cbt types of homework

• Last edited on September 9, 2020

Homework in CBT

Table of contents, why do homework in cbt, how to deliver homework, strategies to increase confidence.

Homework assignments in Cognitive Behavioural Therapy (CBT) can help your patients educate themselves further, collect thoughts, and modify their thinking.

Homework is not something that you just assign randomly. You should make sure you:

• tailor the homework to the patient
• provide a rationale for why the patient needs to do the homework
• uncover any obstacles that might prevent homework from being done (i.e. - busy work schedule, significant neurovegetative symptoms)

Types of homework

Types of homework assignments.

You should also decide the frequency of the homework should be assigned: should it be daily, weekly?

If your patient does not do homework, that’s OK! Explore as a team, in a non-judgmental way, to explore why the homework was not done. Here are some ways to increase adherence to homework:

• Tailor the assignments to the individual
• Provide a rationale for how and why the assignment might help
• Determine the homework collaboratively
• Try to start the homework during the session. This creates some momentum to continue doing the homework
• Set up systems to remember to do the assignments (phone reminders, sticky notes
• It is better to start with easier homework assignments and err on the side of caution
• They should be 90-100% confident they will be able to do this assignment
• Covert rehearsal - running through a thought experiment on a situation
• Change the assignment - It is far better to substitute an easier homework assignment that patients are likely to do than to have them establish a habit of not doing what they had agreed to in session
• Intellectual/emotional role play - “I’ll be the intellectual part of you; you be the emotional part. You argue as hard as you can against me so I can see all the arguments you’re using not to read your coping cards and start studying. You start.”

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Homework in Cognitive Behavioral Supervision: Theoretical Background and Clinical Application

1 Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic

2 Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic

3 Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic

4 Jessenia Inc. - Rehabilitation Hospital Beroun, Akeso Holding, Beroun, The Czech Republic

Ilona Krone

5 Riga`s Stradins University, Riga, Latvia

Julius Burkauskas

6 Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania

Jakub Vanek

Marija abeltina.

7 University of Latvia, Latvian Association of CBT, Riga, Latvia

Alicja Juskiene

Tomas sollar, milos slepecky, marie ociskova.

The homework aims to generalize the patient’s knowledge and encourage practicing skills learned during therapy sessions. Encouraging and facilitating homework is an important part of supervisees in their supervision, and problems with using homework in therapy are a common supervision agenda. Supervisees are encouraged to conceptualize the patient’s lack of homework and promote awareness of their own beliefs and responses to non-cooperation. The supervision focuses on homework twice – first as a part of the supervised therapy and second as a part of the supervision itself. Homework assigned in supervision usually deals with mapping problems, monitoring certain behaviors (mostly communication with the patient), or implementing new behaviors in therapy.

Introduction

The development of competent clinical supervision is crucial to effectively training new CBT therapists and supervisors and maintaining high therapy standards throughout their careers. 1 Clinical supervision is a basis for CBT training, but there are only a few empirical evaluations on the effect of supervision on therapists’ competencies. Wilson et al 2 in their systematic review and meta-analysis, synthesized the experience and impact of supervision for trainee therapists from 15 qualitative studies. Although supervision leads to feelings of distress and self-doubts, it can effectively support supervisees in personal and professional development. It could similarly harm supervisees’ well-being, clinical work and clients’ experiences. Alfonsson et al 3 published a study to evaluate the effects of standardized supervision on rater-assessed competency in six CBT therapists under protocol-based clinical supervision. This is one of the first investigations showing that supervision affects cognitive behavioral competencies. Although several works have studied the effectiveness of supervision on the therapist’s competence and for the therapist’s work with patients in qualitative studies, 3–7 there is still a lack of studies that dealt with the importance of homework in supervision.

Homework is a vital element of cognitive behavioral therapy (CBT) which distinguishes it from many other psychotherapeutic approaches. 8–10 Patients usually participate in therapy by completing homework assignments and taking responsibility for their course.

Assigning and discussing homework is one of the basic competencies of a cognitive-behavioral therapist and a supervisor in the context of counselling, psychology, therapy, and social work. The manuscript aims to refer to homework in several settings: homework in therapy, supervision of homework in therapy, using the homework by the supervisor for the supervisee, and homework in the training of supervisors.

Homework in Therapy

While specific recommendations for the practical usage of homework have been clearly articulated since the early days of CBT, 11 , 12 practitioners state that they do not follow these recommendations. 13–15 For example, many physicians admit that they forget homework or do not focus on standard specifications when, where, how often, and how long the task should last. Often reported non-cooperation in homework assignments may be due to the practice recommendations being too strict or because students think the amount of homework they can assign is limited. 16

The Sense of Homework in the Therapy

Patients verify methods and skills they learned during the session in real situations and the natural environment. 9 , 17 Through homework, patients also test hypotheses that emerged during the session with the therapist (for example, “If I went out on the street alone, I would be so weak that I would pass out or lose control completely”). Homework help that the important part of the therapy takes place between sessions and allows the patients to become independent and manage their problems even after the end of therapy. 10 , 18 Patients learn how to raise hypotheses and test them in real-life situations. Through completing homework persistently during the therapy, patients gain skills on how to plan their activities and gain new skills, and they also collect a rich source of therapeutic diaries. The investigations advocate that adding homework to CBT increases its efficacy and that patients who constantly complete homework have better outcomes. The outcomes of four meta-analyses highlight the value of homework in CBT:

• Kazantzis et al 10 inspected 14 studies that compared results for patients allocated to CBT without or with homework. The average patient in the homework group reported better results than about 70% of controls.
• Outcomes from 16 studies 17 and an updated analysis of 23 studies 19 discovered that higher compliance led to better treatment results among patients who received homework projects during therapy.
• Kazantzis et al 20 studied the relationships between quantity (15 studies) and quality (3 studies) of the homework to treatment results. The effect sizes were medium to large, and these effects remained fairly constant in a 12-month follow-up.

Therapists strategically create homework to reduce patients’ psychopathology and encourage them to practice skills learned during therapy sessions; nevertheless, non-adherence (between 20% and 50%) remains one of the most cited reasons for decreased CBT efficacy. 21 Several reasons for non-adherence to homework might be pointed out –the therapist does not regularly discuss homework with the patient, the patient no longer considers it important and stop doing it. 9 , 22 Discussing homework also allows the therapist to strengthen the patient’s belief in their ability to achieve certain goals. 23 The fact that the patient has completed the assignment must be properly acknowledged, and then therapists discuss the quality of homework separately. 24 Good questions might be, “How did you do your homework? Were there any difficulties in fulfilling them? What kind?” Furthermore: “How can you handle these problems next time? What did you learn while completing your homework? Can it help you cope with other issues?”

How to Increase the Effectiveness of Homework in the Therapy

Homework is the most effective, and it is most likely to succeed if: 19 , 25

• Follows logically from the topics discussed during the session and uses the methods that the patient learned during the session;
• they are clearly and concretely defined, so it is easy to determine whether or to what extent the patient has been successful in fulfilling them (eg, “Leaving the house alone for at least 30 minutes every day”, not “Starting to go out alone”);
• the patient clearly understands their meaning (“To verify your belief that you will faint on the street” or “See for yourself whether your anxiety will continue to rise, remain the same or subside after a certain time”), and they believe they can achieve the goals;
• homework is formulated so that failure is impossible because, in any case, the patient will learn something useful that will help them in therapy;
• the therapist anticipates and discusses obstacles that could hinder the fulfilment of homework and plans procedures to overcome them.

An important aspect of CBT is the patient’s independence. 10 , 18 Homework is typically determined by consensus. To increase the likelihood that the patient will complete the homework, the patient and the therapist should document their assignments in writing. Additionally, it is very convenient for the patient to record the homework, typically pre-prepared. 24 These records serve as a basis for discussing homework in the next session and also allow the therapist to assess the changes achieved during therapy (“A month ago, you were able to go out alone for only half an hour and your anxiety level previously reached level ‘9’, while now you were alone outside for more than an hour and your anxiety do not exceed ‘5’ rated subjectively”).

Because the goal of therapy is to help the patient experience success, the patient’s assigned homework must be feasible. 18 , 26 On the other hand, patients should improve their ability to cope with problems and unpleasant conditions during therapy, they need to exert significant effort to overcome certain unpleasant feelings and emotions. 19 , 20

Even if therapists follow all these rules, they will unavoidably find that sometimes the patient does not complete assigned homework. 20 , 23 In this case, it is required to find out why this happened:

• whether the patient understood what the task was and what it meant
• whether mastering this exercise is important and motivated
• whether unforeseen circumstances prevented them from fulfilling it
• whether the assigned exercise was not very demanding for them in their current mental state

Therefore, therapists do not consider the non-fulfilment of homework a priori as a manifestation of resistance or lack of moral qualities on the patient’s part, then as a problem that must be solved together.

However, if, despite a thorough discussion of homework and agreement on its completion, the patient repeatedly does not even attempt to complete it, does not bring records and fails to justify non-compliance, it is necessary to return to the problem analysis and goal-setting. We need to clarify with the patient whether the problem they are currently dealing with in therapy is really the most important for them, whether the goal they seek to achieve is sufficiently desirable, and whether the therapist offers to achieve is acceptable. 9 , 20

Most practicing CBT therapists report that they use homework and consider homework important for many problems 14 and believe in the role of homework in improving therapeutic outcomes. 24 , 27 Encouraging and facilitating homework is a basic skill of a CBT therapist; therefore, it is an important part of supervision. 19 , 20 , 26 Homework needs to be carefully assigned and discussed ( Box 1 ).

Case Vignette – Discussion About Not Completing Homework with an Anxious Patient

Kazantzis et al 28 advise examining the therapeutic relationship, which significantly impacts therapy adherence, to better comprehend non-cooperation with homework assignments. Data illustrating the therapist’s homework competence and the therapy outcome 29 , 30 show that the therapist is primarily responsible for their patients’ adhering to or failing to do homework. CBT therapists exhibit many interrelated automatic thoughts, assumptions, and behaviors during sessions that affect homework use in therapy. 8 , 15 In training, common negative attitudes for therapists include: “Homework will make patients feel like school and resent!” “They will feel too controlled and limited!”; “Homework will increase some ps’ sense of vulnerability!”; or “Homework will be even more stressful for stressed patients!” Another widespread belief is that the “structure” of CBT, whose homework is important, reduces spontaneity and worsens the therapeutic relationship. 15

In addition, there is some scientific support for these views of therapists’ attitudes toward homework concerning the therapeutic process. 31 The result of these attitudes is either a complete avoidance of homework assignments in a way that is not effective and consequently maintains these beliefs. 8 For example, common behaviors require supervision, such as rapidly discussing directions at the end of a session, neglecting to repeat homework, or failing to justify while designing homework. 9 The CBT Homework Project proposed a practice model 29 that emphasizes the importance of therapist beliefs, therapist empowerment, cognitive conceptualization, and the therapeutic relationship in enhancing homework practice. 23

Theoretical and empirical support for homework assignments in CBT leads most practicing CBT therapists to at least accept in principle that regular and systematic homework assignments will benefit their patients. 8 As a result, CBT therapists favour assigning homework in therapy. However, many beginning therapists encounter problems when they start designing homework (ie, selecting tasks and discussing them with the patient), assigning homework (ie, collaborating on practical aspects of completing homework), and repeating homework in sessions. 32 Incorporating homework into therapy is often superficial, hasty, poorly done, or forgotten. 16 Therefore, problems with using homework in therapy are a common supervision agenda of practicing CBT therapists.

Personal Training and Self-Reflection of the Therapist as a Supervision Intervention

CBT training students are encouraged to conceptualize the patient’s lack of homework and promote awareness of their own beliefs and responses to non-cooperation in the CBT conceptual framework. 8 Suppose the therapist fails to develop this awareness. In that case, errors in clinical judgment may occur, adversely affecting the therapeutic relationship and course of therapy. 33 Self-exercise (practicing CBT techniques and interventions as a therapist) and self-reflection (ie, process reflection) are concepts developed by Bennett-Levy et al, 34 to operationalize a useful understanding of own processes in working with patients. CBT training students are asked to become accustomed to using self-exercise and self-reflection. In a few qualitative studies, self-exercise and self-reflection have proven to improve the therapist’s self-concept, ie, self-confidence, perceived competence in one’s abilities and belief in the effectiveness of the CBT model. 34–36 Calvert et al 37 study checked the use of meta-communication in supervision from supervisees’ perspectives using the Metacommunication in Supervision Questionnaire (MSQ). There were differences in the reported frequency with which the different types of meta-communication were used. It appears that meta-communication around difficult or uncomfortable feelings in the supervisory relationship occurs less often than other components of meta-communication. 1

Below are examples of self-exercise and self-reflective exercises. The following self-assessment is developed to shape thinking before a preliminary meeting with a supervisor. Earlier knowledge has shown that supervisees and supervisors do not always share common ideas about supervision. Therefore, the supervisee could finish this self-assessment as a homework exercise before supervision. A supervisee might want to identify conversation matters that may enable a supervisor to better comprehend their requirements and needs.

Before Starting

Questions regarding previous and desired experience in supervision.

