CBT for Anxiety Worksheets
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If you’re looking for cognitive behavioral therapy (CBT) for anxiety worksheets, you’re in the right place.
This article provides an overview of the benefits of CBT for anxiety and depression, along with several CBT treatment plan for anxiety examples and free downloadable CBT for anxiety worksheets to save to your electronic health record (EHR).
What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy is a therapeutic intervention that can help people manage a range of mental health conditions, including anxiety, depression, substance use disorder, obsessive compulsive disorder, and even chronic pain and other physical conditions. CBT is one of the most common and well-studied types of therapy.
The basic premise of CBT is that our thoughts and feelings are influenced by our perception of events, which in turn, influence our feelings and how we respond.
Thus, CBT works to change distorted thinking patterns into more helpful thoughts, enhance coping strategies, and improve problem solving. As a consequence, a positive effect results in a person’s mood, self-esteem, and quality of life.
Does CBT work for anxiety?
Anxiety disorders are one of the most common mental health conditions, affecting nearly 40 million adults in the United States.
Even though clients may recognize that their anxious thoughts feel irrational, anxiety is an adaptive biological reaction in response to fear or danger. In other words, anxiety is nature’s alarm system.
However, in the cognitive model, anxiety is thought of as a maladaptive response because it perceives an exaggerated threat of danger and an under evaluation of resources.
According to “The Comprehensive Clinician’s Guide to Cognitive Behavioral Therapy” by Leslie Sokol, PhD and Marci Fox, PhD, clients typically avoid situations that cause them anxiety or engage in safe behaviors to neutralize anxious feelings.
In summary, anxiety is a malfunctioning of a person’s internal alarm system, causing anxiety-related behaviors.
CBT is an effective anxiety treatment without medication. The intervention is helpful for several anxiety disorders, including post-traumatic stress disorder (PTSD), obsessive compulsive disorder, generalized anxiety disorder, social anxiety, phobias, and panic disorder.
CBT for anxiety disorders works by:
- Cognitively restructuring thoughts by identifying and modifying unhelpful thoughts.
- Using exposure-based strategies to better understand what the client is afraid of and testing their hypothesis before turning to cognitive restructuring.
- Enhancing coping skills for anxiety, such as relaxation techniques, problem solving, worry time, and distress tolerance.
While each type of anxiety presents in slightly different ways, they share common features, such as:
- The probability error: Overexaggerating or misjudging the threat. For example, a person who is frightened of dogs may think they’ll be attacked every time they see a dog.
- The catastrophic error: Overestimating the severity of negative outcomes. For example, the client might think the dog will cause them to end up in the emergency room and they may die.
- The resource error: Underestimating their ability to cope. This might transpire in the client believing they won’t have any support and won’t be able to cope with the situation.
Types of CBT for anxiety worksheets
Clinicians use CBT for anxiety worksheets to create awareness of unhelpful thoughts, modify thought distortions, and enhance coping skills.
This can include worksheets such as:
Anxiety triggers worksheet
An anxiety triggers worksheet can help clients create awareness of the causes of their anxiety. This worksheet is a helpful first step that can set the stage for CBT interventions by giving clients the tools to identify triggers. Then, they can work with you to understand their dysfunctional thought patterns before turning to cognitive restructuring.
Dysfunctional thought record
This worksheet helps clients identify unhelpful thoughts and patterns. Using a CBT thought log, the client will note the date and time of the situation and their automatic thoughts and feelings.
They can then create a new thought, or work with you in session to restructure their maladaptive thoughts.
Fact checking/catastrophic thinking worksheet
Similar to the dysfunctional thought record, this worksheet takes the log a step further by challenging catastrophic thinking.
It asks the client to consider if their thoughts are true, evidence to support their thoughts, the best, worst, and most likely outcome, and other possible ways to look at the situation.
Create a coping card
This activity involves creating a worry card in session with a client to use when they are feeling anxious. The coping card serves as a reminder that they are capable of coping and thoughts are not facts, along with providing words of affirmation.
Relaxation skills
Worksheets like anchor breathing exercises provide clients with a coping skill to strengthen their distress tolerance skills.
Anchor breathing works by guiding your client into a comfortable position (with their eyes closed or a low gaze) and imagining being in a place that brings them a sense of calm.
Advise them to focus on their breath and. notice it by naming when they are breathing in and breathing out (aloud or silently).
CBT treatment plan for anxiety examples
We’ve included two CBT treatment plans for anxiety examples below.
Generalized anxiety treatment plan example
- Diagnosis/problem: Generalized anxiety disorder (ICD-10 code F41.1). Demonstrates symptoms of feeling nervous, worrying, difficulty relaxing, restlessness, irritability, feeling afraid, constantly on edge, concentration difficulties, and trouble falling or staying asleep.
- Treatment goals: Reduce the overall frequency, intensity, and duration of anxiety so that daily functioning is not impaired.
- Objectives and interventions: Learn and implement two new regulation techniques to reduce and relieve anxiety symptoms, using interventions like mindfulness meditation, anchor breathing, and Yoga Nidra.
- Objectives and interventions: Empower the client to identify, restructure, and reduce automatic thoughts and perceptions through interventions like fact checking thought logs, restructuring exercises, creating more helpful empowering self-talk, and developing new strategies to address fears or worries.
Social anxiety treatment plan example
- Diagnosis/problem: Social anxiety disorder (generalized social phobia ICD-10 code F40.11). Evidenced by symptoms including feeling nervous and anxious about social situations, sweating, blushing, difficulty speaking, avoiding eye contact, rapid heart rate, and self-consciousness.
- Treatment goals: Reduce the overall frequency, intensity, and duration of social anxiety by enhancing coping strategies and social skills.
- Objectives and interventions: Identify and restructure anxiety-related thoughts through thought logs, fact checking worksheets, and exposure therapy.
- Objectives and interventions: Reduce and relieve social anxiety symptoms by teaching mindfulness-based stress reduction techniques.
- Objectives and interventions: Create opportunities to enhance communication skills by teaching assertive communication strategies, roleplay scenarios that trigger the client’s anxiety, and positively reinforce the client’s resources.
How to use the CBT for anxiety worksheets with clients
The CBT for anxiety PDF can be used as in-session prompts to work through automatic thoughts, as a psychoeducation tool, or as homework in between sessions.
Therapists can also instruct clients to use the CBT for anxiety worksheets and activities at home, at work, or at any time the client is feeling anxious to enhance their coping skills and reinforce their ability to cope.
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