Mental Health

CBT – How to Use It Effectively

20 Mins read

If you don’t know anything about psychology, you’ve probably heard of cognitive-behavioral therapy.

It is a common type of therapy practiced around the world.

If you have ever worked with a mental health therapist, a counselor, or a psychiatry clinician, you are probably familiar with the concept of cognitive behavioral therapy.

If you have ever heard friends or loved ones talk about how a mental health professional helped them identify and change their unhelpful thoughts and patterns, you know about the benefits of cognitive behavioral therapy.

One of the most used tools in the psychologist’s toolkit is cognitive behavioral therapy. It can have wildly positive outcomes when put into practice.

We will explore what CBT is, how it works, and how you can apply its principles to improve your own life or the lives of your clients.

We thought you might like to download the 3 Positive CBT exercises for free. The exercises will give you a comprehensive insight into Positive CBT and will give you the tools to apply it in your therapy or coaching.

You can download the free PDF here.

What is CBT?

Our unique patterns of thinking, feeling, and behaving are significant factors in our experiences. Changing these patterns can change our experiences.

Cognitive-behavioral therapy aims to change our thought patterns, our unconscious beliefs, our attitudes, and our behavior in order to help us face difficulties and achieve our goals.

Beck was the first to use cognitive behavioral therapy. Beck was a Freudian at the time.

Beck realized how strong the link between thoughts and feelings is when he practiced psychoanalysis. He altered the therapy he practiced in order to help his clients understand and deal with the automatic, emotion-filled thoughts that came in his clients.

Beck found that cognitive therapy and behavioral techniques produced the best results for his clients. Beck laid the foundations of the most popular and influential form of therapy of the last 50 years in describing and honing this new therapy.

This form of therapy is not designed for lifelong participation and is intended to help clients meet their goals in the near future. Most treatment regimes last from five to ten months, with clients only having one 50- to 60-minute session per week.

The therapist and the client need to be invested in the process and willing to participate in it. The therapist and client work together to identify the problems the client is facing, come up with strategies for addressing them, and create positive solutions.

Cognitive Distortions

Cognitive distortions are the thoughts that are used in cognitive-behavioral therapy to reinforce negative thought patterns or emotions.

Even the most balanced thinker can be affected by some cognitive distortions.

1. Filtering

A person can ignore all of the good things in life to focus on the bad. It is a trap of dwelling on a single negative aspect of a situation even when surrounded by good things.

2. Polarized thinking / Black-and-white thinking

This cognitive distortion is all-or-nothing thinking, with no room for complexity or nuance, and everything is either black or white.

If you don’t perform well in one area, you may see yourself as a total failure, instead of just seeing that you are unskilled in another area.

3. Overgeneralization

Overgeneralization is taking a single incident or point in time and using it as the sole piece of evidence for a broad conclusion.

Someone who is overgeneralizes could bomb an important job interview and instead of brushing it off as a bad experience and trying again, they conclude that they are terrible at interviewing and will never get a job offer.

4. Jumping to conclusions

This distortion is similar to overgeneralization. jumping to conclusions is the tendency to be sure of something without any evidence at all.

We might be convinced that someone dislikes us without having any evidence, or we might be convinced that our fears will come true before we have a chance to find out.

5. Catastrophizing / Magnifying or Minimizing

This distortion involves expecting that the worst will happen or that there will be a catastrophe, based on an incident that is not as bad as it is made out to be. You may make a small mistake at work and think that it will ruin the project you are working on, that your boss will be angry, and that you will lose your job.

One could minimize the importance of positive things, such as an accomplishment at work or a desirable personal characteristic.

6. Personalization

This is a distortion where an individual believes that everything they do has an impact on other people, no matter how irrational that may be. A person with this distortion will feel like they have a bigger role in the bad things that happen around them.

A person may believe that if they were on time, everything would be fine, because they arrived a few minutes late to the meeting.

7. Control fallacies

This distortion involves feeling like everything that happens to you is either a result of external forces or your own actions. Sometimes what happens to us is due to forces we can’t control, and sometimes what it is due to our own actions, but the distortion is assuming that it is always one or the other.

