the effectiveness of this direction of psychotherapy, since everyone knows that it is considered the most scientifically based. I am skeptical about CBT, since in many ways it directly borrows methods from other areas, while many representatives of CBT will confidently tell you that these directions don't work. And modern CBT, as for me, turns into some kind of near-hypnosis with a million proprietary methods for registration, which it is enough for the founder of the method to conduct a simple study. Thus, today, the evidence of CBT more often acts as a marketing ploy. At the same time, CBT, like any other direction of psychotherapy, has no scientific basis, other than these same studies of effectiveness. There is no evidence that our thoughts in any way determine our reactions, while there is quite a lot of evidence that it is emotions that determine our thoughts. There is also no evidence that it is cognitive distortions that lead to disorders, because all the same cognitive distortions occur in both sick and healthy people. At the same time, there is a study that generally shows that the healthier a person is, the more distortions he has [1]. Moreover, again, if CBT was initially a hodgepodge of different, sometimes directly contradictory in their theoreticalbase of techniques, today this discrepancy has only intensified, and you may well meet a therapist who one day will ask you to change your thoughts, then accept them, then express them, and then look for the trauma underlying them. It is interesting that the same applies to cognitive psychology CBT has little relevance, as a number of authors write in their article [2]. You also need to understand that the so-called evidence does not mean either scientific validity or the greatest effectiveness compared to other types of psychotherapy. For example, a meta-analysis by Wampold and colleagues showed that all types of therapies are equally effective in treating depression[3]. In other studies, no difference was found between CBT and EFT[4], between CBT and psychodynamic therapy[5], between CBT and DIT therapy (this is approximately the same as Gestalt therapy)[6]. One meta-analysis indicated that psychodynamic approaches are as effective as DBT in the treatment of borderline disorder[7], while CBT representatives themselves will assure you that only DBT is effective. In general, find studies that show the same effectiveness of CBT and any other psychotherapy can be found in almost any more or less traditional direction and modern implementation of this traditional direction. The only problem is that these studies are contradictory, and except for representatives of CBT, these studies themselves are carried out extremely rarely by anyone. At the same time, one must also understand that most of the effectiveness studies are also biased, and this applies to both CBT and other areas, and it is in principle impossible to adequately measure the effectiveness of psychotherapy. So it turns out that CBT is declared as an evidence-based direction, simply because there There are simply more of these same studies, even though the results of these studies are greatly exaggerated, for example, due to the peculiarities of selecting their participants. By saying all this, I definitely do not want to say that “CBT is ineffective and let’s all go to family constellations together " CBT has many advantages, one of which I, for example, believe is methodical and systematic, which fundamentally distinguishes CBT from most other areas. And the very fact of the existence of research and the desire to conduct it already speaks in favor of CBT. I’m just a supporter of healthy skepticism, or, as they say in CBT, rational thinking, and I believe that none of the directions should be absolutized. And yes, I myself am a certified CBT therapist, but in my practice I use CBT extremely limitedly because I didn’t see much benefit from it. Aaron Beck himself helped people until the last day of his life and died at 100 years old. At the same time, all this time he himself kept an ABC diary and challenged his thoughts. And its therapy is by far the most popular and most researched to date.[1] Alloy, L. B., & Abramson, L. Y. (1988). Depressive realism: Four theoretical perspectives. In L. B. Alloy (Ed.), Cognitive processes in depression (pp. 223–265). The Guilford Press.[2] Deborah C. Beidel, Samuel M. Turner. A critique of the theoretical bases of cognitive behavioral theories and therapy. Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine, USA. 2002.[3] Wampold BE, Minami T, Baskin TW, Callen Tierney S. A meta-(re)analysis of the effects of cognitive therapy versus 'other therapies' for depression. J Affect Disord. 2002 Apr;68(2-3):159-65. doi: 10.1016/s0165-0327(00)00287-1. PMID: 12063144.[4] Bodenmann G, Kessler M, Kuhn R, Hocker L, Randall AK. Cognitive-Behavioral and Emotion-Focused Couple Therapy: Similarities and Differences. Clin Psychol Eur. 2020 Sep 30;2(3):e2741[5] Driessen E, Van HL, Peen J, Don FJ, Twisk JWR, Cuijpers P, Dekker JJM. Cognitive-behavioral versus psychodynamic therapy for major depression: Secondary outcomes of a randomized clinical trial. J Consult Clin Psychol. 2017 Jul;85(7):653-663[6] Butollo W, Karl R, König J, Rosner R. A Randomized Controlled Clinical Trial of Dialogical Exposure Therapy versus Cognitive Processing Therapy for)