Lecture Notes: Cognitive Behavioral Therapy (CBT) Fundamentals

Date: September 3, 2024

Instructor: Dr. Johnson
Course: PSY 305 - Clinical Psychology: Therapeutic Techniques

I. Introduction to Cognitive Behavioral Therapy (CBT)

• Definition: CBT is a structured, time-limited psychotherapy that focuses on the relationship
between thoughts, emotions, and behaviors. It is based on the idea that negative patterns of
thought about the self and the world can lead to emotional distress and behavioral issues.
• Historical Background:
• Developed in the 1960s by Dr. Aaron T. Beck, CBT emerged from earlier behavioral
therapies and psychoanalytic traditions.
• Influenced by Albert Ellis’s Rational Emotive Behavior Therapy (REBT).
• Core Principles:
• Cognitive Restructuring: Identifying and challenging distorted or maladaptive
thoughts.
• Behavioral Activation: Engaging in activities that are likely to improve mood and
functioning.
• Problem-Solving: Developing strategies to cope with stressors.
II. Cognitive Components of CBT
1. Automatic Thoughts:
• Definition: Spontaneous, involuntary thoughts that occur in response to specific
situations.
• Examples: "I’m going to fail this exam," "Nobody likes me."
• Often distorted and contribute to emotional distress.
2. Cognitive Distortions:
• Common Types:
• All-or-Nothing Thinking: Viewing situations in black-and-white terms (e.g.,
"If I’m not perfect, I’m a failure").
• Overgeneralization: Making broad conclusions based on a single event (e.g.,
"I failed this test, so I’ll never succeed in anything").
• Catastrophizing: Expecting the worst possible outcome (e.g., "If I make a
mistake, it will ruin everything").
• Mind Reading: Assuming you know what others are thinking (e.g., "They
think I’m stupid").
3. Core Beliefs and Schemas:
• Definition: Deep-seated, fundamental beliefs about oneself, others, and the world.
• Examples: "I am unlovable," "The world is dangerous."
• Often develop in childhood and underlie automatic thoughts.
4. Cognitive Restructuring Techniques:
• Thought Records: Patients document automatic thoughts, evidence for and against
them, and alternative, more balanced thoughts.
• Socratic Questioning: Therapists ask guided questions to help patients challenge
and reframe negative thoughts.
 • Reattribution: Encouraging patients to consider alternative explanations for events
(e.g., attributing a friend’s unresponsiveness to their busy schedule rather than
personal rejection).
III. Behavioral Components of CBT
1. Behavioral Activation:
• Definition: Increasing engagement in positively reinforcing activities to improve
mood and reduce avoidance behaviors.
• Steps:
• Identify enjoyable or meaningful activities.
• Gradually schedule and increase participation in these activities.
• Track mood and activity levels to reinforce positive changes.
2. Exposure Therapy:
• Definition: Gradual exposure to feared situations or stimuli to reduce anxiety
through habituation.
• Types:
• In Vivo Exposure: Confronting real-life situations.
• Imaginal Exposure: Confronting feared thoughts or memories through
imagination.
• Hierarchy: Developing a list of feared situations ranked by intensity and gradually
working through them.
3. Skills Training:
• Social Skills Training: Teaching communication, assertiveness, and interpersonal
skills.
• Problem-Solving Skills: Teaching strategies to identify problems, generate
solutions, and evaluate outcomes.
4. Relaxation Techniques:
• Progressive Muscle Relaxation (PMR): Tensing and relaxing muscle groups to
reduce physical tension.
• Deep Breathing Exercises: Slowing breathing to calm the nervous system.
• Mindfulness: Focusing on the present moment and accepting experiences without
judgment.
IV. Structure and Process of CBT Sessions
• Session Structure:
• Agenda Setting: Collaboratively establishing the focus for each session.
• Review of Homework: Discussing assignments and any challenges encountered.
• Skill Development: Introducing and practicing new CBT techniques.
• Summary and Feedback: Recapping the session and setting goals for the next one.
• Therapeutic Relationship:
• Collaborative and active partnership between therapist and patient.
• Emphasis on patient empowerment and self-efficacy.
V. Applications of CBT
• Common Indications:
• Depression
• Anxiety Disorders (e.g., GAD, PTSD, OCD)
• Phobias
• Eating Disorders
• Substance Abuse
 • Anger Management
• Effectiveness:
• Extensive research supports CBT as an effective treatment for a wide range of
psychological disorders.
• Often used in conjunction with pharmacotherapy or other therapeutic approaches.
VI. Challenges and Considerations
• Patient Engagement:
• Success in CBT requires active participation and willingness to complete homework
assignments.
• Motivational interviewing can be useful in addressing resistance.
• Cultural Sensitivity:
• Adapting CBT techniques to fit the cultural context and values of the patient.
• Being mindful of how cultural factors influence thoughts, behaviors, and treatment
outcomes.

Next Lecture: We will explore the use of CBT in treating anxiety disorders, focusing on specific
techniques like exposure therapy and cognitive restructuring for panic disorder.
Assigned Reading:
• "Cognitive Therapy of Depression" by Beck et al., Chapters 2-4.
Reminder:
• Case study analysis due next week. Focus on identifying cognitive distortions and applying
CBT techniques discussed in class.

Questions or Clarifications:
• How can CBT be adapted for children and adolescents?
• What are the limitations of CBT in treating complex trauma?