cbt homework for trauma

CBT Techniques: 25 Cognitive Behavioral Therapy Worksheets

It’s an extremely common type of talk therapy practiced around the world.

If you’ve ever interacted with a mental health therapist, a counselor, or a psychiatry clinician in a professional setting, it’s likely you’ve participated in CBT.

If you’ve ever heard friends or loved ones talk about how a mental health professional helped them identify unhelpful thoughts and patterns and behavior and alter them to more effectively work towards their goals, you’ve heard about the impacts of CBT.

CBT is one of the most frequently used tools in the psychologist’s toolbox. Though it’s based on simple principles, it can have wildly positive outcomes when put into practice.

In this article, we’ll explore what CBT is, how it works, and how you can apply its principles to improve your own life or the lives of your clients.

Before you read on, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with a comprehensive insight into Positive CBT and will give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is cbt, cognitive distortions, 9 essential cbt techniques and tools.

• Cognitive Behavioral Therapy Worksheets (PDFs) To Print and Use

Some More CBT Interventions and Exercises

A cbt manual and workbook for your own practice and for your client, 5 final cognitive behavioral activities, a take-home message.

“This simple idea is that our unique patterns of thinking, feeling, and behaving are significant factors in our experiences, both good and bad. Since these patterns have such a significant impact on our experiences, it follows that altering these patterns can change our experiences” (Martin, 2016).

Cognitive-behavioral therapy aims to change our thought patterns, our conscious and unconscious beliefs, our attitudes, and, ultimately, our behavior, in order to help us face difficulties and achieve our goals.

Psychiatrist Aaron Beck was the first to practice cognitive behavioral therapy. Like most mental health professionals at the time, Beck was a  psychoanalysis  practitioner.

While practicing psychoanalysis, Beck noticed the prevalence of internal dialogue in his clients and realized how strong the link between thoughts and feelings can be. He altered the therapy he practiced in order to help his clients identify, understand, and deal with the automatic, emotion-filled thoughts  that regularly arose in his clients.

Beck found that a combination of cognitive therapy and behavioral techniques produced the best results for his clients. In describing and honing this new therapy, Beck laid the foundations of the most popular and influential form of therapy of the last 50 years.

This form of therapy is not designed for lifelong participation and aims to help clients meet their goals in the near future. Most CBT treatment regimens last from five to ten months, with clients participating in one 50- to 60-minute session per week.

CBT is a hands-on approach that requires both the therapist and the client to be invested in the process and willing to actively participate. The therapist and client work together as a team to identify the problems the client is facing, come up with strategies for addressing them, and creating positive solutions (Martin, 2016).

Many of the most popular and effective cognitive-behavioral therapy techniques are applied to what psychologists call “ cognitive distortions ,” inaccurate thoughts that reinforce negative thought patterns or emotions (Grohol, 2016).

There are 15 main cognitive distortions that can plague even the most balanced thinkers.

1. Filtering

Filtering refers to the way a person can ignore all of the positive and good things in life to focus solely on the negative. It’s the trap of dwelling on a single negative aspect of a situation, even when surrounded by an abundance of good things.

2. Polarized thinking / Black-and-white thinking

This cognitive distortion is all-or-nothing thinking, with no room for complexity or nuance—everything’s either black or white, never shades of gray.

If you don’t perform perfectly in some area, then you may see yourself as a total failure instead of simply recognizing that you may be unskilled in one area.

3. Overgeneralization

Overgeneralization is taking a single incident or point in time and using it as the sole piece of evidence for a broad conclusion.

For example, someone who overgeneralizes could bomb an important job interview and instead of brushing it off as one bad experience and trying again, they conclude that they are terrible at interviewing and will never get a job offer.

4. Jumping to conclusions

Similar to overgeneralization, this distortion involves faulty reasoning in how one makes conclusions. Unlike overgeneralizing one incident, jumping to conclusions refers to the tendency to be sure of something without any evidence at all.

For example, we might be convinced that someone dislikes us without having any real evidence, or we might believe that our fears will come true before we have a chance to really find out.

5. Catastrophizing / Magnifying or Minimizing

This distortion involves expecting that the worst will happen or has happened, based on an incident that is nowhere near as catastrophic as it is made out to be. For example, you may make a small mistake at work and be convinced that it will ruin the project you are working on, that your boss will be furious, and that you’ll lose your job.

Alternatively, one might minimize the importance of positive things, such as an accomplishment at work or a desirable personal characteristic.

6. Personalization

This is a distortion where an individual believes that everything they do has an impact on external events or other people, no matter how irrational that may be. A person with this distortion will feel that he or she has an exaggerated role in the bad things that happen around them.

For instance, a person may believe that arriving a few minutes late to a meeting led to it being derailed and that everything would have been fine if they were on time.

7. Control fallacies

This distortion involves feeling like everything that happens to you is either a result of purely external forces or entirely due to your own actions. Sometimes what happens to us is due to forces we can’t control, and sometimes what it’s due to our own actions, but the distortion is assuming that it is always one or the other.

We might assume that difficult coworkers are to blame for our own less-than-stellar work, or alternatively assume that every mistake another person makes is because of something we did.

8. Fallacy of fairness

We are often concerned about fairness, but this concern can be taken to extremes. As we all know, life is not always fair. The person who goes through life looking for fairness in all their experiences will end up resentful and unhappy.

Sometimes things will go our way, and sometimes they will not, regardless of how fair it may seem.

When things don’t go our way, there are many ways we can explain or assign responsibility for the outcome. One method of assigning responsibility is blaming others for what goes wrong.

Sometimes we may blame others for making us feel or act a certain way, but this is a cognitive distortion. Only you are responsible for the way you feel or act.

10. “Shoulds”

“Shoulds” refer to the implicit or explicit rules we have about how we and others should behave. When others break our rules, we are upset. When we break our own rules, we feel guilty. For example, we may have an unofficial rule that customer service representatives should always be accommodating to the customer.

When we interact with a customer service representative that is not immediately accommodating, we might get angry. If we have an implicit rule that we are irresponsible if we spend money on unnecessary things, we may feel exceedingly guilty when we spend even a small amount of money on something we don’t need.

11. Emotional reasoning

This distortion involves thinking that if we feel a certain way, it must be true. For example, if we feel unattractive or uninteresting in the current moment, we think we  are unattractive or uninteresting. This cognitive distortion boils down to:

“I feel it, therefore it must be true.”

Clearly, our emotions are not always indicative of the objective truth, but it can be difficult to look past how we feel.

12. Fallacy of change

The fallacy of change lies in expecting other people to change as it suits us. This ties into the feeling that our happiness depends on other people, and their unwillingness or inability to change, even if we demand it, keeps us from being happy.

This is a damaging way to think because no one is responsible for our own happiness except ourselves.

13. Global labeling / mislabeling

This cognitive distortion is an extreme form of generalizing, in which we generalize one or two instances or qualities into a global judgment. For example, if we fail at a specific task, we may conclude that we are a total failure in not only that area but all areas.

Alternatively, when a stranger says something a bit rude, we may conclude that he or she is an unfriendly person in general. Mislabeling is specific to using exaggerated and emotionally loaded language, such as saying a woman has abandoned her children when she leaves her children with a babysitter to enjoy a night out.

14. Always being right

While we all enjoy being right, this distortion makes us think we must be right, that being wrong is unacceptable.

We may believe that being right is more important than the feelings of others, being able to admit when we’ve made a mistake or being fair and objective.

15. Heaven’s Reward Fallacy

This distortion involves expecting that any sacrifice or self-denial will pay off. We may consider this karma, and expect that karma will always immediately reward us for our good deeds. This results in feelings of bitterness when we do not receive our reward (Grohol, 2016).

Many tools and techniques found in cognitive behavioral therapy are intended to address or reverse these cognitive distortions.

There are many tools and techniques used in cognitive behavioral therapy, many of which can be used in both a therapy context and in everyday life. The nine techniques and tools listed below are some of the most common and effective CBT practices.

1. Journaling

This technique is a way to gather about one’s moods and thoughts. A CBT journal can include the time of the mood or thought, the source of it, the extent or intensity, and how we reacted, among other factors.

This technique can help us to identify our thought patterns and emotional tendencies, describe them, and change, adapt, or cope with them (Utley & Garza, 2011).

Follow the link to find out more about using a thought diary for journaling.

2. Unraveling cognitive distortions

This is a primary goal of CBT and can be practiced with or without the help of a therapist. In order to unravel cognitive distortions, you must first become aware of the distortions from which you commonly suffer (Hamamci, 2002).

Part of this involves identifying and challenging harmful automatic thoughts, which frequently fall into one of the 15 categories listed earlier.

3. Cognitive restructuring

Once you identify the distortions you hold, you can begin to explore how those distortions took root and why you came to believe them. When you discover a belief that is destructive or harmful, you can begin to challenge it (Larsson, Hooper, Osborne, Bennett, & McHugh, 2015).

For example, if you believe that you must have a high-paying job to be a respectable person, but you’re then laid off from your high-paying job, you will begin to feel bad about yourself.

Instead of accepting this faulty belief that leads you to think negative thoughts about yourself, with cognitive restructuring you could take an opportunity to think about what really makes a person “respectable,” a belief you may not have explicitly considered before.

4. Exposure and response prevention

This technique is specifically effective for those who suffer from obsessive-compulsive disorder (OCD; Abramowitz, 1996). You can practice this technique by exposing yourself to whatever it is that normally elicits a compulsive behavior, but doing your best to refrain from the behavior.

You can combine journaling with this technique, or use journaling to understand how this technique makes you feel.

5. Interoceptive exposure

Interoceptive Exposure is intended to treat panic and anxiety. It involves exposure to feared bodily sensations in order to elicit the response (Arntz, 2002). Doing so activates any unhelpful beliefs associated with the sensations, maintains the sensations without distraction or avoidance, and allows new learning about the sensations to take place.

It is intended to help the sufferer see that symptoms of panic are not dangerous, although they may be uncomfortable.

6. Nightmare exposure and rescripting

Nightmare exposure and rescripting are intended specifically for those suffering from nightmares. This technique is similar to interoceptive exposure, in that the nightmare is elicited, which brings up the relevant emotion (Pruiksma, Cranston, Rhudy, Micol, & Davis, 2018).

Once the emotion has arisen, the client and therapist work together to identify the desired emotion and develop a new image to accompany the desired emotion.

7. Play the script until the end

This technique is especially useful for those suffering from fear and anxiety. In this technique, the individual who is vulnerable to crippling fear or anxiety conducts a sort of thought experiment in which they imagine the outcome of the worst-case scenario.

Letting this scenario play out can help the individual to recognize that even if everything he or she fears comes to pass, the outcome will still be manageable (Chankapa, 2018).

8. Progressive muscle relaxation

This is a familiar technique to those who practice mindfulness. Similar to the body scan, progressive muscle relaxation instructs you to relax one muscle group at a time until your whole body is in a state of relaxation (McCallie, Blum, & Hood, 2006).

You can use audio guidance, a YouTube video, or simply your own mind to practice this technique, and it can be especially helpful for calming nerves and soothing a busy and unfocused mind.

9. Relaxed breathing

This is another technique that will be familiar to practitioners of mindfulness . There are many ways to relax and bring regularity to your breath, including guided and unguided imagery, audio recordings, YouTube videos, and scripts. Bringing regularity and calm to your breath will allow you to approach your problems from a place of balance, facilitating more effective and rational decisions (Megan, 2016).

These techniques can help those suffering from a range of mental illnesses and afflictions, including anxiety, depression, OCD, and panic disorder, and they can be practiced with or without the guidance of a therapist. To try some of these techniques without the help of a therapist, see the next section for worksheets and handouts to assist with your practice.

How does cognitive behavioral therapy work – Psych Hub

Cognitive-Behavioral Therapy Worksheets (PDFs) To Print and Use

1. Coping styles worksheet

This PDF Coping Styles Formulation Worksheet instructs you or your client to first list any current perceived problems or difficulties – “The Problem”. You or your client will work backward to list risk factors above (i.e., why you are more likely to experience these problems than someone else) and triggers or events (i.e., the stimulus or source of these problems).