What background information do you think your supervisor requires to understand you at the start? (This may include a curriculum vitae noting appropriate previous experience). What would be the best method to convey these details? Is there any distinction between what you desire from this placement and what you feel you need? What background details about this placement and this supervisor do you have? How does this make you feel? Exists any more information that you need? What do you want and expect your supervisor to concentrate on during supervision? What roles do you want your supervisor to play with respect to you and your work? What supervisory media do you want to experience (for example, taped, “live”, or reported)? What do you intend to do about your feelings? Consider how you feel about your supervisor evaluating your work at the end of the positioning process.

More Specific Questions

• What specific activities during supervision do you recall as being helpful?
• What conditions would be most convenient for you?
• What would you personally anticipate getting from being supervised?
• However, what would you want to receive from supervision prepared that will not be on offer?
• What could you do about this?

Several possible tough issues can appear in supervision. The following list includes concerns the supervisee might consider ( Table 1 ).

Difficulties in Previous Supervisions (Adapted According to Scaife 2019 38 )

In the next step:

• Recognize the two issues which seem to be the most important ones for you.
• What steps can be taken now to minimize the chances that these two concerns will seriously disrupt your cooperation?

Reflection on the Strengths

What are the top three strengths you want your supervisor to uncover as you enter this supervisory relationship?

List 3 points for your development that may or might not be obvious to your supervisor.

Reflection on Difficulties

Therapists regularly discover face-to-face contact with people labelled by society as coming from a specific sub-group.

Which sub-groups make you feel uneasy for whatever reason? Do you want to address this during supervision? 38

Examples of Self-Assessment in the Supervision Process

Exploring sources of stress from clinical work.

Check all that resonate for you. 39

❑ Perfectionism ❑ Fear of failure ❑ Self-doubt ❑ Need for approval ❑ Emotional depletion ❑ Unhealthy lifestyle

Which of them seems to have the greatest impact on your stress levels?

What supervisor has most regularly identified as weak points in your clinical work?

Processing Mistakes

When mistakes are processed in ways that lead to reflection, flexibility, and adjustments in how you function, it can result in learning and growth.

Consider a patient you are now working with (or have recently worked with) with whom you have experienced a therapeutic failure.

Answer the following questions while keeping this experience in mind:

• What are the signs of a therapeutic failure? How can you be certain that what you are doing is not beneficial on some level? What benefits might your patient derive from failure? When did things begin to deteriorate? Which initiatives have been most effective so far, and which have been least effective? How have you been careless?
• Examine your intervention choices as well as how they were carried out:
• What concerns or considerations did you overlook? What is impeding your ability to be more effective? How has your empathy and compassion for this individual been harmed? How can you use this experience to help you grow?

Reflection of Therapeutics Mastery Skills

Favorite techniques.

• Explain three things you have put off in your career or life because they appear risky—you have something to lose and gain.
• Which therapeutic strategies or interventions stimulate you the most?
• What would you call your “hidden weapon”?
• What kind of patients or presenting difficulties interest you the most?
• What would it take to incorporate more of the pleasure and satisfaction you receive when applying the strategies mentioned earlier into other aspects of your work? 39

The following examples from clinical supervision demonstrate how self-exercise and self-reflection can help participants understand their belief system’s impact on homework in CBT.

Supervision of Homework in Therapy

Supervision is classically mandatory for students in cognitive behavioral training and plays a crucial part in therapist development. 2 The typical structure of continuous supervision of one patient includes discussing questionnaires or scales used to measure the severity of the problem (like the Beck depression inventory), homework, events in therapy since the last session, and then discussing the agenda of the current supervision meeting (what will be done in the session, which problem will be addressed), work on a selected issue or problems, homework assignment, session summary and its evaluation by the supervisor. The supervision focuses on homework twice – first as a part of the supervised therapy and second as a part of the supervision itself ( Box 2 ).

Case Vignette – Discussion About Patient´s Homework During Supervision

Whether and how the patient completes homework is a common supervisory issue ( Box 3 ). The therapist often complains that the patient refuses to do homework or rarely does it. 8 , 16

Recording of Paul’s Automatic Thoughts

The picture describes the vicious circle of countertransference reaction, where automatic thoughts lead to developing negative emotions, bodily reactions and behaviors. Any vicious circle components can alert the therapists that their countertransference reaction is taking place.

Case Vignette –Discussion of Setting Homework During Supervision

Homework in Supervision

Homework assignments are a common part of supervisory work. These may involve the patient’s management (eg noticing on their recording how often the therapist strengthens the patient and how and if it is rare to clarify where reinforcement would be appropriate), working on oneself (eg clarifying experiences and attitudes that lead to countertransference in a particular patient, awareness of which other patients may also occur) and theoretical study (the supervisor may advise the therapist to read a professional text that can help better understand and work with the patient). 40

The supervisor helps define a specific engagement, discusses specific therapeutic methods, touches on what methods the therapist has used and what else they may consider the role, for the most part, the implementation of strategies whose ability to use in therapy under supervision will be planned, as part of homework.

Homework assigned in supervision usually deals with mapping problems (supplementing the conceptualization of the case, evaluation, vicious circle of the problem with the patient, etc.), monitoring certain behaviors (mostly communication with the patient), or implementing new, behaviors in therapy (usually using therapeutic strategies). 12 Homework teaches the supervisee to work on self-reflection outside the supervision meetings. 41 Discussing the homework properly at the beginning of the session is important. The mentioned home exercises usually concern the work with the supervised case report of the patient. The basic questions concern homework results, discussing the obstacles in solving them and what the supervisee learned in homework. 8 The discussion gives the supervisor case management information and can point to important practice moments.

Homework Assignment

Before the end of the session, the supervisor and the supervisee agree on a homework assignment. It is optimal when homework arises from a problem addressed in the session’s main part. 8 At the beginning of supervision, proposals for homework assignments usually come from the supervisor and are discussed and recorded in writing. 40 During supervision, the supervisee creates homework assignments, and the content is discussed with the supervisee.

The Meaning of Homework

Homework must make sense for the supervisee; otherwise, he will have no motivation to do it. However, it is also important to make sense of the patient or patients and develop the therapist’s skills and competencies. It is desirable to discuss the meaning of homework in supervision.

Possible Difficulties When Completing Homework

It is advantageous to discuss the anticipated difficulties in completing homework. This has the advantage that the supervisee can prepare for possible difficulties, consider overcoming them and consult with the supervisor. Discussing difficulties helps the supervisee model and later develops the skill to discuss the patient’s homework difficulties.

The Impact of the Therapist’s Belief System

In some therapists, there can be reasons for a more complex level of conceptualization. 42 That is important when the therapist repeats certain mistakes even though they have repeatedly discussed them with the supervisor. At a directly accessible level, the situation with the patient can be described using a vicious circle. The deeper “hidden” level refers to the core beliefs and conditional rules activated in a specific situation with the patient. 40 , 43 A supervisor can use the “falling arrow” technique to map core beliefs and conditional assumptions. 43

One such way is the Therapeutic Belief System (TBS). 44 TBS is a theoretical model useful for understanding the specific beliefs, assumptions, and behaviors that therapists and patients commonly experience that could potentially affect the course of therapy. In line with the cognitive model, TBS provides a framework for identifying therapists’ and patients’ beliefs about themselves, each other, the treatment process, the emotions these beliefs can evoke, and typical behavioral reactions. For example, a therapist may see a patient as an “aggressor”, a “helpless victim”, or a “collaborator”. The participant’s own beliefs may supplement these beliefs about himself, such as “victim”, “co-worker”, “carer”, or “rescuer”. Homework assignments may be perceived by both the therapist and the patient as “hopeless”, “productive”, or simply maintaining the status quo and lead to a different emotional and behavioral response. 8 Thus, TBS can be introduced into supervision to guide the supervisee to consider whether he or she identifies with any of the therapists’ typical beliefs and behaviors outlined in the model. A simple awareness of such patterns can be a useful orientation when considering the role of attitudes and beliefs in integrating homework ( Box 4 ).

Case Vignette – Discussion About Supervisee Homework

The scheme broadly refers to mental structures that integrate and give meaning to events. 45 Schemes can be positive, negative or neutral. In CBT as a treatment for psychological disorders, we focus on dysfunctional patterns often associated with specific diagnostic presentations (for example, emotional vulnerability patterns are common in anxiety disorders). Schema is generally defined as a ubiquitous topic of cognitive functions, emotions, physiological feelings about oneself, and relations with others. 33

Therapists’ schemes run in specific therapies and do not usually signal mental health problems. 8 Therapists’ schemes are influenced by the following factors: training experiences, such as supervision and training phase, therapy model, peer group, clinical experience, and personal experience. 13 , 40 Once identified, the therapist’s scheme can be used in supervision as a starting point to discuss some of the practitioner’s views that may interfere with therapy. 8 Completing structured questionnaires can identify participants’ schemes, basic beliefs, and assumptions. Some examples of useful questionnaires are the Dysfunctional Attitudes Scale, 46 the Personal Faith Questionnaire, 47 the Young Schema Questionnaire 48 and the Therapists’ Schema Questionnaire. 49 Leahy’s Therapists’ Scheme Questionnaire is a relatively straightforward screening technique for identifying therapeutic patterns that could affect a therapeutic relationship. It consists of 46 assumptions related to the 14 most common therapeutic regimens.

Certain schemes are particularly common in CBT supervisees. These include “demanding standards”, “excessive self-sacrifice”, and “special superior person”. 49 Training therapists who identify with the “demanding standards” scheme have a somewhat obsessive, perfectionist, and controlling approach to therapy. These therapists usually have high expectations for keeping a patient’s homework and may not realize that non-compliance with homework is often part of the learning process. Therapists may expect that there is a “right” way to complete a homework assignment, leading to feelings of frustration when assignments produce different results. This may signify insecurity and a notion that if things break from the planned structure, the therapist will be exposed as “incompetent”. Many therapists identify with the “excessive self-sacrifice” pattern, the most commonly observed pattern in both novice and experienced therapists. 33 Leahy 49 proposes that these therapists overstate the importance of their patient relationships. They may fear leaving or feel guilty that they are or feel better than the patient. As a result, the therapist may engage in therapy-defeating behaviors, such as making the homework assignment to the patient’s various needs, having difficulty with appropriate assertiveness in discussing persistent patient non-cooperation, and having a tendency to avoid techniques. Such as exposure or opening of painful memories for fear that the patient will be upset.

Novice therapists who identify with the “special superior person” scheme see the therapeutic situation as an opportunity to achieve excellent results and have high-performance expectations. There may be a tendency for the patient to idealize or, conversely, to devalue or distance himself from patients who do not improve or do their homework. The presence of a “special superior” scheme can be seen as overcompensation in response to “demanding standards” and “excessive self-sacrifice”, which have the thematic connotations of “not being good enough”. The supervision session sets the supervisee in a situation where the supervisor supervises homework through videotaped therapeutic sessions utilizing a cognitive therapy scale (CTS). 50 Feelings of superiority and exceptionality can, in some cases, be a way of dealing with the feelings of inferiority that they experience, that their use of homework is judged in this way.

In addition to recognizing the general responses to the scheme that most training students encounter, the supervisor should help the supervisor become aware of his or her idiosyncratic beliefs and coping styles, which some patients may trigger ( Box 5 ). The supervisor should encourage the supervisee to pay special attention to the “overlapping patterns” in which the therapist’s scheme and the patient’s scheme overlap, leading to the over-identification of the therapist with the patient. 33

Case Vignette – The Supervisor Advises the Therapist to Work with Core Beliefs and Conditional Rules

Homework in Supervisor Training

For supervisors, their supervisors’ training is important. An important part of this training is the practice of self-reflection, which should be requested directly in the meeting and as homework. It can be a task to capture situations in supervision in which they do not feel comfortable using the vicious circle, cognitive restructuring of automatic negative thoughts in these situations, capturing thoughts, emotions, bodily sensations and behaviors in situations where they are aware that they are experiencing countertransference reactions to the supervised therapist. It is also important that in their homework, they reflect on their concentration level during supervision sessions and consider what supervision skills they have used or what they have learned for the next session. A typical complex homework in supervision training is a video recording of supervision sessions and their analysis. The recorded supervision and analysis are then analyzed in the next supervision training meeting.

This article is designed as an overview of views and experiences. Its important element is work samples. This is also a limitation of this article. Assignment of homework in supervision and therapist and supervisor training lacks scientific information about its effectiveness. Nevertheless, assigning homework is an important part of cognitive behavioral therapy. We know quite well about its meaning in prescribing for patients. Less is known about their meaning and effectiveness in supervision. The supervisee encounters problems completing homework assignments for her patients that she brings to the supervisee. Why the patient does not complete the homework may be his problem, but his therapist may also have a part in it his requirements, which include how the homework is assigned, its suitability for the given patient, timing, and complexity. Homework can also belong to the training of supervisors and the supervision of supervision. Here, we do not know any research evidence about their effectiveness in using the most important part of supervision, the patient; however, they are experienced by supervisors and supervisees as useful and meaningful.

Homework in supervision and supervision requires further reflection on their meaning and subsequent research, which should examine their significance for the supervisee’s competence (supervisee) and the ultimate impact on the patient himself.