We might assume that difficult coworkers are to blame for our own less-than-stellar work, or that every mistake another person makes is because of something we did.

8. Fallacy of fairness

We worry about fairness but it can be taken to extremes. Life is not always fair. The person who goes through life looking for fairness will end up unhappy.

Sometimes things will go our way and sometimes they will not, even if it seems fair.

9. Blaming

There are many ways we can explain or assign responsibility for the outcome when things don’t go our way. One way of assigning responsibility is to blame others.

Sometimes we blame others for making us feel or act a certain way, but this is a cognitive distortion. You are responsible for how you act.

10. “Shoulds”

We have implicit or explicit rules about how we should act. We are upset when others break our rules. We feel guilty when we break our own rules. Customer service representatives should always be accommodating to the customer, according to an unofficial rule.

We might get angry when we interact with a customer service representative that is not accommodating. If we have an implicit rule that we are irresponsible if we spend money on unnecessary things, we may feel guilty when we spend a small amount of money on something we don’t need.

11. Emotional reasoning

This distortion involves thinking that if we feel something, it must be true. If we feel unattractive or uninteresting in the current moment, we think we are unattractive. This cognitive distortion is related to it.

“I feel it, therefore it must be true.”

It can be difficult to see how we feel past our emotions, but we do not always know the truth.

12. Fallacy of change

The idea of expecting other people to change is a fallacy. Our happiness depends on other people and their refusal to change, even if we want it, keeps us from being happy.

This is a bad way to think because no one is responsible for our happiness.

13. Global labeling / mislabeling

This cognitive distortion is a form of generalizing, in which we generalize one or two instances or qualities into a global judgement. If we fail at a specific task, we can conclude that we are a total failure in all areas.

We may conclude that a stranger is unfriendly when he or she says something rude. Mislabeling is when you use exaggerated and emotionally loaded language such as “she abandoned her children when she left to go out with her friends.”

14. Always being right

Being wrong is unacceptable, and this distortion makes us think we must be right.

Being right is more important than the feelings of others, and we may think that being fair and objective is more important than being right.

15. Heaven’s Reward Fallacy

This distortion involves expecting that sacrifice will pay off. We may think about karma and expect that it will reward us for good deed. Feelings of bitterness are caused when we don’t receive our reward.

Many of the techniques and tools used in cognitive behavioral therapy are intended to address or reverse cognitive distortions.

9 Essential CBT Techniques and Tools

There are many techniques and tools used in cognitive behavioral therapy that can be used in everyday life. The techniques and tools listed below are some of the most effective.

1. Journaling

This technique can be used to gather information about one’s moods and thoughts. A journal can include the time of the mood, the source of it, the extent or intensity, and how we reacted.

This technique can help us to identify our thought patterns and emotional tendencies, describe them, and change.

2. Unraveling cognitive distortions

This is a goal that can be practiced without the help of a therapist. You must first become aware of the distortions that you commonly suffer in order to untangle cognitive distortions.

There are 15 categories that include harmful automatic thoughts, which are often listed in one of them.

3. Cognitive restructuring

You can begin to explore how those distortions took root once you identify the distortions you hold. You can challenge a belief that is destructive or harmful when you discover it.

If you believe that you must have a high-paying job to be a respectable person, but you are then laid off from your high-paying job, you will feel bad about yourself.

You could take an opportunity to think about what makes a person respectful instead of thinking about how bad you are.

4. Exposure and response prevention

This technique is effective for people with obsessive-compulsive disorder. You can practice this technique by exposing yourself to something that will make you want to do something, but you should refrain from doing it.

You can combine the two to understand how this technique makes you feel.

5. Interoceptive exposure

Interoceptive Exposure is meant to treat panic and anxiety. Exposure to bodily sensations is used to elicit the response. Doing so will allow new learning about the sensations, and will cause any beliefs associated with them to be activated.

It is intended to show the person that panic symptoms are not dangerous.