Once you have defined the problems and understand why you are struggling with them, you then list coping strategies. These are not solutions to your problems, but ways to deal with the effects of those problems that can have a temporary impact. Next, you list the effectiveness of the coping strategies, such as how they make you feel in the short- and long-term, and the advantages and disadvantages of each strategy.

Finally, you move on to listing alternative actions. If your coping strategies are not totally effective against the problems and difficulties that are happening, you are instructed to list other strategies that may work better.

This worksheet gets you (or your client) thinking about what you are doing now and whether it is the best way forward.

2. ABC functional analysis

One popular technique in CBT is ABC functional analysis . Functional analysis helps you (or the client) learn about yourself, specifically, what leads to specific behaviors and what consequences result from those behaviors.

In the middle of the worksheet is a box labeled “Behaviors.” In this box, you write down any potentially problematic behaviors you want to analyze.

On the left side of the worksheet is a box labeled “Antecedents,” in which you or the client write down the factors that preceded a particular behavior. These are factors that led up to the behavior under consideration, either directly or indirectly.

On the right side is the final box, labeled “Consequences.” This is where you write down what happened as a result of the behavior under consideration. “Consequences” may sound inherently negative, but that’s not necessarily the case; some positive consequences can arise from many types of behaviors, even if the same behavior also leads to negative consequences.

This ABC Functional Analysis Worksheet can help you or your client to find out whether particular behaviors are adaptive and helpful in striving toward your goals, or destructive and self-defeating.

3. Case formulation worksheet

In CBT, there are 4 “P’s” in Case Formulation:

• Predisposing factors;
• Precipitating factors;
• Perpetuating factors; and
• Protective factors

They help us understand what might be leading a perceived problem to arise, and what might prevent them from being tackled effectively.

In this worksheet, a therapist will work with their client through 4 steps.

First, they identify predisposing factors, which are those external or internal and can add to the likelihood of someone developing a perceived problem (“The Problem”). Examples might include genetics, life events, or their temperament.

Together, they collaborate to identify precipitating factors, which provide insight into precise events or triggers that lead to “The Problem” presenting itself. Then they consider perpetuating factors, to discover what reinforcers may be maintaining the current problem.

Last, they identify protective factors, to understand the client’s strengths, social supports, and adaptive behavioral patterns.

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4. Extended case formulation worksheet

This worksheet builds on the last. It helps you or your client address the “Four P Factors” described just above—predisposing, precipitating, perpetuating, and protective factors. This formulation process can help you or your client connect the dots between core beliefs, thought patterns, and present behavior.

This worksheet presents six boxes on the left of the page (Part A), which should be completed before moving on to the right-hand side of the worksheet (Part B).

• The first box is labeled “The Problem,” and corresponds with the perceived difficulty that your client is experiencing. In this box, you are instructed to write down the events or stimuli that are linked to a certain behavior.
• The next box is labeled “Early Experiences” and corresponds to the predisposing factor. This is where you list the experiences that you had early in life that may have contributed to the behavior.
• The third box is “Core Beliefs,” which is also related to the predisposing factor. This is where you write down some relevant core beliefs you have regarding this behavior. These are beliefs that may not be explicit, but that you believe deep down, such as “I’m bad” or “I’m not good enough.”
• The fourth box is “Conditional assumptions/rules/attitudes,” which is where you list the rules that you adhere to, whether consciously or subconsciously. These implicit or explicit rules can perpetuate the behavior, even if it is not helpful or adaptive. Rules are if-then statements that provide a judgment based on a set of circumstances. For instance, you may have the rule “If I do not do something perfectly, I’m a complete failure.”
• The fifth box is labeled “Maladaptive Coping Strategies” This is where you write down how well these rules are working for you (or not). Are they helping you to be the best you can be? Are they helping you to effectively strive towards your goals?
• Finally, the last box us titled “Positives.” This is where you list the factors that can help you deal with the problematic behavior or thought, and perhaps help you break the perpetuating cycle. These can be things that help you cope once the thought or behavior arises or things that can disrupt the pattern once it is in motion.

On the right, there is a flow chart that you can fill out based on how these behaviors and feelings are perpetuated. You are instructed to think of a situation that produces a negative automatic thought and record the emotion and behavior that this thought provokes, as well as the bodily sensations that can result. Filling out this flow chart can help you see what drives your behavior or thought and what results from it.

Download our PDF Extended Case Formulation Worksheet .

5. Dysfunctional thought record

This worksheet is especially helpful for people who struggle with negative thoughts and need to figure out when and why those thoughts are most likely to pop up. Learning more about what provokes certain automatic thoughts makes them easier to address and reverse.

The worksheet is divided into seven columns:

• On the far left, there is space to write down the date and time a dysfunctional thought arose.
• The second column is where the situation is listed. The user is instructed to describe the event that led up to the dysfunctional thought in detail.
• The third column is for the automatic thought. This is where the dysfunctional automatic thought is recorded, along with a rating of belief in the thought on a scale from 0% to 100%.
• The next column is where the emotion or emotions elicited by this thought are listed, also with a rating of intensity on a scale from 0% to 100%.
• Use this fifth column to note the dysfunctional thought that will be addressed. Example maladaptive thoughts include distortions such as over-inflating the negative while dismissing the positive of a situation, or overgeneralizing.
• The second-to-last column is for the user to write down alternative thoughts that are more positive and functional to replace the negative one.
• Finally, the last column is for the user to write down the outcome of this exercise. Were you able to confront the dysfunctional thought? Did you write down a convincing alternative thought? Did your belief in the thought and/or the intensity of your emotion(s) decrease?

Download this Dysfunctional Thought Record as a PDF.

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6. Fact-checking

One of my favorite CBT tools is this  Fact Checking Thoughts Worksheet because it can be extremely helpful in recognizing that your thoughts are not necessarily true.

At the top of this worksheet is an important lesson:

Thoughts are not facts.

Of course, it can be hard to accept this, especially when we are in the throes of a dysfunctional thought or intense emotion. Filling out this worksheet can help you come to this realization.

The worksheet includes 16 statements that the user must decide are either fact or opinion. These statements include:

• I’m a bad person.
• I failed the test.
• I’m selfish.
• I didn’t lend my friend money when they asked.

This is not a trick—there is a right answer for each of these statements. (In case you’re wondering, the correct answers for the statements above are as follows: opinion, fact, opinion, fact.)

This simple exercise can help the user to see that while we have lots of emotionally charged thoughts, they are not all objective truths. Recognizing the difference between fact and opinion can assist us in challenging the dysfunctional or harmful opinions we have about ourselves and others.

7. Cognitive restructuring

This worksheet employs the use of Socratic questioning, a technique that can help the user to challenge irrational or illogical thoughts.

The first page of the worksheet has a thought bubble for “What I’m Thinking”. You or your client can use this space to write down a specific thought, usually, one you suspect is destructive or irrational.

Next, you write down the facts supporting and contradicting this thought as a reality. What facts about this thought being accurate? What facts call it into question? Once you have identified the evidence, you can use the last box to make a judgment on this thought, specifically whether it is based on evidence or simply your opinion.

The next page is a mind map of Socratic Questions which can be used to further challenge the thought. You may wish to re-write “What I’m Thinking” in the center so it is easier to challenge the thought against these questions.

• One question asks whether this thought is truly a black-and-white situation, or whether reality leaves room for shades of gray. This is where you think about (and write down) whether you are using all-or-nothing thinking, for example, or making things unreasonably simple when they are complex.
• Another asks whether you could be misinterpreting the evidence or making any unverified assumptions. As with all the other bubbles, writing it down will make this exercise more effective.
• A third bubble instructs you to think about whether other people might have different interpretations of the same situation, and what those interpretations might be.
• Next, ask yourself whether you are looking at all the relevant evidence or just the evidence that backs up the belief you already hold. Try to be as objective as possible.
• It also helps to ask yourself whether your thought may an over-inflation of a truth. Some negative thoughts are based in truth but extend past their logical boundaries.
• You’re also instructed to consider whether you are entertaining this negative thought out of habit or because the facts truly support it.
• Then, think about how this thought came to you. Was it passed on from someone else? If so, is that person a reliable source of truth?
• Finally, you complete the worksheet by identifying how likely the scenario your thought brings up actually is, and whether it is the worst-case scenario.

These Socratic questions encourage a deep dive into the thoughts that plague you and offer opportunities to analyze and evaluate those thoughts. If you are having thoughts that do not come from a place of truth, this Cognitive Restructuring Worksheet can be an excellent tool for identifying and defusing them.

How is positive cognitive-behavioral therapy (CBT) different from traditional CBT?

Although both forms of CBT have the same goal of bringing about positive changes in a client’s life, the pathways used in traditional and positive CBT to actualize this goal differ considerably. Traditional CBT, as initially formulated by Beck (1967), focuses primarily on the following:

• Analyzing problems
• Lessening what causes suffering
• Working on clients’ weaknesses
• Getting away from problems

Instead, positive CBT, as formulated by Bannink (2012), focuses mainly on the following:

• Finding solutions
• Enhancing what causes flourishing
• Working with client’s strengths
• Getting closer to the preferred future

In other words, Positive CBT shifts the focus on what’s right with the person (rather than what’s wrong with them) and on what’s working (rather than what’s not working) to foster a more optimistic process that empowers clients to flourish and thrive.

In an initial study comparing the effects of traditional and Positive CBT in the treatment of depression, positive CBT resulted in a more substantial reduction of depression symptoms, a more significant increase in happiness, and it was associated with less dropout (Geschwind et al., 2019).

Haven’t had enough CBT tools and techniques yet? Read on for additional useful and effective exercises.

1. Behavioral experiments

These are related to thought experiments, in that you engage in a “what if” consideration. Behavioral experiments differ from thought experiments in that you actually test out these “what ifs” outside of your thoughts (Boyes, 2012).

In order to test a thought, you can experiment with the outcomes that different thoughts produce. For example, you can test the thoughts:

“If I criticize myself, I will be motivated to work harder” versus “If I am kind to myself, I will be motivated to work harder.”

First, you would try criticizing yourself when you need the motivation to work harder and record the results. Then you would try being kind to yourself and recording the results. Next, you would compare the results to see which thought was closer to the truth.

These Behavioral Experiments to Test Beliefs can help you learn how to achieve your therapeutic goals and how to be your best self.

2. Thought records

Thought records are useful in testing the validity of your thoughts (Boyes, 2012). They involve gathering and evaluating evidence for and against a particular thought, allowing for an evidence-based conclusion on whether the thought is valid or not.

For example, you may have the belief “My friend thinks I’m a bad friend.” You would think of all the evidence for this belief, such as “She didn’t answer the phone the last time I called,” or “She canceled our plans at the last minute,” and evidence against this belief, like “She called me back after not answering the phone,” and “She invited me to her barbecue next week. If she thought I was a bad friend, she probably wouldn’t have invited me.”

Once you have evidence for and against, the goal is to come up with more balanced thoughts, such as, “My friend is busy and has other friends, so she can’t always answer the phone when I call. If I am understanding of this, I will truly be a good friend.”

Thought records apply the use of logic to ward off unreasonable negative thoughts and replace them with more balanced, rational thoughts (Boyes, 2012).

Here’s a helpful Thought Record Worksheet to download.

3. Pleasant activity scheduling

This technique can be especially helpful for dealing with depression (Boyes, 2012). It involves scheduling activities in the near future that you can look forward to.

For example, you may write down one activity per day that you will engage in over the next week. This can be as simple as watching a movie you are excited to see or calling a friend to chat. It can be anything that is pleasant for you, as long as it is not unhealthy (i.e., eating a whole cake in one sitting or smoking).

