"Cognitive-behavioral therapy”. Can our brains treat our mental illnesses?

"When you have an unpleasant feeling or feeling, try to recall the thoughts that you had prior to this feeling".

Can you do that? Only when you feel angry, upset, sad or any bad feeling start writing the date and date in a table on a white paper, then in the table itself record that feeling, then next to it record the event that caused this feeling, for example a word someone addressed to you or a place You entered it or someone's behavior towards you, whatever it is, then next to these criteria write the idea that ran in your brain during this feeling.

The white paper that we mentioned earlier is often the “homework” or “daily log” in the first or second CBT sessions, but when Beck started it - in the 1960s - the rules of this simple paper had not yet appeared, Beck was He works as a psychoanalyst, but he finds something strange to tell in his famous book "Cognitive Therapy and Emotional Disorders", where he says that between events and responses to them there has always been a gray area that no one sees.

For example, one of them goes out into the street and when she goes a certain distance, she feels nauseous and falls to the ground. Here the school of psychoanalysis will explain this matter as related to sexual desires in the subconscious of this woman, including nudity, for example, or betrayal, which makes the patient feel that she is a bad person and pushes her to the brink of collapse, while the behavioral school sees that the matter is conditional, when this lady arrived in this place similar A previous situation during which a great catastrophe occurred, which caused her to conditional horror, but when Beck asked this lady what she was thinking during this horror that she experienced, she replied that she was thinking of one thing: “I will get lost in the street, someone will kidnap me, I will not be able to go back to home again."

To understand Beck's idea, let's assume that the teacher in a class said that "Hossam" got low grades in the chemistry exam. Here, Ali says to himself while he is a student in the class: "As long as Hossam gets a low grade, maybe I will get a high grade." Munir On the other side of the class he says to himself that “It means I will also get low grades, that could happen to me.” In the back you may find that Ahmed doesn’t care about it, but next to him sits Sameer who says to himself: “It seems that This teacher is unfair."

It is the same event, which is the teacher’s announcement, but despite this, Ali, Munir, Ahmed and Samir each interact with it in a sense of their own, one of them was optimistic, the other was pessimistic, and some did not care, at that point Beck says that the events, then, are not the reason In our response to it, and here he quotes from Stoic philosophy when Epictetus says: "All that happens to people of emotion is not because of things, but because of their thought of things."

Let us give another example to clarify*, Hana and Bahira are friends with “Mona.” The latter had her birthday party recently, but she did not invite Hana or Bahira, in response to the matter, Hana said to herself that Mona “probably forgot to do this”, while Bahira said “You deliberately didn’t invite me.” It is the same event but the response, like the previous example, was different. Bahira is now sad and may think that she will never speak to Mona again, but what did Bahira have to come to such a conclusion?

Beck believes that thoughts descend on our brains completely randomly, but there is a kind of filter that deals with those thoughts and selects a specific type of them that correspond to “core beliefs” within us, Bahira for example has a core belief that says “I am a bad person”, this is the filter The one who chooses the thoughts that fall on her brain and only focuses on the thoughts that confirm that idea, which is that she, for example, is unpopular, and therefore Mona preferred not to invite her to the party, here Beck intervenes to say that mental illness works in the same way.

Which means that the states of sadness and distress that befell Bahira may be normal, but if Bahira’s core beliefs about herself are strong enough, it is enough to cause her to fall into a depressive episode, from that point the sad situations that a person is exposed to are not the cause of depression, but “ core beliefs” themselves, so the true itinerary of the disease is: events, then thoughts, then feelings, Bahira’s distress (feelings) was not because her friend had not invited her to the birthday party (events), but because of Bahira’s own thoughts (ideas).

Beck argues that mental illness stems from significant distortions in our core beliefs. For example, the “tendency to exaggerate.” A woman tends to overemphasize the wrinkles in her skin because she has aged to a constant fear that her husband will leave her. On the other hand, she neglects the merits of her personality completely, jumping to a crude conclusion - jumping to conclusions is one Signs of distorted thinking - says that her husband does not care about her personality at all, the man with whom she spent forty years.

The tendency to intimidate or expect the worst is also one of these distortions, so you find the anxious patient directly inclined to expect that “this might happen to him” when he sees an accident, or to expect that he will die because of this surgery, and in response to those thoughts he refuses to engage in them and panics , and the matter may develop into a fear of hospitals, for example, on the other hand, the “generalization” completes that system, so a person who fails in only one exam sees that he is a “failed person” in general, and one of them sees - and he lost in one of the deals - that he “cannot succeed.” Never in life.

This, in turn, pushes us in the direction of another mistake, which is “ignoring everything that is positive.” The student who was the first in his class attributes this success to chance, luck or anything else, and therefore this opportunity may not be repeated again and I may fail the next exam, and in Our normal lives this happens to all of us, but in cases of mental illness the impact of these distortions in our lives gradually increases. Every bad experience that occurred because of these distortions is supported by continuous feedback loops, and the matter may develop and the person reaches a stage where the idea of ​​“I am a burden on others” dominates. Over his life, to go into depression, and sometimes suicide.

Let's take depression as an example, according to Beck. It consists of three important and fixed beliefs that remain inside a person and filter all thoughts coming to his brain, which are: a negative perception of oneself, a negative perception of life experiences, and a negative view of the future. These beliefs arise because of clear biases in thinking, this person usually thinks sharply (all or nothing), either he will be the first in the class or he will be the dumbest student, or trustworthy or not, and either loved by all people or not at all.

