Psychology 6/70375-001
Cognitive Behavior Therapy
Fall 2010 Monday and Wednesday 12:30 to 1:45
167 Kent Hall


David M. Fresco, Ph.D.


226 Kent Hall Annex

Office Hours:

TBA; By appointment

Email/Telephone: / (330) 672-4049

Course Web Page:

Assigned Texts:

1. Barlow, D. H. (Ed.) (2007). (Fourth edition). Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford. ISBN: 978-1-59385-572-7
2. Pryor, K. (1999). Don't shoot the dog. New York: Bantam.
3. O'Donohue, W. & Fisher, J. E. (2009). General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy. Hoboken, NJ: Wiley. ISBN: 978-0470227770
The required texts are available at the bookstore.


  • Central features of behavior (BT) cognitive-behavior therapy (CBT) and of evidence-based mode of practice more generally
  • Basics of several cognitive-behavioral (CB) theories
  • Methods for assessing, conceptualizing, and treating patients using this approach
  • Theories, methods, and efficacy evidence for BT & CBT for several disorders, primarily anxiety and affective disorders
  • A feel for what it is like to provide and receive BT & CBT
  • Introduction and practice in "third wave" behavior therapies such as mindfulness based cognitive therapy (MBCT) and Acceptance and Commitment Therapy (ACT)


The teaching format is lecture, discussion, and audiotape, videotape, and role-plays demonstrations and exercises.  Class participation is expected.  Participation can come in the form of questions, comments, or class discussion appropriate for a classroom setting. You will also be asked to participate in role-plays, and hopefully share experiences from cases you are seeing outside of this class.


Some of the materials that I will provide for you will be text or audio/video files that require you to install free software on your computer. 

1. Many of the readings I assign outside of our text as well as copies of lecture notes are saved as Adobe Acrobat *.pdf files.  The Adobe Acrobat reader is a free program that is pre-installed on most computers, but can be downloaded at the Adobe webpage.
2. One title you may need is QuickTime from Apple Computer.  Please visit the QuickTime website and install this software for Macintosh or Windows.
3. You may also need the RealOne Player, which is also available for Macintosh or Windows.

Lecture Notes & Readings:

I do provide handouts for my lectures in hopes that you will not simply spend your time writing what you see on the screen or the board.  Also, there may be some supplemental readings.  You can download them below.


There will be one take home exam due around midterm time.  We will settle on a date together. You will have a week to complete it.  I will provide you some history and assessment data on a case.  Your job will be to write up a case formulation and treatment plan for the case.  I expect you to base your treatment recommendations in evidenced based treatments by providing a short review of the empirical literature (nomothetic) but make the treatment plan as idiographic as possible. (5-6 pages plus a one page annotated bibliography of work cited). 

Graded Assignments:

  1. I am assigning you to conduct a behavioral experiment on yourself, a consenting adult, or a pet. The consenting adult can be a current client if you get your supervisor's permission*. Essentially, you will need to gather baseline data on a target behavior, thought, etc., and develop an experiment designed to change the frequency, intensity of that behavior. You will then write up your results in an 8-10 page paper. Grades will be assigned based on the thoughtfulness and thoroughness of the experiment and not on whether the intervention actually works. The paper will be due at the end of the semester.
  2. Generate a fear and avoidance hierarchy for an actual or hypothetical client (1-2 pages). Design some exposure exercises to elicit the fear response from your client.

*If you use a client, we can contemplate the appropriateness of writing up the case as a single-subject design and submitting it for publication

Weekly Assignments:

In addition to readings, you will frequently have homework assignments to complete.  Essentially, I am going to ask you to complete the same homework assignments associated with behavioral technologies that we assign to our clients.  For example, I will ask you to self-monitor your behavior, thoughts, feelings, etc.  These homework assignments will not be handed in for a grade, but instead will form the basis of discussion in class.  So, please complete these tasks honestly with the knowledge that I will not see these private events or require you to self-disclose to the class.  You will have control of what you self-disclose and what you chose not to self-disclose.

Final Grade:

Your grade for the course will be computed as follows:
Midterm 35%
Behavioral Experiment 35%
Graded Homework 10%
Participation/Role Plays/Weekly Homework* 20%

*Evidence of completing it by way of discussion in class


University policy 3342-3-18 requires that students with disabilities be provided reasonable accommodations to ensure their equal access to course content. If you have a documented disability and require accommodations, please contact the instructor at the beginning of the semester to make arrangements for necessary classroom adjustments. Please note, you must first verify your eligibility for these through Student Disability Services (contact 330-672-3391) or visit for more information on registration procedures.