You can also try scheduling an activity for each day that provides you with a sense of mastery or accomplishment (Boyes, 2012). It’s great to do something pleasant, but doing something small that can make you feel accomplished may have more long-lasting and far-reaching effects.

This simple technique can introduce more positivity into your life, and our Pleasant Activity Scheduling Worksheet is designed to help.

4. Imagery-based exposure

This exercise involves thinking about a recent memory that produced strong negative emotions and analyzing the situation.

For example, if you recently had a fight with your significant other and they said something hurtful, you can bring that situation to mind and try to remember it in detail. Next, you would try to label the emotions and thoughts you experienced during the situation and identify the urges you felt (e.g., to run away, to yell at your significant other, or to cry).

Visualizing this negative situation, especially for a prolonged period of time, can help you to take away its ability to trigger you and reduce avoidance coping (Boyes, 2012). When you expose yourself to all of the feelings and urges you felt in the situation and survive experiencing the memory, it takes some of its power away.

This Imagery Based Exposure Worksheet is a useful resource for this exercise.

5. Graded exposure worksheet

This technique may sound complicated, but it’s relatively simple.

Making a situation exposure hierarchy involves means listing situations that you would normally avoid (Boyes, 2012). For example, someone with severe social anxiety may typically avoid making a phone call or asking someone on a date.

Next, you rate each item on how distressed you think you would be, on a scale from 0 to 10, if you engaged in it. For the person suffering from severe social anxiety, asking someone on a date may be rated a 10 on the scale, while making a phone call might be rated closer to a 3 or 4.

Once you have rated the situations, you rank them according to their distress rating. This will help you recognize the biggest difficulties you face, which can help you decide which items to address and in what order. It’s often advised to start with the least distressing items and work your way up to the most distressing items.

Download our Graded Exposure Worksheet here.

Some of these books are for the therapist only, and some are to be navigated as a team or with guidance from the therapist.

There are many manuals out there for helping therapists apply cognitive behavioral therapy in their work, but these are some of the most popular:

• A Therapist’s Guide to Brief Cognitive Behavioral Therapy by Jeffrey A. Cully and Andra L. Teten (PDF here );
• Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression by Ricardo F. Munoz and Jeanne Miranda (PDF here );
• Provider’s Guidebook: “Activities and Your Mood” by Community Partners in Care (PDF here );
• Treatment Manual for Cognitive Behavioral Therapy for Depression by Jeannette Rosselló, Guillermo Bernal, and the Institute for Psychological Research (PDF here ).

Here are some of the most popular workbooks and manuals for clients to use alone or with a therapist:

• The CBT Toolbox: A Workbook for Clients and Clinicians by Jeff Riggenbach ( Amazon );
• Client’s Guidebook: “Activities and Your Mood” by Community Partners in Care (PDF here );
• The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by William J. Knaus and Jon Carlson ( Amazon );
• The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program by William J. Knaus and Albert Ellis ( Amazon );
• Cognitive-Behavioral Therapy Skills Workbook by Barry Gregory ( Amazon );
• A Course in CBT Techniques: A Free Online CBT Workbook  by Albert Bonfil and Suraji Wagage (online here ).

There are many other manuals and workbooks available that can help get you started with CBT, but the tools above are a good start. Peruse our article: 30 Best CBT Books to Master Cognitive Behavioral Therapy for an excellent list of these books.

1. Mindfulness meditation

Mindfulness can have a wide range of positive impacts, including helping with depression, anxiety, addiction, and many other mental illnesses or difficulties.

The practice can help those suffering from harmful automatic thoughts to disengage from rumination and obsession by helping them stay firmly grounded in the present (Jain et al., 2007).

Mindfulness meditations, in particular, can function as helpful tools for your clients in between therapy sessions, such as to help ground them in the present moment during times of stress.

If you are a therapist who uses mindfulness-based approaches, consider finding or pre-recording some short mindfulness meditation exercises for your clients.

You might then share these with your clients as part of a toolkit they can draw on at their convenience, such as using the blended care platform Quenza (pictured here), which allows clients to access meditations or other psychoeducational activities on-the-go via their portable devices.

2. Successive approximation

This is a fancy name for a simple idea that you have likely already heard of: breaking up large tasks into small steps.

It can be overwhelming to be faced with a huge goal, like opening a business or remodeling a house. This is true in mental health treatment as well, since the goal to overcome depression or anxiety and achieve mental wellness can seem like a monumental task.

By breaking the large goal into small, easy-to-accomplish steps, we can map out the path to success and make the journey seem a little less overwhelming (e.g., Emmelkamp & Ultee, 1974).

3. Writing self-statements to counteract negative thoughts

This technique can be difficult for someone who’s new to CBT treatment or suffering from severe symptoms, but it can also be extremely effective (Anderson, 2014).

When you (or your client) are being plagued by negative thoughts, it can be hard to confront them, especially if your belief in these thoughts is strong. To counteract these negative thoughts, it can be helpful to write down a positive, opposite thought.

For example, if the thought “I am worthless” keeps popping into your head, try writing down a statement like “I am a person with worth,” or “I am a person with potential.” In the beginning, it can be difficult to accept these replacement thoughts, but the more you bring out these positive thoughts to counteract the negative ones, the stronger the association will be.

4. Visualize the best parts of your day

When you are feeling depressed or negative, it is difficult to recognize that there are positive aspects of life. This simple technique of bringing to mind the good parts of your day can be a small step in the direction of recognizing the positive (Anderson, 2014).

All you need to do is write down the things in your life that you are thankful for or the most positive events that happen in a given day. The simple act of writing down these good things can forge new associations in your brain that make it easier to see the positive, even when you are experiencing negative emotions.

5. Reframe your negative thoughts

It can be easy to succumb to negative thoughts as a default setting. If you find yourself immediately thinking a negative thought when you see something new, such as entering an unfamiliar room and thinking “I hate the color of that wall,” give reframing a try (Anderson, 2014).

Reframing involves countering the negative thought(s) by noticing things you feel positive about as quickly as possible. For instance, in the example where you immediately think of how much you hate the color of that wall, you would push yourself to notice five things in the room that you feel positively about (e.g., the carpet looks comfortable, the lampshade is pretty, the windows let in a lot of sunshine).

You can set your phone to remind you throughout the day to stop what you are doing and think of the positive things around you. This can help you to push your thoughts back into the realm of the positive instead of the negative.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

In this post, we offered many techniques, tools, and resources that can be effective in the battle against depression, anxiety, OCD, and a host of other problems or difficulties.

However, as is the case with many treatments, they depend on you (or your client) putting in a lot of effort. We encourage you to give these techniques a real try and allow yourself the luxury of thinking that they could actually work.

When we approach a potential solution with the assumption that it will not work, that assumption often becomes a self-fulfilling prophecy. When we approach a potential solution with an open mind and the belief that it just might work, it has a much better chance of succeeding.

So if you are struggling with negative automatic thoughts , please consider these tips and techniques and give them a shot. Likewise, if your client is struggling, encourage them to make the effort, because the payoff can be better than they can imagine.

If you are struggling with severe symptoms of depression or suicidal thoughts, please call the following number in your respective country:

• USA: National Suicide Prevention Hotline at 988;
• UK: Samaritans hotline at 116 123;
• The Netherlands: Netherlands Suicide Hotline at 09000767;
• France: Suicide écoute at 01 45 39 40 00;
• Germany: Telefonseelsorge at 0800 111 0 111 or 0800 111 0 222

For a list of other suicide prevention websites, phone numbers, and resources, see this website .

Please know that there are people out there who care and that there are treatments that can help.

Please let us know about your experiences with CBT in the comments section. If you’ve tried it, how did it work for you? Are there any other helpful exercises or techniques that we did not touch on in this piece? We’d love to know your thoughts.

We hope you enjoyed this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy , 27 (4), 583-600.
• Anderson, J. (2014, June 12). 5 Get-positive techniques from cognitive behavioral therapy. Retrieved from http://www.everydayhealth.com/hs/major-depression-living-well/cognitive-behavioral-therapy-techniques/
• Arntz, A. (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy , 40 (3), 325-341.
• Bannink, F. (2012).  Practicing positive CBT: From reducing distress to building success . John Wiley & Sons.
• Beck, A. T. (1967). Depression. Hoeber-Harper.
• Boyes, A. (2012, December 6). Cognitive behavioral therapy techniques that work: Mix and match cognitive behavioral therapy techniques to fit your preferences. Retrieved from https://www.psychologytoday.com/blog/in-practice/201212/cognitive-behavioral-therapy-techniques-work
• Chankapa, N. P. (2018). Effectiveness of cognitive behavioral therapy on depression and self-efficacy among out-patient female depressants in Sikkim  (Masters dissertation). Retrieved from http://14.139.206.50:8080/jspui/bitstream/1/6059/1/nancy%20chankpa.pdf
• Davis, R. (2019, March 6). The complete list of cognitive behavioral therapy (CBT) techniques. Retrieved from https://www.infocounselling.com/list-of-cbt-techniques/
• Emmelkamp, P. M., & Ultee, K. A. (1974). A comparison of “successive approximation” and “self-observation” in the treatment of agoraphobia. Behavior Therapy, 5 (5), 606–613.
• Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy.  Behaviour research and therapy, 116 , 119-130.
• Grohol, J. (2016). 15 Common cognitive distortions. Retrieved from https://psychcentral.com/lib/15-common-cognitive-distortions/
• Hamamci, Z. (2002). The effect of integrating psychodrama and cognitive behavioral therapy on reducing cognitive distortions in interpersonal relationships. Journal of Group Psychotherapy, Psychodrama & Sociometry ,  55 (1), 3–14.
• Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine , 33 (1), 11-21.
• Larsson, A., Hooper, N., Osborne, L. A., Bennett, P., & McHugh, L. (2016). Using brief cognitive restructuring and cognitive defusion techniques to cope with negative thoughts. Behavior Modification , 40 (3), 452-482.
• Martin, B. (2016). In-depth: Cognitive behavioral therapy.  Retrieved from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/
• McCallie, M. S., Blum, C. M., & Hood, C. J. (2006). Progressive muscle relaxation. Journal of Human Behavior in the Social Environment , 13 (3), 51-66.
• Pathak, N. (Ed.). (2018). Does cognitive behavioral therapy treat depression? Retrieved from https://www.webmd.com/g00/depression/guide/cognitive-behavioral-therapy-for-depression/
• Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2018). Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares. Psychological trauma: theory, research, practice, and policy , 10 (1), 67-75.
• Psychology Tools. (n.d.). Retrieved from https://www.psychologytools.com/
• Therapist Aid. (n.d.). Retrieved from https://www.therapistaid.com/
• Utley, A., & Garza, Y. (2011). The therapeutic use of journaling with adolescents. Journal of Creativity in Mental Health , 6 (1), 29-41.

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Thanks for providing in-depth information on cognitive behavioral therapy techniques.

Loved the article. This was very useful, and very much appreciate all the free resources you included. Mahalo!

I am a nurse and a holistic life coach and these resources were very helpful to revise and improve my practice!

This is ridiculous. More ad than content. Misleading title.It is not a free website that you flood the viewers with so many ads. And if you are making so much money through ads then make the entire content free , since it is for the betterment of patients with mental health

Dear Prasun, We agree, and we are currently looking for another solution as the site experience is suffering too much from this try-out.

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Thank you for the work put into this amazing article! It encompasses every bit of CBT that is so useful for clients increasing their understanding of how “this” works in a very well-written tone. Well done!

Thank you for the useful material that is free of charge. It will come in handy especially the providers guidebook “activities and your mood” for my client who has been diagnosed with depression.

The subject CBT is well covered with comprehensive suggestions for the candidates. The aspect of voluntary access by the Therapist to the mentally challenged/deppressed people , needs to be stressed upon,as majority won’t open up.. Thnx educating on a high value subject.

It is very informative, keep up the good work

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3 Positive CBT Exercises (PDF)

CBT Worksheets, Handouts, And Skills-Development Audio: Therapy Resources for Mental Health Professionals

.st0{fill:none;stroke:#000;stroke-width:2;stroke-linecap:round;stroke-linejoin:round;stroke-miterlimit:10} filter.

