Cognitive Behavioral Therapy (CBT), often known as CBT, stands as a widely employed therapeutic approach among mental health practitioners. Its origins trace back to the 1960s when Aaron Beck developed it primarily to address depression. Here, we delve into a compilation of 20 CBT activities and exercises that can be undertaken with clients during therapy sessions.

Since that time, the foundation that was laid out by Aaron Beck has molded into what is commonly used today in psychotherapies. Additionally, CBT has contributed to the development of other therapeutic approaches including:

• Dialectical Behavioral Therapy (DBT) – View our DBT Worksheets
• Acceptance and Commitment Therapy (ACT) – View our ACT Worksheets
• Mindfulness-Based Cognitive Therapy (MBCT)
• Schema Therapy (ST) – View our Schema Therapy Worksheets

Cognitive Behavioral Therapy is guided by its core characteristics and beliefs. One of which would be that unhealthy thought patterns contribute to mental health difficulties that our clients experience. Another belief is that mental health concerns are tied to learned patterns and unhealthy behaviors.

CBT works to improve the thought patterns that our clients have, as well as to change or decrease the engagement of unhealthy behavior patterns. By focusing on these two factors, CBT affirms that you can reduce an individual’s mental health distress. 

Why CBT?

Cognitive Behavioral Therapy (CBT) is a widely practiced and highly effective therapeutic approach for addressing a variety of emotional and psychological issues. There are several compelling reasons why CBT is often chosen as a preferred treatment option:

1. Evidence-Based: CBT is extensively researched and has a strong evidence base supporting its effectiveness for a wide range of mental health conditions, including depression, anxiety disorders, PTSD, OCD, and more.
2. Structured and Goal-Oriented: CBT is a structured therapy that focuses on specific treatment goals. It provides individuals with practical strategies and tools to address their symptoms and challenges.
3. Empowerment: CBT empowers individuals by teaching them how to identify and challenge negative thought patterns and beliefs that contribute to their emotional distress. This helps clients take an active role in their own healing process.
4. Short-Term and Time-Limited: CBT is often a relatively short-term therapy compared to some other therapeutic approaches. Many clients appreciate the goal of achieving symptom relief and improved functioning within a specific time frame.
5. Skill-Building: CBT equips clients with a set of valuable coping skills that they can use throughout their lives to manage stress, anxiety, and other emotional difficulties.
6. Holistic Approach: CBT takes a holistic approach to mental health by addressing the interconnectedness of thoughts, emotions, behaviors, and physical sensations. It recognizes that changing one aspect can positively impact others.
7. Customized Treatment: CBT can be tailored to meet the individual needs and concerns of each client. Therapists work collaboratively with clients to create personalized treatment plans.
8. Focus on the Present and Future: While it acknowledges the impact of past experiences, CBT primarily focuses on the here and now, helping clients develop skills to manage current challenges and prevent future relapses.
9. Versatility: CBT can be used effectively in various settings, including individual therapy, group therapy, and online therapy platforms. It can also be adapted for different age groups, making it a versatile and accessible option.
10. Transdiagnostic Approach: CBT can be applied across different mental health diagnoses, making it suitable for clients with comorbid conditions or those whose symptoms do not neatly fit into one specific diagnostic category.
11. Long-Lasting Benefits: Many individuals who undergo CBT report lasting improvements in their mental well-being, even after therapy has concluded.
12. Client-Centered: CBT is a collaborative approach that respects the client’s unique experiences and strengths, promoting a sense of ownership in the therapeutic process.

CBT has consistently demonstrated its effectiveness in helping individuals manage and overcome a wide range of mental health challenges. Keep reading to learn CBT activities and exercises you can do with your clients.

What Conditions Can CBT Treat?

While CBT was originally created to help individuals living with depressive symptoms, it has evolved over the past 7 decades. Hofmann et al. demonstrated that CBT has the strongest efficacy support for working with individuals who are struggling with:

• Anger control problems
• Anxiety Disorders
• Bipolar
• Borderline Personality Disorder
• Bulimia
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder
• Somatoform Disorders
• Overall life stress concerns

With that being said, CBT can be used to treat a variety of other mental health concerns as well. 

List of CBT Activities and Exercises

Counselors who use CBT often find that bringing CBT exercises into sessions can be impactful. This can be a great way to introduce new information and new skills to our clients. Cognitive Behavioral Therapy exercises can be used in both group and individual therapy settings.

Examples of Cognitive Behavioral Therapy activities that can be included in clinical sessions include:

