Cognitivo-behavioral psychotherapy

The cognitivo-behavioral therapies (TCC) are the application of the scientific psychology to the therapy of some turbid determined by this particular approach of psychology. According to this approach, the therapeutic one must be based on an experimental and constraining methodology in order to include/understand and to treat the psychological disorders (Phobie S, Addiction S, Psychose S, depressions, anxious disorders…). It cannot of this fact being truly called " psycho - thérapies" , since their access is not done by what one calls " Psyché " in the current scientific context.

These therapies have as a strong point to attack (X) the problem (S) of the patient by practical exercises (contrary to the Psychanalyse and of the clinic psychologies which are centered on the concept of psyché and what constitutes the cause of the disorders). According to Jean Cottraux (1982), the behavioral therapy seems a " relais" effective towards the analytical therapies. In the same article, this author is pleased in addition with " the blooming of the différences" between Psychoanalysis and behaviorism.

History

In 1879, Wundt founds the first laboratory of experimental Psychologie, which tends to study scientifically human psychism.

But the first notions in the beginning of the TCC come later. At the beginning of the 20th century, the experiment of Ivan Pavlov will reveal the traditional Conditionnement: if one presents a stimulus normally neutral, for example of the light, right before giving food to a dog and that the experiment is repeated several times, the dog will end up salivating only at the sight of the first stimulus: there is conditioning. But if the light is presented, several times, without food, salivation will not occur any more because there is " extinction" , déconditionnement.

As for John Watson, in 1920, it induces a Phobie in a child starting from this theory of conditioning. Watson will produce many research - the Béhaviorisme will be sometimes called psychology watsonienne.

But it is only with Mary Cover Jones, in 1924, that the first behavioral therapy will be carried out: it exposes little by little children to the object of their fear, while rewarding them for this " exposure " , as in their showing other children who them are not afraid.

This first behavioral therapy remains an experiment then. Wolpe will theorize besides in 1952 the principle of rewarding the exposure to the phobic object; Solomon in 1953 will formalize the idea even exposure, proving with dogs which if the exposure is sufficiently long the phobia disappears.

Always in 1953, Burrhus F. Skinner discovers what it names operative Conditionnement, which shows how the individuals acquire their behavior - by selecting those which will be positive for them. It will try to apply it to a better comprehension of the education. This concept will prove to mark the behavioral therapies deeply.
Skinner nevertheless will be criticized by Noam Chomsky to propose a theory not explaining the acquisition of a complex behavior: the language. This criticism remains of importance, less by itself that by the will that it will inspire with the psychologues.
The development of data processing, of the Sciences of the communication, the Linguistique will help with the development of a cognitive Psychologie.

As of 1959 the premises of a cognitive therapy appear. Beck, indeed, which is psychoanalyst, is interested in the depression and considers a treatment aiming at the automatic thoughts and the internal monologs.

1961: Albert Bandura reveals that, if one presents to children of two years and half of the adults maltreating a headstock, and that these adults leave, the children will imitate these behaviors violent one. The Imitation functions if the imitated behavior is not seen " directement" , but is only filmed.

Albert Ellis, in 1962, will produce an “rational-emotive” therapy.

In 1965, Ayllon and Azrin develop a therapy based on tokens (rewards) near schizophrenic: in the absence of being able to cure the Psychose, this method makes it possible to teach simple but invaluable tasks in the difficult cases: such as getting dressed, arranging its room.

The first model of Data processing seems to be born in 1968. Mobilizing the new model which the Informatique proposes, Atkinson and Shiffrin will distinguish in the short run a memory sensory, and long-term.

In 1970, Marks, which distinguished simple phobias and social, theorized the idea of immersion: it is a question of confronting, either gradually with increasingly alarming situations in order to make disappear the anxiety, but of directly immersing the patient vis-a-vis his more great fear

Starting from the medium of the Years 1970, develops the behavioral Médecine.

In 1976, Bandura formalizes the idea of training per model (that Cover Jones used already in 1924). It is about a powerful innovation since that the paradigm to be unaware of the psychic one, the “Block box”, is seen détrôné, announcing the development of cognitive therapies.

In 1995, first attempts mobilize the technology of Virtual reality in order to practice the immersion.

New models continue to appear: let us quote for example the therapy of acceptance and engagement (Beam 1999), or the therapy of full conscience, seeking to eliminate the depressive relapses.

Therapeutic principles

The behavioral therapy acts by means of settings in situation and of exposures graduated to the situations causing an anxiety: for example, in the case of a phobia of the spiders, the patient will have initially to imagine a spider, then to observe images of spiders, to touch a bottle where a spider is, and finally to touch the spider. At the same time, he will learn how to control the physiological demonstrations of the fear.

Although strong of an undeniable success in particular in the treatment of the anxious disorders; disorders of the food behavior and the sexual difficulties, the behavioral therapies were to support several criticisms within the current behaviorist, it neglected a big part of human psychic dimension, namely the importance of the bond between thoughts and emotions and the impact of these last about the behavior. In addition, for the theorists behaviorists with the image of Watson, the brain remained regarded as a block box to which it was useless to reach, only counted stimulations, the answers and the consequences of these last on the organization and its environment.

