Cognitive Behavioral Therapy, commonly referred to as CBT, is one of the most commonly used treatment modalities by mental health professionals. CBT was initially developed to treat individuals who were struggling with depression by Aaron Beck, in the 1960s. 

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. Keep reading to learn about 20 CBT exercises and activities you can do with your clients in therapy.

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:

Anxiety Disorders

Somatoform Disorders

Bulimia

Anger control problems

Overall life stress concerns

With that being said, CBT can be used to treat a variety of other mental health concerns as well. This can include bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. These mental health concerns can benefit from CBT; however, they may not have the same impact that the previously identified concerns can have. 

List of Cognitive Behavioral Therapy Exercises & Activities

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:

 Introduce your client to thought records. Working through a thought record worksheet, like the CBT Thought Record worksheet available from TherapyByPro, 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.

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.

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.

Spend time exploring how your client’s behaviors make them feel. Explore behaviors that are associated with pleasurable feelings, as well as distressing emotions.

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.

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.

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.

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. TherapyByPro 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

Final Thoughts on Selecting CBT Activities for Your Clients

Thank you for reading our resource on 20 Cognitive Behavioral Therapy Exercises and Activities 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. 

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

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. 

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