Cognition refers to a person's cognition and views on a thing or an object, his own views, others' ideas, the environment and events.

Cognitive behavioral therapy believes that people's emotions come from people's beliefs, evaluations, explanations or philosophical views on things they encounter, not from the things themselves.

As A·T· Baker, the main representative of cognitive therapy, said, "Disordered behaviors and emotions all originate from disordered cognition".

For example, a person always thinks that his performance is not good enough, and even his parents don't like him. Therefore, he has no confidence, inferiority and bad mood in doing anything. The strategy of treatment is to help him rebuild his cognitive structure, reevaluate himself, rebuild his confidence in himself and change his "bad" cognition.

Cognitive behavioral therapy believes that the goal of treatment is not only to deal with the external manifestations of behavior and emotion, but also to analyze the patients' thinking activities and coping strategies, find out the wrong cognition and correct it.

basic concept

"ABC" theory:

Ellis suggested it.

A refers to the activation of events related to emotions;

B refers to belief, including rational or irrational belief;

C refers to the emotional consequences and behavioral responses related to the event.

The relationship between events and reactions:

It is generally believed that event A directly causes reaction C, but this is not the case. There is an intermediary factor between A and C, B..A's meaning to individuals or whether it causes a reaction is influenced by B, that is, it is determined by people's cognitive attitudes and beliefs.

For example:

An abstract painting; Some people appreciate it and have a pleasant reaction; Some people think that these are just meaningless lines and colors, which will neither produce pleasure nor disgust. Painting is event A, but the reaction C is different, which is because people have different cognitive evaluations of painting.

Cognitive evaluation or belief has an important influence on emotional response or behavior. Irrational or wrong cognition leads to abnormal emotions or behaviors, not the event itself.

Automatic thinking:

The idea that appears in the brain after an event is called automatic thinking.

For example:

Seeing a dog will cause fear. There is an idea between the fear reaction of seeing dogs and dogs biting me, and there may be a horrible imagination of dogs biting. The dog biting me is automatic thinking.

Automatic thinking is not good or bad, only adaptive and non-adaptive. The non-adaptive part is also called distorted thinking or wrong thinking.

Distorted wrong thinking includes subjective speculation, which appears in the form of "automatic thinking", that is, these wrong thoughts are often carried out unconsciously and habitually, so they are not easy to be identified.

Different psychological disorders have different cognitive distortions. For example, most patients with depression have a negative and biased attitude towards themselves, reality and the future, and think that they are losers, everything is unsatisfactory and there is no hope for the future. Anxiety is to prejudice the threats in reality, exaggerate the consequences of things, and only emphasize the unfavorable factors and ignore the favorable factors when facing problems.

Common cognitive distortions:

(1) Subjective speculation:

Lack of evidence, subjective speculation. If a patient doesn't do a good job, it is assumed that all colleagues will look down on her.

(2) One-leaf obstacle:

Regardless of the overall context and background, only look at the details or temporary performance and draw conclusions. If a student can't answer a question in an exam, he will only think about the unanswered question afterwards and feel that all the exams have failed.

(3) Labeling indiscriminately:

That is, a one-sided formulation of yourself or others. For example, a patient blames himself for his child's poor study and thinks he is a "bad mother".

(4) the absolute concept of either/or:

Think that black is white, bad is bad, can not tolerate mistakes, and demand perfection. For example, a patient failed to achieve the predetermined goal in an exam, and then he felt like a loser, and it was all over.

Core beliefs:

Core belief is the core part that supports every automatic thinking, similar to world outlook, values and so on. They are the driving force to guide and promote life. These beliefs are regarded as absolute truth by people, and they think that this is the way things should be.

Most people will maintain positive core beliefs, such as "I am valuable".

People with psychological troubles often have negative core beliefs. For example, a person's core belief is "I am incompetent", so he will tend to pay attention to some information related to this core belief selectively in his life. Even if there is positive information, he will tend to explain negatively and will continue to believe and maintain this belief.

Most negative core beliefs are related to early growth experiences. Different from automatic thinking, core beliefs are deeply hidden in people's hearts and are not easy to be clearly expressed. Generally, it can only be understood during treatment and in the constant inquiry of the therapist.

? Test hypothesis:

One way to identify and correct cognitive distortions and misconceptions is to examine the evidence that supports and does not support a wrong hypothesis.

For example, after being frustrated, a patient thinks that he has "accomplished nothing" and "others look down on me", which makes him very depressed. In fact, he has successfully done many things, graduated from college and worked as a business manager.