Homework presents one of the cornerstones of cognitive-behavioral therapy, CB supervision and the training of CBT supervisors. If applied consistently and collaboratively, homework enhances therapeutic outcomes and increases the patient’s self-confidence. Setting and maintaining a fruitful working alliance for homework can be challenging – issues with homework present one of the common reasons to seek a supervisory consultation. Supervision then focuses on examining the specific case and experienced problems, factors in the interaction between the therapist and their patient, and the therapist’s automatic thoughts, schemas, and behaviors that might maintain the issue. There are several ways to address this topic in supervision. Homework is usually part of supervision because of its usefulness. The supervised therapist may be given similar tasks as the patient receives in therapy: to describe the automatic thoughts that occur to him while guiding the patient, to test them and look for a more rational response, to conduct behavioral experiments, to clarify the core beliefs and conditioned assumptions that influence the formation of the therapeutic relationship, experiments with adequate communication with the patient and others. A therapist’s self-experience through practice can help them improve their therapeutic work.

Acknowledgments

This paper was supported by the research grant VEGA no. APVV-15-0502 Psychological, psychophysiological and anthropometric correlates of cardiovascular diseases.

The authors report no conflicts of interest in this work.

A Comprehensive Model of Homework in Cognitive Behavior Therapy

• Original Article
• Published: 03 July 2021
• Volume 46 , pages 247–257, ( 2022 )

Cite this article

• Nikolaos Kazantzis   ORCID: orcid.org/0000-0001-9559-4160 1 , 2 &
• Allen R. Miller 2  

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This article contributes a comprehensive model of homework in cognitive behavior therapy (CBT). To this end, several issues in the definition of homework and homework compliance are outlined, research on homework-outcome relations is critiqued, before an overview of classical and operant conditioning along with various cognitive theories are tied together in a c omprehensive model. We suggest engagement represents a more clinically meaningful construct than compliance (or adherence). We describe how established behavior and cognitive theories are relevant for understanding patient engagement and what between-session and in-session processes are useful in a comprehensive model. Our primary conclusion from the review of this literature is that current research has focused on limited aspects of homework and missed theoretically meaningful determinants of engagement. Further, little research has sought to examine the role of the therapist in facilitating these theoretically meaningful determinants. The literature on homework is the most advanced of the process research in CBT; the comprehensive model presented here offers clarity for the practicing clinician and represents a testable model for researchers interested in quantifying determinants of homework engagement and the process of integrating homework into CBT.

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Kazantzis, N., Miller, A.R. A Comprehensive Model of Homework in Cognitive Behavior Therapy. Cogn Ther Res 46 , 247–257 (2022). https://doi.org/10.1007/s10608-021-10247-z

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CBT Techniques: 25 Cognitive Behavioral Therapy Worksheets

It’s an extremely common type of talk therapy practiced around the world.

If you’ve ever interacted with a mental health therapist, a counselor, or a psychiatry clinician in a professional setting, it’s likely you’ve participated in CBT.

If you’ve ever heard friends or loved ones talk about how a mental health professional helped them identify unhelpful thoughts and patterns and behavior and alter them to more effectively work towards their goals, you’ve heard about the impacts of CBT.

CBT is one of the most frequently used tools in the psychologist’s toolbox. Though it’s based on simple principles, it can have wildly positive outcomes when put into practice.

In this article, we’ll 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.

Before you read on, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with a comprehensive insight into Positive CBT and will give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is cbt, cognitive distortions, 9 essential cbt techniques and tools.

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

Some More CBT Interventions and Exercises

A cbt manual and workbook for your own practice and for your client, 5 final cognitive behavioral activities, a take-home message.

“This simple idea is that our unique patterns of thinking, feeling, and behaving are significant factors in our experiences, both good and bad. Since these patterns have such a significant impact on our experiences, it follows that altering these patterns can change our experiences” (Martin, 2016).

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

Psychiatrist Aaron Beck was the first to practice cognitive behavioral therapy. Like most mental health professionals at the time, Beck was a  psychoanalysis  practitioner.

While practicing psychoanalysis, Beck noticed the prevalence of internal dialogue in his clients and realized how strong the link between thoughts and feelings can be. He altered the therapy he practiced in order to help his clients identify, understand, and deal with the automatic, emotion-filled thoughts  that regularly arose in his clients.

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

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

CBT is a hands-on approach that requires both the therapist and the client to be invested in the process and willing to actively participate. The therapist and client work together as a team to identify the problems the client is facing, come up with strategies for addressing them, and creating positive solutions (Martin, 2016).

Many of the most popular and effective cognitive-behavioral therapy techniques are applied to what psychologists call “ cognitive distortions ,” inaccurate thoughts that reinforce negative thought patterns or emotions (Grohol, 2016).

There are 15 main cognitive distortions that can plague even the most balanced thinkers.

1. Filtering

Filtering refers to the way a person can ignore all of the positive and good things in life to focus solely on the negative. It’s the trap of dwelling on a single negative aspect of a situation, even when surrounded by an abundance of good things.

2. Polarized thinking / Black-and-white thinking

This cognitive distortion is all-or-nothing thinking, with no room for complexity or nuance—everything’s either black or white, never shades of gray.

If you don’t perform perfectly in some area, then you may see yourself as a total failure instead of simply recognizing that you may be unskilled in one 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.

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

4. Jumping to conclusions

Similar to overgeneralization, this distortion involves faulty reasoning in how one makes conclusions. Unlike overgeneralizing one incident, jumping to conclusions refers to the tendency to be sure of something without any evidence at all.

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

5. Catastrophizing / Magnifying or Minimizing

This distortion involves expecting that the worst will happen or has happened, based on an incident that is nowhere near as catastrophic as it is made out to be. For example, you may make a small mistake at work and be convinced that it will ruin the project you are working on, that your boss will be furious, and that you’ll lose your job.

Alternatively, one might 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 external events or other people, no matter how irrational that may be. A person with this distortion will feel that he or she has an exaggerated role in the bad things that happen around them.

For instance, a person may believe that arriving a few minutes late to a meeting led to it being derailed and that everything would have been fine if they were on time.

7. Control fallacies

This distortion involves feeling like everything that happens to you is either a result of purely external forces or entirely due to your own actions. Sometimes what happens to us is due to forces we can’t control, and sometimes what it’s 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 alternatively assume that every mistake another person makes is because of something we did.

8. Fallacy of fairness

We are often concerned about fairness, but this concern can be taken to extremes. As we all know, life is not always fair. The person who goes through life looking for fairness in all their experiences will end up resentful and unhappy.

Sometimes things will go our way, and sometimes they will not, regardless of how fair it may seem.

When things don’t go our way, there are many ways we can explain or assign responsibility for the outcome. One method of assigning responsibility is blaming others for what goes wrong.

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

10. “Shoulds”

“Shoulds” refer to the implicit or explicit rules we have about how we and others should behave. When others break our rules, we are upset. When we break our own rules, we feel guilty. For example, we may have an unofficial rule that customer service representatives should always be accommodating to the customer.

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

11. Emotional reasoning

This distortion involves thinking that if we feel a certain way, it must be true. For example, if we feel unattractive or uninteresting in the current moment, we think we  are unattractive or uninteresting. This cognitive distortion boils down to:

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

Clearly, our emotions are not always indicative of the objective truth, but it can be difficult to look past how we feel.

12. Fallacy of change

The fallacy of change lies in expecting other people to change as it suits us. This ties into the feeling that our happiness depends on other people, and their unwillingness or inability to change, even if we demand it, keeps us from being happy.

This is a damaging way to think because no one is responsible for our own happiness except ourselves.

13. Global labeling / mislabeling

This cognitive distortion is an extreme form of generalizing, in which we generalize one or two instances or qualities into a global judgment. For example, if we fail at a specific task, we may conclude that we are a total failure in not only that area but all areas.

Alternatively, when a stranger says something a bit rude, we may conclude that he or she is an unfriendly person in general. Mislabeling is specific to using exaggerated and emotionally loaded language, such as saying a woman has abandoned her children when she leaves her children with a babysitter to enjoy a night out.

14. Always being right

While we all enjoy being right, this distortion makes us think we must be right, that being wrong is unacceptable.

We may believe that being right is more important than the feelings of others, being able to admit when we’ve made a mistake or being fair and objective.

15. Heaven’s Reward Fallacy

This distortion involves expecting that any sacrifice or self-denial will pay off. We may consider this karma, and expect that karma will always immediately reward us for our good deeds. This results in feelings of bitterness when we do not receive our reward (Grohol, 2016).

Many tools and techniques found in cognitive behavioral therapy are intended to address or reverse these cognitive distortions.

There are many tools and techniques used in cognitive behavioral therapy, many of which can be used in both a therapy context and in everyday life. The nine techniques and tools listed below are some of the most common and effective CBT practices.

1. Journaling

This technique is a way to gather about one’s moods and thoughts. A CBT journal can include the time of the mood or thought, the source of it, the extent or intensity, and how we reacted, among other factors.

This technique can help us to identify our thought patterns and emotional tendencies, describe them, and change, adapt, or cope with them (Utley & Garza, 2011).

Follow the link to find out more about using a thought diary for journaling.

2. Unraveling cognitive distortions

This is a primary goal of CBT and can be practiced with or without the help of a therapist. In order to unravel cognitive distortions, you must first become aware of the distortions from which you commonly suffer (Hamamci, 2002).

Part of this involves identifying and challenging harmful automatic thoughts, which frequently fall into one of the 15 categories listed earlier.

3. Cognitive restructuring

Once you identify the distortions you hold, you can begin to explore how those distortions took root and why you came to believe them. When you discover a belief that is destructive or harmful, you can begin to challenge it (Larsson, Hooper, Osborne, Bennett, & McHugh, 2015).

For example, if you believe that you must have a high-paying job to be a respectable person, but you’re then laid off from your high-paying job, you will begin to feel bad about yourself.

Instead of accepting this faulty belief that leads you to think negative thoughts about yourself, with cognitive restructuring you could take an opportunity to think about what really makes a person “respectable,” a belief you may not have explicitly considered before.

4. Exposure and response prevention

This technique is specifically effective for those who suffer from obsessive-compulsive disorder (OCD; Abramowitz, 1996). You can practice this technique by exposing yourself to whatever it is that normally elicits a compulsive behavior, but doing your best to refrain from the behavior.

You can combine journaling with this technique, or use journaling to understand how this technique makes you feel.

5. Interoceptive exposure

Interoceptive Exposure is intended to treat panic and anxiety. It involves exposure to feared bodily sensations in order to elicit the response (Arntz, 2002). Doing so activates any unhelpful beliefs associated with the sensations, maintains the sensations without distraction or avoidance, and allows new learning about the sensations to take place.

It is intended to help the sufferer see that symptoms of panic are not dangerous, although they may be uncomfortable.

6. Nightmare exposure and rescripting

Nightmare exposure and rescripting are intended specifically for those suffering from nightmares. This technique is similar to interoceptive exposure, in that the nightmare is elicited, which brings up the relevant emotion (Pruiksma, Cranston, Rhudy, Micol, & Davis, 2018).

Once the emotion has arisen, the client and therapist work together to identify the desired emotion and develop a new image to accompany the desired emotion.

7. Play the script until the end

This technique is especially useful for those suffering from fear and anxiety. In this technique, the individual who is vulnerable to crippling fear or anxiety conducts a sort of thought experiment in which they imagine the outcome of the worst-case scenario.

Letting this scenario play out can help the individual to recognize that even if everything he or she fears comes to pass, the outcome will still be manageable (Chankapa, 2018).

8. Progressive muscle relaxation

This is a familiar technique to those who practice mindfulness. Similar to the body scan, progressive muscle relaxation instructs you to relax one muscle group at a time until your whole body is in a state of relaxation (McCallie, Blum, & Hood, 2006).

You can use audio guidance, a YouTube video, or simply your own mind to practice this technique, and it can be especially helpful for calming nerves and soothing a busy and unfocused mind.

9. Relaxed breathing

This is another technique that will be familiar to practitioners of mindfulness . There are many ways to relax and bring regularity to your breath, including guided and unguided imagery, audio recordings, YouTube videos, and scripts. 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 (Megan, 2016).

These techniques can help those suffering from a range of mental illnesses and afflictions, including anxiety, depression, OCD, and panic disorder, and they can be practiced with or without the guidance of a therapist. To try some of these techniques without the help of a therapist, see the next section for worksheets and handouts to assist with your practice.

How does cognitive behavioral therapy work – Psych Hub

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

1. Coping styles worksheet

This PDF Coping Styles Formulation Worksheet instructs you or your client to first list any current perceived problems or difficulties – “The Problem”. You or your client will work backward to list risk factors above (i.e., why you are more likely to experience these problems than someone else) and triggers or events (i.e., the stimulus or source of these problems).

Once you have defined the problems and understand why you are struggling with them, you then list coping strategies. These are not solutions to your problems, but ways to deal with the effects of those problems that can have a temporary impact. Next, you list the effectiveness of the coping strategies, such as how they make you feel in the short- and long-term, and the advantages and disadvantages of each strategy.

Finally, you move on to listing alternative actions. If your coping strategies are not totally effective against the problems and difficulties that are happening, you are instructed to list other strategies that may work better.

This worksheet gets you (or your client) thinking about what you are doing now and whether it is the best way forward.

2. ABC functional analysis

One popular technique in CBT is ABC functional analysis . Functional analysis helps you (or the client) learn about yourself, specifically, what leads to specific behaviors and what consequences result from those behaviors.