6. Nightmare exposure and rescripting

Those who suffer from nightmares are the ones who should be exposed to it. This technique is similar to interoceptive exposure, in that the nightmare is elicited, which brings up the relevant emotion.

The client and therapist work together to identify the desired emotion and then create a new image to accompany it.

7. Play the script until the end

This technique is useful for people who are afraid. The technique involves an individual who is vulnerable to fear or anxiety imagining the worst-case scenario.

The individual can see that the outcome will still be manageable even if everything comes to pass.

8. Progressive muscle relaxation

This is a technique that many people use. The technique is similar to the body scans and requires you to relax one muscle group at a time until your whole body is in a state of relaxation.

It can be helpful for calming nerves and soothing a busy and unfocused mind if you use audio guidance, a video, or just your own mind.

9. Relaxed breathing

This is a technique that will be familiar to practitioners of meditation. There are many ways to relax and bring regularity to your breath, including guided and unguided imagery, audio recordings, and videos. Bringing regularity and calm to your breath will allow you to approach your problems from a place of balance, facilitating more effective and rational decisions.

These techniques can be used by anyone, and they can be practiced without the supervision of a therapist. To try some of the techniques without the help of a therapist, you can use the next section for handouts and worksheets.

Cognitive-Behavioral Therapy Worksheets (PDFs) To Print and Use

There are many cognitive behavioral therapy worksheets that can help if you are a therapist looking for ways to guide your client through treatment or a hands-on person who loves to learn.

1. Coping styles worksheet

The problem is the first thing you or your client should list. You or your client will list risk factors above and then list the events that triggered them.

You list your strategies after you have defined the problems and understood why you are struggling. These are ways to deal with the effects of your problems that can be temporary. You list the advantages and disadvantages of each strategy, as well as the effectiveness of the strategies.

You move on to the next action. If your strategies are not effective against the problems and difficulties that are happening, you are told to list other strategies that may work better.

This is a way to think about what you are doing and whether it is the best way forward.

2. ABC functional analysis

ABC functional analysis is a popular technique in CBT. This technique helps you learn about yourself and what leads to specific behaviors and what consequences are associated with them.

There is a box in the middle of the page. You write down any problematic behaviors you want to analyze.

The box on the left side of the worksheet is labeled “Antecedents.” In it, you or the client can write down the factors that preceded a particular behavior. These are factors that led up to the behavior that is being considered.

The final box is labeled “Consequences.” This is where you can write down what happened when you considered the behavior. Some positive consequences can arise from many types of behaviors, even if the same behavior also leads to negative consequences.

This ABC Functional Analysis Worksheet can help you or your client to find out if certain behaviors are helpful in achieving your goals or destructive.

3. Case formulation worksheet

There are 4 P’s in case formulation.

Predisposing factors;

Precipitating factors;

Perpetuating factors; and

Protective factors

They help us understand what might be leading to a perceived problem and what can be done to prevent it.

A therapist will work with a client through a series of steps.

Predisposing factors are those external or internal that can add to the likelihood of someone developing a perceived problem. Genetics, life events, or their temperament are example treatment resistant depressions.

They work together to identify the factors that lead to the problem. They consider what perpetuaters may be keeping the problem going.

They identify protective factors to understand the client’s strengths, social supports, and adaptive behavioral patterns.

This case formulation sheet can be downloaded as a PDF.

4. Extended case formulation worksheet

The last is the subject of this worksheet. It helps you or your client address the four P factors. The process can help you connect the dots between core beliefs, thought patterns and present behavior.

The six boxes on the left of the page should be completed before moving on to the right-hand side of the worksheet.

The first box is labeled “The Problem” and it corresponds with the difficulty that your client is experiencing. You are told to write down the events or stimuli that are linked to a certain behavior.

The next box is labeled Early Experiences. You can list the experiences that you had early in life that may have contributed to the behavior.

The third box is called Core Beliefs and is related to the predisposing factor. You can write down some of your core beliefs about this behavior here. These are beliefs that are not explicit, but that you believe deep down.