The process of testing hypotheses not only helps patients to know the facts, but also helps them to discover their distorted understanding and negative attitude towards things.

Check the evidence:

For example, negative thoughts-positive thoughts; I'm stupid-I'll be smarter; I never know how to speak-I can always think and express myself clearly; I'm hopeless-I'll change as long as I work hard; I'm too weak. -I'll be strong.

Defence counsel:

"When challenging your ideas, you can imagine that you have been brought to the trial bench, and the plaintiff (automatic thinking) has been suing you and labeling you incompetent and cowardly. Now your task is to play the defense lawyer and attack the evidence. You must take this job seriously. "

Homework:

According to the treatment process, the client is assigned homework, which generally includes the collection of personal data, the test of hypothesis and the practice of cognitive therapy technology.

Indications:

Cognitive behavioral therapy can be used to treat many diseases and psychological disorders, such as depression, anxiety, anorexia nervosa, sexual dysfunction, drug dependence, phobia, chronic pain, mental illness and so on.

The most important thing is to treat patients with emotional depression, especially adults with unipolar depression, which is an effective short-term treatment.

depress

Cognitive theme:

Deprivation, frustration, loss.

Unreasonable cognition:

People who are extremely depressed will blame themselves for no reason after being frustrated, exaggerating their shortcomings and narrowing their advantages;

Self-blame-blaming yourself for all the responsibilities, showing a cognitive illogical and unrealistic.

Core beliefs:

I'm not okay. I'm not welcome. People don't like me.

Core beliefs are related to personal experience, his cognition of important people and his perception of other people's attitudes.

For example, if a child has had a great loss of experience in childhood, the child cannot understand that things have nothing to do with him. On the contrary, he will think that they have something to do with him and that it is caused by his bad behavior, thus forming the core belief that "I am not good."

The biggest risk of depression is suicide.

Cognitive theme of suicide:

First, a high sense of despair (Baker thinks that "despair" refers to "negative thoughts, negative expectations or pessimism about the future"). The higher the degree of despair, the greater the possibility of suicide;

Second, I feel that I can't cope with the problems of life, conclude that the problems I encounter are impossible to solve, and feel that there is no way out. Therefore, letting them know that things are possible and feasible in crisis intervention can correct unreasonable cognition and reduce the risk of suicide.

Anxiety disorders

Cognitive theme of anxiety disorder;

1, exaggerating the danger:

An exaggerated response to a person's perceived danger; Give a disastrous explanation for things getting out of control. Most of their cognitive contents revolve around physical or psychological and social dangers, such as fear of death, madness, out of control, fainting, being monitored, making mistakes, accidents and so on. They will selectively pay attention to threat information that has been screened out for physiological or psychological reasons.

For example, a relative of the client died of a myocardial infarction. After witnessing the rescue process, the idea that "it would be terrible if she had a heart attack" came into her mind. She woke up in her sleep that night and felt her heart beating and chest tightness, so she thought "she had a heart attack." This catastrophic thought and explanation pushed her anxiety to the peak and formed the first panic attack.

Core beliefs of patients with anxiety disorder:

I have no confidence, I am incompetent, and the outside world is dangerous. The theme of the core belief is "danger". The core belief of danger plays an important role in body feeling and cognitive misunderstanding. Dangerous core beliefs bring dangerous automatic thinking, which in turn leads to anxiety.

Obsessive-compulsive disorder

Cognitive model:

(1), too high a sense of responsibility is not appropriate.

Misunderstanding of responsibility is a unique manifestation of obsessive-compulsive disorder. They have a high sense of responsibility, fear of dereliction of duty and a high sense of mission, guilt and guilt.

(2) Threat assessment

Obsessive-compulsive disorder patients overestimate the danger and harmful consequences and underestimate the individual's coping ability.

(3) Perfectionism

Perfectionism thinking mode, a way to control and reduce injuries, is also the main factor to produce and maintain obsessive-compulsive symptoms, and this cognitive mode will increase the overestimation of danger. The manifestations of perfectionism in obsessive-compulsive disorder include: the understanding of things must be perfect; Everything must be done just right; Absolute symmetry, certainty and ideological control.

(4) the importance of thinking

Obsessive-compulsive disorder patients pay too much attention to and control their own thinking because they are afraid of being responsible for bad consequences. The boundary between thinking and behavior is unclear, and they think that a certain thinking will lead to a certain behavior.

