20 Cognitive Behavioral Therapy (CBT) Exercises and Activities

Cognitive Behavioral Therapy, commonly referred to as CBT, is one of the most commonly used treatments by mental health professionals. CBT was originally developed by Aaron Beck in the 1960s to treat people struggling with depression.

Since then, the foundation laid by Aaron Beck has evolved into what is widely used in psychotherapy today. In addition, CBT has contributed to the development of other therapeutic approaches:

Cognitive Behavioral Therapy is driven by its core characteristics and beliefs. One may be that unhealthy thought patterns contribute to the mental health challenges our clients experience. Another belief is that mental health problems are related to learned patterns and unhealthy behaviors.

CBT works to improve the way our clients think, as well as change or reduce association with unhealthy behavior patterns. By focusing on these two factors, CBT confirms that you can reduce a person’s mental health problem. Keep reading to learn about 20 CBT exercises and activities you can do in therapy with your clients.

What conditions can CBT treat?

Although CBT was originally created to help people living with depressive symptoms, it has evolved over the past 7 decades. Hofmann et al. CBT has been shown to have the strongest efficacy support for working with individuals who struggle with:

• Anxiety disorders
• Somatoform disorders
• Bulimia
• Anger management problems
• General life stress concerns

However, CBT can also be used to treat other mental health problems. This may include bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. These mental health problems may benefit from CBT; however, they may not have the impact that previously identified concerns may have.

List of Cognitive Behavioral Therapy Exercises and Activities

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

Examples of Cognitive Behavioral Therapy activities that can be incorporated into clinical sessions include:

1. Familiarize your client with thought notes. Working with a thought record worksheet like the existing CBT Thought Record worksheet TherapyByPro, can help clients become familiar with their thought patterns. This involves noting the thought-provoking event, the negative automatic thoughts they are experiencing, and the evidence that supports the thoughts. You can encourage clients to complete 2-3 insight notes between sessions to be reviewed in their next session.
2. Take the time to introduce cognitive distortions to your client and review common distortions. Allow the customer to identify with examples that may be relevant. You can then move on to process thinking problems and provide tools they can use to recognize cognitive distortions.
3. Spend time reviewing and exploring your client’s core beliefs. Take time to talk about how our core beliefs affect our mental health. Usage a CBT Core Beliefs worksheet template can provide your client with a visual aid that shows their core beliefs.
4. Take the time to explore how your customer’s behavior makes them feel. Explore behaviors associated with pleasurable feelings as well as distressing feelings.
5. Take time to consider the use of core skills and how they can help us cope with the emotional distress we feel. Ask your client to pay attention to their surroundings using their senses. Encourage your client to use reasoning skills outside of the session to review their usefulness in managing their difficulties.
6. Introduce your client to the acronym PAUSE (Pause, Action, Realize, Calm, and Breathe). Take time to practice the related steps in session and encourage your client to use them outside of session when they start to feel anxious or worried. Allow time to review your customer’s experience using it.
7. Introduce your client to mindfulness. Given the attention mindfulness has received on various media platforms, they may have their own understandings or expectations of mindfulness. Give them time to explore their understanding of mindfulness and how mindfulness skills can help manage anxiety and other mental health symptoms.
8. For customers facing a disaster a decatastrophizing worksheet can help clients evaluate their thoughts about the event or situation that triggered anxiety symptoms. TherapyByPro offers a worksheet that breaks down the process by identifying the event, the specific fear or anxiety present, and evaluating the evidence that supports or refutes the anxiety.
9. Take the time to explore what your customer’s concerns are holding them back. What are the things they want to be able to do and what they can’t do? Use this as an opportunity to review their experiences with cognitive distortions and unhealthy thinking.
10. Take the time to review the three-component model of emotions associated with CBT. It involves discussing how our thoughts directly affect our feelings, which often affects our behavior. You can go through this model with a real life example that your customer is experiencing. Additionally, you can use this as an opportunity to discuss when using CBT strategies would be most effective.
11. Some customers benefit from access mindfulness worksheets can walk them through mindfulness practices outside of counseling sessions. This may include a thought-emptying exercise, observing how they feel before and after a mindfulness practice, and writing down their goals and priorities.
12. Introduce your client to meditation practices. Like mindfulness, there has been an influx of information about mindfulness practices that can influence your clients’ understanding of it. Take the time to explore their understanding of meditation and fill in the blanks. Take time to practice different forms of meditation. Remember that some clients, especially those with a history of trauma, may have difficulty sitting and/or closing their eyes during a meditation practice.
13. Take the time to review breathing exercises that can help clients manage stressful moments. This can include pranayama breathing, lengthening their breath, abdominal breathing, focusing on the breath, and box breathing. Encourage your client to use these breathing exercises outside of the session and talk about their experiences in future sessions.
14. Clients experiencing panic attacks can use a panic attack diary worksheet recording specific details of their experiences. This allows them to bring the worksheet to the session to review and process. Additionally, clients can benefit from keeping a diary to review their progress.
15. If your client is uncomfortable around you, ask them where in their body they feel uncomfortable. Encourage your client to stay in the moment and work with you to appreciate the sad thoughts they are feeling. This allows them to understand if their symptoms are relevant to their concerns. After evaluating their thoughts, check their current experiences with discomfort in their bodies.
16. If you have a client who has difficulty setting, planning, or working toward goals, it may be helpful to review helpful goal setting strategies. This includes breaking down larger goals into smaller and more manageable tasks and focusing on realistic expectations. You can then spend time exploring their current goal or formulating a new goal they can work towards.
17. Provide your client with a list of activities and hobbies they enjoy. Ask your client to identify 1-2 new activities or hobbies they are willing to try. Allow time to monitor their practice in future sessions.
18. Explore your clients’ experience of negative self-talk. How does their inner voice speak to them and how has it affected them? Explore ways your clients can challenge their negative self-talk and replace those thoughts with thoughts that show more compassion and kindness.
19. Explore the difference between gathering information and seeking reassurance. If your client can identify a need for reassurance, explore where that need comes from in their life. Is there an area in their life where they are insecure or unsure? Do they have a history of trauma, abuse, or neglect that affects their behavior?
20. Encourage your client to be grateful every day, specifically identify 3 things they are grateful for every day. Encourage them to bring their lists to the session.

Final Thoughts on Selecting CBT Activities for Your Clients

Thanks for reading our resource on 20 Cognitive Behavioral Therapy Exercises and Activities to Do in Therapy with Your Clients. Cognitive Behavioral Therapy activities can allow counselors to educate clients about the mental health issue they are struggling with and how they can work to manage their distress in a healthy way. In addition, there is an opportunity to practice skills related to CBT activities that your client can apply to real-life experiences.

Cognitive Behavioral Therapy is one of the primary therapeutic approaches for Counselors due to its positive impact 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 are interested in learning more about Cognitive Behavioral Therapy training and how it can fit into your clinical work, talk to your supervisor or colleague about the opportunities available to develop your skill set.

TherapyByPro is a program online mental health directory connecting mental health professionals with clients in need. If you are a mental health professional, you can Join our community and add your experience listing here. We have templates for assessments, practice forms, and worksheets that mental health professionals can use to facilitate their practice. Look at all of us mental health worksheets here.

Resources:

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