CBT is one of the most effective psychological treatments when it comes to managing anxiety and depression, and can be a highly useful approach to apply in online therapy.
If you help clients tackle cognitive distortions and unhelpful thinking styles, we’ve compiled a list of essential worksheets that should be part of your therapy toolbox.
How To Use CBT Worksheets in Therapy
Cognitive-behavioral therapy (CBT) is based on the idea that thoughts, feelings, physical sensations and behaviors are interlinked, and that changing negative thought patterns can enhance the way we act and feel.
It encompasses a variety of techniques and interventions that have been proven effective in the treatment of many mental disorders.
Besides anxiety and depression, a few examples include:
- Panic disorder
- Bipolar disorder
- Borderline personality disorder, and
- Obsessive-compulsive disorder.
With the advent of online therapy, guided online CBT has become an increasingly popular way for mental health professionals to help clients manage behavioral health conditions without the need to meet in person as often.
CBT worksheets, exercises, and activities play a large role in these treatments to encourage further progress between sessions, in the same way that face-to-face CBT involves between-session practice.
5 Example Tools For Treating Anxiety
So what types of online CBT worksheets can be used to help clients cope better with symptoms of anxiety?
There is a wide spectrum of therapeutic approaches that range from self-help activities to guided interventions, and all of them focus on identifying and changing unhelpful thoughts, feelings, and behaviors.
Here are a few of the best-known techniques that can be applied with the right tools.
Identifying cognitive distortions
Recognizing and identifying maladaptive automatic thoughts is a main goal of CBT.
Recognizing and identifying maladaptive automatic thoughts is a main goal of CBT. Cognitive distortions describe inaccurate or exaggerated perceptions, beliefs, and thoughts that can contribute to or increase anxiety, so increasing a client’s awareness of these is the first step to unraveling them and feeling better.
Quenza’s Unhelpful Thinking Styles – “Shoulding” and “Musting” worksheet, shown below, is an example exercise that can help clients recognize the damaging impacts of using “should” and “must” statements to place unreasonable demands or unnecessary pressure on themselves.
Cognitive restructuring involves disputing the distortions that underpin a client’s challenges. Various techniques that can be helpful here include Socratic questioning, decatastrophizing, and disputing troublesome thoughts with facts.
One example CBT exercise is the Cognitive Restructuring Expansion shown below, which can help clients identify automatic thoughts and substitute them with more fair, rational ways of thinking.
Journaling and thought records
Journaling is a form of self-monitoring that helps clients identify their thought patterns and emotional tendencies, as shown by the Stress Diary Expansion below.
Journals can involve logging negative thoughts or feelings as homework, with the aim of positioning clients to manage them successfully.
Stress Reduction Techniques
Stress reduction exercises such as deep breathing, meditation, and progressive muscle relaxation can all be effective CBT tools for managing anxiety.
The example below is Quenza’s Progressive Muscle Relaxation exercise, which clients can practice to increase their sense of control and calm when stressed or anxious.
Diaphragmatic breathing is another useful relaxation exercise often used in CBT for anxiety.
With this mindfulness practice, clients learn to regulate their breath and activate their body’s relaxation response, as shown in Quenza’s audio Diaphragmatic Breathing exercise below.
CBT Worksheets for Depression (PDF)
CBT worksheets are useful resources for therapists helping clients manage depression, because they can be used to encourage your clients’ progress between sessions.
If you are a mental health professional, the following worksheets can be shared as homework. Each is available as a customizable Quenza Expansion for easy sharing with clients with a $1, 30-day Quenza trial.
The ABC Model of Helpful Behavior
ABC is an acronym for Antecedents, Behavior, and Consequences, and the ABC model proposes that behavior can be learned and unlearned based on association, reward, and punishment.
This CBT worksheet allows clients to reflect on adaptive behavior, thus building their awareness of the triggers for and consequences of this behavior.
After introducing the ABC Model of Behavior and the ABC Model of Helpful Behavior, the exercise asks clients to try it out themselves by:
- Describing a recent personal problem
- Recalling a helpful behavior that they carried out that contributed to the problem in a positive way.
- Recalling the Antecedents of the helpful Behavior – where they were, who they were with, and what they were doing, thinking, and feeling
- Considering the short- and long-term Consequences of that behavior – how they felt, what happened, and what others said or did.
