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9 CBT Worksheets and Tools for Anxiety and Depression
CBT is one of the most effective psychological treatments when it comes to managing anxiety and depression, and can be a highly useful approach to apply in online therapy.
If you help clients tackle cognitive distortions and unhelpful thinking styles, we’ve compiled a list of essential worksheets that should be part of your therapy toolbox.
How To Use CBT Worksheets in Therapy
Cognitive-behavioral therapy (CBT) is based on the idea that thoughts, feelings, physical sensations and behaviors are interlinked, and that changing negative thought patterns can enhance the way we act and feel.
It encompasses a variety of techniques and interventions that have been proven effective in the treatment of many mental disorders.
Besides anxiety and depression, a few examples include: [1]
- Panic disorder
- Bipolar disorder
- Borderline personality disorder, and
- Obsessive-compulsive disorder.
With the advent of online therapy, guided online CBT has become an increasingly popular way for mental health professionals to help clients manage behavioral health conditions without the need to meet in person as often.
CBT worksheets, exercises, and activities play a large role in these treatments to encourage further progress between sessions, in the same way that face-to-face CBT involves between-session practice. [2]
The Importance of Tailoring CBT Worksheets to Individual Needs
While CBT worksheets are effective tools, it is crucial to tailor these resources to the unique needs of each client.
Every individual’s experience with anxiety and depression is different, and a one-size-fits-all approach may not be as effective. Personalization involves understanding the specific triggers, thought patterns, and behaviors of a client.
For instance, a client struggling with social anxiety may benefit more from worksheets focusing on exposure and social skills training, while someone with generalized anxiety disorder might need tools aimed at managing worry and improving relaxation techniques.
Customizing worksheets also means considering the client’s cultural background, personal preferences, and level of cognitive functioning.
This tailored approach not only enhances the therapeutic alliance but also ensures that the interventions are more impactful, leading to better outcomes.
Therapists should regularly review and adjust the worksheets to keep them relevant and aligned with the client’s progress and evolving needs.
5 Example Tools For Treating Anxiety
So what types of online CBT worksheets can be used to help clients cope better with symptoms of anxiety ?
There is a wide spectrum of therapeutic approaches that range from self-help activities to guided interventions, and all of them focus on identifying and changing unhelpful thoughts, feelings, and behaviors.
Here are a few of the best-known techniques that can be applied with the right tools.
Identifying cognitive distortions
Recognizing and identifying maladaptive automatic thoughts is a main goal of CBT.
Recognizing and identifying maladaptive automatic thoughts is a main goal of CBT. Cognitive distortions describe inaccurate or exaggerated perceptions, beliefs, and thoughts that can contribute to or increase anxiety, so increasing a client’s awareness of these is the first step to unraveling them and feeling better.
Quenza’s Unhelpful Thinking Styles – “Shoulding” and “Musting” worksheet, shown below, is an example exercise that can help clients recognize the damaging impacts of using “should” and “must” statements to place unreasonable demands or unnecessary pressure on themselves.
Cognitive restructuring
Cognitive restructuring involves disputing the distortions that underpin a client’s challenges. Various techniques that can be helpful here include Socratic questioning, decatastrophizing, and disputing troublesome thoughts with facts.
One example CBT exercise is the Cognitive Restructuring Expansion shown below, which can help clients identify automatic thoughts and substitute them with more fair, rational ways of thinking.
Journaling and thought records
Journaling is a form of self-monitoring that helps clients identify their thought patterns and emotional tendencies, as shown by the Stress Diary Expansion below.
Journals can involve logging negative thoughts or feelings as homework, with the aim of positioning clients to manage them successfully.
Stress Reduction Techniques
Stress reduction exercises such as deep breathing, meditation, and progressive muscle relaxation can all be effective CBT tools for managing anxiety.
The example below is Quenza’s Progressive Muscle Relaxation exercise, which clients can practice to increase their sense of control and calm when stressed or anxious.
Breathing Exercises
Diaphragmatic breathing is another useful relaxation exercise often used in CBT for anxiety.
With this mindfulness practice, clients learn to regulate their breath and activate their body’s relaxation response, as shown in Quenza’s audio Diaphragmatic Breathing exercise below.