The cognitive therapy acts on the thoughts of the patient displaying a cognitive distorsion (for example, an excessive fear to be contaminated by a disease could be fought by information on the disease in question and the evaluation of the real risks).

The cognitive therapies, after in particular work of Beck seemed a complement necessary to the pure behaviorist approach by stressing the importance of the unconscious diagrams of thought at the human being and the way in which the diagrams dysfonctionnels can generate and/or maintain various mental disorders. The cognitive therapy does not differ in its methodology from the behavioral therapy yielding with the requirements from the effectiveness and the evaluation. The success of the treatments of the depressive states by the cognitive techniques raised the hope that other pathologies could profit from this type of approach and at present several researchers work to apply this approach in a broader pathological register including the disorders of mood, the anxious states, the personality disorders and the psychoses.

In practice, the psychotherapists, who are not necessarily doctors, trained with these techniques mix the approaches behavioral and cognitive in the same therapeutic project with an aim of improving the effectiveness, with the result that one generally speaks about cognitivo-behavioral therapy (TCC) to indicate this therapeutic approach.

Course of a therapy

The TCC are " therapies actives" : the psychotherapist is not satisfied to listen to the patient, but exchange with him, informs it, proposes techniques, etc to him.

Among its techniques appear the exposure (in imagination, Thérapie by virtual reality or " in vivo "), relieving, façonnement, modeling, the cognitive reorganization,…

Evaluation before treatment
: The analyzes functional: it is a question of studying which is the problem which one wishes to solve, to specify this problem, to include/understand the context and the history of it. It is about a qualitative analysis. Several grids makes it possible to carry out this analysis, like BASIC IDEA , the grid SECCA
: A quantitative evaluation is also carried out. It is pressed on several elements: car-recording, scales of car-evaluation, evaluations external.

Installation of an objective
: It acts above all of a therapeutic contract, determining the goal of the therapy.
: The objective will be graduated: once targeted the problem, it is question of the way which will lead to the resolution, step by step.

Application of the program
: The application of the program simply consists in following the program, stage by stage. One does not retrogress but a stage can, occasionally, take a little more time.

Evaluation of the results
: The cognitive psychotherapist and the patient evaluate the result of the therapy. It was seen that this one started with an evaluation, that others can take place in the course of treatment. This last evaluation will inform about the success of the therapy.
: It is not impossible to consider a new therapy following this evaluation, so of new objectives are considered.

Presentation of the techniques

Relieving:

autogenic Training
progressive Relieving of Jacobson

TCC and Psychoanalysis

The cognitivo-behavioral and psychoanalytical therapies are basically different.

Contrary to the psychoanalysis, and analytical psychopathology where the symptom is carrying direction for the patient, since conceived like expression of a singularity and a subjective history in bond with the assumption of unconscious, holding them of the behaviorist current are based rather on the laws of the training and the various forms of conditioning to explain the formation of the symptoms. The treatment is thus not founded on the problems of the origin of the symptom where on its role and its particpation in the psychic economy of the subject. The treatment answers on the contrary the topicality of the symptom and aims its remission.

Each therapy thus starts with a behavioral analysis detailed with an aim of leading to a scientific assumption on the way in which the symptom was constituted and on the consequences which result from this. The therapy itself will use scientifically validated and reproducible techniques from one patient to another. Throughout the therapy, the patient will be evaluated with each stage and the discussed again initial assumption. The success of the therapy consists ideally of the disappearance of the symptom and its consequences on the life of the patient.

These points did not prevent certain psychoanalysts from being interested to the TCC, of which Dollard, Miller or most consensual Beck; nor certain behaviorists to direct certain patients towards the couch. Triple taken of load (" tri-focale"), combining TCC, analyzes psychiatric regulations, is current practice vis-a-vis the compulsif obsessional Trouble.

Protocols of research and evaluations of the TCC

August 1st It is a scientific approach in conformity with the requirements of Popper.

Indications

The mental diseases for which the effectiveness of the TCC is " attestée" (nonexhaustive list)

the Agoraphobia
the attacks of panic
turbid anxious
the social
the post-traumatic syndrome of stress
the obsession-compulsions
Depressions ambulantoire of average intensity, the old subject and hospitalized phobias
Prevention of the Personality disorder Suicide
borderline among women
chronic Syndrome of tiredness
Insomnia
Alcoholism/Drug-addiction S
Bulimia

Criticisms of the cognitivo-behavioral therapies

They are blamed, in particular, by holding of the psychoanalytical theories which affirm that they would not take into account " the human dimension of the patient" and that they would aim only the symptoms, taken " literally " , without work of interpretation.

In manner can be anecdotic, part of the film Clockwork orange takes as a starting point the conditioning to describe a totalitarian company.

As regards France, the criticism of the TCC often doubles questioning of a possibility of evaluation of psychotherapies.

References

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