(5) Excessive demand for control

The core of obsessive-compulsive disorder is that their lives need external control, and they need to absolutely control their own environment. Doing everything perfectly is a way to reduce danger and avoid criticism. Obsessive-compulsive disorder patients also require their own thoughts to avoid danger and injury. Obsessive-compulsive concept is the collapse of the normal psychological system that controls too much and does not allow thinking.

(6) Everything needs to be determined.

Obsessive-compulsive disorder patients can't stand the uncertainty of perfection and danger perception, and self-efficacy doubt is one of the cognitive ways of obsessive-compulsive disorder. When a customer asks for certainty, he will repeatedly say, "In case something goes wrong, I may be that person." Cognitive therapists admit the possibility of this existence and cannot rule it out. In fact, the real question is why it is difficult for customers to accept uncertainty. The discussion of this problem leads to the discussion of predicting the demand of things with certainty, which shows that the parties have the demand of complete control, otherwise disaster will come.

anorexia nervosa

Cognitive theme:

The focus is on the unreasonable cognition of one's appearance, face shape and weight. "I am fat", "I am not beautiful" and "thin is beautiful".

Core beliefs:

Appearance is everything. If I am not beautiful, no one likes me. I am not attractive.

Taboo:

Including patients with hallucinations, delusions, severe mental illness or depression, patients with unstable family system are not suitable for cognitive behavioral therapy.

Many people think that the reason why I am in a bad mood is that I have encountered something unlucky, which seems to be a psychological distress caused by a bad thing. In ABC theory, due to cognitive function, it is uncertain whether adverse events will bring psychological distress, and may even bring growth and good opportunities. This is an important concept of cognitive behavioral therapy: irrational or wrong cognition will lead to abnormal emotions or behaviors, not just the events themselves.

The relationship between automatic thinking and core belief: If psychological activity is compared to a tree, then automatic thinking is a leaf and core belief is a root. Unreasonable cognitive style or automatic thinking comes from its deep core beliefs. The formation of core beliefs is related to early experiences. Once formed, it will exert a subtle influence on people's thinking and behavior. This kind of influence is too hidden to be easily realized, so we often hear the saying that "the authorities are fascinated and the bystanders are clear" in our lives. When encountering some similar events, it will trigger core beliefs.

For example:

People who lost their mothers in their early years may be hit by bad life events when they grow up, such as failing in major exams, being seriously ill and encountering serious difficulties. This may lead to their potential sense of loss, which is manifested in many negative automatic thinking. Under the influence of unreasonable ideas, they will gradually lose the ability of objective judgment, and finally fully confirm the core belief, that is, "I am bad, and no one can help me." I am a loser. "

So simply changing automatic thinking is not enough. In order to completely give up some unreasonable cognition, we must also start with changing the core beliefs.

(1) Cognitive behavioral therapy needs to identify unreasonable cognition in action, replace unreasonable cognition in action and change core beliefs in action, so action is very important.

(2) The therapist will assign homework and ask it to be done every day. Unreasonable cognition is formed over time and needs constant practice and practice to change it. Therefore, cognitive behavioral therapy is not simply to change cognition, but to experience and correct cognition in action. Many people only pay attention to cognition and ignore action, and as a result, they become "giants of thought and dwarfs of action" and become cognitive theorists, but they can't solve their own problems.

Only some people can experience trauma but become stronger.

"On the contrary, only those who choose to remember them deeply and understand them choose to live seriously and gain peace and strength in the process. They believe in themselves more than fate.

When we talk about the word "trauma", we often associate it with various adverse effects on individual development.

However, in recent years, psychologists have found that some people who have experienced traumatic events such as long-term humiliation or abuse, terminal illness, death of relatives, war, terrorist attacks, etc. From these experiences, I have gained positive personal growth. These people are called "survivors".

The word survivor, on the one hand, represents their negative life experiences, and at the same time, it is also a manifestation of strength-the word emphasizes that "they have strongly measured those negative events."

1995, Richard Tedeschi and Lawrence calhoun put forward the concept of "post-traumatic growth". Post-traumatic growth refers to the positive psychological changes experienced by some people after struggling with challenging life situations: after trauma, individuals develop a higher level of adaptability, psychological function and life consciousness than before.

Not everyone who has experienced trauma will have "post-traumatic growth", so what makes some people have such post-traumatic growth? How did it happen?