CBT Worksheets for Depression (PDF)
CBT worksheets are useful resources for therapists helping clients manage depression, because they can be used to encourage your clients’ progress between sessions.
If you are a mental health professional, the following worksheets can be shared as homework. Each is available as a customizable Quenza Expansion for easy sharing with clients with a $1, 30-day Quenza trial .
The ABC Model of Helpful Behavior
ABC is an acronym for Antecedents, Behavior, and Consequences, and the ABC model proposes that behavior can be learned and unlearned based on association, reward, and punishment.
This CBT worksheet allows clients to reflect on adaptive behavior, thus building their awareness of the triggers for and consequences of this behavior.
After introducing the ABC Model of Behavior and the ABC Model of Helpful Behavior, the exercise asks clients to try it out themselves by:
- Describing a recent personal problem
- Recalling a helpful behavior that they carried out that contributed to the problem in a positive way.
- Recalling the Antecedents of the helpful Behavior – where they were, who they were with, and what they were doing, thinking, and feeling
- Considering the short- and long-term Consequences of that behavior – how they felt, what happened, and what others said or did.
Unhelpful Thinking Styles – Emotional Reasoning
This worksheet invites clients to identify and decrease the negative impact of a specific cognitive bias known as “Emotional Reasoning,” which can be common in clients with depression.
As an introduction, clients learn about the negative impacts of regarding emotions as evidence of the truth, or basing one’s view of situations, yourself, or others on how they feel at a certain moment.
They are then invited to reflect on a time when they used emotional reasoning and describe the situation as well as their thoughts and emotions at the time.
Through self-reflection, this therapy exercise aims to help the user separate their feelings from their thoughts so that they can reduce the negative effect of emotional reasoning on their wellbeing.
De-Catastrophizing
As we’ve seen, patients with symptoms of depression often experience negative thoughts that result from faulty thinking rather than accurate experiences of reality.
Catastrophizing is amplifying the importance of adverse events and situations while minimizing their positive aspects or outcomes. The Decatastrophizing Expansion can be an impactful cognitive restructuring technique to help with this cognitive distortion when it is practiced over time.
Clients are asked to describe the situation that they are currently catastrophizing about before answering a series of questions to challenge their thinking:
- What is the worst that can happen?
- What three events would have to take place for the worst to happen?
- How likely is it that all three of these events will take place?
- What is a more likely outcome, given what you know about the situation?
Here’s an example of the PDF copy that you or your clients can download of these exercises: Decatastrophizing CBT worksheet
To customize these CBT worksheets for depression and browse more, take a look at the $1, 30-day Quenza trial .
Can CBT Help Build Self Esteem?
Studies have shown CBT to be useful in developing a client’s self-esteem so that they start to perceive themselves as more worthy and deserving. [3]
Cognitive restructuring is particularly can equip them with the skills to challenge or refute negative self-talk. This involves:
- Helping clients explore repetitive negative self-talk can be damaging to their sense of self-worth
- Challenging harmful cognitive distortions
- Supporting in the development of a more balanced, positive self-perspective.
Quenza’s Challenging Unhelpful Thoughts , pictured above, is an example CBT worksheet for self-esteem with the following prompts and questions:
- Describe a negative thought that keeps coming back.
- On a scale of 1 to 10, how strongly do you believe this thought to be true?
- What evidence supports this thought?
- What evidence do you have against the thought?
- What would you tell a friend (to help them) who would have the same thought?
Integrating Technology with CBT Worksheets for Enhanced Engagement
The advent of technology has significantly transformed the landscape of psychological treatments, including CBT.
Digital tools and applications can greatly enhance the engagement and effectiveness of CBT worksheets.
Interactive platforms allow clients to complete worksheets on their devices, providing instant feedback and progress tracking.
Additionally, gamification elements, such as rewards for completing tasks or interactive scenarios, can make the therapy process more engaging and motivating for clients.
Teletherapy platforms can integrate these digital worksheets, allowing therapists to monitor their clients’ progress in real time and make adjustments as needed.
Moreover, digital tools often include additional resources like videos, guided meditations, and forums for peer support, which can complement the worksheets and provide a more holistic approach to treatment.