Guidelines for Un-graded Homework Assignments

There will be a number of homework assignments that I will ask you to complete, but not for a grade.  Rather, I wish to have a discussion with you as to what the experience is like.  By knowing what the experience is like, you will likely be a more effective therapist when it comes time to assign such a task to a client or patient. 
Here is a list of questions I would like you to keep in mind in advance of a discussion we may have about a certain assignment.  Please be prepared to discuss your experience along the lines of these questions:

1.   What you found helpful about the intervention, if anything
2.   What you didn't like about the intervention, if anything
3.   What, if anything, you learned that will help you use this intervention successfully in a clinical situation
4.   How long (total over the course of the week) you spent completing the assignment.




Review classical and instrumental conditioning
Behavioral Assessment


Introductions, Nuts and nolts of the class

Classical & Instrumental Conditioning
Behavioral Assessment

Don't Shoot the Dog (Begin reading to familiarize yourself with instrumental conditioning)

Schroeder, C. S. & Gordon, B. N. (1991). Chapter 3. Assessment. Assessment and Treatment of Childhood Problems. (pp. 40-70). New York:  Guilford.



Functional Analysis and Idiographic Approaches


Happy Labor Day, no class Sept 6.

Functional Analysis and Idiographic Approaches

Bissett, R. T. &. Hayes, S. C. (1999). The likely success of functional analysis tied to the DSM. Behaviour Research and Therapy, 37, 379-383.

Haynes, S. N., Leisen, M. B., & Blaine, D. D. (1997).  Design of individualized behavioral treatment programs using functional analytic clinical case models.  Psychological Assessment, 9, 334-348.

Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001).  Patient-focused research:  Using patient outcome data to enhance treatment effects.  Journal of Consulting and Clinical Psychology, 69, 159-172.

Nelson-Gray, R.O. & Farmer, R.F. (1999). Behavioral assessment of personality disorders. Behaviour Research and Therapy, 37, 347-368.

Optional Readings:
Farmer, R. F. & Nelson-Gray, R. O. (1999). Functional analysis and response covariation in the assessment of personality disorders: a reply to Staats and to Bissett and Hayes. Behaviour Research and Therapy, 37, 385-394.

Staats, A. W. (1999). Valuable, but not maximal: it's time behavior therapy attend to its behaviorism, Behaviour Research and Therapy, 37, 369-378.

Complete your own activity log for the coming week; report back next week on the results. (Not to turn in, just to discuss.)


Case Conceptualization and Treatment Planning

Activity log homework

Case Conceptualization and Treatment Planning

Persons, J. B. (1989). The case formulation model. Cognitive Therapy in Practice:  A Case Formulation Approach. (pp. 1-18). New York:  Norton.

Persons, J. B. & Fresco, D. M. (2008). Adult depression. In J. Hunsley & E. J. Mash (Eds.) A Guide To Assessments That Work. (pp. 96-120). New York:  Oxford University Press.

Persons, J. B. (1989). The Problem List. Cognitive Therapy in Practice:  A Case Formulation Approach. (pp. 19-36). New York:  Norton.

Kazdin, A. E. (1993).  Evaluation in clinical practice:  Clinically sensitive and systematic methods of treatment delivery. Behavior Therapy, 24, 11-45.

On Wednesday, come to class with a case in mind that you are treating. We will use this approach to develop a behavioral case formulation of your case.


Develop and carry out a self-monitoring assignment for a minimum of one week using the A-B-C log and report on what you learned from doing it in class. (Not to turn in, just to discuss.)


The Thought Record & Cognitive Restructuring


ABC Homework

The Thought Record & Cognitive Restructuring

Persons, J. B., Davidson, J. & Tompkins, M. A. (2001). Chapter 5: Using the thought record. Essential Components of Cognitive Behavior Therapy for Depression. Washington, DC: American Psychological Association.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Chapter 8: Cognitive Techniques. Cognitive Therapy of Depression (pp. 142-166). New York: Guilford.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Chapter 12: Depressogenic Assumptions. Cognitive Therapy of Depression (pp. 244-271). New York: Guilford.

On Wednesday, come to class with a case that you are treating in mind (or to roleplay a client). We will work on using a thought record and engaging in cognitive interventions.


Homework: Complete your own DRDT and report back next week. (Not to turn in, just to discuss.)