In the middle of the worksheet is a box labeled “Behaviors.” In this box, you write down any potentially problematic behaviors you want to analyze.

On the left side of the worksheet is a box labeled “Antecedents,” in which you or the client write down the factors that preceded a particular behavior. These are factors that led up to the behavior under consideration, either directly or indirectly.

On the right side is the final box, labeled “Consequences.” This is where you write down what happened as a result of the behavior under consideration. “Consequences” may sound inherently negative, but that’s not necessarily the case; 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 whether particular behaviors are adaptive and helpful in striving toward your goals, or destructive and self-defeating.

3. Case formulation worksheet

In CBT, 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 a perceived problem to arise, and what might prevent them from being tackled effectively.

In this worksheet, a therapist will work with their client through 4 steps.

First, they identify predisposing factors, which are those external or internal and can add to the likelihood of someone developing a perceived problem (“The Problem”). Examples might include genetics, life events, or their temperament.

Together, they collaborate to identify precipitating factors, which provide insight into precise events or triggers that lead to “The Problem” presenting itself. Then they consider perpetuating factors, to discover what reinforcers may be maintaining the current problem.

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

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These detailed, science-based exercises will equip you or your clients with tools to find new pathways to reduce suffering and more effectively cope with life stressors.

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4. Extended case formulation worksheet

This worksheet builds on the last. It helps you or your client address the “Four P Factors” described just above—predisposing, precipitating, perpetuating, and protective factors. This formulation process can help you or your client connect the dots between core beliefs, thought patterns, and present behavior.

This worksheet presents six boxes on the left of the page (Part A), which should be completed before moving on to the right-hand side of the worksheet (Part B).

• The first box is labeled “The Problem,” and corresponds with the perceived difficulty that your client is experiencing. In this box, you are instructed to write down the events or stimuli that are linked to a certain behavior.
• The next box is labeled “Early Experiences” and corresponds to the predisposing factor. This is where you list the experiences that you had early in life that may have contributed to the behavior.
• The third box is “Core Beliefs,” which is also related to the predisposing factor. This is where you write down some relevant core beliefs you have regarding this behavior. These are beliefs that may not be explicit, but that you believe deep down, such as “I’m bad” or “I’m not good enough.”
• The fourth box is “Conditional assumptions/rules/attitudes,” which is where you list the rules that you adhere to, whether consciously or subconsciously. These implicit or explicit rules can perpetuate the behavior, even if it is not helpful or adaptive. Rules are if-then statements that provide a judgment based on a set of circumstances. For instance, you may have the rule “If I do not 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 (or not). Are they helping you to be the best you can be? Are they helping you to effectively strive towards your goals?
• Finally, the last box us titled “Positives.” This is where you list the factors that can help you deal with the problematic behavior or thought, and perhaps help you break the perpetuating cycle. These can be things that help you cope once the thought or behavior arises or things that can disrupt the pattern once it is in motion.

On the right, there is a flow chart that you can fill out based on how these behaviors and feelings are perpetuated. You are instructed to think of a situation that produces a negative automatic thought and record the emotion and behavior that this thought provokes, as well as the bodily sensations that can result. Filling out this flow chart can help you see what drives your behavior or thought and what results from it.

Download our PDF Extended Case Formulation Worksheet .

5. Dysfunctional thought record

This worksheet is especially helpful for people who struggle with negative thoughts and need to figure out when and why those thoughts are most likely to pop up. Learning more about what provokes certain automatic thoughts makes them easier to address and reverse.

The worksheet is divided into seven columns:

• On the far left, there is space to write down the date and time a dysfunctional thought arose.
• The second column is where the situation is listed. The user is instructed to describe the event that led up to the dysfunctional thought in detail.
• The third column is for the automatic thought. This is where the dysfunctional automatic thought is recorded, along with a rating of belief in the thought on a scale from 0% to 100%.
• The next column is where the emotion or emotions elicited by this thought are listed, also with a rating of intensity on a scale from 0% to 100%.
• Use this fifth column to note the dysfunctional thought that will be addressed. Example maladaptive thoughts include distortions such as over-inflating the negative while dismissing the positive of a situation, or overgeneralizing.
• The second-to-last column is for the user to write down alternative thoughts that are more positive and functional to replace the negative one.
• Finally, the last column is for the user to write down the outcome of this exercise. Were you able to confront the dysfunctional thought? Did you write down a convincing alternative thought? Did your belief in the thought and/or the intensity of your emotion(s) decrease?

Download this Dysfunctional Thought Record as a PDF.

6. Fact-checking

One of my favorite CBT tools is this  Fact Checking Thoughts Worksheet because it can be extremely helpful in recognizing that your thoughts are not necessarily true.

At the top of this worksheet is an important lesson:

Thoughts are not facts.

Of course, it can be hard to accept this, especially when we are in the throes of a dysfunctional thought or intense emotion. Filling out this worksheet can help you come to this realization.

The worksheet includes 16 statements that the user must decide are either fact or opinion. These statements include:

• I’m a bad person.
• I failed the test.
• I’m selfish.
• I didn’t lend my friend money when they asked.

This is not a trick—there is a right answer for each of these statements. (In case you’re wondering, the correct answers for the statements above are as follows: opinion, fact, opinion, fact.)

This simple exercise can help the user to see that while we have lots of emotionally charged thoughts, they are not all objective truths. Recognizing the difference between fact and opinion can assist us in challenging the dysfunctional or harmful opinions we have about ourselves and others.

7. Cognitive restructuring

This worksheet employs the use of Socratic questioning, a technique that can help the user to challenge irrational or illogical thoughts.

The first page of the worksheet has a thought bubble for “What I’m Thinking”. You or your client can use this space to write down a specific thought, usually, one you suspect is destructive or irrational.

Next, you write down the facts supporting and contradicting this thought as a reality. What facts about this thought being accurate? What facts call it into question? Once you have identified the evidence, you can use the last box to make a judgment on this thought, specifically whether it is based on evidence or simply your opinion.

The next page is a mind map of Socratic Questions which can be used to further challenge the thought. You may wish to re-write “What I’m Thinking” in the center so it is easier to challenge the thought against these questions.

• One question asks whether this thought is truly a black-and-white situation, or whether reality leaves room for shades of gray. This is where you think about (and write down) whether you are using all-or-nothing thinking, for example, or making things unreasonably simple when they are complex.
• Another asks whether you could be misinterpreting the evidence or making any unverified assumptions. As with all the other bubbles, writing it down will make this exercise more effective.
• A third bubble instructs you to think about whether other people might have different interpretations of the same situation, and what those interpretations might be.
• Next, ask yourself whether you are looking at all the relevant evidence or just the evidence that backs up the belief you already hold. Try to be as objective as possible.
• It also helps to ask yourself whether your thought may an over-inflation of a truth. Some negative thoughts are based in truth but extend past their logical boundaries.
• You’re also instructed to consider whether you are entertaining this negative thought out of habit or because the facts truly support it.
• Then, think about how this thought came to you. Was it passed on from someone else? If so, is that person a reliable source of truth?
• Finally, you complete the worksheet by identifying how likely the scenario your thought brings up actually is, and whether it is the worst-case scenario.

These Socratic questions encourage a deep dive into the thoughts that plague you and offer opportunities to analyze and evaluate those thoughts. If you are having thoughts that do not come from a place of truth, this Cognitive Restructuring Worksheet can be an excellent tool for identifying and defusing them.

How is positive cognitive-behavioral therapy (CBT) different from traditional CBT?

Although both forms of CBT have the same goal of bringing about positive changes in a client’s life, the pathways used in traditional and positive CBT to actualize this goal differ considerably. Traditional CBT, as initially formulated by Beck (1967), focuses primarily on the following:

• Analyzing problems
• Lessening what causes suffering
• Working on clients’ weaknesses
• Getting away from problems

Instead, positive CBT, as formulated by Bannink (2012), focuses mainly on the following:

• Finding solutions
• Enhancing what causes flourishing
• Working with client’s strengths
• Getting closer to the preferred future

In other words, Positive CBT shifts the focus on what’s right with the person (rather than what’s wrong with them) and on what’s working (rather than what’s not working) to foster a more optimistic process that empowers clients to flourish and thrive.

In an initial study comparing the effects of traditional and Positive CBT in the treatment of depression, positive CBT resulted in a more substantial reduction of depression symptoms, a more significant increase in happiness, and it was associated with less dropout (Geschwind et al., 2019).

Haven’t had enough CBT tools and techniques yet? Read on for additional useful and effective exercises.

1. Behavioral experiments

These are related to thought experiments, in that you engage in a “what if” consideration. Behavioral experiments differ from thought experiments in that you actually test out these “what ifs” outside of your thoughts (Boyes, 2012).

In order to test a thought, you can experiment with the outcomes that different thoughts produce. For example, you can test the thoughts:

“If I criticize myself, I will be motivated to work harder” versus “If I am kind to myself, I will be motivated to work harder.”

First, you would try criticizing yourself when you need the motivation to work harder and record the results. Then you would try being kind to yourself and recording the results. Next, you would compare the results to see which thought was closer to the truth.

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

2. Thought records

Thought records are useful in testing the validity of your thoughts (Boyes, 2012). 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.

For example, you may have the belief “My friend thinks I’m 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,” and evidence against this belief, like “She called me back after not answering the phone,” and “She invited me to her barbecue next week. If she thought I was a bad friend, she probably wouldn’t have invited me.”

Once you have evidence for and against, the goal is to 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. If I am understanding of this, I will truly be a good friend.”

Thought records apply the use of logic to ward off unreasonable negative thoughts and replace them with more balanced, rational thoughts (Boyes, 2012).

Here’s a helpful Thought Record Worksheet to download.

3. Pleasant activity scheduling

This technique can be especially helpful for dealing with depression (Boyes, 2012). It involves scheduling activities in the near future that you can look forward to.

For example, you may write down one activity per day that you will engage in over the next week. This can be as simple as watching a movie you are excited to see or calling a friend to chat. It can be anything that is pleasant for you, as long as it is not unhealthy (i.e., eating a whole cake in one sitting or smoking).

You can also try scheduling an activity for each day that provides you with a sense of mastery or accomplishment (Boyes, 2012). It’s great to do something pleasant, but doing something small that can make you feel accomplished may have more long-lasting and far-reaching effects.

This simple technique can introduce more positivity into your life, and our Pleasant Activity Scheduling Worksheet is designed to help.

4. Imagery-based exposure

This exercise involves thinking about a recent memory that produced strong negative emotions and analyzing the situation.

For example, if you recently had a fight with your significant other and they said something hurtful, you can bring that situation to mind and try to remember it in detail. Next, you would try to label the emotions and thoughts you experienced during the situation and identify the urges you felt (e.g., to run away, to yell at your significant other, or to cry).

Visualizing this negative situation, especially for a prolonged period of time, can help you to take away its ability to trigger you and reduce avoidance coping (Boyes, 2012). When you expose yourself to all of the feelings and urges you felt in the situation and survive experiencing the memory, it takes some of its power away.

This Imagery Based Exposure Worksheet is a useful resource for this exercise.

5. Graded exposure worksheet

This technique may sound complicated, but it’s relatively simple.

Making a situation exposure hierarchy involves means listing situations that you would normally avoid (Boyes, 2012). For example, someone with severe social anxiety may typically avoid making a phone call or asking someone on a date.

Next, you rate each item on how distressed you think you would be, on a scale from 0 to 10, if you engaged in it. For the person suffering from severe social anxiety, asking someone on a date may be rated a 10 on the scale, while making a phone call might be rated closer to a 3 or 4.

Once you have rated the situations, you rank them according to their distress rating. This will help you recognize the biggest difficulties you face, which can help you decide which items to address and in what order. It’s often advised to start with the least distressing items and work your way up to the most distressing items.

Download our Graded Exposure Worksheet here.

Some of these books are for the therapist only, and some are to be navigated as a team or with guidance from the therapist.

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

• A Therapist’s Guide to Brief Cognitive Behavioral Therapy by Jeffrey A. Cully and Andra L. Teten (PDF here );
• Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression by Ricardo F. Munoz and Jeanne Miranda (PDF here );
• Provider’s Guidebook: “Activities and Your Mood” by Community Partners in Care (PDF here );
• Treatment Manual for Cognitive Behavioral Therapy for Depression by Jeannette Rosselló, Guillermo Bernal, and the Institute for Psychological Research (PDF here ).

Here are some of the most popular workbooks and manuals for clients to use alone or with a therapist:

• The CBT Toolbox: A Workbook for Clients and Clinicians by Jeff Riggenbach ( Amazon );
• Client’s Guidebook: “Activities and Your Mood” by Community Partners in Care (PDF here );
• The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by William J. Knaus and Jon Carlson ( Amazon );
• The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program by William J. Knaus and Albert Ellis ( Amazon );
• Cognitive-Behavioral Therapy Skills Workbook by Barry Gregory ( Amazon );
• A Course in CBT Techniques: A Free Online CBT Workbook  by Albert Bonfil and Suraji Wagage (online here ).

There are many other manuals and workbooks available that can help get you started with CBT, but the tools above are a good start. Peruse our article: 30 Best CBT Books to Master Cognitive Behavioral Therapy for an excellent list of these books.

1. Mindfulness meditation

Mindfulness can have a wide range of positive impacts, including helping with depression, anxiety, addiction, and many other mental illnesses or difficulties.

