Hauke Gernot, Lohr Christina
Embodiment Resources Academy (ERA) Europa, Munich, Germany.
Front Psychol. 2022 Apr 11;13:842488. doi: 10.3389/fpsyg.2022.842488. eCollection 2022.
We apply the Free Energy Principle (FEP) to cognitive behavioral therapy (CBT). FEP describes the basic functioning of the brain as a predictive organ and states that any self-organizing system that is in equilibrium with its environment must minimize its free energy. Based on an internal model of the world and the self, predictions-so-called priors-are created, which are matched with the information input. The sum of prediction errors corresponds to the Free Energy, which must be minimized. Internal models can be identified with the cognitive-affective schemas of the individual that has become dysfunctional in patients. The role of CBT in this picture is to help the patient update her/his priors. They have evolved in learning history and no longer provide adaptive predictions. We discuss the process of updating in terms of the exploration-exploitation dilemma. This consists of the extent to which one relies on what one already has, i.e., whether one continues to maintain and "exploit" one's previous priors ("better safe than sorry") or whether one does explore new data that lead to an update of priors. Questioning previous priors triggers stress, which is associated with increases in Free Energy in short term. The role of therapeutic relationship is to buffer this increase in Free Energy, thereby increasing the level of perceived safety. The therapeutic relationship is represented in a dual model of affective alliance and goal attainment alliance and is aligned with FEP. Both forms of alliance support exploration and updating of priors. All aspects are illustrated with the help of a clinical case example.
我们将自由能原理（FEP）应用于认知行为疗法（CBT）。自由能原理将大脑的基本功能描述为一个预测器官，并指出任何与环境处于平衡状态的自组织系统都必须将其自由能降至最低。基于对世界和自我的内部模型，会产生预测——即所谓的先验，这些先验会与信息输入进行匹配。预测误差的总和对应于自由能，自由能必须被最小化。内部模型可以与个体的认知情感图式相联系，而这些图式在患者中已变得功能失调。在这种情况下，认知行为疗法的作用是帮助患者更新其先验。这些先验是在学习历史中形成的，不再提供适应性预测。我们从探索-利用困境的角度讨论更新过程。这包括一个人在多大程度上依赖已有的东西，即一个人是继续维持并“利用”其先前的先验（“宁可事先谨慎有余，不要事后追悔莫及”），还是探索能导致先验更新的新数据。质疑先前的先验会引发压力，这在短期内与自由能的增加有关。治疗关系的作用是缓冲这种自由能的增加，从而提高感知到的安全水平。治疗关系在情感联盟和目标达成联盟的双重模型中得以体现，并与自由能原理相一致。两种联盟形式都支持先验的探索和更新。所有方面都借助一个临床案例进行说明。