According to the definition of APA( 1994), traumatic events refer to events related to (actual or threatening) death or serious injury, and contact with such events will make people feel fear, fear and helplessness.

Tedeschi (20 12) believes that events that can cause trauma usually include the following characteristics:

A. The occurrence of the event is sudden, unexpected or unusual;

B it usually involves physical injury or feeling that one's life is threatened;

C. it makes people feel out of control.

Traumatic events in some stages of life are more likely to make people vulnerable, such as childhood and around 20 years old.

However, the researchers found in some survivors that in the process of fighting against traumatic events, although the pain did not disappear, they also experienced some new positive psychological changes.

For example, in the study of former war criminals who have been detained in Vietnamese prisons for eight years, it is surprising to find that most of them have experienced continuous positive personal growth after their release. Moreover, those who have experienced the worst situation-repeated torture, hunger and physical injury-will grow up more actively than others (Fretwell, 20 13).

Calhoun said that in the cases he studied, about 35-75% of the survivors experienced different degrees of post-traumatic growth (kushner, 20 16).

How did this growth happen? Is it a direct result of trauma?

The answer is no.

Tedeschi (2004) believes that although it is called "post-traumatic growth", the most critical factor contributing to growth is not the trauma itself, but the process of survival-the process of struggling against trauma and finally surviving, which determines how far we can grow. Although few of us consciously and systematically try to give meaning to trauma or seek the benefits of trauma, this growth is real when we work hard.

In every individual who experiences trauma, the negative and positive effects of trauma coexist. It's just that the ratio of the two is different for everyone. Some people can overcome the negative effects through the process of "survival" and let themselves have more positive effects. From this perspective, post-traumatic growth is both a process and the result of this process.

Tedeschi and calhoun (1996) believe that when we struggle with traumatic events, we will gain growth in the following three aspects:

1. Self-change

I don't know if you have ever experienced trauma, but have you ever thought, "The worst can't be worse than now. Even in the face of such difficulties, I can handle it well. What else can't I handle? "

After trying to get through the trauma, we will find that we are stronger than we thought. The study found that the experience of coping with and dealing with trauma made survivors more self-reliant, improved their sense of self-efficacy and value, and changed their views on themselves.

Simply put, their self-evaluation of their ability to cope with difficulties will be improved, and they will be more confident that they will be able to cope with difficulties in the future (Tedeschi, 1996). This is because we will summarize and infer our own survival process in the predicament more widely.

2. Changes in interpersonal relationships.

Research on mothers of newborns with serious diseases and individuals who have lost their parents found that 60% people think they have benefited from this process. 20% reported that this experience made their family relationship closer (Affleck, 1985). This is because traumatic experience makes them realize how important the relationship with others is and how quickly they can lose someone close to them, thus cherishing the relationship with others more (Malinak, 1979).

Some children who have been neglected and abused by their parents will also cherish and appreciate those who have given love outside the family (friends, teachers, lovers). This kind of treasure will make their relationship closer.

In addition, trauma is also an opportunity for us to rediscover the neglected social support system. When we are traumatized, we will be more willing to expose ourselves than before. This kind of self-exposure will enable us to find suitable social support. When we get a response, we will understand that we can rely on others and are willing to accept others' help when we are in trouble. In the report of raped women, 25% said that they had improved their relationship with estranged family members because of their injuries (Burt, 1987).

At the same time, we will be more sensitive to the pain of others because of our experience, so we will become a more caring person. This will also bring us a better relationship.

3. The change of life philosophy.

In addition to changing our view of ourselves and others, the process of fighting trauma will also change our view of life. In women diagnosed with cancer, there is such a change: they begin to adjust their life focus and have a new judgment on what they should pay attention to, such as appreciating their life value more, making themselves live more easily and enjoy life (Taylor, 1984).

In the long run, the process of fighting trauma finally strengthened the spiritual belief of survivors and enhanced their sense of meaning in life. They will get emotional relief and establish a new philosophy of life, such as believing that good things and bad things will happen to the same person, and this is nothing (Aldwin, 1994).

How does post-traumatic growth happen?

-"Post-traumatic growth model"

Tedeschi and calhoun (20 14) put forward a model of post-traumatic growth:

1. First of all, when individuals experience traumatic events, we will be greatly challenged in three aspects:

The challenge of managing sadness, that is, how to control and deal with one's extreme negative emotions;

Challenges in life schema, beliefs and goals, that is, how to deal with their doubts about the basic knowledge and beliefs of the world and establish new and higher values and goals; When trauma makes you doubt life, you have to find ways to re-establish your basic understanding and belief in the world.

