Cognitive Behavioural Therapy (CBT) can provide a clear structure and focus for therapy.

It
has been thoroughly researched and has shown to be as effective as medication in treating
depression and anxiety. CBT can also prevent relapse at the end of a course of therapy. CBT
is used to treat: low mood, low self esteem, stress, general anxiety disorder, obsessive
compulsive disorder, post traumatic stress disorder, health anxiety, social anxiety, panic
attacks, phobias, eating disorders, sleeping problems and many more psychological disorders.

Many people who come for therapy need to change something in their lives. The key idea
behind CBT is that:

What you think and do affects the way you feel.

CBT is ‘present focussed’, that means it works with thoughts, feelings and behaviours in the
here-and-now. Sometimes, through no fault of their own, people get ‘stuck’ in vicious
cycles, that is, the things they do to solve a problem can inadvertently keep it going.

CBT is about finding out what is keeping us ‘stuck’ and making changes in our thinking and
actions in order to improve the way we feel. CBT looks at what needs to be changed for the
individual and then targets those specific areas.

The cognitive aspect of CBT looks at altering ways of thinking, such as a person’s thoughts,
thinking patterns, beliefs, ideas, assumptions and mental imagery. It teaches us how some
thinking patterns may be contributing to creating a distorted picture, which in turn, can lead
to feeling’s of depression or anxiety.

The behavioural aspect of CBT helps us to meet any challenges in our lives with a calmer
mind, which allows us to take actions that provide desirable results. The behavioural aspects
can also help loosen the hold between difficult situations and any habitual reactions to them,
such as fear or depression.

When engage in a cognitive behavioural approach to therapy, the therapist (or course
facilitator should you choose to book on to one of our courses) will take an active part in
helping you solve your difficulties and at times it may feel like you are being tutored or
educated. You may be asked to complete ‘homework’ tasks to speed up the work done in the
therapy sessions and you may also receive handouts (or a workbook if attending a course)
which will remind you of what has been covered in the therapy sessions. This information
will help build up a useful resource for relapse prevention.

CBT is a collaborative approach to therapy and therefore needs your active participation in
order to be helpful. There is a lot of evidence to show it is an effective treatment

Overview
Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You
work with a mental health counselor (psychotherapist or therapist) in a structured way,
attending a limited number of sessions. CBT helps you become aware of inaccurate or
negative thinking so you can view challenging situations more clearly and respond to them in
a more effective way.
CBT can be a very helpful tool in treating mental health disorders, such as depression, post-
traumatic stress disorder (PTSD) or an eating disorder. But not everyone who benefits from
CBT has a mental health condition. It can be an effective tool to help anyone learn how to
better manage stressful life situations.

Why it's done

Cognitive behavioral therapy is used to treat a wide range of issues. It's often the preferred
type of psychotherapy because it can quickly help you identify and cope with specific
challenges. It generally requires fewer sessions than other types of therapy and is done in a
structured way.

CBT is a useful tool to address emotional challenges. For example, it may help you:

 Manage symptoms of mental illness

 Prevent a relapse of mental illness symptoms
 Treat a mental illness when medications aren't a good option
 Learn techniques for coping with stressful life situations
 Identify ways to manage emotions
 Resolve relationship conflicts and learn better ways to communicate
 Cope with grief or loss
 Overcome emotional trauma related to abuse or violence
 Cope with a medical illness
 Manage chronic physical symptoms

Mental health disorders that may improve with CBT include:

 Sleep disorders
 Sexual disorders
 Depression
 Bipolar disorders
 Anxiety disorders
 Phobias
 Obsessive-compulsive disorder (OCD)
 Eating disorders
 Substance use disorders
 Schizophrenia
 PTSD

In some cases, CBT is most effective when it's combined with other treatments, such as
antidepressants or other medications.

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Risks
In general, there's little risk in getting cognitive behavioral therapy. Because it can explore
painful feelings, emotions and experiences, you may feel emotionally uncomfortable at times.
You may cry, get upset or feel angry during a challenging session, or you may also feel
physically drained.

Some forms of CBT, such as exposure therapy, may require you to confront situations you'd
rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary
stress or anxiety.

However, working with a skilled therapist will minimize any risks. The coping skills you
learn can help you manage and conquer negative feelings and fears.