Resource type

Therapy tool.

Grounding Techniques Menu

Information handouts.

Cognitive Distortions – Unhelpful Thinking Styles (Extended)

Choosing Your Values

Fight Or Flight Response

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Window Of Tolerance

Assertive Communication

Therapy Blueprint (Universal)

Forgiveness

Embracing Uncertainty

Grounding Techniques

Unforgiveness

Audio Collection: Psychology Tools For Developing Self-Compassion

Insufficient Self-Control

Punitiveness

Thought Record (Evidence For And Against)

Obsessive Compulsive Disorder (OCD) Formulation

Intolerance Of Uncertainty

Prompts For Challenging Your Negative Thinking

Before I Blame Myself And Feel Guilty

Theory A / Theory B

Assertive Responses

Motivational Systems (Emotional Regulation Systems)

Worry Flowchart

Mistrust/Abuse

Unhelpful Thinking Styles (Archived)

Unmet Emotional Needs

Audio Collection: Psychology Tools For Relaxation

Low Self-Esteem Formulation

Activity Menu

Examining Your Negative Thoughts

Coping Styles And Responses (Schema Therapy)

Social Anxiety Formulation

Behavioral Activation Activity Diary

Using Behavioral Activation To Overcome Depression

Post-Traumatic Stress Disorder (PTSD) Formulation

Thought Distortion Monitoring Record

Emotions Motivate Actions

Fair Fighting Rules For Resolving Conflict

Anxiety - Self-Monitoring Record

Cross Sectional Formulation

What Is Cognitive Behavioral Therapy (CBT)?

Responses To Threat: Freeze, Appease, Flight, Fight

Abandonment

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook

Treatments that work™.

How Trauma Can Affect You (CYP)

How Your Past Affects Your Present (CBT)

Health Anxiety Formulation

Behavioral Experiment (Portrait Format)

Values: Connecting To What Matters

What Are Schemas?

What Keeps Generalized Anxiety And Worry Going?

Worry Postponement

Fear Ladder

Progressive Muscle Relaxation

Guidelines For Better Sleep

Mastery Of Your Anxiety And Worry (Second Edition): Workbook

Behavioral Experiment

Panic Formulation

Emotional Inhibition

Evaluating Unhelpful Automatic Thoughts

Emotional Deprivation

Failure To Achieve

Compassionate Thought Challenging Record

Understanding Generalized Anxiety And Worry

Decatastrophizing

Reactions To Trauma

Exposure And Response Prevention

Relaxed Breathing

How Your Past Affects Your Present (Schema Therapy)

What Is Worry?

Intrusive Thoughts Images And Impulses

What Keeps Depression Going?

Friendly Formulation

Uncovering Your Deeper Beliefs

What Is Rumination?

Audio Collection: Psychology Tools For Mindfulness

Checklist For Better Sleep

Understanding Obsessive Compulsive Disorder (OCD)

Habituation

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Therapist Guide

Understanding Low Self-Esteem

Simple Thought Record

Longitudinal Formulation 2

Changing Avoidance (Behavioral Activation)

What Keeps Obsessive Compulsive Disorder (OCD) Going?

Defectiveness

Properties Of Trauma Memories

CBT Appraisal Model

Understanding Post-Traumatic Stress Disorder (PTSD)

Core Belief Magnet Metaphor

Managing Your Substance Use Disorder (Third Edition): Workbook

Types Of Dissociation

What Keeps Low Self-Esteem Going?

What is psychology tools.

Psychology Tools develops and publishes evidence-based psychotherapy resources and tools for mental health professionals. Our online library gives you access to everything you need to deliver more effective therapy and support your practice. With a wide range of topics and resource types covered, you can feel confident knowing you’ll always have a range of accessible and effective materials to support your clients, whatever challenges they are facing, whatever stage you are at, and however you work.

Choose from assessment and case formulations to psychoeducation, interventions and skills development, CBT worksheets, exercises, and much more. Our resources include detailed therapist guidance, references and instructions, so they are equally suitable for those with less experience but who want to expand their practice. Each resource explains how to work with the material most effectively, and how to use it with clients.

Are these resources suitable for you?

Psychology Tools is used by thousands of professionals all over the world as a key part of their practice and preparation, and our resources are designed to be used with clients who experience psychological difficulties or distress. Professionals who use our resources include:

• Clinical, Counseling, and Practitioner Psychologists
• Family Doctors / General Practitioners
• Licensed Clinical Social Workers
• Mental Health Nurses
• Psychiatrists
• Psychological Wellbeing Practitioners
• Psychotherapists
• Therapists (CBT Therapists, ACT Therapists, DBT Therapists)

Psychology Tools resources are perfect for individuals, teams and students, whatever their preferred modality, or career stage.

What kinds of resources are available at Psychology Tools?

Psychology Tools offers a range of relatable, engaging, and evidence-based resources to ensure that your clients get the most out of therapy or counseling. Each resource has been carefully designed with accessibility in mind and is informed by best practice guidelines and the latest scientific research.

Therapeutic exercises are used in many evidence-based psychotherapies including cognitive behavioral therapy, rational emotive behavior therapy, compassion-focused therapy, schema therapy, emotion-focused therapy, systemic family-based therapies, and several others.

Therapists and counselors benefit from incorporating exercises into their work. They can be used to:

• Introduce and explain key concepts.
• Collect information about clients’ difficulties.
• Bring therapeutic ideas to life.
• Keep therapy active and engaging.
• Alleviate distress and/or reduce problematic symptoms.
• Practice new skills and coping strategies.
• Develop new insights and self-awareness.
• Give clients a sense of accomplishment and progress.

Psychology Tools offers a variety of exercises that you can use with your clients as a part of therapy or counseling. These interventions can be incorporated into your sessions, assigned as homework tasks, or used stand-alone interventions. Many of our exercises are either evidence-based (meaning they have been shown to effectively treat certain difficulties) or evidence-derived (meaning they form part of a treatment program that has been shown to effectively treat certain difficulties).

The exercises available at Psychology Tools have a variety of applications. You can use them to:

• Develop case conceptualizations , formulations, and treatment plans.
• Address specific difficulties, such as worry, insomnia, and self-focused attention.
• Introduce clients to new skills, such as grounding , problem-solving, relaxation, and assertiveness .
• Support key interventions, such as exposure and response prevention, safety planning with high-risk clients, and perspective-taking.
• Plan treatments and prepare for supervision.

Psychology Tools exercises have been developed with practicality and convenience in mind. Most exercises include simple step-by-step instructions so that clients can use them independently or with the support of their therapist or counselor. In addition, therapist guidance is available for each exercise, which includes a detailed description of the task, relevant background information, an overview of its aims and potential uses in therapy, and simple instructions for its delivery. A comprehensive list of references is also provided so that you can access key studies and further your understanding of each exercise’s applications in psychotherapy.

Did you know that 40 – 80% of medical information is immediately forgotten by patients (Kessels, 2003)? The same is probably true of therapy and counseling, so clients will almost always benefit from having access to additional written information.

Psychology Tools information handouts provide clear, concise, and reliable information, which will empower your clients to take an active role in their treatment. Learning about their mental health, helpful strategies and techniques, and other psychoeducation topics helps clients better understand and overcome their difficulties. Moreover, clients who understand the process and content of therapy are more likely to invest in the process and commit to making positive changes.

Psychology Tools information handouts can help your clients:

• Understand their difficulties and what keeps them going.
• Learn what therapy is and how it works.
• Understand what they are doing in therapy and why.
• Remember and build upon what has been discussed during sessions.
• Create a personalized collection of resources that can used between appointments.

Our illustrated information handouts cover a wide variety topics. Each has been informed by scientific evidence, best practice guidelines, and expert opinion, ensuring they are both credible and consistent with evidence-based therapies. Topics featured among these resources include:

• ‘ What is… ’ handouts. These one-page resources provide a concise summary of common mental health problems (e.g., anxiety , depression , low self-esteem ), key therapeutic approaches (such as cognitive behavioral therapy, eye movement desensitisation and reprocessing , and compassion-focused therapy), and psychological mechanisms which maintain the problem (such as worry and rumination ).
• ‘ What keeps it going… ’ handouts. These handouts explain the key mechanisms that maintain difficulties such as burnout, panic disorder, PTSD, and perfectionism. You can use them to inform your case conceptualization or as a roadmap in therapy.
• ‘ Recognizing… ’ handouts. These guides can help you identify and assess specific disorders.
• Simple explanations of key psychological concepts, such as safety behaviors , psychological flexibility, thought suppression, and unhelpful thinking styles .
• Overviews of important psychological theories, such as operant conditioning and exposure.

Each information handout comes with guidance written specifically for therapists and counselors. It provides suggestions for introducing psychoeducation topics, facilitating helpful discussions related to the handout, and ensuring the content is relevant to your clients.

Worksheets are a core ingredient of many evidence-based therapies such as CBT. Our worksheets take many forms (e.g., diaries, diagrams, activity planners, records, and questionnaires) and can be used throughout the course of therapy.

How you incorporate worksheets into therapy or counselling depends on each client’s difficulties, goals, and stage of recovery. You can use them to:

• Assess and monitor clients’ difficulties.
• Inform treatment plans and guide decision-making.
• Teach clients new skills such as ‘self-monitoring’ or ‘thought challenging’.
• Ensure that clients apply their learning in the real world.
• Track their progress over time.
• Help clients to take an active role in their recovery.

Clients also benefit from using worksheets. These tools can help them:

• Become more aware of their difficulties.
• Identify when, how, and why these problems occur.
• Practice using new skills and techniques.
• Express and explore difficult feelings.
• Process difficult events.
• Consolidate and integrate insights from therapy.
• Support their self-reflection.
• Feel empowered and build self-efficacy.

Psychology Tools offers a wide variety of worksheets. They include general forms that are widely applicable, disorder-specific worksheets, and logs that are used in specific therapies such as CBT , schema therapy, and compassion-focused therapy . These resources are typically available in editable or fillable formats, so that they can be tailored to your client’s needs and used in a flexible manner.

Guides & self-help

People want clear guidance on mental health, whether for themselves or a loved one.

Our ‘ Understanding… ’ series is designed to introduce common mental health difficulties such as depression, PTSD, or social anxiety. Each of these guides uses a clear and accessible structure so that readers can understand them without any prior therapy knowledge. Topics addressed in each guide include:

• What the problem is.
• How it arises.
• Where it might come from.
• What keeps it going.
• How the problem can be treated.

Other guides address important topics such as trauma and dissociation, or the effects of perfectionism. They usually contain a mixture of psychoeducation, practical exercises and skills development. They promote knowledge, optimism, and positive action related to these difficulties, and have been informed by current research and evidence-based treatments, ensuring they are consistent with best practices.

Therapists can use Psychology Tools guides in several ways:

• As a screening tool. Clients can read the guide to see if the difficulty or topic is relevant to them.
• As psychoeducation. Each guide provides essential information related to the difficulty or topic so that client can develop a better understanding of it.
• As self-help. Each guide describes key skills and techniques that can be used to overcome the difficulty.

Each guide contains informative illustrations, practical examples, and simple instructions so that clients can easily relate to the content and apply it to their difficulties.

Therapy audio

Audio exercises are a particularly convenient and engaging way help your clients and can add variety to your therapeutic toolkit. Psychology Tools audio resources can help your clients:

• Augment and consolidate their learning in therapy.
• Practice new techniques.
• Integrate skills and practices into their daily lives.
• Access additional support when they need it.
• Create a sense a continuity between your meetings.