The practice can help those suffering from harmful automatic thoughts to disengage from rumination and obsession by helping them stay firmly grounded in the present (Jain et al., 2007).

Mindfulness meditations, in particular, can function as helpful tools for your clients in between therapy sessions, such as to help ground them in the present moment during times of stress.

If you are a therapist who uses mindfulness-based approaches, consider finding or pre-recording some short mindfulness meditation exercises for your clients.

You might then share these with your clients as part of a toolkit they can draw on at their convenience, such as using the blended care platform Quenza (pictured here), which allows clients to access meditations or other psychoeducational activities on-the-go via their portable devices.

2. Successive approximation

This is a fancy name for a simple idea that you have likely already heard of: breaking up large tasks into small steps.

It can be overwhelming to be faced with a huge goal, like opening a business or remodeling a house. This is true in mental health treatment as well, since the goal to overcome depression or anxiety and achieve mental wellness can seem like a monumental task.

By breaking the large goal into small, easy-to-accomplish steps, we can map out the path to success and make the journey seem a little less overwhelming (e.g., Emmelkamp & Ultee, 1974).

3. Writing self-statements to counteract negative thoughts

This technique can be difficult for someone who’s new to CBT treatment or suffering from severe symptoms, but it can also be extremely effective (Anderson, 2014).

When you (or your client) are being plagued by negative thoughts, it can be hard to confront them, especially if your belief in these thoughts is strong. To counteract these negative thoughts, it can be helpful to write down a positive, opposite thought.

For example, if the thought “I am worthless” keeps popping into your head, try writing down a statement like “I am a person with worth,” or “I am a person with potential.” In the beginning, it can be difficult to accept these replacement thoughts, but the more you bring out these positive thoughts to counteract the negative ones, the stronger the association will be.

4. Visualize the best parts of your day

When you are feeling depressed or negative, it is difficult to recognize that there are positive aspects of life. This simple technique of bringing to mind the good parts of your day can be a small step in the direction of recognizing the positive (Anderson, 2014).

All you need to do is write down the things in your life that you are thankful for or the most positive events that happen in a given day. The simple act of writing down these good things can forge new associations in your brain that make it easier to see the positive, even when you are experiencing negative emotions.

5. Reframe your negative thoughts

It can be easy to succumb to negative thoughts as a default setting. If you find yourself immediately thinking a negative thought when you see something new, such as entering an unfamiliar room and thinking “I hate the color of that wall,” give reframing a try (Anderson, 2014).

Reframing involves countering the negative thought(s) by noticing things you feel positive about as quickly as possible. For instance, in the example where you immediately think of how much you hate the color of that wall, you would push yourself to notice five things in the room that you feel positively about (e.g., the carpet looks comfortable, the lampshade is pretty, the windows let in a lot of sunshine).

You can set your phone to remind you throughout the day to stop what you are doing and think of the positive things around you. This can help you to push your thoughts back into the realm of the positive instead of the negative.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

In this post, we offered many techniques, tools, and resources that can be effective in the battle against depression, anxiety, OCD, and a host of other problems or difficulties.

However, as is the case with many treatments, they depend on you (or your client) putting in a lot of effort. We encourage you to give these techniques a real try and allow yourself the luxury of thinking that they could actually work.

When we approach a potential solution with the assumption that it will not work, that assumption often becomes a self-fulfilling prophecy. When we approach a potential solution with an open mind and the belief that it just might work, it has a much better chance of succeeding.

So if you are struggling with negative automatic thoughts , please consider these tips and techniques and give them a shot. Likewise, if your client is struggling, encourage them to make the effort, because the payoff can be better than they can imagine.

If you are struggling with severe symptoms of depression or suicidal thoughts, please call the following number in your respective country:

• USA: National Suicide Prevention Hotline at 988;
• UK: Samaritans hotline at 116 123;
• The Netherlands: Netherlands Suicide Hotline at 09000767;
• France: Suicide écoute at 01 45 39 40 00;
• Germany: Telefonseelsorge at 0800 111 0 111 or 0800 111 0 222

For a list of other suicide prevention websites, phone numbers, and resources, see this website .

Please know that there are people out there who care and that there are treatments that can help.

Please let us know about your experiences with CBT in the comments section. If you’ve tried it, how did it work for you? Are there any other helpful exercises or techniques that we did not touch on in this piece? We’d love to know your thoughts.

We hope you enjoyed this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy , 27 (4), 583-600.
• Anderson, J. (2014, June 12). 5 Get-positive techniques from cognitive behavioral therapy. Retrieved from http://www.everydayhealth.com/hs/major-depression-living-well/cognitive-behavioral-therapy-techniques/
• Arntz, A. (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy , 40 (3), 325-341.
• Bannink, F. (2012).  Practicing positive CBT: From reducing distress to building success . John Wiley & Sons.
• Beck, A. T. (1967). Depression. Hoeber-Harper.
• Boyes, A. (2012, December 6). Cognitive behavioral therapy techniques that work: Mix and match cognitive behavioral therapy techniques to fit your preferences. Retrieved from https://www.psychologytoday.com/blog/in-practice/201212/cognitive-behavioral-therapy-techniques-work
• Chankapa, N. P. (2018). Effectiveness of cognitive behavioral therapy on depression and self-efficacy among out-patient female depressants in Sikkim  (Masters dissertation). Retrieved from http://14.139.206.50:8080/jspui/bitstream/1/6059/1/nancy%20chankpa.pdf
• Davis, R. (2019, March 6). The complete list of cognitive behavioral therapy (CBT) techniques. Retrieved from https://www.infocounselling.com/list-of-cbt-techniques/
• Emmelkamp, P. M., & Ultee, K. A. (1974). A comparison of “successive approximation” and “self-observation” in the treatment of agoraphobia. Behavior Therapy, 5 (5), 606–613.
• Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy.  Behaviour research and therapy, 116 , 119-130.
• Grohol, J. (2016). 15 Common cognitive distortions. Retrieved from https://psychcentral.com/lib/15-common-cognitive-distortions/
• Hamamci, Z. (2002). The effect of integrating psychodrama and cognitive behavioral therapy on reducing cognitive distortions in interpersonal relationships. Journal of Group Psychotherapy, Psychodrama & Sociometry ,  55 (1), 3–14.
• Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine , 33 (1), 11-21.
• Larsson, A., Hooper, N., Osborne, L. A., Bennett, P., & McHugh, L. (2016). Using brief cognitive restructuring and cognitive defusion techniques to cope with negative thoughts. Behavior Modification , 40 (3), 452-482.
• Martin, B. (2016). In-depth: Cognitive behavioral therapy.  Retrieved from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/
• McCallie, M. S., Blum, C. M., & Hood, C. J. (2006). Progressive muscle relaxation. Journal of Human Behavior in the Social Environment , 13 (3), 51-66.
• Pathak, N. (Ed.). (2018). Does cognitive behavioral therapy treat depression? Retrieved from https://www.webmd.com/g00/depression/guide/cognitive-behavioral-therapy-for-depression/
• Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2018). Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares. Psychological trauma: theory, research, practice, and policy , 10 (1), 67-75.
• Psychology Tools. (n.d.). Retrieved from https://www.psychologytools.com/
• Therapist Aid. (n.d.). Retrieved from https://www.therapistaid.com/
• Utley, A., & Garza, Y. (2011). The therapeutic use of journaling with adolescents. Journal of Creativity in Mental Health , 6 (1), 29-41.

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Thanks for providing in-depth information on cognitive behavioral therapy techniques.

Loved the article. This was very useful, and very much appreciate all the free resources you included. Mahalo!

I am a nurse and a holistic life coach and these resources were very helpful to revise and improve my practice!

This is ridiculous. More ad than content. Misleading title.It is not a free website that you flood the viewers with so many ads. And if you are making so much money through ads then make the entire content free , since it is for the betterment of patients with mental health

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Thank you for the work put into this amazing article! It encompasses every bit of CBT that is so useful for clients increasing their understanding of how “this” works in a very well-written tone. Well done!

Thank you for the useful material that is free of charge. It will come in handy especially the providers guidebook “activities and your mood” for my client who has been diagnosed with depression.

It is very informative, keep up the good work

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3 Positive CBT Exercises (PDF)

CBT Session Structure and Use of Homework

Importance of Time Management

The importance of promoting resilience and avoiding dependence makes it vital to manage time well, in terms of both individual sessions and the course of sessions as a whole. For example, many agencies that provide CBT may offer a limited number of sessions (perhaps from six to 12).

This means that careful planning is required to ensure that the client is clinically safe to leave at the end of each session and – in particular – at the end of the full course of sessions.

Having limited time can be used in a positive way to focus the client on working hard to collaborate with the therapist and to explore their own thoughts, feelings and behaviours. It is ethically appropriate to explain to the client that CBT is a gradual process that will help them take incremental steps towards changing their thoughts, emotions and behaviours.

Session Agenda

Structure is one of Bordin’s (1979) triad of elements of CBT. As well as the idiosyncratic formulation – often seen as the ‘backbone’ of CBT treatment, and displayed between therapist and client (e.g. on a table where each can see it clearly) during sessions – another key tool in structuring CBT is the session agenda.

The session agenda is agreed collaboratively at the start of each session, based on items that the therapist and client wish to include. It is helpful to relate the structure of each session to the formulation. This also has a role in supporting the client’s education in the CBT model. Key items would typically be:

• following up homework completed since the previous session
• briefly reviewing the client’s experience since then
• practising CBT tasks.

As the BABCP emphasises, it is vital in CBT that the therapist and client work together in changing the client’s behaviours, thinking patterns or both. Because the active involvement of the client is required, it is important to set and work to an agenda, so setting out clearly the expectations of the client at every stage, making use of limited time and giving the sessions a problem-solving atmosphere.

The therapist has a responsibility to ensure that the agenda is of a manageable size, reining in client expectation if need be so that it can be achieved within the 50-minute session. As with the formulation, it is useful for both parties to be able to see the agenda during the session.

Agenda-setting also serves to strengthen the working alliance. Simmons & Griffiths (2014: 39) observe: ‘Setting the agenda together with your client underlies the general philosophy of CBT, that of active collaboration between therapist and client.’ Indeed, the therapist may even include time to obtain client feedback on the working alliance at the end of each session (by adding ‘Feedback’ to the agenda).

Use of ‘Homework’

A common feature of CBT is that the therapist sets the client ‘homework’, which is then reviewed in the next session; this aims to help clients generalise and apply their learning.

Homework in CBT refers essentially to tasks set to be completed by the client between sessions. For some clients, ‘homework’ is a word that triggers difficult memories of school days, possibly for some linked to a failure or other schema. It is therefore important to be aware of any such sensitivity in clients.

For example, if a client’s failure schema is triggered by the term ‘homework’, we might choose either to refer to it instead as ‘between-session tasks’ or to look with the client at how our use of the word is different from the way teachers used it at school – e.g. that CBT homework is always agreed (i.e. set collaboratively rather than imposed), and is about exploration and learning rather than any externally imposed expectation of outcome.

Purpose of Homework

Homework tasks are an important part of CBT practice, based on the view that client change does not come about purely as a result of in-session work – i.e. that significant effort is required by the client between sessions. In other words, there are 168 hours in the client’s week and only one of them is spent with the therapist.

Introducing the concept of homework early in therapy is also useful in getting the message across to the client that the working alliance requires significant effort and commitment from them – i.e. in promoting the understanding that the responsibility for change lies very much with them, guided by the therapist as professional facilitator.

Homework can also help enhance client autonomy, showing them they can become their own therapist using the CBT model.

Tailoring Homework to Client Needs

Homework tasks should be tailored to the client’s idiosyncratic formulation. Key points to consider are how challenging it will be for the individual client – and also how specific, practical and measurable.

When negotiating homework, we must therefore always use the core conditions and put ourselves in the client’s frame of reference. For example, we might see a small change in activity levels as perfectly manageable but this may seem huge for a depressed client.

Homework tasks should be just enough to challenge a client to extend themselves but not so much that it feels overwhelming. In the latter case, the likelihood is that the client will then simply not attempt it at all, so negating the point of the homework entirely.

It is also important to bear in mind the client’s schemas when setting homework. For example, a client with a failure schema would need very manageable tasks in the early days (with less challenge built in), while a client with a subjugation schema might agree to homework they knew to be unsuitable just to please the therapist.

Checking Homework

It is important that the therapist remembers to check homework during the next session – otherwise, the client may feel frustrated that they have invested time and energy in doing this with no apparent interest or follow-up from their counsellor.

This could detrimentally affect the bond and also lead to non-compliance with homework tasks in future. Sufficient time should be allowed in the session agenda to discuss the client’s experience of their homework tasks and learning from these.

Again, the therapist should hold in mind when evaluating homework any client schemas that may affect this. For example, a client with an unrelenting standards schema might be harsh on themselves in evaluating their achievements.

In this case, the therapist would need to tease out the client’s successes, and could use the work to help challenge the related negative automatic thoughts (e.g. filtering, all-or-nothing thinking or discounting the positive).

Free Handout Download

Non-compliance with homework.

There are many possible reasons for non-compliance with homework tasks, and exploring these is an important part of therapy. Homework non-compliance may link with schema avoidance.