Emotions: Neglected No More


DRDT Homework

Introduction to emotions in a CBT context

Keltner, D. & Gross, J. J. (1999). Functional Accounts of Emotions. Cognition and Emotion, 13, 467-480.

Levenson, R. W. (1999). The Intrapersonal Functions of Emotion. Cognition and Emotion, 13, 481-504.

Keltner, D. & Haidt, J. (1999). Social Functions of Emotions at Four Levels of Analysis. Cognition and Emotion, 13, 505-521.

Samoilov, A., & Goldfried, M. R. (2000). Role of emotion in cognitive-behavior therapy. Clinical Psychology: Science and Practice, 7 373-385.

Mennin, D. S. & Farach, F. (2007). Emotion and Evolving Treatments for Adult Psychopathology. Clinical Psychology: Science and Practice, 14, 329-352.

Greenberg, L. S. (2007). Emotion Coming of Age. Clinical Psychology: Science and Practice, 14,414-421.


Use what you learned from last week's homework to modify a behavior by modifying an antecedent, consequence, or behavior itself or ideally more than one of these. (Not to turn in, just to discuss.)


Exposure Methods:  Overview


ABC Behavior Modification Homework

Overview of exposure therapy

Barlow, Ch. 1, 2 & 4

Bouton, M. E., Mineka, S., & Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review, 108, 4-32.

Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear:  Exposure to corrective information. Psychological Bulletin, 99, 20-35.

Hofmann, S. G., (2007). Cognitive Factors that Maintain Social Anxiety Disorder: A Comprehensive Model and its Treatment Implications, Cognitive Behaviour Therapy, 36, 193–209.

Optional Readings:
Hofmann, S.G., Richey, J. A., Asnaani, A., and Sawyer, A.T. (in press). Avoiding Treatment Failures in Social Anxiety Disorder. In M.W. Otto, S.G. Hofmann (Eds.), Avoiding Treatment Failures in the Anxiety Disorders, Series in Anxiety and Related Disorders.

Hofmann, S.G., & Scepkowski, L.A. (2006). Social Self-Reappraisal Therapy for Social Phobia: Preliminary Findings, Journal of Cognitive Psychotherapy: An International Quarterly, 20, 45-57.


Exposure Methods:  Practice and Role-plays


ABC Behavior Modification Homework

Both days, come prepared to role-play as an anxious client and also to role-play as a therapist treating an anxious client. We will work on developing exposure exercises


Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy 37, 559-574.

Sloan, T. & Telch, M. J. (2002). The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: an experimental investigation. Behaviour Research and Therapy 40, 235-251.

Alden, L. E. & Bieling, P. (1998). Interpersonal consequences of the pursuit of safety. Behaviour Research and Therapy, 36, 53-64.

Powers, M. B., Smits, J. A. J., & Telch, M. J. (2004). Disentangling the Effects of Safety-Behavior Utilization and Safety-Behavior Availability During Exposure-Based Treatment: A Placebo-Controlled Trial. Journal of Consulting and Clinical Psychology, 72, 448–454.

Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26, 153–161.

Lovibond, P. F., Davis, N. R., & O'Flaherty, A. S. (2000). Protection from extinction in human fear conditioning. Behaviour Research and Therapy, 38,

Develop Fear and Avoidance Hierarchy for actual or fictional patient. (Turn in next Monday.)


Cognitive Therapy of Depression


Overview of cognitive therapy of depression

Barlow, Ch. 6

Persons, J. B. (2008). Cognitive theories and their clinical implications. The Case Formulation Approach to Cognitive-behavior Therapy. New York: Guilford.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford. (Graze the whole book)


Wednesday: We will roleplay and discuss aspects of cognitive therapy strategies.

Turn in: Written assignment on Fear and Avoidance Hierarchy for actual or fictional patient.


Dialectical Behavior Therapy
  DMF away at meeting in Madison, WI

Guest Lecturer for the week: Dr. Karin Coifman

Readings and materials: TBA

Behavioral Activation Treatment for Depression


Behavioral activation therapy for depression

Barlow, Ch. 8.

Ferster, C.B. (1973). A functional analysis of depression. American Psychologist, 28, 857-870.

Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255-270.

Lejuez, C.W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for depression: Treatment manual. Behavior Modification, 25, 255-286.

Wednesday: We will roleplay and discuss aspects of Behavioral Activation strategies.

Homework: Practice with your relaxation tape daily and report back next week on the results.


Mindfulness Based Cognitive Therapy


Guided relaxation practice

Bishop, S. R. et al. (2004). Mindfulness: A Proposed Operational Definition. Clinical Psychology: Science and Practice, 11, 230-242.

