Ndani angapindule ndi chithandizo chamankhwala?

Nkhawa ndi kupsinjika maganizo, kusokonezeka kwa kudya ndi phobias, banja ndi mavuto oyankhulana - mndandanda wa mafunso omwe chidziwitso-makhalidwe ochiritsira amayankha akupitiriza kukula chaka ndi chaka.

Kodi izi zikutanthauza kuti psychology yapeza "chinsinsi cha zitseko zonse", mankhwala a matenda onse? Kapena kodi ubwino wa chithandizo chamtundu umenewu n'ngokokomeza? Tiyeni tiyese kuzilingalira.

Bweretsaninso malingaliro

Poyamba panali khalidwe. Ili ndilo dzina la sayansi yamakhalidwe (motero dzina lachiwiri la chidziwitso-khalidwe labwino - chidziwitso-khalidwe, kapena CBT mwachidule). Katswiri wa zamaganizo waku America a John Watson anali woyamba kukweza chizindikiro cha khalidwe kumayambiriro kwa zaka za zana la XNUMX.

Lingaliro lake linali kuyankha ku chidwi cha ku Ulaya ndi Freudian psychoanalysis. Kubadwa kwa psychoanalysis kudagwirizana ndi nthawi yotaya mtima, kukhumudwa komanso ziyembekezo za kutha kwa dziko. Izi zinaonekera mu ziphunzitso za Freud, amene ananena kuti gwero la mavuto athu aakulu ndi kunja maganizo - mu chikomokere, choncho n'kovuta kwambiri kulimbana nawo.

Njira yaku America, m'malo mwake, idaganiza zophweka, kuchita bwino komanso kukhala ndi chiyembekezo. John Watson ankakhulupirira kuti cholinga chiyenera kukhala pa khalidwe laumunthu, momwe timachitira ndi zokopa zakunja. Ndipo - yesetsani kuwongolera machitidwe omwewo.

Komabe, njira iyi idapambana osati ku America kokha. Mmodzi wa makolo a khalidwe ndi Russian physiologist Ivan Petrovich Pavlov, amene analandira Nobel Prize pa kafukufuku wake ndi kuphunzira reflexes mpaka 1936.

Posakhalitsa zinadziwikiratu kuti pofuna kuphweka, khalidweli linali litataya khandalo ndi madzi osamba—m’chenicheni, kuchititsa munthu kuchita zonse zotheka ndi kusokoneza psyche. Ndipo ganizo la sayansi linasunthira mbali ina.

M'zaka za m'ma 1950 ndi 1960, akatswiri a zamaganizo Albert Ellis ndi Aaron Beck "adabweza psyche pamalo ake", moyenerera akuwonetsa kuti pakati pa kusonkhezera kwakunja ndi kuchitapo kanthu kwa izo pali chochitika chofunika kwambiri - makamaka, munthu mwiniwakeyo amachitira. Kapena kani, malingaliro ake.

Ngati psychoanalysis amaika chiyambi cha mavuto aakulu mu chikomokere, osafikirika kwa ife, ndiye Beck ndi Ellis ananena kuti tikulankhula zolakwika «cognitions» - zolakwa chikumbumtima. Kupeza zomwe, ngakhale sizophweka, ndizosavuta kuposa kulowa mumdima wakuya wa chikomokere.

Ntchito ya Aaron Beck ndi Albert Ellis imatengedwa ngati maziko a CBT lero.

Zolakwa za chidziwitso

Zolakwa za chidziwitso zingakhale zosiyana. Chitsanzo chimodzi chosavuta ndicho chizolowezi chomaona chochitika chilichonse kukhala chochita ndi inuyo panokha. Tinene kuti abwana anali okhumudwa lero ndikukupatsani moni wa mano. “Amadana nane ndipo mwina atsala pang’ono kundichotsa ntchito” ndi mmene anthu amachitira pa nkhaniyi. Koma si zoona.