By leveraging technology, therapists can ensure that CBT remains a dynamic and accessible option for clients, regardless of their location or schedule.
CBT Toolbox for Online Therapists
Once you’ve found the most useful tools for your programs and are ready to start treating clients, it’s time to organize them for easy, convenient delivery.
Without a centralized library of digital materials – and the ability to quickly personalize and share them – it’s easy to spend more time than is necessary on the admin side of helping others.
With the right CBT app , you should have an entire toolbox of CBT worksheets plus the tools you need to deliver them:
- Activity design tools: for efficiently creating online CBT interventions
- Customizable templates: e.g., Quenza Expansions that include personalizable science-based exercises and activities
- Documentation tools: e.g., Quenza Notes – A secure, convenient way to create and store session notes and collaborate with clients
- Pathway builder tools: which help you assemble separate worksheets and tools into programs and mental health treatment plans
- Real-time results tracking: to securely collect and store client responses and results
- A free client app: so that clients can easily receive, complete, and return your CBT resources and assemble a library of their finished activities.
Whether you’re new to the world of online therapy or coaching or simply looking to increase your impact, our free 30-page guide is a great place to start.
This PDF will give you an easy-to-understand introduction to the essentials of digital practice: how to create and share your own CBT interventions, keep clients engaged in their treatment, and improve your clients’ results while growing and scaling your business.
Click here to download your copy of Coach, This Changes Everything .
Final Thoughts
Practicing CBT online for the first time may take some adapting, but the ability to help more clients with less work is always worth the payoff.
Hopefully, these worksheets and resources give you a solid starting point for building your CBT toolkit. Let your fellow practitioners know how you use them – leave a comment and join in the conversation below!
- ^ NHS. (2022). Overview - Cognitive behavioural therapy (CBT). Retrieved from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
- ^ Harvard Health Publishing. (2015). Online cognitive-behavioral therapy: The latest trend in mental health care. Retrieved from https://www.health.harvard.edu/blog/online-cognitive-behavioral-therapy-the-latest-trend-in-mental-health-care-201511048551
- ^ McKay, M., & Fanning, P. (2016). Self-esteem. New Harbinger.
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- Valued Living Questionnaire (Version 2) | Wilson, Groom | 2002 Download Archived Link
- Scale Download Primary Link Archived Link
- Scale Download Primary Link
- Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786.
- Scale Download Archived Link
- Hamilton M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry, 23, 56–62.
- MADRS Score Card Download Archived Link
- Montgomery, S.A., Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134 (4): 382–89.
- Scale phqscreeners.com Download Primary Link
- Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric annals, 32(9), 509-515.
- Scale – Adult Download Primary Link Archived Link
- Scale – Child Age 11-17 Download Primary Link Archived Link
- Reference Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12(1), 63-70.
- Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome scale. Comprehensive psychiatry, 49(2), 131-140.
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- Mood And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Trimingham | 2011 Download Primary Link
- The Path to Positivity: Six Practical Sections for Becoming a More Positive Person | Caroline Lavelock, Everett Worthington | 2013 Download Primary Link Archived Link
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- Metacognitive Training For Depression (D-MCT) Manual | Jelinek, Schneider, Hauschild, Moritz | 2023 Download Primary Link Archived Link
- Suicide and self injury: a practitioners guide | Forensic Psychology Practice Ltd | 1999 Download Archived Link
- Depression In Adults: Treatment And Management (NICE Guideline) | NICE | 2022 Download Primary Link
- Behavioural activation treatment for depression (BATD) manual | Lejuez, Hopko & Hopko | 2001 Download Archived Link
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- Cognitive-behavioral therapy for depression in young people: a modular treatment manual | Orygen | 2015 Download Primary Link Archived Link
- Depression In Adults: Recognition And Management | National Institute for Health and Care Excellence (NICE) guidelines | 2009 Download Primary Link Archived Link
- Individual therapy manual for cognitive-behavioural treatment of depression | Ricardo Muñoz, Jeanne Miranda | 1996 Download Primary Link Archived Link
- Manual for group cognitive-behavioral therapy of major depression: a reality management approach (Instructor’s manual) | Muñoz, Ippen, Rao, Le, Dwyer | 2000 Download Primary Link
- Cognitive-Behavioural Therapy (CBT) Group Program For Depression | Milner, Tischler, DeSena, Rimer Download Primary Link Archived Link
- Cognitive behaviour therapy for depression in young people: manual for therapists | Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) Study CBT Sub-Group | 2010 Download Primary Link Archived Link
- CBT For Depression In Veterans And Military Service Members – Therapist Manual | Wenzel, Brown, Carlin | 2011 Download Primary Link Archived Link
- Group therapy manual for cognitive behavioral treatment of depression | Muñoz, Miranda | 1993 Download Archived Link
- Behavioural activation treatment for depression – revised (BATD-R) manual | Lejuez, Hopko, Acierno, Daughters, Pagoto | 2011 Download Archived Link
- Symptoms of Depression Download Primary Link Archived Link
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Recommended Reading
- Behavioural activation treatment for depression: returning to contextual roots | Jacobson, Martell, Dimidjian | 2001 Download Primary Link Archived Link
What Is Depression?
