CBT Triangle Worksheet
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Cognitive behavioral therapy (CBT) is an evidence-based therapeutic modality you can use to support your clients’ growth and treatment objectives. Worksheets, like the CBT triangle worksheet in this article, can facilitate the treatment goals of your CBT sessions.
CBT is one of the most widely used therapeutic interventions that can be applied to a broad range of mental health issues.
This guide provides an overview of CBT, how to use the CBT triangle—which describes the link between thoughts, feelings, and actions—and includes a free, downloadable CBT triangle worksheet to save to your practice management software and use at your convenience.
What is CBT?
Cognitive behavioral therapy was developed by Aaron Beck in the 1960s when he noticed his patients with depression verbalized thoughts that lacked validity. He later termed these unsubstantiated thoughts “cognitive distortions.”
Beck’s findings led him to conceptualize depression as more of a cognitive disorder, as opposed to a mood disorder—eventually publishing a treatment manual to this effect. Considered a psychotherapeutic innovation at the time, Beck went on to use the same approach with more complex interventions—incorporating cognitive, emotional, and behavioral components to his newly found therapeutic modality.
Developing one of the most widely used, researched, and empirically validated interventions, Beck has been described as a pioneer by his contemporaries and successors in the field.
CBT interventions have been demonstrated to be effective in treating a range of mental health disorders and non-psychiatric disorders, including:
- Depression
- Anxiety
- Bipolar disorder
- Personality disorders
- Bulimia
- Anger problems
- Stress
- Post-traumatic stress disorder
- Non-psychiatric disorders, including chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, insomnia, migraines, and other chronic pain conditions
What is the CBT triangle?
CBT is based on a cognitive model that describes the relationship between a person’s automatic thoughts, feelings, and behaviors in response to a situation or event.
This is also called the CBT triangle or cognitive triangle. Typically, the top of the triangle represents thoughts, while the bottom left and right of the triangle represent our behaviors and emotions.
Without CBT interventions, the pattern continues, but by changing one part of the triangle, clients can improve their situation as a whole.
CBT triangle examples
To better understand the CBT triangle, here are three situations to illustrate the model:
Scenario 1
Recent graduate, Dave, receives a job offer by email and thinks: “Wow. All this hard work in grad school was worth it. I’ll finally have the opportunity to put what I’ve learned into action. This company must really believe in my ability. I will respond right away and tell them I can start on Monday.”
They also start to feel a boost of feel-good hormones and confidence, making them pick up the phone to tell their friend the good news.
Scenario 2
Samantha, also a recent graduate in Dave’s class, receives the same job offer and thinks: “Oh, no. I don’t feel like I’m ready. I feel so depressed after school, so how can I show up and pretend to know what I’m doing? People will judge me, think I’m stupid, and the manager will think they’ve made a mistake hiring me. I’m going to turn down the job. I just can’t make a fool of myself like that.”
After declining the job, Samantha goes to bed feeling really depressed and hopeless, wishing the day would just end.
Scenario 3
Samantha’s girlfriend, Sara, hears about Samantha’s job offer and thinks: “This is such good news. I knew they’d find a job. They are so smart; they just needed an opportunity to practice what they already know. Everyone will love them and I’m sure their depression will improve in no time. I’m so excited for them and am going to make them a celebratory dinner tonight, with their favorite meal, and buy them a bunch of flowers to show them how happy I am for them.”
In these examples, the job offer serves as an external trigger, which causes the two graduates, and Samantha’s girlfriend, to have different automatic thoughts about the situation. Each party experiences different emotional responses, influencing their behavior.
The internal trigger describes the bodily reaction each person experiences in response to the external stimulus. In the CBT model, both internal and external triggers can elicit negative automatic thoughts and reactions—in turn, influencing distressing or positive responses and behavioral choices.
How to use the CBT triangle in your practice
There are various ways you can use the CBT triangle in your practice to support clients in challenging negative thoughts and patterns.
It may be helpful to follow this format:
- Event: Choose a random, innocuous example—like going on a first date—or focus on something the client has already mentioned that displays a cognitive distortion.
- Automatic thought: Ask the client to consider several possible thoughts someone might have in that situation. The key here is to describe different possible thoughts from multiple angles. You can help them by selecting a neutral response or a more distorted thought.
- Emotional and bodily reaction: Then, ask the client to think about how that person is feeling in that situation. Ask: What emotions are present, and how do you think this shows up in their body? You could use cues, like an emotions chart or body diagram, to help them identify these emotions and sensations.
- Behavioral reactions: Next, ask the client to look at possible actions or behaviors the person may take because of their automatic thoughts and emotions.
- Bring it together: Help the client understand how emotions impact thoughts and behaviors and vice-versa. The goal is to support the client in understanding the connection between their perception and reaction.
It may be helpful to remind the client that thoughts are not facts. Thoughts can be subjective or based on past stressful experiences, which may influence how we interpret them.
You could offer clients the CBT triangle worksheet to work on in session or as homework to support their understanding of this concept. If needed, you can also offer them a trauma workbook for adults to get to the core of their automatic thoughts.
What’s included in the CBT triangle worksheet?
The CBT triangle worksheet contains three pages:
- Page 1 is an illustration of the CBT triangle, which shows the key components of the cognitive model
- Page 2 provides possible scenarios that illustrate the model for your clients
- Page 3 is a CBT triangle worksheet for clients to use in session and at home
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