For example, a client may use avoidance to protect themselves from the difficult feelings associated with a failure schema. In other words, they may think that if they don’t attempt the homework task, then at least they can’t fail at it.

Offering the client the core conditions is important in exploring the reasons for non-completion of homework tasks. Clients may initially say they have not had time, and the therapist needs to take the time to discuss their real reasons for not doing the homework. This provides a valuable opportunity for new learning about – and hence understanding of – the client’s patterns of thinking, feeling and behaving.

Bordin E (1979) ‘The generalizability of the psychoanalytic concept of the working alliance’, Psychotherapy: Theory, Research and Practice , 16, 252–260.

Simmons J & Griffiths R (2014) CBT for Beginners , Sage

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Empower Your Clients: Effective Therapy Homework Ideas Unveiled

The power of therapy homework, what is therapy homework.

Therapy homework refers to assignments or tasks that are given to clients by therapists, psychologists, coaches, or practitioners as part of the therapeutic process. These assignments are designed to be completed outside of therapy sessions and are tailored to address specific therapeutic goals and objectives.

Therapy homework can take various forms, depending on the therapeutic approach and the client’s needs. It may involve activities such as journaling, practicing mindfulness exercises, completing worksheets or thought records, engaging in self-reflection, or working on specific skills. The purpose of therapy homework is to actively involve clients in their own healing process and empower them to take ownership of their growth and development.

Benefits of Assigning Therapy Homework

Assigning therapy homework offers numerous benefits for both clients and therapists. Some of the key advantages include:

• Continuity and Reinforcement : Therapy homework provides an opportunity for clients to reinforce and apply what they have learned in therapy sessions to their daily lives. It helps to bridge the gap between sessions, ensuring that progress continues beyond the therapy room.
• Active Engagement : Engaging in therapy homework encourages clients to actively participate in their treatment. It promotes a sense of agency and responsibility, empowering clients to take an active role in their own healing journey.
• Skill Development : Therapy homework allows clients to practice and develop new skills, strategies, and coping mechanisms in real-life situations. It helps to reinforce positive changes and build resilience.
• Generalization of Learning : Through therapy homework, clients have the opportunity to generalize the insights gained in therapy to different contexts and relationships. It supports the transfer of therapeutic gains into their day-to-day lives.
• Increased Self-Awareness : Therapy homework often involves self-reflection and introspection, which can deepen clients’ self-awareness and understanding of their thoughts, emotions, and behaviors. This increased self-awareness can be a catalyst for personal growth and transformation.
• Collaborative Process : Assigning therapy homework fosters a collaborative therapeutic relationship between clients and therapists. It encourages open communication, feedback, and discussion, leading to a more effective and tailored treatment approach.

By incorporating therapy homework into the therapeutic process, therapists can enhance the effectiveness of their interventions and facilitate meaningful change in their clients’ lives.

To explore therapy homework ideas for different therapeutic needs, refer to our articles on  therapy homework assignments ,  therapy homework for anxiety ,  therapy homework for depression , and many more.

Finding the Right Therapy Homework Ideas

When it comes to assigning therapy homework,  tailoring  the activities to each individual client is essential for maximizing their engagement and progress. By customizing the homework, therapists can address specific needs and help clients work towards their therapeutic goals. Additionally, incorporating the client’s  goals and interests  into the assignments can enhance motivation and make the process more enjoyable.

Tailoring Homework to the Client

To ensure the therapy homework is effective, it’s crucial to consider the unique characteristics and preferences of each client. Tailoring the assignments involves taking into account factors such as the client’s age, cultural background, learning style, and personal circumstances.

For example, if a client is struggling with anxiety, it may be beneficial to assign homework that focuses on relaxation techniques, such as deep breathing or progressive muscle relaxation. On the other hand, a client who is working on building assertiveness skills may benefit from practicing role-plays or assertiveness exercises outside of therapy sessions.

By tailoring the therapy homework to the client’s specific needs and challenges, therapists can provide targeted support and facilitate progress towards their therapeutic goals. For more ideas on therapy homework assignments, check out our article on  therapy homework assignments .

Incorporating Client Goals and Interests

Incorporating the client’s goals and interests into therapy homework is an effective way to increase motivation and engagement. By aligning the assignments with the client’s aspirations, they are more likely to be actively involved in the therapeutic process.

For example, if a client is working towards improving their self-esteem, therapy homework could involve engaging in self-affirmation exercises or creating a self-compassion journal. If a client is interested in mindfulness, incorporating mindfulness exercises and  meditation  into the homework can be highly beneficial.

By connecting the therapy homework to the client’s personal goals and interests, therapists can foster a sense of ownership and investment in the therapeutic journey. This approach helps to create a more meaningful and impactful therapeutic experience.

Remember, therapy homework is most effective when it is tailored to the client’s individual needs and incorporates their goals and interests. By taking these factors into account, therapists can empower their clients to actively engage in their own healing process.

Therapy Homework Ideas for Different Needs

When it comes to therapy homework, tailoring the assignments to the unique needs of each client is essential. This ensures that the homework aligns with their therapeutic goals and interests. In this section, we will explore therapy homework ideas for different needs, including  Cognitive Behavioral Therapy (CBT) techniques ,  mindfulness and meditation exercises ,  journaling and writing prompts , and  creative expressive arts activities .

Cognitive Behavioral Therapy (CBT) Techniques

CBT techniques are widely used in therapy to help individuals identify and modify negative thought patterns and behaviors. Assigning CBT-based homework can provide clients with practical tools to challenge unhelpful thoughts and develop healthier coping mechanisms. Some therapy homework ideas for CBT may include:

• Thought Records : Encourage clients to keep a thought record where they write down and examine their negative thoughts, identify cognitive distortions, and reframe them with more realistic and positive alternatives.
• Behavioral Experiments : Suggest clients engage in real-life experiments to test the validity of their negative beliefs and assumptions, helping them gather evidence to challenge and modify those beliefs.
• Activity Scheduling : Encourage clients to create a schedule of activities that promote positive emotions, engagement, and a sense of accomplishment. This can help them break the cycle of negative thoughts and behaviors.

To discover more therapy homework ideas for specific topics or concerns, such as anxiety, depression, self-esteem, or assertiveness, check out our article on  therapy homework assignments .

Mindfulness and Meditation Exercises

Mindfulness and meditation exercises can be valuable homework assignments to help clients develop present-moment awareness, reduce stress, and cultivate emotional well-being. Some therapy homework ideas for mindfulness and meditation include:

• Breathing Exercises : Encourage clients to practice deep breathing exercises, focusing on their breath as it enters and leaves their body. This can help promote relaxation and reduce anxiety.
• Body Scan Meditation : Suggest clients engage in a body scan meditation, guiding their attention from head to toe, paying attention to physical sensations and releasing tension.
• Mindful Eating : Encourage clients to practice mindful eating by fully engaging their senses, savoring each bite, and paying attention to the tastes, textures, and smells of their food.

For more mindfulness and meditation exercises, along with guided scripts, consider referring to our article on  therapy homework for mindfulness .

Journaling and Writing Prompts

Journaling and writing prompts can be effective tools for self-reflection, emotional expression, and personal growth. Assigning writing exercises as therapy homework allows clients to explore their thoughts, feelings, and experiences in a safe and structured way. Some therapy homework ideas for journaling and writing prompts include:

• Gratitude Journal : Encourage clients to keep a gratitude journal, writing down three things they are grateful for each day. This practice can help shift their focus towards positive aspects of their lives.
• Letter Writing: Suggest clients write a letter to themselves, expressing self-compassion , forgiveness, or encouragement. This can be a powerful exercise for promoting self-acceptance and self-care.
• Emotional Release Writing : Encourage clients to engage in free-writing, allowing their thoughts and emotions to flow onto the paper without judgment or self-censorship. This can be a cathartic exercise for emotional processing.

To explore more journaling and writing prompts for therapy homework, consider referring to our article on  therapy homework for journaling .

Creative Expressive Arts Activities

Engaging in creative expressive arts activities can provide clients with a unique and alternative way to explore their emotions, enhance self-expression, and gain insights into their inner world. Some therapy homework ideas for creative expressive arts activities include:

• Art Therapy : Encourage clients to engage in art therapy exercises, such as drawing, painting, or collaging, to express their emotions and access their subconscious mind.
• Music Therapy : Suggest clients create a playlist of songs that resonate with their emotions and help them process their feelings, or encourage them to engage in music improvisation as a form of expression.
• Drama Therapy : Encourage clients to engage in role-playing exercises or create and act out scenes to explore different perspectives and gain insights into their own experiences.

For additional therapy homework ideas for creative expressive arts activities, refer to our article on  therapy homework for self-expression .

By incorporating therapy homework ideas that align with the specific needs and interests of each client, therapists can empower their clients to actively participate in their own healing journey and make progress towards their therapeutic goals.

Implementing Effective Therapy Homework

To ensure the effectiveness of therapy homework assignments, it is crucial to follow certain guidelines. This section will discuss three key aspects of implementing effective therapy homework:  providing clear instructions ,  setting realistic expectations , and  encouraging accountability and follow-up .

Providing Clear Instructions

When assigning therapy homework, it is essential to provide your clients with clear and concise instructions. Clearly outline the purpose of the assignment, the specific tasks or exercises involved, and any guidelines or resources they may need. Using simple and straightforward language will help ensure that your clients understand what is expected of them.

Additionally, consider providing written instructions or  therapy homework worksheets  that your clients can refer to as they complete their assignments. This will serve as a helpful reminder and guide, increasing the likelihood of successful completion.

Setting Realistic Expectations

Setting realistic expectations is crucial when assigning therapy homework. Take into account your clients’ individual circumstances, such as their available time, resources, and personal commitments. Tailor the assignments to their specific needs and abilities to ensure they can be realistically accomplished within the given timeframe.

By setting achievable goals, you will motivate your clients and increase their confidence in their ability to complete the assignments. This, in turn, will enhance their engagement and overall progress during therapy.

Encouraging Accountability and Follow-up

Encouraging accountability and follow-up is essential for effective therapy homework. Regularly check in with your clients to inquire about their progress and address any challenges or questions they may have. This demonstrates your support and commitment to their growth.

Encourage your clients to keep a record of their experiences, insights, or reflections related to their therapy homework. This can be in the form of a journal, a digital document, or even a dedicated  therapy homework app  that allows them to track their progress and thoughts.

By reviewing their completed assignments and discussing their experiences during therapy sessions, you can provide valuable feedback and insights. This feedback will reinforce their efforts and help them integrate their learnings into their daily lives.

Remember to offer encouragement and praise for your clients’ hard work and dedication. Celebrate their achievements, no matter how small, as it will motivate them to continue their therapeutic journey.

As you implement these strategies for effective therapy homework, you will empower your clients to actively engage in their healing process. Providing clear instructions, setting realistic expectations, and encouraging accountability and follow-up will ensure that therapy homework becomes a valuable tool for their growth and progress.

Enhancing Client Engagement

When it comes to therapy homework,  client engagement  is vital for effective progress and positive outcomes. Building a supportive relationship, offering feedback and encouragement, and addressing challenges and concerns are key elements in fostering client engagement .

Building a Supportive Relationship

Establishing a supportive and trusting relationship with clients is essential for effective therapy. Creating a safe and non-judgmental environment allows clients to feel comfortable sharing their thoughts, emotions, and experiences. Actively listening, demonstrating empathy, and validating their feelings are effective ways to build rapport and foster a strong therapeutic alliance.

By developing a supportive relationship, clients are more likely to engage in therapy homework willingly and openly. They will feel understood, respected, and motivated to actively participate in their therapeutic journey.

Offering Feedback and Encouragement

Providing feedback and encouragement throughout the therapy process can significantly enhance client engagement. Regularly acknowledging their progress, recognizing their efforts, and celebrating their achievements can boost their motivation and self-confidence.

Offering constructive feedback that highlights their strengths and areas of improvement can help clients gain valuable insights. It’s essential to provide feedback in a compassionate and non-judgmental manner, ensuring that clients feel supported and encouraged to continue their growth.

Addressing Challenges and Concerns

Therapy is not always a smooth journey, and clients may encounter challenges or have concerns along the way. As a therapist, it is crucial to address these issues promptly and effectively. Actively listen to their concerns, validate their emotions, and work collaboratively to find solutions.

By addressing challenges and concerns, clients will feel heard and supported, which promotes their engagement in therapy. Whether it’s modifying therapy homework assignments, exploring different strategies, or adjusting treatment goals, adapting the therapy process to meet their specific needs can enhance client engagement and overall therapeutic outcomes.

Remember, client engagement is a dynamic process that requires ongoing attention and effort. By building a supportive relationship, offering feedback and encouragement, and addressing challenges and concerns, therapists can empower their clients and create a collaborative therapeutic environment. This environment promotes active engagement in therapy homework and facilitates positive change.

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Cognitive Behavioral Therapy (CBT): Types, Techniques, Uses

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Cognitive behavioral therapy (CBT) is a form of talking therapy that can be used to treat people with a wide range of mental health problems.

CBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact together.  Specifically, our thoughts determine our feelings and our behavior.

Therefore, negative and unrealistic thoughts can cause us distress and result in problems. When a person suffers from psychological distress, how they interpret situations becomes skewed, which, in turn, has a negative impact on the actions they take.