Challenges in life narration: how to get rid of painful narration and establish new narrative methods? Narration, that is, how we tell our own stories, what we pay attention to in the stories and how to interpret the details, not only shows what kind of people we are, but also shapes what kind of people we will become. The narrative object of trauma may be others (for example, in a support group) or ourselves (for example, keeping a diary), but both of them will force us to face the traumatic events directly and ask the meaning of life directly.

2. Most individuals will go into repeated thinking, that is, ruminating. At first, meditation was mostly automatic and intrusive (intrusive means that you are out of your control, but you don't want to think about it, but you always enter your mind). These thoughts will automatically enter our minds, making us involuntarily think about the trauma again and again.

In the process of meditation, some people can relieve their sadness, manage the passive meditation process and enter active and thoughtful meditation. Others will go to the outside world for support. They will expose themselves to others through communication and prayer, and get exemplary learning and support from other role models (such as psychological counselors) on how to recognize and how to deal with them, and gain a new perspective of life narrative, thus entering active meditation.

3. After entering intentional meditation, individuals can gradually change their cognitive schema (that is, some basic frames for you to know the world) and narrative style, and make new meaning discoveries, so as to gain post-traumatic growth and life wisdom. The acquisition of life wisdom is a continuous process, which will make us "constantly balance reflection and action, measure the known and the unknown, accept the contradiction of life more, and understand the basic problems related to human survival with a more open mind".

Cognitive strategies in post-traumatic growth

Zoellner(2006) thinks that the "post-traumatic growth model" contains several important cognitive strategies, which play an important role in promoting post-traumatic growth.

Positive cognitive reassessment.

Positive cognitive reappraisal refers to understanding the events that produce negative emotions in a more positive way. It is a "pay attention first" emotion regulation strategy, that is, don't wait to react to emotions, but reinterpret them when they are generated and received.

Cognitive reappraisal is the most effective strategy to make survivors feel strong and able to control and manage difficult situations (Castro, 20 16).

The process of cognitive reappraisal includes: when we encounter an event that causes us to have negative emotions, we first try to identify our negative emotions and label them, such as "I am beginning to feel angry" or "I feel very anxious". Then, systematically re-analyze the personal impact of this incident, describe and evaluate the trauma in a new and optimistic way, and analyze its positive significance to our present and future lives.

Deliberate:

For post-traumatic growth, intentional meditation refers to "repeated thinking about meaning seeking, problem solving, memory and expectation" (Martin, 1996). As mentioned above, after a traumatic event, we often go into unintentional meditation first, and then into intentional and constructive meditation. When intentional meditation and positive reappraisal occur one after another, the degree of post-traumatic growth is the highest.

Acceptance coping (acceptance coping):

In the study of 9. 1 1 traumatic population, it is an important strategy to promote post-traumatic growth by using the strategy of "accepting and coping", that is, calmly accepting the traumatic events that have happened and accepting the things that cannot be changed when coping with trauma (Butler et al., 2005). On the contrary, if we take a defensive response, that is, show denial and anger at catastrophic events, it is not conducive to the positive growth of individuals.

Pursuing a sense of meaning

The research published in PNAS 2065438+03 found that happiness and meaning often do not overlap, happiness often pays more attention to the present and self-interest, while meaning is longer-term and altruistic; It doesn't mean that people with high happiness must have a higher sense of meaning, and vice versa. Individuals who report negative events and painful struggles (less happiness) have a stronger sense of meaning in life. They need a sense of meaning, keep faith in adversity, and believe that what they get is a longer-term and more grand return in life.

Studies have also proved that if a person has a strong sense of meaning, they may get better post-traumatic growth. In the study of spinal cord injuries and parents who have lost their children, it is found that if individuals have a strong sense of meaning (think that the world is meaningful, both positive and negative experiences are meaningful, they are willing to pursue meaning, and challenging situations are worth investing), then they will better achieve traumatic growth (Zoellner, 2006).

"At that time, suicide did not die, and now every day is like rebirth." From this we find that the owners of similar stories all know their misfortunes, but they are obsessed with the past. The past is not for forgetting-the advice to "forget the past and forget the pain" is always weak. On the contrary, only those who choose to remember them deeply and understand them choose to live seriously and gain peace and strength in the process. They believe in themselves more than fate.

Ding guijun

201April 9 1 1