Here a person resorts to a dangerous generalization saying: “No one loves me,” just because one person does not love him, and this comes to a conclusion saying: “I am stupid, so no one will love me,” and therefore the matter can develop for everything else, so the depressed patient says to himself Based on these rules: “My wife is cheating on me,” and the depression patient says: “He was late tonight, he must have been with someone else,” and a third says: “He finished talking to me quickly, he doesn’t want to talk to me,” and the matter develops into more complex things, and he sees One of them had a broken flight of stairs in his house, to say to himself in general: “This house is dilapidated,” and the matter develops into “I made a mistake in choosing the house and it seems that I am a victim of fraud.” This was built on the same rule: “I am stupid,” and thus these intellectual distortions cause Later Developments.

From these examples we understand that cognitive-behavioral therapy is based on the idea that there is no great ambiguity in the matter, proponents of psychoanalysis believe that the ideas that cause illness are embedded in the depths of our history right up to childhood and can only be extracted with a lot of digging inside you, but doctors do not They are interested in ideas in the first place and tend directly to the pharmacological effect on our nerve cells, at that point Beck appears in his school, and sees that some of our conscious thoughts are what may be the cause of mental illness, and also in our disorders and our usual daily fears.

But those thoughts pass quickly and automatically in our brains, so we cannot easily pay attention to them. Someone makes a mistake in the exam and goes into a state of great sadness for the following days, thinking that the reason for his sadness is this mistake. Here, the function of the cognitive therapist - during the first and second sessions in particular - is to push you to understand the hierarchy of your awareness because it is not so much about the event as to the thoughts that lie within you.

 (For example: Amr passes” Ideas” that says someone will criticize him in a company meeting, here “feelings” appear, which is fear, followed by “behaviour” that Amr avoids going to those meetings). This is the first path to treatment, and through intensive training that includes behavioral exercises in addition to cognitive dialogues, and with a slow and calm gradation because the patient does not improve once his intellectual distortions are known, these distorted core beliefs can be changed to others closer to reality, which affects the symptoms of the disease.

From here, Beck introduces us to the techniques of cognitive therapy, explaining that the patient usually imagines that he will undergo a kind of complete intervention to change his thoughts while sitting to receive help, but Beck clarifies an important point that is one of the reasons for the superiority of cognitive-behavioral therapy, which is that the goal of the therapist is not to solve all problems The patient's cognitive biases are only problems that cause satisfactory outcomes, while the rest of the current, or even future, intellectual biases are left to the patient himself to try to deal with. Beck's therapy, and the cognitive model in general, is a state of cooperation that results in the patient gaining a "learning to learn" experience so that they can solve their problems.

Beck is very interested in the “learning to learn” experience, and points out that it will be effective no matter how long the road takes. Moreover, the therapist has, at any given moment of treatment, a number of resources to confront the problem and deal with it always more than he thinks, and therefore the It just requires more investigation into the patient's complex beliefs, and at that point Beck adds that both the therapist and the patient exaggerate their perceptions of the patient's fragility, as the patient can usually perform better than expected in therapy sessions!

Sometimes you will find that Beck has slightly exaggerated assumptions, such as the perception that change is “always” possible and that “any behavior can be modified,” but if we decide to reflect on the history of cognitive behavioral therapy, we will find that these exaggerations were justified at the time, from the moment it appeared. To CBT as the expected messiah of psychological sciences, for several reasons, including its promising initial experimental results, and also because it has introduced psychology into more testable technical aspects. In analytic therapy, for example, the personality of the therapist itself is part of the treatment. Also, in CBT you will see that there are no interests in deep depth or research behind the patient’s history, this has led to a shorter period of CBT (several months compared to years for analytic therapy).

Currently, cognitive-behavioral therapy has found its way to treat many mental illnesses, mainly with very good experimental results in cases of depression and anxiety disorders such as phobia or obsessive-compulsive disorder, personality disorders and addiction, but it has also extended to other areas such as psychosis. Cognitive-behavioral therapy not only raised the cure rates, sometimes reaching 70% (in combination with the drug), but also reduced the number of relapses in patients because, unlike medication, it establishes a mechanism of thinking that automatically resists the disease after the patient learns it and learns how to use it to learn About the same, currently, cognitive-behavioral therapy is the number 1 choice for the doctor, followed by medication, and not vice versa, in some cases, especially in some disorders of children, but CBT is usually combined with medications and the results in this case are the best.

Recently, a third wave of cognitive-behavioral therapy has emerged that has integrated it into other domains. Acceptance and commitment therapy has emerged, and mindfulness-based cognitive therapy has also emerged. Despite the apparent differences between these mechanisms, they all agree that the state of "self-awareness" and "vigilance" can help patients The difference remains over how we will deal with our core beliefs, do we change them or adapt to them? Although the enthusiasm for cognitive behavioral therapy - with its old rules - is not what it used to be, it is still one of the best therapeutic mechanisms that have helped millions of patients around the world.

But what is remarkable - apart from the therapeutic purposes - is that the scope of cognitive-behavioral therapy established a different philosophy that says that one of us is able to control himself in a way that no one would have expected. psychological, or even to the concentrations of neurotransmitters in his brain cells, according to the vocabulary of neuroscience, but he is - even to a degree - able to resist and make a decision, and this deserves contemplation

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