A variety of audio resources are available at Psychology Tools. Each one has been developed and recorded by highly experienced clinical psychologists and can be easily integrated into your therapeutic practice. Audio collections include:

• Psychology Tools for Developing Self-Compassion
• Psychology Tools for Relaxation
• Psychology Tools for Mindfulness
• Psychology Tools for Overcoming PTSD

Many of these audio resources are widely applicable (e.g., mindfulness-based tools), although problem-specific resources are also available (e.g., tools for overcoming PTSD). You can use these tools:

• During your therapy sessions.
• As a homework task for clients to complete.
• As a stand-alone intervention or ongoing part of therapy.

Authored by leading psychologists including David Barlow, Michelle Craske, and Edna Foa,  Treatments That Work™  is a series of workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books in the series – therapist guide and workbook – contains step by step procedures for delivering evidence-based psychological interventions. Clinical illustrations and worksheets are provided throughout.

You can use these workbooks:

• To plan treatment for a range of specific difficulties including depression, obsessive compulsive disorder (OCD), social anxiety, and substance use.
• As a self-help intervention that you guide the client through during sessions.
• As a supplement to therapy, which clients work through independently.
• To consolidate the content of your sessions.
• As an ongoing intervention at the end of treatment (e.g., for difficulties that haven’t been fully addressed).

Each book is available to download chapter-by-chapter, and Psychology Tools members with a currently active subscription to our ‘Complete’ plan are licensed to share copies with their clients.

Archived resources

We work hard to keep all resources up to date, so we regularly review and update our library. However, we understand that you might get used to a certain version of a resource as part of your workflow. Instead of removing older versions, we keep some in our archive so that you can still access them if you want to. We also clearly explain if an improved version is available, so you can choose which you prefer.

Series and ranges

As well as many topic-specific resources, we also publish a variety of ranges and series.    

• The ‘What is…’ series. These one-page resources cover a range of common mental health problems. In client friendly language they provide a concise summary of the problem, what it can feel like, what maintains it and an overview of key evidence-based therapeutic approaches (e.g., CBT, EMDR, and compassion-focused therapy) to treatment.
• The ‘What keeps it going…’ series . These are one-page diagrams that explain what tends to maintain common mental health conditions such as burnout, panic disorder, PTSD, and perfectionism. You can use them to inform your case conceptualization or as a roadmap in therapy. They provide a quick and easy way for clients to understand why their disorder persists and how it might be interrupted.
• The ‘Recognizing…’ series can help you identify and assess specific disorders.
• The ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are comprehensive sources of information for your clients. Concepts are explained in an easily digestible way with plenty of case examples and diagrams. Each guide covers symptoms, treatments and some key maintenance factors .
• The ‘Guide to…’ resources give clients a deep dive into a condition or treatment approach. They cover a mixture of information, psychoeducation, practical exercises and skills development to help clients learn to manage their condition. Each of these guides offers psychoeducation about the topic alongside a range of practical exercises with clear instructions to help clients identify, monitor, and address their symptoms.
• The ‘ Self-monitoring’ collection provides problem-specific records designed to help you and your clients get the most from this essential but often overlooked technique. Covering a broad range of conditions, these worksheets allow you to give clients a tool that is targeted to their experience, with relevant language and prompts.

Multilingual library of translations

Did you know that Psychology Tools has the largest online, searchable library of multilingual therapy resources? We aim to make our resources accessible to everyone. With over 3500 resources across 70 languages, you can give clients resources in their native language, enabling a deeper understanding and engagement with the treatment process. Translations are carried out by specially selected professional translators with experience of psychology, and our pool of volunteer mental health professionals. We also make sure that the resource design is the same for each translated resource so that you can be confident you know what section you are looking at, even if you don’t speak the language.

Simply find the resource you want to use, then explore which languages that resource is available in, or you can see all the resources available in a particular language by using our search filters.  

What formats are the resources available in, and how can I use them?

People work in different ways. Our formats are designed to reflect that, so you can choose the style that suits how you and your client want to work. Psychology Tools resources are perfectly formatted to work whether you practice face to face, remotely, or use a blended approach.

• Professional version. Designed for clinicians, this comprehensive option includes everything you need to use the resource confidently. As well as the resource, each PDF contains useful information, including therapist guidance explaining how to use the resource most effectively, descriptions that provide theoretical context, instructions, therapist prompts, and references. Some resources also include case examples and annotations where appropriate.
• Client version.  This is a blank PDF of the resource, with client-friendly instructions where appropriate, but without the theoretical description. These are ideal for printing and using in-session, or giving to a client.
• Fillable PDFs are great for clients who want to work with resources online instead of on paper. Your client can fill in and save the resource on a computer, before sending it back to you without the need for a printer. This format is also useful if you have remote sessions with clients and want to work through a resource on screen together.
• Editable PowerPoint documents are useful if you want to make any changes to the resource structure, or personalize it for your client.
• Editable Word documents are also useful if you want to make changes to the resource, and are more suited to printing.

How do we design our resources to support your practice?

Our resources are informed by evidence-based treatments, best practice guidelines, and the latest published research. They are written by highly experienced therapists and experts in mental health, ensuring they are effective and as up to date as possible. In addition, every resource goes through a rigorous peer review process to confirm they are accurate and easy to use.

Each resource is designed with both clients’ and therapists’ needs in mind. For clients, that means using clear, user-friendly language, as well as plenty of visual and case examples, illustrations, diagrams and vignettes that readers can relate to. They include information on how the resource can help them, how they should use it, and other useful tips.

We also include useful information and descriptions for clinicians to help them use the resource most effectively. The therapist versions of each resource contain therapist guidance, prompts, instructions, and full references. They outline how the resource can be used and what types of problems it could be helpful for.

• Designed to make strong theory-practice links . We pay close attention to the theory underpinning our resources, which provides therapists with useful context and helps them make theory-practice links. Having a greater understanding of each tool ensures best practice.
• One concept per page. Wherever possible, we create resources using the principle of one therapeutic concept per page, as this ensures that we have distilled the idea down to its essence. This makes each tool simple for therapists to communicate and easy for clients to grasp. We also pay close attention to visual layout and design, to make our resources as accessible as possible. Every resource aims to maximize clinical benefit and engagement, without overwhelming readers.
• Action focused. Resources are designed to be interactive, collaborative and goal-focused, with prompts to facilitate self-monitoring of progress and goals.

How can I use this page?

This page is where you can explore all the resources in the Psychology Tools library. The different search filters on the left-hand side enable you to customize your search, depending on what you need. Materials are organized by resource type, problem, and therapy tool, though you can also filter by language or use the search box. You can find more detailed instructions for how to find resources here .  

Can I share resources directly with my clients?

If you have a paid Psychology Tools membership, you are licensed to share resources with clients in the course of your professional work. You can even email resources (even large audio collections) directly to your clients from our website. All emails are secure and encrypted, so it is a quick and easy way to save you time and facilitate clients’ self-practice.

What if I need more help?

We have a wide range of ‘ How-to’ guides and an FAQ in our help centre , which answers questions on how to use the library and tools, such as ‘ How do I download resources? ’ or ‘ How do I email resources to my clients directly from the website? ’.

Kessels, R. P. C. (2003). Patients’ memory for medical information . Journal of the Royal Society of Medicine, 96 , 219-222.

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The Counseling Palette

• Sep 15, 2021
• 10 min read

10 Top CBT Worksheets for Learning Cognitive Behavioral Therapy

Updated: Sep 28, 2023

These worksheets cover the most important skills from cognitive behavioral therapy (CBT)

The magic of CBT worksheets is that they take vague concepts and make them real.

Ironically, you need to do more than think about CBT -- your skills must be put into practice!

CBT worksheets help teach and reinforce skills learned in therapy. They are often used by therapists specialized in cognitive behavioral therapy and related treatments.

Below are the 10 top CBT worksheets focused on dealing with anxiety, restructuring thoughts, and addressing trauma and fears.

They can help treat issues like anxiety, post-traumatic stress disorder (PTSD), phobias, depression, and more.

Need resources right away? Skip ahead to here take a look at the CBT for anxiety and PTSD bundle.

Article Contents:

1. cbt triangle worksheet.

2. Challenging Thoughts Worksheets

3. Anxiety Management Worksheet

4. Strong Emotions Worksheet

5. Trauma-Focused CBT Worksheet

6. Exposure Hierarchy

7. Trauma Narrative

9 . Emotions Wheel Worksheet

10. Mindfulness Worksheet

CBT worksheets and tools are typically very structured, and follow the cognitive behavioral therapy approach. The basic idea of CBT, or cognitive behavioral therapy , is that patterns of thinking impact everything else. How we think about things can make life better or worse, regardless of the circumstances.

Our thoughts influence our feelings, which lead to our behaviors. The printable worksheets below start with the basic approach and expand into specialized areas, such as using CBT to treat PTSD.

Here are 10 top CBT worksheets focused on thoughts, feelings, and behaviors.

The CBT triangle is a commonly used tool to describe the basic principles of this therapy. This worksheet walks you step by step through the most basic process of CBT. It includes examples as well as space to write your own thoughts and begin to challenge them.

The cognitive (CBT) triangle came out of the early work of Aaron Beck, who developed CBT. He noticed that many people in therapy continued to suffer from mental health conditions such as depression, even as therapy progressed.

He termed the phrase “automatic thoughts,” to describe the thinking pattern many people experience. Most significantly, Dr. Beck found that how people thought about a situation resulted in how they experienced it, regardless of the situation itself.

Most significantly, Dr. Beck found that how people thought about a situation resulted in how they experienced it, regardless of the situation itself.

For example, someone may be running late for work. If they begin to think about getting fired and all of the things that would result from that, they might feel panicked or frustrated, and start driving erratically.

Alternatively, the same person may think differently, coaching themselves in a positive way. They may think, “I rarely run late, and my boss is very understanding, so it will be okay.”

With this change in thinking, they are likely to think more clearly and avoid feeling anxious. They may then calmly text their boss and drive carefully but efficiently toward work.

This process demonstrates the event (running late), the thought (catastrophizing versus positive self-talk) and the behavior (erratic driving versus planning).

Shop CBT triangle worksheet.

2. Challenging Thoughts Worksheet

The challenging thoughts worksheet is a cognitive restructuring worksheet. It walks you through challenging everyday negative thoughts, at a bit of a deeper level than the CBT triangle. It can also be an alternative format to learning the triangle.

Negative thoughts are sometimes called core beliefs, Negative core beliefs are thoughts that tend to pervade our everyday lives. They’re the “issues,” or “triggers,” you just can’t seem to get over. While most negative core beliefs are also distorted beliefs, the reverse isn’t necessarily true.

Negative core beliefs tend to involve shame, and how the person feels about themselves as a whole. This often relates to their abilities and worthiness.

For example, a basic distorted belief might be, “I’ll never pass my algebra class,” while a negative core belief might state, “I’m too stupid to succeed at anything.”

Once you understand the basics of CBT, the next step is to begin to challenge specific thoughts that happen regularly. For example, someone may think, “I mess everything up,” or “I can’t keep any friends.” These thoughts become a habit, and are likely to affect self-esteem, and even become a self-fulfilling prophecy. Because someone thinks they can’t keep friends, they stop trying to make them.

This worksheet keeps these thought patterns in mind, and help the user begin to challenge these beliefs. Terms often used include “stuck points,” “cognitive distortions,” or “negative thoughts.”

Shop challenging thoughts worksheet.

While there are multiple types of anxiety conditions, all of them relate to our thoughts. Meanwhile, many CBT therapists start with anxiety management skills. These include steps like mindfulness or self-soothing.

This anxiety management worksheet includes multiple ideas to deal with anxiety, as well as a page to outline your plan for future anxiety spells.

Ongoing anxiety is usually caused by thinking patterns. Ruminating thoughts, catastrophizing, and assuming the worst are common symptoms of multiple conditions. These thought patterns, combined with the hypervigilance that come along with them, can make it difficult to cope day to day.

These anxious thoughts are common, and likely originate from the human need to prepare for the worst and avoid danger. After all, if our ancestors hadn’t been a bit paranoid we may not be here today.

However, frequently thinking negatively can lead to overwhelming anxiety and nearly constant feelings of anxiety. Anxiety worksheets can help with coping while also addressing the root thoughts that perpetuate these fears.