How you prepare

You might decide on your own that you want to try cognitive behavioral therapy. Or a doctor
or someone else may suggest therapy to you. Here's how to get started:

 Find a therapist. You can get a referral from a doctor, health insurance plan, friend or other
trusted source. Many employers offer counseling services or referrals through employee
assistance programs (EAPs). Or you can find a therapist on your own — for instance, through
a local or state psychological association or by searching the Internet.
 Understand the costs. If you have health insurance, find out what coverage it offers for
psychotherapy. Some health plans cover only a certain number of therapy sessions a year.
Also, talk to your therapist about fees and payment options.
 Review your concerns. Before your first appointment, think about what issues you'd like to
work on. While you can also sort this out with your therapist, having some sense in advance
may provide a starting point.

Check qualifications

Psychotherapist is a general term, rather than a job title or indication of education, training or
licensure. Examples of psychotherapists include psychiatrists, psychologists, licensed
professional counselors, licensed social workers, licensed marriage and family therapists,
psychiatric nurses, or other licensed professionals with mental health training.

Before seeing a psychotherapist, check his or her:

 Background and education. Trained psychotherapists can have a number of different job
titles, depending on their education and role. Most have a master's or doctoral degree with
specific training in psychological counseling. Medical doctors who specialize in mental health
(psychiatrists) can prescribe medications as well as provide psychotherapy.
 Certification and licensing. Make sure that the therapist you choose meets state
certification and licensing requirements for his or her particular discipline.
 Area of expertise. Ask whether the therapist has expertise and experience treating your
symptoms or your area of concern, such as eating disorders or PTSD.

The key is to find a skilled therapist who can match the type and intensity of therapy with
your needs.

What you can expect

Cognitive behavioral therapy may be done one-on-one, or in groups with family members or
with people who have similar issues. It often includes:

 Learning about your mental health condition

 Learning and practicing techniques such as relaxation, coping, resilience, stress management
and assertiveness

Your first therapy session

At your first session, your therapist will typically gather information about you and ask what
concerns you'd like to work on. The therapist will likely ask you about your current and past
physical and emotional health to gain a deeper understanding of your situation. Your therapist
may discuss whether you might benefit from other treatment as well, such as medications.

The first session is also an opportunity for you to interview your therapist to see if he or she
will be a good match for you. Make sure you understand:

 His or her approach

 What type of therapy is appropriate for you
 The goals of your treatment
 The length of each session
 How many therapy sessions you may need

It might take a few sessions for your therapist to fully understand your situation and concerns,
and to determine the best course of action. If you don't feel comfortable with the first
therapist you see, try someone else. Having a good "fit" with your therapist can help you get
the most benefit from CBT.

During CBT

Your therapist will encourage you to talk about your thoughts and feelings and what's
troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist
can help you gain more confidence and comfort.

CBT generally focuses on specific problems, using a goal-oriented approach. As you go

through the therapy process, your therapist may ask you to do "homework" — activities,
reading or practices that build on what you learn during your regular therapy sessions — and
encourage you to apply what you're learning in your daily life.

Your therapist's approach will depend on your particular situation and preferences. Your
therapist may combine CBT with another therapeutic approach — for example, interpersonal
therapy, which focuses on your relationships with other people.

Steps in CBT

CBT typically includes these steps:

 Identify troubling situations or conditions in your life. These may include such issues as a
medical condition, divorce, grief, anger or symptoms of a mental illness. You and your
therapist may spend some time deciding what problems and goals you want to focus on.
  Become aware of your thoughts, emotions and beliefs about these problems. Once you've
identified the problems to work on, your therapist will encourage you to share your
thoughts about them. This may include observing what you tell yourself about an experience
(self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself,
other people and events. Your therapist may suggest that you keep a journal of your
thoughts.
 Identify negative or inaccurate thinking. To help you recognize patterns of thinking and
behavior that may be contributing to your problem, your therapist may ask you to pay
attention to your physical, emotional and behavioral responses in different situations.
 Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask
yourself whether your view of a situation is based on fact or on an inaccurate perception of
what's going on. This step can be difficult. You may have long-standing ways of thinking
about your life and yourself. With practice, helpful thinking and behavior patterns will
become a habit and won't take as much effort.

Length of therapy

CBT is generally considered short-term therapy — about 10 to 20 sessions. You and your
therapist can discuss how many sessions may be right for you. Factors to consider include:

 Type of disorder or situation

 Severity of your symptoms
 How long you've had your symptoms or have been dealing with your situation
 How quickly you make progress
 How much stress you're experiencing
 How much support you receive from family members and other people

Confidentiality

Except in very specific circumstances, conversations with your therapist are confidential.
However, a therapist may break confidentiality if there is an immediate threat to safety or
when required by state or federal law to report concerns to authorities. These situations
include:

 Threatening to immediately or soon (imminently) harm yourself or take your own life
 Threatening to imminently harm or take the life of another person
 Abusing a child or a vulnerable adult (someone over age 18 who is hospitalized or made
vulnerable by a disability)
 Being unable to safely care for yourself

Results
Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go
away. But it can give you the power to cope with your situation in a healthy way and to feel
better about yourself and your life.