The fourth box is called “Conditional assumptions/rules/attitudes.” It is where you list the rules that you adhere to, whether consciously or subconsciously. Even if the rules are not helpful or adaptive, they can still perpetuate the behavior. Rules are statements that give a judgement based on circumstances. You may have a rule that says if I don’t do something perfectly, I’m a complete failure.

The fifth box is labeled “Maladaptive Coping Strategies.” This is where you write down how well these rules are working for you. Are they helping you to be the best you can be? Are they helping you to achieve your goals?

The last box was titled Positives. This is where you can list the factors that can help you deal with the problematic behavior or thought. These can be things that help you cope when you have thought or behavior that is disrupting the pattern.

There is a flow chart on the right that you can fill out based on how these behaviors are perpetuated. You are told to think of a situation that causes a negative automatic thought and record the emotion and behavior that it causes, as well as the bodily sensations that can result. You can fill out the flow chart to see what drives your behavior.

Download our PDF Extended Case Formulation Worksheet.

5. Dysfunctional thought record

This is a great tool for people who struggle with negative thoughts and need to figure out when and why they pop up. Learning more about what makes certain automatic thoughts think is easier to reverse.

The worksheet is divided into seven columns:

There is space on the far left to write down the time and date when a thought came to mind.

The situation is listed in the second column. The user is told to describe the event that led to the thought.

The third column is for the thought. This is where the automatic thought is recorded, along with a rating of belief in the thought on a scale from zero to 100%.

The next column contains the emotion or emotions elicited by this thought, with a rating of intensity from zero to 100%.

The thought that will be addressed is called the dysfunctional thought. Maladaptive thoughts include distortions such as over-generalizing or dismissing the positive of a situation.

The user is supposed to write down alternative thoughts that are more positive and functional to replace the negative one.

The user has to write down the outcome of the exercise in the last column. Were you able to confront the thought? Did you write down a convincing alternative thought? Did your belief in the thought and intensity of your emotion go down?

Download this Dysfunctional Thought Record as a PDF.

6. Fact-checking

The Fact Checking Thoughts Worksheet is one of the best tools for recognizing that your thoughts are not necessarily true.

The lesson is at the top of the sheet.

Thoughts are not facts.

It can be hard to accept this when we are in the throes of a thought or emotion. You can fill out this one to help you realize it.

The user must decide whether the statements are fact or opinion. These statements are included.

I’m a bad person.

I failed the test.

I’m selfish.

I didn’t lend my friend money.

There is a correct answer for each of these statements. The correct answers for the statements are as follows: opinion, fact, opinion, fact.

The user can see that while we have a lot of emotionally charged thoughts, they are not all objective truths. It is possible to understand the difference between fact and opinion to challenge harmful opinions.

7. Cognitive restructuring

The use of Socratic questioning can help the user challenge irrational or illogical thoughts.

The first page of the activity has a thought bubble. You can use this space to write down a thought that is destructive or irrational.

You write down the facts that support and undermine this thought. What facts are accurate about this thought? What facts call it a question? You can use the last box to make a judgement on the thought, whether it is based on evidence or your opinion.

A mind map of Socratic Questions can be used to challenge the thought. It is easier to challenge the thought against these questions if you re- write “What I’m Thinking” in the center.

One question asks if this thought is a black-and-white situation or if reality leaves room for shades of gray. This is where you think about things like making things simple or complex, and whether you are using all-or-nothing thinking.

One person asks if you could be making false assumptions. Writing it down will make this exercise more effective.

A third bubble tells you to think about whether other people might have different interpretations of the same situation.

Next, ask yourself if you are looking at all the relevant evidence or just the evidence that supports your belief. Try to be objective.

It is helpful to ask yourself if your thought may be over-inflation of a truth. Negative thoughts are based on truth but can be past their logical boundaries.

You are told to consider whether you are entertaining this thought out of habit or if the facts support it.

Think about how this thought came to you. Was it passed on from one person to another? Is that person a reliable source of truth?

You have to identify how likely the scenario you bring up is and whether it is the worst-case scenario to complete the worksheet.