Shop anxiety management worksheet.

4. Dealing With Strong Emotions Worksheet

Strong feelings can be overwhelming. This guide takes a look at how to rate, ride out, or cope with difficult emotions.

For example, if your emotion is simply uncomfortable, it's usually best to wait it out and allow the feeling to move through you. Otherwise it's likely to just keep coming back.

If a feeling is more significant and seems to interfere with your daily life, it may be best to work with a therapist on processing the emotion. Sometimes it's good to face the feeling head on, which will allow your body to learn the difference between the worry about danger and actual danger.

For example, worrying about danger might be thinking about a dog attacking you. It could cause your nervous system to become really alarmed, not realizing that there's no dog in sight.

By staying with that fear, your body will have the experience of getting to the other side and start to figure out that the fear is a feeling and not an event.

In other cases, if you have a history or pattern of self-harm, it's best to work closely with a therapist so you can fine-tune your plan. In some cases you may want to face your emotions while in other cases you may need some soothing to get through the moment.

This CBT worksheet on dealing with strong emotions is a great resource for therapists and their clients to work on feelings together.

Shop strong emotions worksheet.

This worksheet is created for trauma focused CBT Therapies. It includes the most common steps used in therapies like TF-CBT (trauma-focused CBT) and CPT (cognitive processing therapy).

Many people think of PTSD as simply a result of trauma. While trauma is at the core of it, it goes beyond that. The majority of people experience trauma at some point. At first, it causes feelings of worry, confusion, and sometimes self-blame for what happened.

However, within a few weeks to a month, most people come to terms with what happened. They understand that the trauma was an isolated event, and that there wasn’t anything they could do to change it.

A percentage of people, however, aren’t able to get through this process. This could be due to still being in danger, to past trauma complicating their ability to process, or simply having too much going on to deal with it initially.

This lack of processing leads to “stuck points,” or cognitive distortions relating to the trauma. They typically run along the lines of people blaming themselves, or feeling they can’t deal with difficulties in the world.

The most effective trauma therapies all deal with processing of the traumatic event, and this worksheet walks through the typical steps.

Shop the trauma thoughts worksheet.

6. Exposure Hierarchy Worksheet

Many people develop avoidance as a way to deal with anxiety, phobias, and PTSD. An exposure hierarchy helps people measure which fears are the worst, and how they progress over time.

This worksheet includes a simple but effective way to create an exposure hierarchy, as well as homework sheets to record your exposure activities.

Exposure, or fear, hierarchies are commonly used in CBT, CPT, and TF-CBT therapies.

Fears are sometimes measured by numbers, called SUDS (subjective units of distress). Over time the fear is tracked, to see if it becomes better or worse.

Most often, exposure hierarchies are used along with homework assignments to help people face their fears. This exposure helps them overcome avoidance that may be interfering with their daily life.

The avoidance hierarchy worksheet includes the basic steps to get started.

Shop the exposure hierarchy worksheet.

The trauma narrative is a technique commonly used in therapies like cognitive processing therapy (CPT), or trauma-focused cognitive behavioral therapy (TF-CBT). This worksheet is written with the client in mind, and should generally be used under the direction of a trained therapist.

A trauma narrative is sometimes used as a part of cognitive behavioral PTSD therapies. It involves writing about memories of a difficult situation.

When someone is experiencing PTSD, it's because their brain is confusing the memory of a bad event with the actual event. Your brain continues to think about what happened, and it keeps your brain on high alert, creating a cycle.

One of the ways to interrupt that process is to write about the difficult memories so that you can integrate them into your life, rather than continue to re-experience them. As mentioned, it's recommended that you work through a trauma narrative as part of trauma-focused CBT therapy.

Shop the trauma narrative worksheet.

8. Kids Anger Worksheet

One of the most common struggle kids deal with are angry outbursts . This is because they haven't had the time to understand and learn how to cope with strong emotions.

Although it doesn't say it outright, this set of kids anger worksheets address the CBT triangle. It uses the anger iceberg as a way to illustrate feelings underlying anger.

It actually is a set of three worksheets covering identifying emotions, recognizing harmful behaviors, and creating more positive behaviors. The worksheets are kid-friendly and work well with TF-CBT therapy for kids.

Shop the kids anger worksheets.

9. Emotions Wheel Worksheet

Emotions are a sometimes overlooked part of CBT treatment. Sometimes people think they should or shouldn't be having certain feelings . They might also be unsure of what they're feeling and when.

However, feelings worksheets help with recognizing, regulating, and coping with emotions. This makes it easier to move into the next step of recognizing how thoughts can relate to ongoing emotional struggles.

Common difficult emotions relating to anxiety, depression, or trauma include:

Frustration

Disappointment

The emotions wheel set includes multiple handouts and worksheets based on feelings wheels. It covers both comfortable and uncomfortable emotions like those above. It also has sections that recognize the physical sensations of emotions, and sections to create your own emotional coping wheel.

Shop the emotions wheel worksheets.

10. Mindfulness for CBT Worksheet

New waves of cognitive therapies, including CBT, incorporate mindfulness. It's an important part of the regulating step, and helps you soothe the flight-or fight response.

It can also make it easier to move onto the next steps of recognizing thoughts and emotions. When your brain is in survival mode it can be difficult to work through challenging thoughts or exposure techniques.

Mindfulness takes it down a notch, much like medication would. It also is a great skill in and of itself, and can prevent mental health, and even some physical conditions, down the road.

Shop the mindfulness worksheet.

CBT Therapy Worksheet Bundle

Over the years, I've found that many of the same strategies overlap for conditions like anxiety and PTSD. At the same time, there are some additional steps necessary when processing trauma. I've bundled all of my related pages into this set .

More CBT Resources

In addition to worksheets, CBT-based games can be a great way to teach important concepts. Here's a list of some of our other activities. You can find them all together in our Giant Store Bundle .

CBT Coping Jeopardy-Like Game

If you're looking for a fun, interactive game for classrooms or telehealth, check this out! It covers many of the CBT concepts in the worksheets. It's a great way to reinforce all of the concepts you're learning. Learn more.

CBT Lingo (Bingo-Like Game)

CBT Lingo is a fun, interactive, educational game that helps you teach concepts of CBT. It goes beyond the typical "novelty" cards often created for therapy and other classroom games. The game is compatible with real bingo, so you can actually "call" the game with numbers, either in-person or via telehealth.

CBT Lingo, which works similar to bingo, includes 75 prompts focused on topics like thoughts, feelings, and behaviors, and skills used in cognitive behavioral therapy. It has various options, so it works with teens, college students, and adults.

It can even help with teaching CBT concepts to therapy students.

Here are some sample prompts included in the game:

What does all or nothing thinking mean?

What's one physical symptom of anxiety?

What are the three points of the CBT triangle?

What is ruminating?

Want to give it a go? You can download and use it in-person or via telehealth. Get more details here.

CBT Quest Board Game

CBT board games are another less intimidating way to teach skills. This downloadable board game , called CBT quest, can be printed and used in person, or adapted for online use. It includes 32 prompts with reusable questions, such as:

Give an example of a challenging thought

Describe or show a grounding technique

Describe or name a cognitive distortion

Interested in trying this fun activity? Download it here.

Finding Peace from PTSD Book

If you're working specifically with PTSD, this book is helpful. It lays out the most common strategies used in trauma-focused CBT therapies. Such therapies include:

Prolonged Exposure

Cognitive Processing Therapy

Trauma-Focused CBT

The book was also created to go along with the worksheets in the CBT for PTSD and Anxiety bundle, so the two make great companions! Learn more about the book.

Obviously games and worksheets can’t replace other types of therapy. However, these tools can help you learn to identify thinking patterns, challenge everyday negative thoughts, question your anxiety thoughts, and understand your thoughts relating to PTSD.

For more helpful tools, download it all with our giant store bundle. It includes all of the activities above plus many more great resources .

Sources: Beck Institute for Cognitive Behavioral Therapy. 2021, https://beckinstitute.org/

Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

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Does Psychotherapy With CBT Involve Homework?

How to work with the real-life triggers of trauma experiences..

Posted November 18, 2019 | Reviewed by Lybi Ma

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Psychotherapy for posttraumatic stress disorder ( PTSD ) routinely ought to include homework. Many evidence-based treatments (EBTs) for other disorders also include homework, and the systematic nature of the homework and the goal of homework to directly improve function are common differences between EBTs and the less-structured types of psychotherapies.

The rationale for homework is quite simple. Homework provides opportunities for patients to take the skills they practiced in offices and employ them in real-life situations. Real-life exposure is where the rubber hits the road. The triggers are more real. The anxiety is more intense. The associated memories, sensations, and images are richer. The automatic negative thoughts that arise may be deeper, different, or more salient than the automatic negative thoughts that arise in office-based exposures. All of these elements allow a deeper dive into symptoms in the context of everyday functioning.

Will Patients Do Homework?

When I first started as a therapist, it felt odd to assign homework for patients. Most of us have a naturally negative vibe about homework because it is associated with school (i.e., it sounds like work). Also, it did not seem in sync with the way psychotherapy is portrayed in movies or the way it is taught in training programs. Wasn’t psychotherapy supposed to be an intense, one-on-one experience in the psychotherapy office where dreams , hopes, disappointments, or self-deception are peeled back layer by layer to find that elusive kernel of what life is all about? Sure, it can be, but for most people that is neither how psychotherapy can proceed nor what they need.

Once I learned another way of doing psychotherapy with structure and direction in cognitive behavioral therapy (CBT), it was not at all difficult to engage patients in homework. In my research study with very young children with PTSD, I kept track (of course) and 100% of patients could complete some homework. In total, they completed 82% of all homework assignments (Scheeringa et al., 2011). My experiences with adolescents and adults are similar. Within the structure and repetition of EBT protocols, homework flows naturally.

What Is Homework?

Exposure therapy for PTSD employs exposure exercises in two types of settings. The setting most commonly discussed is exposure to anxiety-provoking memories in the office, which I described in my last post. The second type of setting is homework, or in vivo exposure conducted outside of the office by patients on their own. In vivo exposure is an important component of PTSD treatment, and can oftentimes be the critical, most important factor. There are eight main steps to good in vivo exposures:

(1) Practice with non- trauma exposures before doing trauma exposures. Before doing the first trauma-related homework, my manuals have patients complete two non-trauma homework assignments, which are exposures to stimuli that will make them slightly anxious but are not related to their trauma experiences. I want to make sure they are comfortable with the procedure and do not get overwhelmed by pushing themselves too far too fast. There will be plenty of time for trauma exposures and there is no need to rush.

(2) The in vivo exposures ought to be highly-planned out ahead of time. The details of the exposure, including the stimulus, location, day, and time of day are written on the homework sheet which patients take with them. One reason for this level of precision is to make the work as user-friendly as possible; the clients take the homework sheets home with them and they have all the details they need to remember on one sheet of paper. Another reason for this is to close a potential loophole of avoidance so that clients cannot come back next week and say they forgot what they were supposed to do.

(3) Make the first in vivo trauma exposure easy. The first one needs to feel successful. One of the worst things that can happen is patients try an exposure that is highly-anxiety provoking and they end the exposure feeling overwhelmed and remain triggered and distressed for hours or days, which would amplify the natural feeling of avoidance and make them feel like failures. Again, there will be plenty of time for trauma exposures and there is no need to rush.

(4) Rate the degree of anxiety. At the beginning of the exposure, patients rate their level of anxiety on a scale of 1-10 on a feelings thermometer.

(5) Keep it short. We tell patients to do the in vivo exposure only once per week and for only 30 seconds if at all possible. This brevity acknowledges that it is natural for patients to have avoidance and we are not aiming for them to be superhuman. But also, quite simply, that is all it usually seems to take. If patients truly have PTSD and are truly triggered by reminders with powerful fear reactions, 30 seconds is actually a good amount of time. In addition, even though the guidance is to limit exposure to 30 seconds, the guidance is often treated as a minimum guideline. Many patients do it longer than that, which allows an added benefit of patients feeling like they surpassed the goal.

