Cognitive Behavioral Therapy Lecture 2 Page: 1

Cognitive Behavioral Psychotherapy

PSYC 651
Lecture 2
Chapter 1
I. Introduction
A. Cognitive therapy was developed by Aaron Beck at the
University of Pennsylvania in the early 1960s as a structured,
short-term present-oriented psychotherapy for depression.
B. The Cognitive Model proposed that distorted or dysfunctional
thinking ) which influences the patient’s mood and behavior) is
common to all psychological disturbances.
C. Treatment is based on both a cognitive formulation of a specific
disorder and its application to the conceptualization or
understanding of the individual patient.
D. A problem important to the patient is specified, and associated
dysfunctional idea is identified and evaluated, a reasonable plan
is devised and the effectiveness of the intervention is assessed.
E. 10 Principles of Cognitive Therapy
i. Cognitive therapy is based on an ever-evolving
formulation of the patient and her problems in cognitive
terms.
1. Current thinking
2. Problematic behaviors
3. Precipitating factors
4. Developmental events
5. Enduring patters of interpreting these events
ii. Cognitive therapy requires a sound therapeutic alliance
(basic ingredients of warmth, empathy, caring, genuine
regard and competence)
iii. Cognitive therapy emphasizes collaborative and active
participation (shift through the course of therapy from
therapist to the patient over time)
iv. Cognitive therapy is goal oriented and problem focused.
v. Cognitive therapy initially emphasizes the present.
Attention shifts to the past in three circumstances
1. Patient expresses a strong predilection to do so
2. Current problem produces little or no cognitive,
behavioral, and emotional change
3. Therapist judges that it is important to understand
how and when important dysfunctional ideas
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originated and how these ideas affect the patient

today.
vi. Cognitive therapy is educative, aims to teach the patient
to be her own therapist, and emphasizes relapse
prevention.
vii. Cognitive therapy aims to be time limited.
viii. Cognitive therapy sessions are structured
1. Check mood
2. Brief review of the week
3. Collaboratively set an agenda
4. Elicit feedback about previous session
5. Review homework
6. Discusses the agenda items
7. Sets new homework
8. Summarizes and seeks feedback of current session
ix. Cognitive therapy teaches patients to identify, evaluate,
and respond to their dysfunctional thoughts and beliefs.
1. Socratic questioning
2. Collaborative empiricism
3. Guided discovery
x. Cognitive therapy uses a variety of techniques to change
thinking, mood, and behavior
II. Developing as a Cognitive Therapist
• Three Stages
i. Therapist learns to structure the session and to use basic
techniques, as well as the basic skills of conceptualizing
a case in cognitive terms
ii. Therapist begin to integrate their conceptualization with
the knowledge of techniques
iii. More automatic integrating new data into
conceptualization

Chapter 2 Cognitive Conceptualization

I. Basic Conceptualization
A. Questions
i. What is the patient’s diagnosis?
ii. What are her current problems; how did these problems
develop and how are they maintained?
iii. What dysfunctional thoughts and beliefs are associated
with the problems; what reactions (emotional,
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physiological, and behavioral) are associated with her

thinking?
B. Hypothesizes development of psychological disorder:
i. What early learning and experiences (and perhaps genetic
predispositions) contributed to her problems today?
ii. What are the underlying beliefs (including attitudes,
expectations, and rules) and thoughts?
iii. How has she coped with her dysfunctional beliefs? What
cognitive, affective, and behavioral mechanisms, both
positive and negative, has she developed to cope with her
dysfunctional beliefs? How did (and does) she view
herself, others, her personal world, and her future?
iv. What stressors contributed to her psychological problems
or interfere with her ability to solve these problems?
C. The Cognitive Model
i. Hypothesizes that people’s emotions and behaviors are
influenced by their perception of events. It is not the
situation in and of itself that determines what people feel
but rather the way in which they construe a situation.
(note: hermeneutics)
ii. The way people feel is associated with the way in which
they interpret and think about a situation. The situation
itself does not directly determine how they feel.
iii. Automatic Thoughts: quick evaluative thoughts that are
not the result of deliberation or reasoning.
iv. In general people are not aware of automatic thoughts but
are far more likely to be aware of the emotion that
follows. “What was going through your mind just
then?”
1. Focusing Techniques
2. Zig-Zag Ahhh
3. Notion connecting experience of emotion with a
physiological sensation.
D. Beliefs
i. Core beliefs are understandings that are so fundamental
and deep that they often are not articulated, even to
themselves
ii. They are experienced as absolute truths
iii. Core beliefs are the most fundamental level of belief:
they are global, rigid, and over generalized
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iv. Automatic thoughts the actual words or images that go

through a person’s mind are situation specific and may be
considered the most superficial level of cognition
v. Between automatic thoughts and core beliefs are
intermediate thoughts (which are based on rules, attitudes
and assumptions)
II. Attitudes, Rules and Assumptions
A. Core beliefs influence the development or an intermediate class
of beliefs which consist of (often unarticulated) attitudes, rules
and assumptions
B. Intermediate thoughts organize experience in a coherent way in
order for the person to function adaptively (note: here the basis
premise of Constructivism that people’s cognitive experience is
driven by self-organizing processes)
C. What is of particular significance to the Cognitive Therapist is
that dysfunctional beliefs can be unlearned and new beliefs that
are more reality based and functional can be developed and
learned through therapy.
D. Relationship of Automatic Thoughts, Intermediate Thoughts
and Core Beliefs
i. Automatic thoughts are connected to moment to moment
distress
ii. Intermediate thoughts go across situations and
significantly influence the options perceived as available
in problems solving, as well as act as a screen in the
patients perception of situations
iii. Core beliefs are the deepest level are most resilient, and
change of these core beliefs makes the patient less likely
to relapse in the future (hmm possible quasi-medical
model with AT as symptoms and CB as disease?)
III. Relationship between behavior to Automatic Thoughts
A. Situation Automatic Thoughts Emotion Behavior
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COGNITIVE MODEL

Core Belief

I’m Incompetent

Intermediate Belief

If I don’t understand something

Perfectly, then I’m dumb

Situation Automatic Thoughts Reactions

Read this book This is too hard. I’ll Emotions

never understand it.

Sadness

Behavioral

Closes Book

Physiological

Heaviness