Cognitive Behavioral Therapy (CBT) Exercises
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CBT exercises (aka cognitive behavioral therapy exercises) have been proven useful in the treatment of anxiety and depression.
Cognitive behavioral therapy (CBT) is one of the most commonly researched and utilized forms of therapy treatment.
CBT is based on the premise that human experience is facilitated by the interconnection between thoughts, emotions, physical sensations, and behaviors. Thoughts are highlighted as the prominent influence on a person’s experience.
Keep reading to learn about cognitive behavioral therapy exercises you can use in your practice, including CBT exercises for anxiety and CBT exercises for depression.
How CBT works
The CBT model states that thoughts influence an individual’s emotions and body sensations, which in turn, impacts their actions.
CBT proposes that emotions cannot be directly influenced, but they can be changed by identifying and modifying the thoughts that are the source of the emotion.
When challenging emotions or mental health conditions are present, such as anxiety or depression, CBT assumes that there are distorted thoughts causing those feelings. If a person can modify those distorted thoughts or cognitions into alternative thoughts, then the levels of anxiety or depression can be reduced.
For example, if a person is turned down for a job opportunity and thinks to themself, “I always get overlooked” or “I’m never going to get a job,” it stands to reason they are likely going to feel increased depression, lower self-esteem, and some amount of hopelessness.
This might cause them to feel tired, have less energy, and ultimately, stop applying for more jobs.
Using CBT techniques, they may be able to interrupt this negative cycle if they can identify their distorted thoughts and replace them with more realistic thoughts such as, “It hurts that I didn’t get this job, but I have been hired for half of the jobs I’ve applied for in my life. I can keep applying and will likely find something in the near future.”
This new thought is not sugar coated and still recognizes the sadness of having their job application rejected, but it reduces hopelessness and depression by reminding the person that they have been successful in past job searches.
This reduced despair and new flicker of hope can bring increased levels of motivation and energy, getting them back on track to continue applying for jobs.
CBT exercises and worksheets
CBT exercises can be conducted in session between a therapist and client, or outside of session with a client practicing the skills independently.
When working with clients struggling with anxiety or depression, worksheets can be great tools to support the CBT process. Digital or printable worksheets can be used in session with a client or given to the client to complete on their own, as homework.
These worksheets can increase the client’s awareness of their own experiences, lead the client to question their thoughts, and help them change any distorted thoughts in order to establish new emotional and behavioral patterns.
It is helpful for therapists to have a library of cognitive behavioral therapy exercises and worksheets at their disposal in order to help their clients.
Keep reading for exercise suggestions, along with downloadable PDFs that you can add to your toolkit.
Thought records
Thought records and journals are CBT exercises often used as ways to help clients build insights around their thoughts, emotions, physical sensations, and behaviors in any given situation.
In the Thought Record worksheet, provided in this article, clients are given a space to identify the event/trigger, their thoughts and cognitive distortions, emotions (with rated intensity 0-100), physical sensations, and behaviors in a specific situation.
They are also prompted to identify helpful alternative thoughts that could be applied in a similar situation, as well as rate how strongly they believe those new thoughts, on a scale of 0-100.
Helping clients review these moments retroactively, and come up with realistic alternative thoughts, can create much greater capacity to manage anxiety or depression in future situations.
Thought distortions
One of the most important cognitive behavioral therapy exercises that a clinician can facilitate is helping clients to identify their own distorted patterns of cognition.
These are common patterns of thought that distort or exaggerate the reality of situations in various ways.
A person struggling with anxiety may ruminate on a threat that isn’t present, or a person diagnosed with depression may focus heavily on things that go wrong.
The CBT worksheet for adults PDF, included in this article, briefly explains various distortions to clients to help them identify their own distortions and record examples of times they have experienced them.
CBT exercises for anxiety
CBT is one of the most trusted treatments for anxiety because you can target the worries and ruminations in a person’s mind.
Catastrophizing is a thought distortion where a person predicts the worst case outcome in a situation. This is a common experience for people with anxiety.
Below are two CBT exercises that can be very helpful for anxiety, particularly for those who catastrophize.
The survey method
A client who fears the worst and predicts catastrophic outcomes—but has started to question if their thinking might be a distortion—can utilize the survey method.
This method is a form of reality testing. It simply involves sharing a feared outcome with close and trusted people in a client’s life and asking for their opinions on the matter.
The surveyed group may confirm the client’s prediction, they may completely dispute the prediction, or they might say the catastrophic prediction is a possibility, but not a certainty.
Whatever the consensus, the client finds new information to help them either confirm their thinking or disconfirm their thinking, which can encourage them to reframe their thoughts.
Balanced predictions
When a client is catastrophizing, they are using their imagination to predict the worst case scenario. Balanced thinking is what is needed in these instances.
To help with this, we’ve created a cognitive behavioral therapy technique PDF titled Balance Predictions.
The worksheet prompts the client to first write out their worst case scenario prediction.
Next, they are prompted to use their imagination and think of the absolute best case scenario outcome, even if it seems a bit far-fetched.
Finally, they are asked to consider what they truly know about the situation and make a balanced prediction of the most likely outcome.
Going through this cognitive process can have a great impact on reducing anxiety about the future.
CBT exercises for depression
Negative and self-defeating thinking are some of the root causes of depression for many people.
Therapists can help illuminate these thoughts for clients and guide them to a greater sense of hope, meaning, and self-compassion.
CBT self-help worksheets and CBT exercises, such as those provided below, can be great resources to support clients with depression.
Best friend technique
Clients who are struggling with negative or self-critical thoughts can benefit from a new vantage point.
Clinicians can prompt clients to think about their best friend or a close family member going through the same exact situation and experiencing the same thoughts as the client. The client is then prompted to identify what they would say to their best friend, or family member, about this situation.
Often, this leads to more balanced, logical, compassionate, or hopeful thoughts. The client can then be asked how they would feel about adopting those different sentiments for themselves.
Evaluating the evidence
For people struggling with depressive thoughts and emotions, a helpful tactic is to ground themselves in the facts.
The downloadable worksheet, titled Evaluating the Evidence, helps clients to be like detectives and investigate the objective evidence that would support or undermine the truth of their depressive thought.
Clients pick one thought, then list as much objective truth as possible for both sides of the argument, leaving out any assumptions.
Once they have their list of evidence, they can make a conclusion on whether or not they believe their original thought is completely true or not.
If the thought is not 100% accurate, they are prompted to identify an alternative thought that is derived from the list of evidence they compiled.
The ultimate goals of CBT exercises
All of these cognitive behavioral therapy exercises are intended to help clients:
- Identify their current thoughts
- Comprehend the influence of these thoughts on their emotions, body, and behaviors
- Question the reality of these thoughts
- Recognize any distorted thinking patterns
The ultimate goal, however, is to help clients develop new alternative thoughts that are authentic and believable to the client and grounded in reality.
In turn, this can reduce the intensity of their negative emotions and symptoms.
The final column of the Thought Record worksheet is a great place to have the clients come up with these helpful alternative thoughts.
Once an alternative thought is developed, helping clients find ways to keep these new thoughts visible is extremely important.
A client who develops a helpful new thought, but never thinks of it again after a session, is not going to see improvement. The client should be prompted to consider ways they can continue to see, read, think about, and recite their new thoughts.
Practicing their new thinking can give their brain a chance to develop lasting neural pathways to support their mental health.
Giving clients CBT exercises, as well as other ways to stay connected to their newfound thoughts, can reinforce the reduction of depression and anxiety in their lives.
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