1. Some clients benefit from having access to mindfulness worksheets that can walk them through mindfulness practices outside of counseling sessions. This can include a thought-dumping exercise, observing how they feel before and after a mindfulness exercise, and writing down their goals and priorities.
2. Explore the difference between information gathering and reassurance seeking. If your client can identify with needing reassurance, explore where this need is coming from in their life. Is there an area of their life that they are not confident or sure about? Do they have a history of trauma, abuse, or neglect that is influencing their behaviors?
3. Spend time reviewing and exploring your client’s core beliefs. Spend time talking about how our core beliefs impact our mental health. Using a CBT Core Beliefs worksheet template can provide your client with a visual aid showing their core beliefs.
4. Spend time exploring what your client’s anxiety has kept them from doing. What are some things that they would like to be able to do, that they have not been able to do? Use this as an opportunity to review their experience with cognitive distortions and unhealthy thoughts.
5. Spend time introducing cognitive distortions to your client, and review common distortions. Allow the client to identify with examples that they can relate to. You can then move into the process of thought challenges and provide tools that they can utilize when they recognize cognitive distortions.
6. Introduce your client to the acronym PAUSE (Pause, Activity, Understand, Soothe, and Exhale). Spend time practicing the associated steps in session, and encourage your client to use them when they begin to notice their anxiety or worry outside of their session. Allow time to review your client’s experience using it.
7. Provide your client with a list of enjoyable activities and hobbies. Ask your client to identify 1-2 new activities or hobbies that they would be willing to try. Allow time to follow up regarding their experience in future sessions.
8. For clients who experience catastrophizing, using a decatastrophizing worksheet can help clients evaluate their thoughts related to an event or situation that is provoking anxiety symptoms. TherapyPatron offers a worksheet that breaks down the process by identifying the event, the specific fear or worry present, and evaluating the evidence supporting or disproving the worry.
9. Clients who experience panic attacks can benefit from using a panic attack diary worksheet to note specific details of their experience. This allows them to bring the worksheet into a session to review and process. Additionally, clients may benefit from holding onto their diary entries to review their progress.
10. If you have a client who is struggling with setting, planning, or working towards goals, it may be beneficial to review helpful goal-setting strategies. This includes breaking larger goals into smaller, and more manageable tasks and being mindful of realistic expectations. You can then spend time exploring a current goal that they have or to formulate a new goal they can work towards.
11. Explore your clients experience with negative self-talk. How does their inner voice speak to them, and how has this impacted them? Explore ways that your clients can challenge their negative self-talk and replace these thoughts with those that show more compassion and kindness.
12. Encourage your client to practice gratitude daily, specifically identifying 3 things daily that they are grateful for. Encourage them to bring their lists into the session.
13. Spend time exploring how your client’s behaviors make them feel. Explore behaviors that are associated with pleasurable feelings, as well as distressing emotions.
14. Introduce your client to thought records. Working through a thought record worksheet, like the CBT Thought Record worksheet available from TherapyPatron, can help clients become familiar with the patterns of their thoughts. This would include noting the event that led to the thought, negative automatic thoughts that they experienced, and the evidence they have that supports the thoughts. You can encourage clients to complete 2-3 thought records in between sessions that will be reviewed in their next session.
15. Spend time reviewing the use of grounding skills and how they can help us cope with the emotional distress we feel. Ask your client to focus on their environment, by using their senses. Encourage your client to use grounding skills outside of their session to review their usefulness in managing their distress.
16. Spend time reviewing breathing exercises that can help clients manage stressful moments. This can include pranayama breathing, lengthening their exhale, abdomen breathing, breath focus, and box breathing. Encourage your client to use these breathing exercises outside of the session and talk about their experience in future sessions.
17. Introduce your client to meditation practices. Similarly to mindfulness, there has been an influx of information regarding mindfulness practices which may have impacted your clients understanding of it. Take time to explore their perception of meditation, and fill in any gaps that they may be missing. Set time aside to practice different forms of meditation. Keep in mind that some clients, especially those with a history of trauma, may struggle to sit and/or close their eyes during a meditation exercise.
18. If your client is feeling anxious while in your presence, ask them where they feel anxious within their body. Encourage your client to stay present at the moment, and work with you to evaluate the distressing thoughts they are feeling. This allows them to recognize if their symptoms are appropriate for their concern. Once you evaluate their thoughts, check in on their current experience with anxiety within their body.
19. Spend time reviewing the three-component model of emotions associated with CBT. This would include discussing how our thoughts have a direct impact on how we feel, which is often influencing our behaviors. You can walk through this model with a real-life example that your client has experienced. Additionally, you can use this as an opportunity to discuss when it would be most impactful to use CBT strategies.
20. Introduce your client to mindfulness. With the attention that mindfulness has gotten on various media platforms, they may have their own understanding or expectation of mindfulness. Allow for time to explore their understanding of mindfulness, and how mindfulness skills can help manage anxiety and other mental health symptoms.

Final Thoughts on Choosing the Right CBT Activities

Thank you for reading our resource on 20 CBT activities and exercises you can do with your clients in therapy. Cognitive Behavioral Therapy activities can provide counselors with an opportunity to educate clients about the mental health concern that they are struggling with and how they can work towards managing their distress in a healthy manner. Additionally, your client has an opportunity to practice skills associated with CBT activities that they can apply to their real-life experiences.

Cognitive Behavioral Therapy is one of the go-to therapeutic approaches for Counselors due to the positive impact it can have on our client’s well-being. It is important to remember that we are ethically bound to practice within the limits of our knowledge and experience. If you would like to learn more about Cognitive Behavioral Therapy exercises and how they can fit into your clinical work, speak with a supervisor or colleague about available opportunities that can build your skill set. 

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

Resources:

Hofmann, S.G., Asnaani, A., Vank, I.J.J., Sawyer, A., & Fang, A. (2012) The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 42-44.  Doi:10.1007/s10608-12-9476-1. 

Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.