CBT aims to help people become aware of when they make negative interpretations and of behavioral patterns that reinforce distorted thinking. 

Cognitive therapy helps people develop alternative ways of thinking and behaving to reduce their psychological distress.

CBT Triangle

The cognitive behavioral therapy (CBT) triangle, commonly called the ‘cognitive triangle,’ provides a structured framework to understand the interplay between thoughts, feelings, and behaviors.

It is a foundational element in the study and practice of cognitive behavioral therapy.

The cognitive triangle is a tool used in CBT to demonstrate the interplay between thoughts, feelings, and behaviors.

Individuals can identify and avoid harmful patterns by recording and categorizing negative thoughts. While surface emotions might be apparent, deeper underlying emotions can influence reactions.

Addressing these root emotions and modifying thought patterns can lead to positive behavioral changes, aiding in treating mental health issues like anxiety or depression.

Thoughts: Cognitive Processes

Situated at the top of the triangle, thoughts serve as the cognitive foundation. Research indicates that individuals produce thousands of thoughts daily .

Among these, cognitive distortions , or erroneous thinking patterns, can significantly influence one’s perceptions and interpretations. Common distortions include:

• All-or-nothing thinking : Viewing situations in binary terms, without considering nuance.
• Catastrophizing : Anticipating the most adverse outcomes without empirical justification.
• Mind Reading : Presuming to understand others’ thoughts without direct evidence.
• Emotional reasoning : Basing conclusions on emotions rather than objective data.
• Labeling : Characterizing oneself or others based on a singular trait or event.
• Personalization : Attributing external events to oneself without a clear causal link.

Intrusive thoughts , which can hinder daily functioning, are common, as evidenced by their mention by therapists. Many people experience them, suggesting these thoughts might arise from inherent brain patterns rather than facts.

In CBT, challenging these thoughts is essential, and with practice, the brain can reprogram its default thinking patterns.

The cognitive therapist teaches clients how to identify distorted cognitions through a process of evaluation. The clients learn to discriminate between their own thoughts and reality. They learn the influence that cognition has on their feelings, and they are taught to recognize, observe, and monitor their own thoughts.

The behavior part of the therapy involves setting homework for the client to do (e.g., keeping a diary of thoughts). The therapist gives the client tasks to help them challenge their irrational beliefs.

The idea is that the client identifies their unhelpful beliefs and then proves them wrong. As a result, their beliefs begin to change.

Feelings: Emotional Responses

Feelings are emotional responses that influence our communication, reactions, and decisions.

While they can motivate positive actions, such as waking up energized and preparing breakfast, they can also lead to negative behaviors if not addressed appropriately, like suppressing anger or resorting to substance abuse.

Recognizing and healthily expressing these feelings is crucial for emotional well-being. Dismissing or ridiculing them is counterproductive. 

Emotions are best managed through acceptance; understanding and validation can alleviate emotional intensity. Though originating in the brain, feelings manifest in the body, alerting us to potential issues or affirming positive situations.

To establish a healthy relationship with emotions, it’s vital to accept and validate them. This process can reduce their overpowering nature.

When managing challenging feelings, it’s essential to acknowledge them, seek balance, and, if persistent, examine underlying thoughts that might reinforce them.

Behaviors: Observable Actions

Behaviors are responses to stimuli and are influenced by thoughts and feelings. They can indicate an individual’s emotions, especially when not verbally expressed.

For instance, becoming an overly protective parent can be a behavior stemming from certain thoughts and feelings.

Cognitive Behavioral Therapy (CBT) can modify behaviors using techniques like behavioral activation , which aims to increase engagement in positive activities, and gradual exposure , which systematically introduces individuals to feared or avoided situations in a controlled manner.

For example, someone anxious in social situations may set a homework assignment to meet a friend at the pub for a drink.

Over time, these methods help individuals confront and alter negative patterns, promoting healthier behaviors and responses.

General Assumptions

• The cognitive approach believes that mental illness stems from faulty cognitions about others, our world, and us. This faulty thinking may be through cognitive deficiencies (lack of planning) or cognitive distortions (processing information inaccurately).
• These cognitions cause distortions in how we see things; Ellis suggested it is through irrational thinking, while Beck proposed the cognitive triad.
• We interact with the world through our mental representation of it. If our mental representations are inaccurate or our ways of reasoning are inadequate, our emotions and behavior may become disordered.

Cognitive behavioral therapy is, in fact, an umbrella term for many different therapies that share some common elements.

Two of the earliest forms of Cognitive Behavioral Therapy were Rational Emotive Behavior Therapy ( REBT ), developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s.

Rational Emotive Behavior Therapy (REBT) is a type of cognitive therapy first used by Albert Ellis, focusing on resolving emotional and behavioral problems.

The goal of this therapy is to change irrational beliefs to more rational ones.

REBT encourages people to identify their general and irrational beliefs (e.g., ‘I must be perfect’) and subsequently persuades them to challenge these false beliefs through reality testing.

Albert Ellis (1957, 1962) proposes that each of us holds a unique set of assumptions about ourselves and our world that guide us through life and determine our reactions to the various situations we encounter.

Unfortunately, some people’s assumptions are largely irrational, guiding them to act and react in inappropriate ways that prejudice their chances of happiness and success.  Albert Ellis calls these basic irrational assumptions .

Some people irrationally assume they are failures if they are not loved by everyone they know – they constantly seek approval and repeatedly feel rejected.  All their interactions are affected by this assumption so that a great party can leave them dissatisfied because they don’t get enough compliments.

According to Ellis, these are other common irrational assumptions :

• The idea that one should be thoroughly competent at everything.
• The idea that it is catastrophic when things are not the way you want them to be.
• The idea that people have no control over their happiness.
• The idea that you need someone stronger than yourself to depend on.
• The idea that your history greatly influences your present life.
• The idea that there is a perfect solution to human problems, and it’s a disaster if you don’t find it.

Ellis believes that people often forcefully hold on to this illogical way of thinking and therefore employ highly emotive techniques to help them vigorously and forcefully change this irrational thinking.

The ABC Model

A major aid in cognitive therapy is what Albert Ellis (1957) called the ABC Technique of Irrational Beliefs .

The first three steps analyze the process by which a person has developed irrational beliefs and may be recorded in a three-column table.

• A – Activating Event or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking.
• B – Beliefs. In the second column, the client writes down the negative thoughts that occurred to them.
• C – Consequence. The third column is for the negative feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column, C, is next explained by describing emotions or negative thoughts that the client thinks are caused by A. This could be anger, sorrow, anxiety, etc.

Ellis believes that it is not the activating event ( A ) that causes negative emotional and behavioral consequences ( C ) but rather that a person interprets these events unrealistically and therefore has an irrational belief system ( B ) that helps cause the consequences ( C ).

REBT Example

Gina is upset because she got a low mark on a math test. The Activating event, A, is that she failed her test. The Belief, B, is that she must have good grades or she is worthless. The Consequence, C, is that Gina feels depressed.

After identifying irrational beliefs, the therapist will often work with the client in challenging the negative thoughts based on evidence from the client’s experience by reframing it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.

A therapist would help Gina realize that there is no evidence that she must have good grades to be worthwhile or that getting bad grades is awful.  She desires good grades, and it would be good to have them, but it hardly makes her worthless.

If she realizes that getting bad grades is disappointing but not awful and that it means she is currently bad at math or studying but not as a person, she will feel sad or frustrated but not depressed.

The sadness and frustration are likely healthy negative emotions and may lead her to study harder from then on.

Critical Evaluation

Rational emotive behavior therapists have cited many studies in support of this approach.  Most early studies were conducted on people with experimentally induced anxieties or non-clinical problems such as mild fear of snakes (Kendall & Kriss, 1983).

However, several recent studies have been done on actual clinical subjects and have also found that rational emotive behavior therapy ( REBT ) is often helpful (Lyons & Woods 1991).

Cognitive Therapy

Aaron Beck’s (1967) therapy system is similar to Ellis’s but has been most widely used in cases of depression .  Cognitive therapists help clients to recognize the negative thoughts and errors in logic that cause them to be depressed.

The therapist also guides clients to question and challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply alternative ways of thinking in their daily lives.

Aaron Beck believes that a person’s reaction to specific upsetting thoughts may contribute to abnormality. As we confront the many situations that arise in life, both comforting and upsetting thoughts come into our heads.  Beck calls these unbidden cognitions automatic thoughts.

When a person’s stream of automatic thoughts is very negative, you would expect a person to become depressed (e.g., ‘I’m never going to get this essay finished, my girlfriend fancies my best friend, I’m getting fat, I have no money, my parents hate me – have you ever felt like this?’).

Quite often, these negative thoughts will persist despite contrary evidence.

Beck (1967) identified three mechanisms that he thought were responsible for depression:

• The cognitive triad (of automatic negative thinking)
• Negative self-schemas
• Errors in Logic (i.e., faulty information processing)

The Cognitive Triad

The cognitive triad is three forms of negative (i.e., helpless and critical) thinking that are typical of individuals with depression: namely, negative thoughts about the self, the world, and the future.

These thoughts tended to be automatic in depressed people as they occurred spontaneously.

As these three components interact, they interfere with normal cognitive processing, leading to impairments in perception, memory, and problem-solving, with the person becoming obsessed with negative thoughts.

Negative Self-Schemas

Beck believed that depression-prone individuals develop a negative self-schema.

They possess a set of beliefs and expectations about themselves that are essentially negative and pessimistic.

Beck claimed that negative schemas might be acquired in childhood due to a traumatic event. Experiences that might contribute to negative schemas include:

• Death of a parent or sibling.
• Parental rejection, criticism, overprotection, neglect, or abuse.
• Bullying at school or exclusion from a peer group.

People with negative self-schemas become prone to making logical errors in their thinking, and they tend to focus selectively on certain aspects of a situation while ignoring equally relevant information.

Cognitive Distortions

Beck (1967) identifies several illogical thinking processes (i.e., distortions of thought processes ). These illogical thought patterns are self-defeating and can cause great anxiety or depression for the individual.

• Arbitrary interference : Drawing conclusions on the basis of sufficient or irrelevant evidence: for example, thinking you are worthless because an open-air concert you were going to see has been rained off.
• Selective abstraction : Focusing on a single aspect of a situation and ignoring others: E.g., you feel responsible for your team losing a football match even though you are just one of the players on the field.
• Magnification : exaggerating the importance of undesirable events. E.g., if you scrape a bit of paintwork on your car and, therefore, see yourself as a totally awful driver.
• Minimization : underplaying the significance of an event. E.g., you get praised by your teachers for an excellent term’s work, but you see this as trivial.
• Overgeneralization : drawing broad negative conclusions on the basis of a single insignificant event. E.g., you get a D for an exam when you normally get straight As and you, therefore, think you are stupid.
• Personalization : Attributing the negative feelings of others to yourself. E.g., your teacher looks really cross when he comes into the room, so he must be cross with you.

Butler and Beck (2000) reviewed 14 meta-analyses investigating the effectiveness of Beck’s cognitive therapy and concluded that about 80% of adults benefited from the therapy.

It was also found that the therapy was more successful than drug therapy and had a lower relapse rate, supporting the proposition that depression has a cognitive basis.

This suggests that knowledge of the cognitive explanation can improve the quality of people’s lives.

REBT Vs. Cognitive Therapy

• Albert Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. In contrast, Beck stresses the quality of the therapeutic relationship.
• REBT is often highly directive, persuasive, and confronting. Beck places more emphasis on the client discovering misconceptions for themselves.
• REBT uses different methods depending on the client’s personality; in Beck’s cognitive therapy, the method is based on the particular disorder.

Strengths of CBT

• Model has great appeal because it focuses on human thought. Human cognitive abilities have been responsible for our many accomplishments, so they may also be responsible for our problems.
• Cognitive theories lend themselves to testing. When experimental subjects are manipulated into adopting unpleasant assumptions or thoughts, they become more anxious and depressed (Rimm & Litvak, 1969).
• Many people with psychological disorders, particularly depressive, anxiety, and sexual disorders, have been found to display maladaptive assumptions and thoughts (Beck et al., 1983).
• Cognitive therapy has been very effective in treating depression (Hollon & Beck, 1994) and moderately effective for anxiety problems (Beck, 1993).

Limitations of CBT

Lewinsohn (1981) studied a group of participants before they became depressed and found that those who later became depressed were no more likely to have negative thoughts than those who did not develop depression.

This suggests that hopeless and negative thinking may result from depression rather than the cause of it.

• The cognitive model is narrow in scope: Thinking is just one part of human functioning, and broader issues need to be addressed.
• Ethical issues : RET is a directive therapy aimed at changing cognitions, sometimes quite forcefully. For some, this may be considered an unethical approach.

Beck, A. T. (1967). Depression: Causes and treatment . Philadelphia: University of Pennsylvania Press.

Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy.

Beck, A. T, & Steer, R. A. (1993). Beck Anxiety Inventory Manual . San Antonio: Harcourt Brace and Company.

Butler, A. C., & Beck, J. S. (2000). Cognitive therapy outcomes: A review of meta-analyses. Journal of the Norwegian Psychological Association , 37, 1-9.

Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients.  World Psychiatry ,  22 (1), 105-115.

Dobson, K. S., & Block, L. (1988). Historical and philosophical bases of cognitive behavioral theories. Handbook of Cognitive behavioral Therapies. Guilford Press, London.