Unhelpful Thinking Styles – Emotional Reasoning
This worksheet invites clients to identify and decrease the negative impact of a specific cognitive bias known as “Emotional Reasoning,” which can be common in clients with depression.
As an introduction, clients learn about the negative impacts of regarding emotions as evidence of the truth, or basing one’s view of situations, yourself, or others on how they feel at a certain moment.
They are then invited to reflect on a time when they used emotional reasoning and describe the situation as well as their thoughts and emotions at the time.
Through self-reflection, this therapy exercise aims to help the user separate their feelings from their thoughts so that they can reduce the negative effect of emotional reasoning on their wellbeing.
As we’ve seen, patients with symptoms of depression often experience negative thoughts that result from faulty thinking rather than accurate experiences of reality.
Catastrophizing is amplifying the importance of adverse events and situations while minimizing their positive aspects or outcomes. The Decatastrophizing Expansion can be an impactful cognitive restructuring technique to help with this cognitive distortion when it is practiced over time.
Clients are asked to describe the situation that they are currently catastrophizing about before answering a series of questions to challenge their thinking:
- What is the worst that can happen?
- What three events would have to take place for the worst to happen?
- How likely is it that all three of these events will take place?
- What is a more likely outcome, given what you know about the situation?
Here’s an example of the PDF copy that you or your clients can download of these exercises: Decatastrophizing CBT worksheet
To customize these CBT worksheets for depression and browse more, take a look at the $1, 30-day Quenza trial.
Can CBT Help Build Self Esteem?
Studies have shown CBT to be useful in developing a client’s self-esteem so that they start to perceive themselves as more worthy and deserving.
Cognitive restructuring is particularly can equip them with the skills to challenge or refute negative self-talk. This involves:
- Helping clients explore repetitive negative self-talk can be damaging to their sense of self-worth
- Challenging harmful cognitive distortions
- Supporting in the development of a more balanced, positive self-perspective.
Quenza’s Challenging Unhelpful Thoughts, pictured above, is an example CBT worksheet for self-esteem with the following prompts and questions:
- Describe a negative thought that keeps coming back.
- On a scale of 1 to 10, how strongly do you believe this thought to be true?
- What evidence supports this thought?
- What evidence do you have against the thought?
- What would you tell a friend (to help them) who would have the same thought?
CBT Toolbox for Online Therapists
Once you’ve found the most useful tools for your programs and are ready to start treating clients, it’s time to organize them for easy, convenient delivery.
Without a centralized library of digital materials – and the ability to quickly personalize and share them – it’s easy to spend more time than is necessary on the admin side of helping others.
With the right CBT app, you should have an entire toolbox of CBT worksheets plus the tools you need to deliver them:
- Activity design tools: for efficiently creating online CBT interventions
- Customizable templates: e.g., Quenza Expansions that include personalizable science-based exercises and activities
- Documentation tools: e.g., Quenza Notes – A secure, convenient way to create and store session notes and collaborate with clients
- Pathway builder tools: which help you assemble separate worksheets and tools into programs and mental health treatment plans
- Real-time results tracking: to securely collect and store client responses and results
- A free client app: so that clients can easily receive, complete, and return your CBT resources and assemble a library of their finished activities.
Whether you’re new to the world of online therapy or coaching or simply looking to increase your impact, our free 30-page guide is a great place to start.
This PDF will give you an easy-to-understand introduction to the essentials of digital practice: how to create and share your own CBT interventions, keep clients engaged in their treatment, and improve your clients’ results while growing and scaling your business.
Click here to download your copy of Coach, This Changes Everything.
Practicing CBT online for the first time may take some adapting, but the ability to help more clients with less work is always worth the payoff.
Hopefully, these worksheets and resources give you a solid starting point for building your CBT toolkit. Let your fellow practitioners know how you use them – leave a comment and join in the conversation below!
- ^ NHS. (2022). Overview - Cognitive behavioural therapy (CBT). Retrieved from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
- ^ Harvard Health Publishing. (2015). Online cognitive-behavioral therapy: The latest trend in mental health care. Retrieved from https://www.health.harvard.edu/blog/online-cognitive-behavioral-therapy-the-latest-trend-in-mental-health-care-201511048551
- ^ McKay, M., & Fanning, P. (2016). Self-esteem. New Harbinger.