The stimuli for in vivo exposure are unique to every trauma. For domestic violence trauma, homework exposure typically involves driving to the house where the domestic violence occurred and sitting in the car a block away. For motor vehicle accidents, this often involves driving to the spot where the accident occurred.

(6) Re-rate the degree of anxiety. On a scale of 1-10, determine if anxiety has increased or not in response to the stimulus.

(7) Use a relaxation skill to manage the anxiety. After 30 seconds of exposure, use one or more of the relaxation techniques, e.g. controlled breathing, muscle relaxation, or happy-place mental imagery . Do this even if there was no increase in anxiety from the exposure.

(8) Final rating of the degree of anxiety. On a scale of 1-10, determine if anxiety has returned near to baseline.

Sometimes clients are not able to do the planned homework exposures because they get too anxious prior to the exposure worrying about becoming anxious. This is called anxiety sensitivity. In such cases, the homework can be shifted so that the exposure is simply getting ready to do an exposure but not actually doing the exposure. Preparation to do the exposure is the exposure.

In my experience, in vivo exposure is the most important type of homework in the treatment of PTSD. Trauma memories stored in the brain are analogous to a frightening tiger locked in a cage. Office-based exposures are like talking about walking up to the cage. In vivo exposures are like actually walking up to the cage. It opens up a whole different level of experience for treatment.

Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52, 8, 853-860. DOI: 10.1111/j.1469-7610.2010.02354.x

Michael S. Scheeringa, M.D., is Professor and Vice Chair of Research for psychiatry at Tulane University School of Medicine.

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Cognitive Behavioural Therapy Worksheets and Exercises

The following Cognitive Behavioural Therapy – CBT worksheets and exercises can be downloaded free of charge for use by individuals undertaking NHS therapy or by NHS practitioners providing CBT in primary or secondary care settings. These worksheets form part of the Think CBT Workbook, which can also be downloaded as a static PDF at the bottom of this page. Please share or link back to our page to help promote access to our free CBT resources. 

The Think CBT workbook and worksheets are also available as an interactive/dynamic document that can be completed using mobile devices, tablets and computers. The interactive version of the workbook can be purchased for single use only for £25. All Think CBT clients receive a free interactive/dynamic copy of the workbook and worksheets free of charge.

Whilst these worksheets can be used to support self-help or work with other therapists, Cognitive Behavioural Therapy is best delivered with the support of a BABCP accredited CBT specialist. If you want to book an appointment with a professionally accredited CBT expert, call (01732) 808626, complete the simple contact form on the right side of this page or email [email protected]  

Please note: if you are a private business or practitioner and wish to use our resources, please email [email protected]  to purchase a registered copy. This material is protected by UK copyright law. Please respect copyright ownership.

Exercise 1 - Problem Statements

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Exercise 2 - Goals for Therapy

Exercise 3 - personal strengths / resources, exercise 4 - costs / benefits of change, exercise 5 - personal values, exercise 6 - the cbt junction model, exercise 7 - the cross-sectional cbt model, exercise 8 - the longitudinal assessment, exercise 9 - layers of cognition, exercise 10 - cognitive distortions, exercise 11 - theory a-b exercise, exercise 12 - the cbt thought record, exercise 13 - cognitive disputation "putting your thoughts on trial", exercise 14 - the cbt continuum, exercise 15 - the self-perception continuum, exercise 16 - the cbt responsibility pie chart, exercise 17 - noticing the thought, exercise 18 - four layers of abstraction, exercise 19 - semantic satiation, exercise 20 - the characterisation game, exercise 21 - speed up / slow down, exercise 22 - word translation, exercise 23 - the time-traveller's log, exercise 23a -the time-traveller's log continued, exercise 24 - leaves on a stream, exercise 25 - the traffic, exercise 26 - clouds in the sky, exercise 27 - taming the ape - an anchoring exercise, exercise 28 - the abc form in functional analysis, exercise 29 - pace activity exercise, exercise 30 - graded hierachy of anxiety provoking situations, exercise 31 - the behavioural experiment, exercise 32 - act exposures exercise, exercise 33 - worry - thinking time, exercise 34 - submissive, assertive & aggressive communication, exercise 35 - sleep hygiene factors, exercises 36 - 38.

(Abdominal Breathing, Aware Breathing & The Five-Minute Daily Recharge Practice)

Exercise 39 - Wheel of Emotions

Exercise 40 - linking feelings and appraisals, exercise 41 - personal resilience plan, exercise 42 - cbt learning log, act with choice exercise, angels and devils worksheet, transdiagnostic model of ocd worksheet, tuning in exercise, penguin-based therapy (pbt), big picture exercise, post-therapy journal, catch it-check it-change it exercise.

A brief cognitive change exercise for identifying and altering negative thinking

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• What Will People Think of Me?
• Who Holds Up My Safety Net? (Boys)
• Who Holds Up My Safety Net? (Girls)
• Challenging Thoughts Exercise
• Coping Skills (for Adults)
• Coping Skills (for Caregivers and Children)
• Coping Skills Diary Card
• Crisis Prevention Plan (CPP) Guide Tips Sheet
• Crisis Prevention Plan (CPP) Template for CBT
• Emotions Thermomenter
• Feelings Ball Game
• Helping Me Handle My Emotions
• If I Need Help Form
• In the Moment Coping Skill Toolbox Personal Time Out
• Mood Monitoring Sheet
• My Strengths
• The Critic Inside You
• Things I Do Well
• Viewing My Problems in a New Light

Identifying and Rating Feelings (Client Handouts)

• Distress Thermometer
• Feeling Detective – 1
• Feeling Detective – 2
• How Does My Body React
• Masking Your Feelings
• Working with Our Feelings (Young Child)
• Working with Our Feelings 2
• Writing About Your Feelings (Anxious & Coping)

Relaxation (Client Handouts)

• Active Relaxation
• Breathing Retraining Exercises
• CBT+Relaxation Homework sheet
• Controlled Breathing Log
• Learn How to Relax
• Muscle Relaxing
• Observing Your Breath Exercises for Parents
• Relaxation Exercises
• Relaxation Journal
• Relaxation Log
• Relaxation Scripts for Kids
• Relaxation Scripts for Younger Children
• Tense or Relaxed
• Ways to Relax by Using Breathing

Sleep Hygiene (Client Handouts)

• Sleep Tips for Teens
• Tips For a Great Night’s Sleep (Teens)
• Tips For a Great Night’s Sleep (Kids)
• Conquering Nightmares
• My Plan for a Great Night’s Sleep
• Sleep Hygiene: Basic Guidelines
• Sleep Hygiene Tips (Adults)

Tips for Parents

• Help With Getting Your Child to Sleep – Basic Suggestions From the American Academy of Pediatrics
• How Do I Teach My Child Good Sleep Habits
• Ways to Help My Child Sleep
• Muscle Relaxation Exercise Transcript
• Sample Teaching Activities for Feelings Identification

CBT for Anxiety

Anxiety (client handouts).

• Anxiety Common Unhelpful Helpful Thoughts Tool
• Anxiety Common Unhelpful Helpful Thoughts Tool – Spanish
• CBT+ Relaxation Homework sheet
• Anxiety Information
• Anxiety Information – Spanish version
• Anxiety Treatment Description
• Feeling Pattern Exercise
• Negative Self-Talk
• Parental/Caregiver Involvement: Helping Your Child Manage Anxiety
• Replacing Negative Thoughts
• Replacing Negative Thoughts Exercise
• Worry Time Log
• Stress worry anxiety Handout for parents

For Coping Skills Please Refer to Coping Skills Page Cognitive Restructuring

• Cognitive Restructuring Worksheet – Spanish

Exposure (Client Handouts)

• Sample In Vivo Exposures CBT+
• Doing Exposure Worksheet
• Exposure Homework Worksheet
• Hercules and the Hydra: Explaining Avoidance and Gradual Exposure
• How to Handle Anxious Thinking
• How to Handle Anxious Thinking – Spanish
• CBT+ Strategies for Worry: A Therapist’s Guide
• Cheat Sheet – Anxiety
• N2K (Need to Know) Changing Unhelpful Cognitions Sheet
• N2K (Need to Know) Exposure/Facing Up Skills Sheet
• N2K (Need to Know) Fear Ladder Sheet

Training Videos

Cbt for depression, depression (client handouts).

• Small Talk and Friend Making Tips
• Take Action to Feel Better
• Taking Charge of Negative Emotions
• What Gets in Your Way
• Actions I Took to Feel Better
• Activity Scheduling – At Home Practice Sheet
• Activity Scheduling – At Home Practice Sheet – Spanish Version
• CBT+ Getting Active Homework Sheet
• CBT+ Getting Active Homework Sheet – Spanish
• CBT+ Goal Setting Worksheet
• Depression Relapse Prevention Worksheet
• Depression Common Unhelpful Helpful Thoughts Tool
• Depression Information
• Depression Information – Spanish version
• Depression Information and Treatment Roadmap
• Depression Information and Treatment Roadmap – Spanish
• Depression Pattern Exercise
• Depression Steps
• FAST D Activity Scheduling
• Getting Active
• Goal Setting Bricks Handout
• Goal Setting Bricks Handout – Spanish
• List of Things I Can Do to Feel Good
• Mood Monitoring Homework Sheet
• Mood Monitoring Homework Sheet – Spanish version
• Problem Solving Worksheet Advanced
• Problem Solving Worksheet Advanced – Spanish
• Problem Solving Skills Worksheet – Basic
• Problem Solving Skills Worksheet – Basic – Spanish
• So You Have a Problem
• Thinking Mistakes for Kids
• Cheat Sheet – Depression
• N2K (Need to Know) Behavioral Activation Sheet
• Socratic Techniques for Changing Unhelpful Thought

CBT for Trauma

Trauma information.

• Trauma and Posttraumatic Stress Youth
• Trauma Information Pamphlet For Parents (from UCLA)
• Trauma Psycho Ed Cards For Children
• CBT for Trauma Information Youth
• Date Rape/Acquaintance Rape
• Dissociation Information
• Finding a Therapist for Evidence-Based Treatment
• Gangs: Tips for Parents (NCTSN link)
• Parenting Tips When Your Child Has Experienced Trauma
• Parenting Tips When Your Child Has Experienced Trauma – Spanish version
• Psychoeducation: General Questions
• SA Psychoed Children
• Talking With Your Child About Trauma: Guidelines For Foster Parents
• TF-CBT Information
• Things Families Can Do to Cope with Trauma
• Things Families Can Do to Cope with Trauma – Spanish version
• Trauma and Posttraumatic Stress – Spanish
• Trauma and Posttraumatic Stress
• Trauma and Posttraumatic Stress Caregiver – Spanish
• Trauma and Posttraumatic Stress Caregiver

Trauma Related (Client Handouts)

• I Think This Happened Because…
• Letter to Mom (Sexual Assault)
• Name the Blame: Who’s at Fault
• PTSD Coping Tool
• Questions About Your Understanding of Family Violence
• Self Talk Examples
• Thoughts and Feelings Children Have
• Trauma Common Unhelpful Helpful Thoughts Tool
• WHY Checklist (for Physical Abuse)
• WHY Checklist (for Sexual Assault)

Child Sexual Abuse

• Facts About Child Sexual Assualt
• If Your Child Has Been Sexually Abused
• What is Sexual Assault? (Teen Handout)

Client's Rights

• A Child’s Bill of Personal Safety Rights
• My Dating Bill of Rights
• Rights of Child Victims and Witnesses (RCW)

For Coping Skills Please Refer to Coping Skills Page Creating the Trauma Narrative (Client Handouts)