Sitiganizira zinthu zimene sitikuzidziwa. Nanga mwana wa bwana akadwala? Ngati anakangana ndi mkazi wake? Kapena wangodzudzulidwa pa msonkhano ndi ma sheya? Komabe, nkosatheka, ndithudi, kuchotseratu kuthekera kwakuti bwana alidi ndi kanthu kotsutsa inu.

Koma ngakhale mu nkhani iyi, kubwereza "Zowopsya bwanji, chirichonse chapita" ndi kulakwitsa kwa chidziwitso. Ndikopindulitsa kwambiri kudzifunsa ngati mungasinthe china chake pazochitikazo komanso phindu lomwe lingakhalepo kusiya ntchito yomwe muli nayo pano.

Chitsanzochi chikuwonetseratu "kukula" kwa CBT, komwe sikufuna kumvetsetsa chinsinsi chomwe chinkachitika kuseri kwa chitseko cha chipinda chogona cha makolo athu, koma chimathandizira kumvetsetsa vuto linalake.

Ndipo njira iyi inakhala yothandiza kwambiri: "Palibe mtundu umodzi wa psychotherapy womwe uli ndi umboni wa sayansi," akugogomezera katswiri wamaganizo Yakov Kochetkov.

Akunena za kafukufuku wa katswiri wa zamaganizo Stefan Hofmann akutsimikizira kuti njira za CBT ndizochita bwino.¹: kusanthula kwakukulu kwa nkhani za 269, zomwe ziri ndi ndemanga zambiri za mabuku.

Mtengo Wochita Mwachangu

“Chidziwitso-khalidwe labwino la psychotherapy ndi psychoanalysis mwamwambo zimatengedwa ngati mbali ziwiri zazikulu za psychotherapy yamakono. Chifukwa chake, ku Germany, kuti mupeze chiphaso cha boma cha katswiri wazamisala yemwe ali ndi ufulu wolipira kudzera pa desiki la ndalama za inshuwaransi, ndikofunikira kukhala ndi maphunziro oyambira m'modzi mwa iwo.

Chithandizo cha Gestalt, psychodrama, chithandizo chamankhwala cham'mabanja, ngakhale kutchuka kwawo, kumangodziwikabe ngati mitundu yowonjezera, "akatswiri a zamaganizo Alla Kholmogorova ndi Natalia Garanyan.². Pafupifupi mayiko onse otukuka, kwa inshuwaransi, thandizo la psychotherapeutic ndi chidziwitso-khalidwe labwino la psychotherapy ndizofanana.

Kwa makampani a inshuwaransi, mikangano yayikulu ndikutsimikiziridwa mwasayansi, kugwiritsa ntchito kosiyanasiyana komanso nthawi yayitali yamankhwala.

Nkhani yosangalatsa imalumikizidwa ndi zochitika zomaliza. Aaron Beck adanena kuti atayamba kuchita CBT, adatsala pang'ono kutaya ndalama. Mwachizoloŵezi, psychotherapy inatenga nthawi yaitali, koma pambuyo pa magawo angapo, makasitomala ambiri adauza Aaron Beck kuti mavuto awo adathetsedwa bwino, choncho sawona kuti palibe chifukwa chowonjezera ntchito. Malipiro a psychotherapist atsika kwambiri.

Njira yogwiritsira ntchito

Kutalika kwa maphunziro a CBT kungakhale kosiyana. "Amagwiritsidwa ntchito panthawi yochepa (magawo a 15-20 pochiza matenda ovutika maganizo) komanso nthawi yayitali (zaka 1-2 pazochitika za umunthu)," Alla Kholmogorova ndi Natalya Garanyan adanena.

Koma pafupifupi, izi ndizochepa kwambiri kuposa, mwachitsanzo, maphunziro apamwamba a psychoanalysis. Izi zitha kuzindikirika osati kungowonjezera, komanso kuchotsera.