Signs and symptoms of depression.
To meet DSM-5 diagnostic criteria for major depressive disorder an individual must have experienced five of the following symptoms for at least two weeks:
- a depressed mood that is present most of the day, nearly every day
- diminished interest in activities which were previously experienced as pleasurable
- fatigue or a loss of energy
- sleep disturbance (insomnia or hypersomnia)
- feelings of worthlessness, self-reproach, or excessive guilt
- a diminished ability to think or concentrate, or indecisiveness
- recurrent thoughts of death or suicide, or suicidal behavior
- changes in appetite marked by a corresponding weight change
- psychomotor agitation or retardation to a degree which is observable by others
Psychological Models and Theory of Depression
Beck’s cognitive theory of depression (Beck, Rush, Shaw, & Emery, 1979) forms the basis for cognitive behavioral approaches for the treatment of depression. Beck’s theory proposes that there are different levels of cognition that can be dysfunctional in depression: core beliefs, rules and assumptions, and negative automatic thoughts. CBT aims to balance negatively biased cognition with more rational and accurate thoughts, beliefs, and assumptions. CBT also systematically aims to increase levels of rewarding activity.
Acceptance and commitment therapy (ACT) proposes that distress, including symptoms of depression, are the result of psychological inflexibility (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Indicators of psychological inflexibility include:
- ‘buying in’ to negative thoughts and narratives;
- engaging in worry or rumination that takes us away from the present moment;
- losing contact with our values—what is important to us.
Evidence-Based Psychological Approaches for Working with Depression
Many psychological therapies have an evidence base for working with depression:
- Cognitive behavioral therapy (CBT)
- Behavioral activation (BA)
- Acceptance and commitment therapy (ACT)
- Mindfulness-based cognitive therapy (MBCT) for preventing relapse
- Interpersonal therapy (IPT)
Resources for Working with Depression
Psychology Tools resources available for working therapeutically with depression may include:
- psychological models of depression
- information handouts for depression
- exercises for depression
- CBT worksheets for depression
- self-help programs for depression
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford Press.
- Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy , 44 (1), 1–25.
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They want to help, but they don't know where to begin. The Supporting Someone with Depression worksheet describes several practical and meaningful ways to support someone who is battling depression. Tips... Download therapy worksheets, resources, and tools for depression. Handouts include activities, education, and CBT tools for overcoming ...
2 Group Therapy Worksheets. Delivering CBT in a group therapy format is sometimes recommended for those who may benefit from a group to relate to when dealing with symptoms and situations specific to depression.. Individuals may also benefit from group cohesion and can potentially use the group as an arena for challenging their negative thoughts and behavior (Thimm & Antonsen, 2014).
During Depression: (1) If I avoid challenges, I'll be okay, but if I try to do hard things I'll fail. (2) If I avoid asking for help, my incompetence won't show but if I do ask for help, people will see how incompetent I am. SITUATION #2 Thinking of asking son for help in revising resume SITUATION #1 Thinking about bills SITUATION #3
Cognitive-Behavioral Therapy Worksheets (PDFs) To Print and Use. If you're a therapist looking for ways to guide your client through treatment or a hands-on person who loves to learn by doing, there are many cognitive-behavioral therapy worksheets that can help. 1. Coping styles worksheet.