Hayes, A. M., & Feldman, G. (2004). Clarifying the Construct of Mindfulness in the Context of Emotion Regulation and the Process of Change in Therapy. Clinical Psychology: Science and Practice, 11, 255-262.

Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1993). Three-year follow-up and clinical implications of Mindfulness Meditation-Based Stress Reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192-200.

Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting & Clinical Psychology, 68, 615-623.

Williams, J. M. G., Teasdale, J. D., Segal, Z. V., & Soulsby, J. (2000). Mindfulness-based cognitive therapy reduces overgeneral autobiographical memory in formerly depressed patients. Journal of Abnormal Psychology, 109, 150-155.

Fresco, D. M., Flynn, J. J., Mennin, D. S., & Haigh, E. A. P. (in press). Mindfulness-Based Cognitive Therapy. In J. D. Herbert & E. Forman. Acceptance and Mindfulness in Cognitive Behavior Therapy. New York: Wiley.



Mindfulness (Cont'd)


No Class Wed, Nov 17 DMF@ABCT

Baer, R. A (2003). Mindfulness training as a clinical intervention:  A conceptual and empirical review. Clinical Psychology: Science and Practice.

Dimidjian, S. & Linehan, M. M. (2003). Defining an Agenda for Future Research on the Clinical Application of Mindfulness Practice. Clinical Psychology: Science and Practice.

Kabat-Zinn, J.(2003). Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice.

Roemer, R. & Orsillo, S. M. (2003). Mindfulness: A promising intervention strategy in need of further study. Clinical Psychology: Science and Practice.

Teasdale, J. D., Segal, Z. V., & Williams, J. M. G. (2003). Mindfulness Training and Problem Formulation. Clinical Psychology: Science and Practice

Both days, we will practice and discuss mindfulness exercises that can be implemented in practice.



Acceptance and Commitment Therapy (ACT)


No Class Wed, Nov 24-Thanksgiving Recess

Blackledge, J. T. & Hayes, S. C. (2001). Emotion Regulation in Acceptance and Commitment Therapy. Journal of Clinical Psychology, 57, 243-255.

Hayes, S. C. (1994). Content, context, and the types of psychological acceptance. In S. C. Hayes, N. S. Jacobsen, V. M. Follette, & M. J. Dougher. Acceptance and Change:  Content and Context in Psychotherapy. (pp. 13-32). Reno:  Context Press.

Hayes, S. C. & Pankey, J. (2003). Psychological acceptance. In W. T. O'Donohue, J. E. Fisher, & S. C. Hayes (Eds.), Empirically supported techniques of cognitive behavior therapy: A step by step guide for clinicians. New York: Wiley.

Luoma, J. & Hayes, S. C. (2003). Cognitive defusion. In W. T. O'Donohue, J. E. Fisher, & S. C. Hayes (Eds.), Empirically supported techniques of cognitive behavior therapy: A step by step guide for clinicians. New York: Wiley.

Blackledge, J. T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. The Behavior Analyst Today, 3, 421-433.

Wilson, K. G. & Murrell, A. R. (in press). Values-Centered Interventions: Setting a Course for Behavioral Treatment. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.). The new behavior therapies: Expanding the cognitive behavioral tradition. New York: Guilford Press.

Optional Assignment:
Complete the very useful RFT Tutorial created by Eric Fox.



Acceptance and Commitment Therapy (ACT) (Cont'd)



We will watch Acceptance and Commitment Therapy by Steven C. Hayes.



Emotion Regulation Therapy (ERT) for GAD

Mennin, D. S. & Fresco, D. M. (2009). Emotion regulation as an integrative framework for understanding and treating psychopathology (356-379). In A.M. Kring & D.S. Sloan (Editors). Emotion Regulation and Psychopathology, New York: Guilford Press.

Borkovec, T. D. & Sharpless. (2004). Generalized Anxiety Disorder: Bringing cognitive behavioral therapy into the valued present. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds). Mindfulness and Acceptance: Expanding the cognitive-behavioral tradition (pp. 209-242). New York: Guilford.

Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002).  Applying an emotion regulation framework to integrative approaches to Generalized Anxiety Disorder. Clinical Psychology:  Science & Practice, 9,85-90.

Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Emotion regulation deficits as a key feature of generalized anxiety disorder: Testing a theoretical model. Behaviour Research and Therapy, 43, 1281-1310
Turn in:  Behavioral Experiment Paper