• Clarification Questions To Sexual Assault Offenders
• Dealing with Trauma: A TF-CBT Workbook for Teens
• Dealing with Trauma: A TF-CBT Workbook for Teens – Spanish version
• Feelings Children Have (About Abuse)
• Feelings About Being Abused
• How the Abuse Has Affected How I See Myself
• Letter to the Perpetrator
• Remembering What Happened
• Telling the Sexual Assault Secret
• Tu Libro de Actividades de TF-CBT (Your Very Own TF-CBT Workbook – Spanish version)
• Your Very Own Grief TF-CBT Workbook
• What Will People Think of Me
• Your Own TF-CBT Workbook
• Imaginal Exposure Homework
• Sexual Abuse Alert List for Children
• Telling About What Happened
• Thinking about my Experience
• Hercules and Hydra Example: Explaining Avoidance and Gradual Exposure in Trauma
• In Vivo Exposure Homework
• Integrating Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Racial Socialization for Black Youth and Families: An Implementation Manual
• BT+ Framework
• Cheat Sheet – TF-CBT A-Practice Checklist
• Child Caregiver Conjoint Work – Fitzgerald
• Dyad Practice-Facilitating Detailed Narratives
• Engaging Highly Anxious/Resistant Kids in Starting the TN
• Exposure Treatment Exercise – Sample
• N2K (Need to Know) Trauma Narrative Sheet
• Prolonged Exposure Protocol with Details
• Sample Gradual Exposure Hierarchy
• Sample Thought Stopping Scripts From TF CBT Website Training
• Technique for Preparing for and Conducting Parent Child Sessions
• Socratic Strategies for Self-Blame Thoughts
• TF-CBT A – Take 5
• Trauma and Autism Spectrum Disorder – A Reference Guide
• The Trauma Narrative
• CBT for Trauma Checklist
• Trauma Narrative Gradual Exposure Handout
• Trauma Narrative Steps
• Implementing Trauma-Focused Cognitive Behavioral Therapy for LGBTQ Youth and their Caregivers

Parent Management Training (PMT)

Cdc parenting videos (links), child sexual behaviors.

• ATSA Report of the Task Force on Children with Sexual Behavior Problems
• Child Sexual Behavior Rules Examples
• Cover your BASES for Parents
• Sexual Behavior and Children: When Is It a Problem and What to Do About It
• Touching Rules for Young Children

Links to Handouts in Spanish

Parenting handouts.

• CBT+ Home Token Economy Guide
• Child – Directed Interaction Skills
• Difficult Teens
• Discipline Skills to Master
• Giving Effective Instructions
• Giving Good Directions
• Guidelines for Effective Discipline
• My Child’s Problem Behavior: Info for Caregivers
• How to Motivate your Younger Child to Behave
• How to Motivate Your Teen to Behave
• Praisable Behaviors
• Parental-Caregiver Involvement: Helping Your Child Manage Anxiety
• Thoughts and Actions: An Exercise for Parents
• Time-Out Tips for Caregivers
• Tips for Managing Extreme Behavior in the Moment
• Tips for Managing Extreme Behavior in the Moment – Spanish
• Types of Discipline
• Types of Rewards
• Using Planned Ignoring and Attending
• Using Time-Out
• 101 Phrases of Praise
• 101 Phrases of Praise – Spanish
• Behavior Plan Caregiver Worksheet Our Plan to Change Behavior
• Behavior Problems Information
• Behavior Problems Information – Spanish

Parenting Worksheets

• Helping Your Child Learn Appropriate Ways to Express Feelings
• Identifying Your Problematic Thoughts Worksheet
• If… Then (Privileges Worksheet)
• Low Cost Rewards
• Low Cost Rewards – Spanish
• Natural and Logical Consequences
• Parents: Common Feelings and Thoughts about Sexual Abuse
• Physical Punishment Information Sheet
• Praise and Recognition – a parents Worksheet
• Praise/Recognition Worksheet – Spanish
• Problem Solving Skills Worksheet
• Removing Privileges
• Rewarding Good Behavior Star Chart
• Tantrum Tips
• Tracking Behavior
• Tracking Behavior – Detailed
• Tracking Behavior – Detailed – Spanish
• Tracking Behavior – Positive
• Using Time Out Worksheet
• ABC Worksheet for behavior problems – Spanish
• Are We Having Fun Yet?
• Behavior Chart (Sun and Sail)
• Behavior Management Basics
• Behavior Plan Caregiver Worksheet Our Plan to Change Behavior – Spanish
• Communication Checks: A Self Quiz
• Functional Behavioral Caregiver Handout
• Functional Behavioral Caregiver Handout – Spanish

Teacher Handouts

• Behavior Chart (Great Start – Car)
• Behavior Chart (Right Track – Train)
• Behavior Chart (Sun and Sail – Blank)
• Behavior Chart (Ladybug)
• Daily School Behavior Report Card
• Cheat Sheet – Behavior
• Functional Behavior Analysis Article from Child Study Center
• Functional Behavior Analysis Handout
• N2K (Need to Know) One on One Time Sheet
• N2K (Need to Know) Praise Sheet
• N2K (Need to Know) Rewards Sheet

General Skills

• CBT+ Screen and Device Struggles
• Let’s Be Friends
• Me and My Friends
• My Prevention Plan (Sexual Assault)
• Problem Checklist
• Problem Clues
• Problem Solving Steps
• Psych-Ups (Learned Optimism)
• Rappin’ the Problem
• Role-Play Situations Related to Making Requests: Example Situations for Children
• Small Talk and Friend Making
• Being Assertive

Family Communication

• Common Unreasonable Beliefs – Parent Worksheet
• Constructive Family Communication Patterns
• Family Communication Agreement for Action
• Family Communication Patterns Handout
• How to Communicate with Support
• Negative Family Communication Patterns
• Problem Solving Communication Training Article

Family Problem Solving

• Example Behavior Contracts For Kids
• Parent Assessment
• Problem Solving Worksheet (Family Communication)
• Problem Solving Outline
• Problem Solving (Overview)
• Steps to Family Problem Solving

Substance Use

Substance use (client handouts).

• CRAAFT Screening Test – Self Administered
• Effects of High Risk Drinking
• WHO – ASSIST
• ASSIST Feedback Sheet
• CBT+ Screening and Brief Intervention for Substance Use
• CETA Brief Intervention for Substance Abuse
• CRAAFT Screening Interview – Clinician Administered
• CRAFFT Screen Scoring Tool and Intervention Steps

Suicide and Self Injury

Assessment tools.

• WICHE SPRC Pocket Guide for Primary Care
• Sample In-Depth Safety Assessment and Decision Tree (Seattle Children’s Hospital)

Clinical Tools

• CBT+ Managing and Treating Suicide Risk and Non-Suicidal Self-Injury – Clinical Tips
• CBT+ Safety Plan Worksheet
• CBT+ Safety Plan How-To Guide for Clinicians
• Crisis Support Plan for Family (from SPRC & WICHE Behavioral Health Program)
• Chain Analysis Worksheet

Apps/Technology

Organizational tools.

• National Suicide Prevention Toolkit for Primary Care Practices

Training Resources

• National Suicide Prevention Toolkit for Primary Care (WICHE Behavioral Health Program)
• Cover your BASES (for Parents)
• “Not Okay” Behaviors that Break the Sexual Behavior Rules
• Sexual Behavior Rules Example
• Touching Rules (for Young Children)
• Sexual Behavior and Children: When is it a Problem and What to do About it
• SBP Recommendations for Supervision and parenting

Other Mental Health Problems

Info sheets on other mental health problems.

• Attachment Disorders and Attachment Problems
• Attachment Explanation for Caregivers
• Attention Deficit Hyperactivity Disorder(ADHD)
• Autism and Autism Spectrum Disorder
• Psychosis in Children and Adolescents

Helpful Videos

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
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• Medical economics
• Medical research
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• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
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• Sports medicine & Kinesiology
• Vaccination
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• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
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• Multiple sclerosis
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• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
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• Full List »

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August 12, 2024

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When bullying focuses on weight, trauma-focused CBT is promising treatment, research reveals

by Eva Cornman, Yale University

Researchers at Yale School of Medicine (YSM) have tested the first psychotherapeutic treatment of any kind for bullying—specifically weight-related bullying. It is important work, because no evidence-based treatments aimed at youth who experience bullying are currently in use, according to the researchers.

Bullying can lead to a number of harmful results, such as social and academic difficulties, anxiety, depression, self-harm, and suicide. Weight-related bullying, in particular, can be a precursor for eating disorders, weight gain, and obesity. Yet until now, efforts have been directed at reducing bullying rather than treating its victims.

"Most of the research has been about preventing bullying from happening or helping schools to manage the effects of bullying, but nothing really for the individual patient, which is bizarre because we know that bullying has all of these really severe consequences," says Janet Lydecker, Ph.D., assistant professor of psychiatry at YSM and first author of a study published in the International Journal of Eating Disorders on July 15.

Lydecker and her team adapted a trauma-focused cognitive-behavioral therapy (TF-CBT) combined with CBT for eating disorders to treat youth who experienced weight-related bullying, called "TF-CBT-WB," (which stands for trauma-focused CBT for weight bullying), and tested its feasibility in 30 adolescents.

The study found that the treatment improved such symptoms as traumatic stress , eating disorder severity, and body image concerns. Lydecker hopes to expand on these promising results in future studies.

A trauma-focused approach

Historically, TF-CBT has been used to treat youth who have had such traumatic experiences as abuse or a near-death incident, but researchers are beginning to expand the definition of what counts as trauma. Bullying, in particular, has been found to cause clinical levels of traumatic stress in children. Because bullying occurs as distinct events, causing children to feel unsafe and leading to distress, it meets the criteria for treatment with TF-CBT.

"People will say [bullying] is a 'little-T' trauma, meaning it's not the official trauma that the DSM [Diagnostic and Statistical Manual of Mental Disorders] may talk about," says Lydecker. "But it still does function like a trauma, especially among adolescents whose whole world revolves around their peers and their peer relationships."

Although it has not been tested clinically, a standard CBT approach to treating bullying might frame it as a stressor and help patients to learn coping strategies. By treating bullying as a trauma, Lydecker's approach requires patients to create a narrative by recounting the bullying experiences, then go back through the narrative and identify distorted thoughts and emotions.

Lydecker says she expected TF-CBT-WB for appearance-related bullying to help prevent later development of eating disorders, rather than treat existing ones. Therefore, she was surprised to find a high initial rate of severe eating disorder psychopathology among the participants.

After three months of weekly treatment sessions, she and her team compared the participants' eating disorder symptoms before and after TF-CBT-WB treatment and saw clinically significant reductions in eating disorder severity, body image and eating concerns, and binge eating.

Lydecker believes these results demonstrate that TF-CBT-WB may be promising not only for bullying treatment, but for eating disorder treatment, as well.

"In the eating disorder field, we need more treatment," she says. "This could be a way to treat some of that underlying self-concept and distress that come from these appearance-related bullying experiences. This may be a different option for people with eating disorders, and we really need that flexibility."

The future of TF-CBT-WB

While the results were promising, additional research will be needed to learn more about the treatment's efficacy.

For one, it was difficult to comprehensively gauge the success of TF-CBT-WB because no other treatment was studied. For ethical reasons, the study did not have an inactive control group (such as a waitlist), and because no evidence-based treatment for bullying exists, there was no standard of care to use as comparison—something Lydecker hopes that future studies will address.

Lydecker has already begun planning for studies that will have larger cohorts and extended follow-up periods to see how long the effects of the treatment last. She's also interested in figuring out a way to assess whether a patient would benefit more from TF-CBT or standard CBT.

Additionally, she'd like to determine whether there are any differences in outcomes for youth who are "bully victims," children who are both bullies and have been bullied. Lydecker hopes that the research will gain interest, both for scientists and patients alike.

"The goal is to get this as quickly as possible to clinicians and patients who need it," she says.

"If kids have experienced bullying, they don't have to just work through it on their own. Bullying might be common, but it's not a normal part of childhood development that can be brushed over. It really does require working with a mental health provider if there's any sort of distress."

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