Getting the most out of CBT

CBT isn't effective for everyone. But you can take steps to get the most out of your therapy
and help make it a success.
  Approach therapy as a partnership. Therapy is most effective when you're an active
participant and share in decision-making. Make sure you and your therapist agree about the
major issues and how to tackle them. Together, you can set goals and assess progress over
time.
 Be open and honest. Success with therapy depends on your willingness to share your
thoughts, feelings and experiences, and on being open to new insights and ways of doing
things. If you're reluctant to talk about certain things because of painful emotions,
embarrassment or fears about your therapist's reaction, let your therapist know about your
reservations.
 Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip
therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some
thought to what you want to discuss.
 Don't expect instant results. Working on emotional issues can be painful and often requires
hard work. It's not uncommon to feel worse during the initial part of therapy as you begin to
confront past and current conflicts. You may need several sessions before you begin to see
improvement.
 Do your homework between sessions. If your therapist asks you to read, keep a journal or
do other activities outside of your regular therapy sessions, follow through. Doing these
homework assignments will help you apply what you've learned in the therapy sessions.
 If therapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from
CBT after several sessions, talk to your therapist about it. You and your therapist may decide
to make some changes or try a different approach.

Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to
prevent, detect, treat or manage this disease.

What is CBT?
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, the beliefs we may or
may not know we hold, our attitudes, and ultimately our behavior in order to help us face our
difficulties and more effectively strive towards our goals.

The founder of Cognitive Behavioral Therapy is a psychiatrist named Aaron Beck, a man
who practiced psychoanalysis until he noticed the prevalence of internal dialogues 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 arise throughout the day.
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 but focuses more on helping
clients meet their goals in the near future. Most CBT treatment regimens last from five to ten
months, with one 50 to 60-minute session per week.

Cognitive Behavioral Therapy 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 new
strategies for addressing them, and thinking up positive solutions (Martin, 2016).

Cognitive Distortions
Many of the most popular and effective Cognitive Behavioral Therapy techniques are applied
to what psychologists call “cognitive distortions” (Grohol, 2016).

Cognitive distortions: inaccurate thoughts that reinforce negative thought patterns or

emotions.

Cognitive distortions are faulty ways of thinking that convince us of a reality that is simply
not true.

There are 15 main cognitive distortions that can plague even the most balanced thinkers at
times:

Filtering

Filtering refers to the way many of us can somehow ignore all of the positive and good things
in our day to focus solely on the negative. It can be far too easy to dwell on a single negative
aspect, even when surrounded by an abundance of good things.
Polarized Thinking / “Black and White” Thinking

This cognitive distortion is all about seeing black and white only, with no shades of grey.
This is all-or-nothing thinking, with no room for complexity or nuance. If you don’t perform
perfectly in some area, then you may see yourself as a total failure instead of simply unskilled
in one area.

Overgeneralization

Overgeneralization is taking a single incident or point in time and using it as the sole piece of
evidence for a broad general conclusion. For example, a person may be on the lookout for a
job but have a bad interview experience, but instead of brushing it off as one bad interview
and trying again, they conclude that they are terrible at interviewing and will never get a job
offer.

Jumping to Conclusions

Similar to overgeneralization, this distortion involves faulty reasoning in how we make

conclusions. Instead of overgeneralizing one incident, however, jumping to conclusions
refers to the tendency to be sure of something without any evidence at all. We may be
convinced that someone dislikes us with only the flimsiest of proof, or we may be convinced
that our fears will come true before we have a chance to find out.

Catastrophizing / Magnifying or Minimizing

This distortion involves expectations that the worst will happen or has happened, based on a
slight incident that is nowhere near the tragedy that 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, your boss will be furious, and you will lose your job. Alternatively, we may
minimize the importance of positive things, such as an accomplishment at work or a
desirable personal characteristic.

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 the link between. The person
suffering from this distortion will feel that they have an unreasonably important role in the
bad things that happen around them. For instance, a person may believe that the meeting they
were a few minutes late in getting to was derailed because of them and that everything would
have been fine if they were on time.

Control Fallacies

Another distortion involves feeling that everything that happens to you is a result of external
forces or due to your own actions. Sometimes what happens to us is due to forces we can’t
control, and sometimes what happens is due to our actions, but the false thinking is in
assuming that it is always one or the other. We may assume that the quality of our work is
due to working with difficult people, or alternatively that every mistake someone else makes
is due to something we did.
Fallacy of Fairness

We are often concerned about fairness, but this concern can be taken to extremes. As we
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.