These questions encourage a deep dive into the thoughts that plague you and give you opportunities to analyze and evaluate them. If you are having thoughts that are not true, this Cognitive Restructuring Worksheet can be used to defusing them.

Some More CBT Interventions and Exercises

Have you yet had enough CBT tools and techniques? Read on for more effective exercises.

1. Behavioral experiments

These are related to thought experiments that involve a question of what if. Thought experiments are different from behavioral experiments in that you actually test out what ifs outside of your thoughts.

You can experiment with different thoughts to see if they produce the same results. You can test the thoughts.

If I am kind to myself, I will be motivated to work harder.

You would try to criticize yourself when you need to work harder and record the results. You would try to be kind to yourself and record the results. You would compare the results to see which thought was closer to reality.

These Behavioral Experiments to Test Beliefs can help you learn how to be your best self.

2. Thought records

Thought records can be used to test the validity of your thoughts. They involve gathering and evaluating evidence for and against a particular thought, allowing for an evidence-based conclusion on whether the thought is valid or not.

You may have a belief that your friend is a bad friend. You would think of all the evidence for this belief, such as “She didn’t answer the phone the last time I called” or “She canceled our plans at the last minute” She probably wouldn’t have invited me if she thought I was a bad friend.

Once you have evidence for and against, you can come up with more balanced thoughts, such as, “My friend is busy and has other friends, so she can’t always answer the phone when I call.” I will be a good friend if I am aware of this.

Thought records use logic to ward off negative thoughts and replace them with more balanced, rational thoughts.

Here’s a helpful Thought Record Worksheet to download.

3. Pleasant activity scheduling

This technique can be used to deal with depression. It involves scheduling activities that you can look forward to.

You can write down one activity per day that you will do over the next week. This can be done in a number of ways, such as watching a movie or calling a friend. It can be anything that is pleasant for you if it is not bad for you.

You can try to schedule an activity for each day that will give you a sense of mastery or accomplishment. It is great to do something pleasant, but doing something small that can make you feel accomplished may have more long-term effects.

The Pleasant Activity Scheduling Worksheet is designed to help introduce more positivity into your life.

4. Imagery-based exposure

This exercise involves thinking about a memory that made you angry and analyzing the situation.

If you had a fight with your significant other recently and they said something that was not nice, you can try to remember it in detail. You would try to identify the feelings you felt during the situation and label them.

It is possible to take away the ability to cause you to be afraid and to reduce your avoidance of situations. It takes some of the power away when you expose yourself to all of the feelings and urges you felt in the situation.

This is a useful resource for this exercise.

5. Graded exposure worksheet

This technique is relatively simple and it may sound complicated.

The way to make a situation exposure hierarchy is to list situations that you would normally avoid. Someone with severe social anxiety may avoid calling someone or asking someone out on a date.

You rate each item on a scale from 0 to 10, to see how distressed you would be if you were involved in it. Asking someone on a date may be rated a 10 on the scale, while making a phone call may be rated a 3 or 4.

You rank the situations according to their distress rating after you rated them. This will help you recognize the biggest difficulties you face, which will help you decide which items to address and what order. It is advised to start with the least distressing items and work your way up to the most distressing items.

Download our Graded Exposure Worksheet here.

A manual and a book for your own practice.

There are many books and manuals that can help you get started with CBT.

Some of the books are for the therapist only, and others are for a team or with guidance from the therapist.

There are many guides out there for helping therapists apply cognitive behavioral therapy in their work, but some of the most popular are:

A Therapist’s Guide to Brief Cognitive Behavioral Therapy is available in PDF.

The Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression was written by Ricardo F. Munoz and Jeanne Miranda.

The Community Partners in Care has a Provider’s Guidebook.

The Treatment Manual for Cognitive Behavioral Therapy for Depression was written by Jeannette Rossell, and was published by the Institute for Psychological Research.

Some of the most popular workbooks and manual for clients to use alone or with a therapist are listed.

Jeff Riggenbach wrote The CBT Toolbox: A Workbook for Clients and Clinicians.

