1) CBT examination. First contact. It is important to recognize that a patient who is struggling with a physical illness may be surprised, concerned, and offended by the offer of psychotherapeutic treatment. Sometimes he interprets the offer to participate in psychotherapeutic treatment as a manifestation of the insufficiency of somatic treatment, and for these reasons, he may be distrustful and embarrassed at the first contact. The first conversation with a somatically ill patient in the psychotherapist's office should include the following points: A brief explanation of the reasons that led to the decision undergo a psychotherapeutic examination; Discussion of the patient’s first sensations and opinions; Brief teaching about the principles of CBT. The first conversation should include the following aspects: Behavioral, cognitive and functional analysis; Degree of impairment: - physical condition, - social activity, - work activity, - important relationships, The patient’s opinion about the development of the disease; The patient’s opinion about his own ability to cope with the symptoms of the disease and treatment. Assessment of the current state of physical health. Therapy sessions are divided according to the program, as described in the general section. There are some permanent points of the program that are used regularly. These include: 1) Summary of the last session; 2) Brief updating of the patient’s condition and important events in his life; 3) Review of homework; 4) Patient feedback. When using CBT for work with patients who have health problems and other difficulties, it is advisable to add 1 more point: 5) Assessing the current physical state of health. This is precisely the moment in the therapeutic session when the patient and therapist have the opportunity to discuss the role of the physical state in relation to the remaining points of the session .The need to maintain the KBT management structure. There are key themes that are unique to the practice of CBT and differentiate it from other psychological treatments. It is important that these themes are not lost when applying CBT to people suffering from serious illnesses. Cognitive or behavioral techniques should not be allowed to be used without structure, collaboration, or in isolation from homework, because these are the elements that characterize CBT. Beginning therapists may make excuses for why they have abandoned structured CBT (e.g., “It was all very tragically, it seemed cruel to me at that moment to talk about recordings, measurements and such things." In addition, patients with serious illnesses can argue their health problems as an obstacle to cooperation with the CBT therapist, and thus convince the therapist of the need for use combined, more supportive therapy. Below is an example of an appropriate conversation in such a situation. 2) Assessment and measurement. Self-observation. It is rarely possible to fully define the problem immediately after the first examination. Further assessment should include data from a period of self-observation (which also serves to provide a baseline with which we will compare the effect of treatment) and completion of self-assessment questionnaires. At the beginning of self-observation, we will ask the patient to keep a record of important variables ( for example, about the observed problem, about the thoughts that arise when the problem appears, about general mood and behavior). The therapist emphasizes that at this stage the patient should describe his behavior and thoughts associated with the problem, but not try to determine what is causing them. An appropriate option would be to devote at least 1 additional session to the assessment after the therapist has reviewed the available medical documentation At the same time, the patient can collect additional data through self-observation, which can then be reviewed. It is also necessary to consider those aspects of the patient's past life that may have increased the patient's stress. It is advisable to establish contact with the doctorand other health care professionals who are currently caring for the patient, obtain their views on the patient's illness and inform them about the initiation of therapy. It is necessary to agree on the boundaries that must be respected during treatment. Once the self-monitoring data has been obtained, the process of patient involvement can begin into treatment. Self-monitoring usually takes the form of daily notes. It includes variables that, based on initial examination, appear to be important, although some basic measurements (eg, pain intensity) should be kept constant. Other details recorded during the day (for example, thoughts about a brain tumor, stressful events, problem-solving behavior) may change during the course of treatment and as the formulation of the problem is clarified. Later, during treatment, notes can be made on the use and effect of problem-solving techniques learned by the patient in therapy. Self-monitoring should include medication treatment because it can be seen as disease behavior that maintains a focus on problems, sometimes and in connection with side effects. Questionnaires. Although many questionnaires have been created for physical problems, only a few have proven suitable for clinical practice. When working with pain, it is advisable to use the McGill Pain Questionnaire, as it measures the perceived, emotional and evaluative components of pain, as well as its intensity. None of the questionnaires measuring somatization and pain behavior have demonstrated clinical effectiveness. Measuring anxiety and depression in patients with somatic complaints poses a particular problem because questionnaires aimed at uncovering these conditions are largely based on physical symptoms. To overcome this problem, the Hospital Anxiety and Depression Scale was created, which has the advantage of being short, easy to analyze and relatively sensitive to changes in condition. Physiological measurements. In patients in whom a physiological correlate of disease can be established, it is sometimes appropriate to obtain appropriate direct measurements of these physiological values ​​to assess progress made and to provide feedback to the therapist and patient about the effectiveness of treatment (eg, repeated blood pressure measurements, measurement of the size of skin inflammation in dermatologic patients). There are simple devices that measure the degree of activity that are of great value in solving a number of problems, especially in the case of chronic pain. For example, a pedometer allows you to compare activity at different times of the day, or on different days. When developing an exercise program, pedometers provide quick and easy feedback and are very helpful in identifying additional exercise goals. 3) Problems and goals, treatment plan. As with other CBT programs, effective treatment is based on a precise formulation of the problems and goals of therapy, which are individual and different for each patient. Accurate identification of the main problems will allow for targeted selection of appropriate CBT methods. To reduce anxiety and treat depression in somatic diseases, we use similar methods as in the treatment of these conditions without somatic illness. When using them, it is important to take into account the influence of somatic disease. This refers to drug treatment, hospitalization, deterioration, etc. All this must be reflected in the formulation of the problem and goals of therapy, as well as in the state of the treatment plan, which must be flexible. We must provide for the need to reformulate and change plans in accordance with the current physical condition. 4) Treatment interventions. Although approaches to treating individual diseases differ, the principles are common to all diagnoses. When applying various treatment methods, one should proceed from these principles. General principles of cognitive-behavioral]