CBT nthawi zambiri imaimbidwa mlandu wantchito yachiphamaso, kufanizira mapiritsi ochepetsa ululu omwe amachepetsa zizindikiro popanda kukhudza zomwe zimayambitsa matendawa. "Chidziwitso chamakono chamankhwala chimayamba ndi zizindikiro," akufotokoza motero Yakov Kochetkov. Koma kugwira ntchito motsimikiza mtima kumathandizanso kwambiri.

Sitikuganiza kuti zimatengera zaka zambiri kuti tigwire nawo ntchito. Nthawi zonse maphunziro 15-20 misonkhano, osati milungu iwiri. Ndipo pafupifupi theka la maphunzirowa likugwira ntchito ndi zizindikiro, ndipo theka likugwira ntchito ndi zifukwa. Kuonjezera apo, kugwira ntchito ndi zizindikiro kumakhudzanso zikhulupiriro zozama.

Ntchitoyi, mwa njira, imaphatikizapo kukambirana ndi wothandizira, komanso njira yowonetsera. Zili mu mphamvu yoyendetsedwa pa kasitomala pazinthu zomwe zimakhala ngati magwero a mavuto.

Mwachitsanzo, ngati munthu akuwopa utali, ndiye panthawi ya mankhwala ayenera kukwera khonde la nyumba yokwera kwambiri kuposa kamodzi. Choyamba, pamodzi ndi wothandizira, ndiyeno paokha, ndipo nthawi iliyonse kumtunda wapamwamba.

Nthano ina ikuwoneka kuti imachokera ku dzina lenileni la chithandizo: bola ngati ikugwira ntchito mwachidziwitso, ndiye kuti wothandizira ndi mphunzitsi woganiza bwino yemwe sasonyeza chifundo ndipo satha kumvetsa zomwe zimakhudza maubwenzi aumwini.

Izi sizowona. Thandizo lachidziwitso la maanja, mwachitsanzo, ku Germany limadziwika kuti ndi lothandiza kwambiri moti liri ndi udindo wa pulogalamu ya boma.

Njira zambiri m'modzi

"CBT sipadziko lonse lapansi, sichichotsa kapena kusintha njira zina zamaganizo," akutero Yakov Kochetkov. "M'malo mwake, amagwiritsa ntchito bwino zomwe apeza m'njira zina, nthawi iliyonse amatsimikizira kuti zikuyenda bwino kudzera mu kafukufuku wasayansi."

CBT si imodzi, koma mankhwala ambiri. Ndipo pafupifupi matenda aliwonse masiku ano ali ndi njira zake za CBT. Mwachitsanzo, chithandizo cha schema chinapangidwira kusokonezeka kwa umunthu. "Tsopano CBT imagwiritsidwa ntchito bwino pazochitika za psychoses ndi bipolar disorders," akupitiriza Yakov Kochetkov.

- Pali malingaliro omwe adabwereka ku chithandizo cha psychodynamic. Ndipo posachedwapa, The Lancet inafalitsa nkhani yokhudza kugwiritsa ntchito CBT kwa odwala omwe ali ndi schizophrenia omwe amakana kumwa mankhwala. Ndipo ngakhale mu nkhani iyi, njira imeneyi amapereka zotsatira zabwino.

Zonsezi sizikutanthauza kuti CBT yadzikhazikitsa yokha ngati No. 1 psychotherapy. Iye ali ndi otsutsa ambiri. Komabe, ngati mukufuna mpumulo wachangu pazochitika zinazake, ndiye kuti akatswiri 9 mwa 10 a mayiko a Kumadzulo angalimbikitse kulumikizana ndi katswiri wodziwa bwino zamaganizo.

¹ S. Hofmann et al. "Kuthandiza Kwachidziwitso Chachidziwitso: Kuwunika kwa Meta-kuwunika." Kusindikizidwa pa intaneti mu nyuzipepala ya Cognitive Therapy and Research kuchokera pa 31.07.2012.

² A. Kholmogorova, N. Garanyan «Cognitive-behavioral psychotherapy» (m'gulu la "Malo amakono a psychotherapy", Kogito-center, 2000).