The Community Partners in Care has a client’s guide.

The Cognitive Behavioral Workbook for Anxiety is a step-by-step program.

The Cognitive Behavioral Workbook for Depression is a step-by-step program.

Cognitive-Behavioral Therapy Skills Workbook by Barry Gregory (Amazon);

Albert Bonfil and Suraji Wagage wrote a course in online cognitive behavioral therapy.

The tools above are a good start, but there are many other manual and workbooks that can help you get started.

5 Final Cognitive Behavioral Activities

There are a few more activities and exercises that we would like to cover, so please check them out.

1. Mindfulness meditation

Helping with depression, anxiety, addiction, and many other mental illnesses can be achieved with the help of the practice of muslems.

The practice can help those suffering from harmful automatic thoughts to disengage from their thoughts and stay focused on the present.

In between therapy sessions, the use ofMindfulness meditations can be helpful to help clients ground themselves in the present moment during times of stress.

If you are a therapist who uses a method calledMindfulness-based approaches, you should find some short meditations for your clients.

You might give these to your clients as part of a toolkit they can use at their convenience, such as using the blended care platform Quenza, which allows clients to access meditations or other psychoeducational activities on-the-go via their portable devices.

2. Successive approximation

This is a name that you have probably already heard of, and it is a simple idea of breaking up large tasks into small steps.

It can be hard to see a big goal like opening a business or remodeling a house. It’s true that the goal of overcoming depression or anxiety can seem like a monumental task, so mental health treatment can be similar.

We can map out the path to success by breaking the large goal into small, easy-to-accomplish steps.

3. Writing self-statements to counteract negative thoughts

It can be difficult for someone who is new to treatment to use this technique, but it can be very effective.

It can be hard to confront a client who is plagued by negative thoughts if you have a strong belief in their thoughts. It is helpful to write down a positive thought in order to counteract negative thoughts.

If you keep hearing the thought of being worthless, try writing down a statement like “I am a person with worth” or “I am a person with potential.” It can be difficult to accept these replacement thoughts, but the more you bring out positive thoughts to counteract the negative ones, the stronger the association will be.

4. Visualize the best parts of your day

It is difficult to see that there are positive aspects of life when you are depressed. The technique of bringing to mind the good parts of your day can be a small step in the direction of recognizing the positive.

You can write down the things you are thankful for or the positive events that happen in a day in your life. The act of writing down good things can make it easier to see the positive in yourself even when you are sad.

5. Reframe your negative thoughts

It can be easy to let negative thoughts dictate your actions. If you find yourself thinking negatively when you see something new, try reframing it.

Reframing involves noticing things that make you feel positive. If you were to think of how much you hate the color of that wall, you would want to notice five things in the room that you like.

You can set your phone to remind you to stop and think of the positive things around you. This can help you to push your thoughts back into positive territory.

A Take-Home Message

In this post, we offered many techniques, tools, and resources that can be used to fight depression, anxiety, and other problems.

Many treatments depend on you and your client putting in a lot of effort. We encourage you to give these techniques a try and to think that they could work.

When we approach a potential solution with the assumption that it won’t work, we can make a self-fulfilling prophecy. It has a better chance of succeeding if we approach a potential solution with an open mind and believe that it will work.

If you are having a hard time with negative automatic thoughts, please consider these tips and techniques. If your client is struggling, encourage them to make the effort because the payoff can be better than they think.

If you are struggling with depression or suicidal thoughts, please call the number in your country.

USA: National Suicide Prevention Hotline at 1-800-273-8255;

UK: Samaritans hotline at 116 123;

The Netherlands: Netherlands Suicide Hotline at 09000767;

France has a suicide hotline at 01 45 39 40.

Protestants, Catholics, and children and youth are all reachable at the same time.

This website has a list of other suicide prevention websites.

There are people who care and there are treatments that can help.

Please let us know about your experience with the program. How did it work for you? We did not touch on any other helpful exercises or techniques in this piece. We would love to hear your thoughts.

We hope you liked it. You can download the 3 Positive CBT Exercises for free.

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