Blaming

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 because we are the only ones responsible for the way we feel or act.

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.

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 must be 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.

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 push and press and demand it, keeps us from being happy. This is clearly
a damaging way to think since no one is responsible for our happiness except for us.

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 this 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.

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.

Heaven’s Reward Fallacy

This distortion involves expecting that any sacrifice or self-denial on our part will pay off.
We may consider this karma, and expect that karma will always immediately reward us for
our good deeds. Of course, 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.

9 Essential CBT Techniques and Tools

There are many tools and techniques used in Cognitive Behavioral Therapy, many of which
have spread from the therapy context to everyday life. The nine techniques and tools listed
below are some of the most common and effective CBT practices.

Journaling
This technique is a way of “gathering data” about our moods and our thoughts. This journal
can include the time of the mood or thought, the source of it, the extent or intensity, and how
we responded to it, among other factors. This

technique can help us to

identify our thought patterns and emotional tendencies, describe them and find out how to
change, adapt, or cope with them.

Unraveling Cognitive Distortions

This is a main goal of CBT and can be practiced with or without the help of a therapist. In
order to unravel the cognitive distortions you hold, you must first become aware of which
distortions you are most vulnerable to. Part of this involves identifying and challenging our
harmful automatic thoughts, which frequently fall into one of the categories listed earlier.

Cognitive Restructuring

Once you identify the distortions or inaccurate views on the world you hold, you can begin to
learn about how this distortion took root and why you came to believe it. When you discover
a belief that is destructive or harmful, you can begin to challenge it. For example, if you
believe that you must have a high paying job to be a respectable person, but you lose your
high paying job, you will begin to feel bad about yourself.

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

Exposure and Response Prevention

This technique is specifically effective for those who suffer from obsessive compulsive
disorder (OCD). 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 and
writing about it. You can combine journaling with this technique, or use journaling to
understand how this technique makes you feel.

Interoceptive Exposure

This technique is intended to treat panic and anxiety. It involves exposure to feared bodily
sensations in order to elicit the response, activates any unhelpful beliefs associated with the
sensations, maintains the sensations without distraction or avoidance, and allow 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.

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. 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.

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, where they imagine the outcome of the worst case scenario. Letting this
scenario play out can help the individual to recognize that even if everything they fear comes
to pass, it will likely turn out okay.

Progressive Muscle Relaxation (PMR)

This is a familiar technique to those who practice mindfulness. Similar to the body scan, this
technique instructs you to relax one muscle group at a time until your whole body is in a state

of relaxation. 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.

Relaxed Breathing

This is another technique that is not specific to CBT but 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 decision making (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.
Cognitive Behavioral Therapy Worksheets (PDF) To Print
and Use
If you’re a therapist looking for ways to guide your client through treatment or a hands-on
person who loves to learn by doing, there are many Cognitive Behavioral Therapy
worksheets that can help.

Alternative Action Formulation

This worksheet instructs the user to first list any problems or difficulties you are having.
Next, you list your vulnerabilities (i.e., why you are more likely to experience these problems
than someone else) and triggers (i.e., the stimulus or source of these problems).

Once you have defined the problems and understand why you are struggling with them, you
go on to list coping strategies. These are not solutions to problems, but ways in which you
can deal with the effects of these problems that can have a temporary impact. Next, you list
the effects of these coping strategies, such as how they make you feel in the short-term 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.

This worksheet will be available for download soon.

Functional Analysis

One popular technique in Cognitive Behavioral Therapy is functional analysis. This

technique 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 or other behaviors you wish 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 the
consequences of the behavior, or what happened as a result of the behavior under
consideration. “Consequences” may sound inherently negative, but they are not necessarily
negative; some positive consequences can arise from many types of behaviors, even if more
negative consequences result as well.

This worksheet can help you or your client to find out whether particular behaviors are
adaptive and helpful in striving towards your goals, or destructive and self-defeating.
This worksheet will be available for download soon.

Longitudinal Formulation

This worksheet helps you address what some Cognitive Behavioral Therapy therapists call
the “5 P Factors” – presenting, predisposing, precipitating, perpetuating, and positives. This
formulation process can help you connect the dots between your core beliefs and thought
patterns and your present behavior.

This worksheet presents five boxes at the top of the page, which should be completed before
moving on to the rest of the worksheet.