Here are nine common CBT techniques for depression: 2. 1. Cognitive Restructuring. In challenging your thought patterns, tone, and self-talk, you learn about potential cognitive distortions and unhealthy thought patterns that could be increasing depressive emotions or suicidal thoughts.
As with anxiety, there is a range of practical CBT homework activities that aid in treating depression. It should be noted that it is common for clients experiencing symptoms of depression to report concentration and memory deficits as reasons for not completing homework assignments (Garland & Scott, 2005).
CBT can help you to learn ways to stop spiraling down into feelings of depression. This illustration shows that "giving in" to the "slowed-down" feeling that often comes with depression leads to a . downward spiral: do less, feel worse, do even less, etc. In therapy, you will learn ways of stopping this
As a homework task for clients to complete. As a stand-alone intervention or ongoing part of therapy. Treatments That Work™ Authored by leading psychologists including David Barlow, Michelle Craske, and Edna Foa, Treatments That Work™ is a series of workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books ...
worksheet. 20. The cognitive triangle illustrates how thoughts, emotions, and behaviors affect one another. This idea forms the basis of cognitive behavior therapy (CBT). Perhaps most important to CBT, when a person changes their thoughts, they will also change their emotions and behaviors. By targeting irrational or maladaptive thoughts, mood ...
Embark on a transformative journey toward emotional well-being by exploring our free online Cognitive Behavioral Therapy workbook tailored to address anxiety and depression. This comprehensive resource is designed to empower you with practical CBT interventions and exercises rooted in evidence-based therapeutic techniques. Dive into a self ...
9 CBT Worksheets and Tools for Anxiety and Depression. CBT is one of the most effective psychological treatments when it comes to managing anxiety and depression, and can be a highly useful approach to apply in online therapy. If you help clients tackle cognitive distortions and unhelpful thinking styles, we've compiled a list of essential ...
CBT helps you identify and challenge negative thought patterns that contribute to depression. Cognitive behavioral therapy (CBT) is a widely used and effective treatment for several psychiatric ...
The cognitive triangle illustrates how thoughts, emotions, and behaviors affect one another. This idea forms the basis of cognitive behavior therapy (CBT). Perhaps most important to CBT, when a person changes their thoughts, they will also change their emotions and behaviors. By targeting irrational or maladaptive thoughts, mood and behavior ...
Depression is characterized by an extended period of low mood, anhedonia, and reduction in activity. Dysthymia (persistent depressive disorder) is characterized by a depressed mood that occurs for most of the day, more days than not, and has been present for at least two years. Depression is a heterogeneous condition with many different ...
CBT Worksheets for Depression and Anxiety Cognitive-Behavioral Therapy ( CBT ) is a form of psychotherapy that combines cognitive therapy with behavioral therapy (Westbrook et al., 2011). It examines the relationship between a person's thoughts, feelings, and behaviors and helps individuals to understand and alter negative patterns.
Depression. (Client Handouts) Actions I Took to Feel Better. Activity Scheduling - At Home Practice Sheet. Activity Scheduling - At Home Practice Sheet - Spanish Version. CBT+ Getting Active Homework Sheet.
Cognitive behavioral therapy (CBT) is known to be a highly effective approach to mental health treatment. One factor underlying its success is the homework component of treatment.
A session-to-session examination of homework engagement in cognitive therapy for depression: Do patients experience immediate benefits?. Behaviour Research and Therapy, 72, 56-62. Kazantzis, N., & L'Abate, L. (2006). Handbook of homework assignments in psychotherapy: Research, practice, and prevention. New York, NY: Springer.
36. Save. Teach your clients to challenge their negative thoughts and self-talk using this CBT worksheet. In this worksheet your client will be asked to take a step back and consider their situation and thoughts from a new perspective, such as that from a friend. Each question is designed to lead your client to look at their negative thoughts ...
Cognitive-Behavioral Therapy has "been shown to be as effective as medications in the treatment of a number of psychiatric illnesses" (Tang & Kreindler, 2017, p. 1). ... Clients who complete their homework assignments progress better than those who don't (Beck, 2011). ... Homework ideas for depression and anxiety: 3 Exercises ...