1. The first box is labeled “Precipitating Events / Triggers,” and corresponds with the
Precipitating factor. In this box, you are instructed to write down the events or stimuli that
provoke a certain behavior.
2. The next box is labeled “Early Experiences” and corresponds to the Predisposing factor. This
is where you list the experiences that you had early on, all the way back to childhood, that
may have contributed to the behavior.
3. The third box is “Core Beliefs,” which is also related to the Predisposing factor. This is where
you write down some of the 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.”
4. The fourth box is “Old Rules for Living,” 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.”
5. The final box is labeled “Presenting Problems / Effects of Old Rules.” This is where you write
down how well these rules are working for you. Are they helping you to be the best you can
be? Are they helping you to effectively strive towards your goals?

Below this box, there are two flow charts 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 the behavior that this thought
provokes, as well as the bodily sensations that can result. Filling out these flow charts can
help you see what drives your behavior or thought and what results from it.

Below these two charts is the box “Protective Factors.” 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. This 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.

Finally, the last box is “New Rules for Living.” This box relates to the Positive factor, in that
it provides you with an opportunity to create new rules for yourself that will disrupt the
destructive cycle and allow you to become more effective in meeting your therapeutic goals.
This worksheet will be available for download soon.

Dysfunctional Thought Record

This worksheet is especially helpful for people who are struggling with negative thoughts
and need to figure out when and why they are most likely to pop up. By learning more about
what provokes certain automatic thoughts, they become easier to address and reverse.

The worksheet is divided into seven columns:

1. On the far left, there is space to write down the date and time a dysfunctional thought
arose.
2. 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.
3. 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%.
4. 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%.
5. The fifth column is labeled “Distortion.” This column is where the user will identify which
cognitive distortion(s) they are suffering from with regards to this specific dysfunctional
thought, such as all-or-nothing thinking, filtering, jumping to conclusions, etc.
6. The second to last column is for the user to write down alternative thoughts, more positive
and functional thoughts that can replace the negative one.
7. 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?

Fact or Opinion

One of my favorite Cognitive Behavioral Therapy worksheets is the “Fact or Opinion”

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 right 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.

This worksheet will be available for download soon.

Cognitive Restructuring

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

The top of the worksheet describes how thoughts are a running dialogue in our minds, and
they can come and go so fast that we hardly have time to address them. This worksheet aims
to help us capture one or two of these thoughts and analyze them.

1. The first box to be filled out is “Thoughts to be questioned.” This is where you write down a
specific thought, usually, one you suspect is destructive or irrational.
2. Next, you write down the evidence for and against this thought. What evidence is there that
this thought is accurate? What evidence exists that calls it into question?
3. Once you have identified the evidence, you can make a judgment on this thought,
specifically whether it is based on facts or your feelings.
4. Next, you answer a question on whether this thought is truly a black and white situation, or
whether reality leaves room for shades of grey. This is where you think about whether you
are using all-or-nothing thinking, or making things unreasonably simple when they are truly
complex.
5. In the last box on this page, you consider whether you could be misinterpreting the evidence
or making any unverified assumptions.

On the next page, you are instructed 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.

The next box asks you whether your thought may an exaggeration of a truth. Some negative
thoughts are based in truth but extended past their logical boundaries.

Next, you are instructed to consider whether you are entertaining this negative thought out of
habit or because the facts truly support it.

Once you have decided whether the facts support this thought, you are encouraged to think
about how this thought came to you. Was it passed on from someone else? If so, are they a
reliable source for 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 may plague you,
and offer an opportunity to analyze and evaluate them for truth. If you are having thoughts
that do not come from a place of truth, this worksheet can be an excellent tool for identifying
and defusing them.

Some More CBT Interventions and Exercises

Haven’t had enough CBT tools and techniques yet? Continue on for more useful and
effective exercises!

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 thought:

“If I criticize myself, I will be motivated to work harder” vs. “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 can help you learn how to best strive towards your therapeutic
goals and how to be your best self.

Thought Records

Thought records are useful in testing the validity of your thoughts (Boyes, 2012). They
involve gathering and evaluating the 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 cancelled 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).

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 longer lasting and farther
reaching effects.

This simple technique can introduce more positivity into your day and help you make your
thinking less negative.

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, 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.

Situation Exposure Hierarchies

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

Situation Exposure Hierarchies involves making a list of things that you would normally
avoid (Boyes, 2012). For example, someone with severe social anxiety may typically avoid
making a phone call instead of emailing 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 instead of emailing might be
rated closer to a 3 or 4.
Once you have rated each item, 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 may be best to start with the less distressing items and work
your way up to the most distressing items.