Ellis, A. (1957). Rational Psychotherapy and Individual Psychology. Journal of Individual Psychology , 13: 38-44.

Ellis, A. (1962). Reason and Emotion in Psychotherapy . New York: Stuart.

Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive-behavioral therapies. In A. E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 428—466). New York: Wiley.

Kendall, P. C., & Kriss, M. R. (1983). Cognitive-behavioral interventions. In: C. E. Walker, ed. The handbook of clinical psychology: theory, research and practice, pp. 770–819. Homewood, IL: Dow Jones-Irwin.

Lewinsohn, P. M., Steinmetz, J. L., Larson, D. W., & Franklin, J. (1981). Depression-related cognitions: antecedent or consequence?. Journal of abnormal psychology , 90(3), 213.

Lyons, L. C., & Woods, P. J. (1991). The efficacy of rational-emotive therapy: A quantitative review of the outcome research. Clinical Psychology Review , 11(4), 357-369.

Rimm, D. C., & Litvak, S. B. (1969). Self-verbalization and emotional arousal. Journal of Abnormal Psychology, 74(2) , 181.

Further Information

• BounceBack® – a free skill-building program managed by the Canadian Mental Health Association (CMHA)
• Cognitive behavioral therapy
• Cognitive and behavioral therapies
• An Overview of Psychopathology
• An appraisal of rational-emotive therapy Making sense of cognitive behavior therapy (CBT)

What is the main difference between CBT and DBT?

The main difference between CBT and DBT is CBT focuses on challenging negative thought patterns, while DBT emphasizes acceptance and change, offering skills for emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness.

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How Much Does Homework Matter in Therapy?

What research reveals about the work you do outside of therapy sessions..

Posted April 16, 2017 | Reviewed by Ekua Hagan

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Homework is an important component of cognitive behavior therapy (CBT) and other evidence-based treatments for psychological symptoms. Developed collaboratively during therapy sessions, homework assignments may be used by clients to rehearse new skills, practice coping strategies, and restructure destructive beliefs.

Although some clients believe that the effectiveness of psychotherapy depends on the quality of in-session work, consistent homework during the rest of the week may be even more important. Without homework, the insights, plans, and good intentions that emerge during a therapy session are at risk of being buried by patterns of negative thinking and behavior that have been strengthened through years of inadvertent rehearsal. Is an hour (or less) of therapeutic work enough to create change during the other 167 hours in a week?

Research on homework in therapy

Research on homework in therapy has revealed some meaningful results that can be understood collectively through a procedure called meta-analysis. A meta-analysis is a statistical summary of a body of research. It can be used to identify the average impact of psychotherapy homework on treatment outcomes across numerous studies. The results of four meta-analyses listed below highlight the value of homework in therapy:

• Kazantzis and colleagues (2010) examined 14 controlled studies that directly compared treatment outcomes for clients assigned to psychotherapy with or without homework. The data favored the homework conditions, with the average client in the homework group reporting better outcomes than about 70% of those in the no-homework conditions.
• Results from 16 studies (Kazantzis et al., 2000) and an updated analysis of 23 studies (Mausbach et al., 2010) found that, among those who received homework assignments during therapy, greater compliance led to better treatment outcomes. The effect sizes were small to medium, depending on the method used to measure compliance.
• Kazantzis et al. (2016) examined the relations of both quantity (15 studies) and quality (3 studies) of homework to treatment outcome. The effect sizes were medium to large, and these effects remained relatively stable when follow-up data were collected 1-12 months later.

Taken together, the research suggests that the addition of homework to psychotherapy enhances its effectiveness and that clients who consistently complete homework assignments tend to have better mental health outcomes. Finally, although there is less research on this issue, the quality of homework may matter as much as the amount of homework completed.

To enhance the quality of homework, homework assignments should relate directly to a specific goal, the process should be explained with clarity by the therapist, its method should be rehearsed in session, and opportunities for thoughtful out-of-session practice should be scheduled with ideas about how to eliminate obstacles to completion.

To find a therapist, please visit the Psychology Today Therapy Directory .

Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in Cognitive and Behavioral Therapy: A meta‐analysis. Clinical Psychology: Science and Practice, 7(2), 189-202.

Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta‐analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144-156.

Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755-772.

Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34(5), 429-438.

Joel Minden, Ph.D., is a clinical psychologist, author of Show Your Anxiety Who’s Boss , director of the Chico Center for Cognitive Behavior Therapy, and lecturer in the Department of Psychology at California State University, Chico.

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What Is Cognitive Behavioral Therapy (CBT)?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

Verywell / Daniel Fishel

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Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.

Cognitive behavioral therapy combines cognitive therapy with behavior therapy by identifying maladaptive patterns of thinking, emotional responses, or behaviors and replacing them with more desirable patterns.

Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen our emotional difficulties, depression , and anxiety . These spontaneous negative thoughts also have a detrimental influence on our mood.

Through CBT, faulty thoughts are identified, challenged, and replaced with more objective, realistic thoughts.

Everything You Need to Know About CBT

This video has been medically reviewed by Steven Gans, MD .

Types of Cognitive Behavioral Therapy

CBT encompasses a range of techniques and approaches that address our thoughts, emotions, and behaviors. These can range from structured psychotherapies to self-help practices. Some of the specific types of therapeutic approaches that involve cognitive behavioral therapy include:

• Cognitive therapy centers on identifying and changing inaccurate or distorted thought patterns, emotional responses, and behaviors.
• Dialectical behavior therapy (DBT)  addresses destructive or disturbing thoughts and behaviors while incorporating treatment strategies such as emotional regulation and mindfulness.
• Multimodal therapy suggests that psychological issues must be treated by addressing seven different but interconnected modalities: behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological considerations.
• Rational emotive behavior therapy (REBT) involves identifying irrational beliefs, actively challenging these beliefs, and finally learning to recognize and change these thought patterns.

While each type of cognitive behavioral therapy takes a different approach, all work to address the underlying thought patterns that contribute to psychological distress.

Cognitive Behavioral Therapy Techniques

CBT is about more than identifying thought patterns. It uses a wide range of strategies to help people overcome these patterns. Here are just a few examples of techniques used in cognitive behavioral therapy. 

Identifying Negative Thoughts

It is important to learn what thoughts, feelings, and situations are contributing to maladaptive behaviors. This process can be difficult, however, especially for people who struggle with introspection . But taking the time to identify these thoughts can also lead to self-discovery and provide insights that are essential to the treatment process.

Practicing New Skills

In cognitive behavioral therapy, people are often taught new skills that can be used in real-world situations. For example, someone with a substance use disorder might practice new coping skills and rehearse ways to avoid or deal with social situations that could potentially trigger a relapse.

Goal-Setting

Goal setting can be an important step in recovery from mental illness, helping you to make changes to improve your health and life. During cognitive behavioral therapy, a therapist can help you build and strengthen your goal-setting skills .

This might involve teaching you how to identify your goal or how to distinguish between short- and long-term goals. It may also include helping you set SMART goals (specific, measurable, attainable, relevant, and time-based), with a focus on the process as much as the end outcome.

Problem-Solving

Learning problem-solving skills during cognitive behavioral therapy can help you learn how to identify and solve problems that may arise from life stressors, both big and small. It can also help reduce the negative impact of psychological and physical illness.

Problem-solving in CBT often involves five steps:

• Identify the problem
• Generate a list of potential solutions
• Evaluate the strengths and weaknesses of each potential solution
• Choose a solution to implement
• Implement the solution

Self-Monitoring

Also known as diary work, self-monitoring is an important cognitive behavioral therapy technique. It involves tracking behaviors, symptoms, or experiences over time and sharing them with your therapist.

Self-monitoring can provide your therapist with the information they need to provide the best treatment. For example, for people with eating disorders, self-monitoring may involve keeping track of eating habits, as well as any thoughts or feelings that went along with consuming a meal or snack.

Additional cognitive behavioral therapy techniques may include journaling , role-playing , engaging in relaxation strategies , and using mental distractions .

What Cognitive Behavioral Therapy Can Help With

Cognitive behavioral therapy can be used as a short-term treatment to help individuals learn to focus on present thoughts and beliefs.

CBT is used to treat a wide range of conditions, including:

• Anger issues
• Bipolar disorder
• Eating disorders
• Panic attacks
• Personality disorders

In addition to mental health conditions, cognitive behavioral therapy has also been found to help people cope with:

• Chronic pain or serious illnesses
• Divorce or break-ups
• Grief or loss
• Low self-esteem
• Relationship problems
• Stress management

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Benefits of Cognitive Behavioral Therapy

The underlying concept behind CBT is that thoughts and feelings play a fundamental role in behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents, and other air disasters may avoid air travel as a result.

The goal of cognitive behavioral therapy is to teach people that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment.

CBT is known for providing the following key benefits:

• It helps you develop healthier thought patterns by becoming aware of the negative and often unrealistic thoughts that dampen your feelings and moods.
• It is an effective short-term treatment option as improvements can often be seen in five to 20 sessions.
• It is effective for a wide variety of maladaptive behaviors.
• It is often more affordable than some other types of therapy .
• It is effective whether therapy occurs online or face-to-face.
• It can be used for those who don't require psychotropic medication .

One of the greatest benefits of cognitive behavioral therapy is that it helps clients develop coping skills that can be useful both now and in the future.

Effectiveness of Cognitive Behavioral Therapy

CBT emerged during the 1960s and originated in the work of psychiatrist Aaron Beck , who noted that certain types of thinking contributed to emotional problems. Beck labeled these "automatic negative thoughts" and developed the process of cognitive therapy. 

Where earlier behavior therapies had focused almost exclusively on associations, reinforcements , and punishments to modify behavior, the cognitive approach addresses how thoughts and feelings affect behaviors.

Today, cognitive behavioral therapy is one of the most well-studied forms of treatment. It has been shown to be effective in the treatment of a range of mental conditions, including anxiety, depression, eating disorders, insomnia, obsessive-compulsive disorder , panic disorder, post-traumatic stress disorder , and substance use disorder.

• Research indicates that cognitive behavioral therapy is the leading evidence-based treatment for eating disorders .
• CBT has been proven helpful in those with insomnia, as well as those who have a medical condition that interferes with sleep, including those with pain or mood disorders such as depression.
• Cognitive behavioral therapy has been scientifically proven to be effective in treating symptoms of depression and anxiety in children and adolescents.
• A 2018 meta-analysis of 41 studies found that CBT helped improve symptoms in people with anxiety and anxiety-related disorders, including obsessive-compulsive disorder and post-traumatic stress disorder.
• Cognitive behavioral therapy has a high level of empirical support for the treatment of substance use disorders, helping people with these disorders improve self-control , avoid triggers, and develop coping mechanisms for daily stressors.

CBT is one of the most researched types of therapy, in part, because treatment is focused on very specific goals and results can be measured relatively easily.

Verywell Mind's Cost of Therapy Survey , which sought to learn more about how Americans deal with the financial burdens associated with therapy, found that Americans overwhelmingly feel the benefits of therapy:

• 80% say therapy is a good investment
• 91% are satisfied with the quality of therapy they receive
• 84% are satisfied with their progress toward mental health goals

Things to Consider With Cognitive Behavioral Therapy

There are several challenges that people may face when engaging in cognitive behavioral therapy. Here are a few to consider.

Change Can Be Difficult

Initially, some patients suggest that while they recognize that certain thoughts are not rational or healthy, simply becoming aware of these thoughts does not make it easy to alter them.

CBT Is Very Structured

Cognitive behavioral therapy doesn't focus on underlying, unconscious resistance to change as much as other approaches such as  psychoanalytic psychotherapy . Instead, it tends to be more structured, so it may not be suitable for people who may find structure difficult.

You Must Be Willing to Change

For cognitive behavioral therapy to be effective, you must be ready and willing to spend time and effort analyzing your thoughts and feelings. This self-analysis can be difficult, but it is a great way to learn more about how our internal states impact our outward behavior.

Progress Is Often Gradual

In most cases, CBT is a gradual process that helps you take incremental steps toward behavior change . For example, someone with social anxiety might start by simply imagining anxiety-provoking social situations. Next, they may practice conversations with friends, family, and acquaintances. By progressively working toward a larger goal, the process seems less daunting and the goals easier to achieve.

How to Get Started With Cognitive Behavioral Therapy

Cognitive behavioral therapy can be an effective treatment choice for a range of psychological issues. If you or someone you love might benefit from this form of therapy, consider the following steps:

• Consult with your physician and/or check out the directory of certified therapists offered by the National Association of Cognitive-Behavioral Therapists to locate a licensed professional in your area. You can also do a search for "cognitive behavioral therapy near me" to find local therapists who specialize in this type of therapy.
• Consider your personal preferences , including whether face-to-face or online therapy will work best for you.
• Contact your health insurance to see if it covers cognitive behavioral therapy and, if so, how many sessions are covered per year.
• Make an appointment with the therapist you've chosen, noting it on your calendar so you don't forget it or accidentally schedule something else during that time.
• Show up to your first session with an open mind and positive attitude. Be ready to begin to identify the thoughts and behaviors that may be holding you back, and commit to learning the strategies that can propel you forward instead.

What to Expect With Cognitive Behavioral Therapy

If you're new to cognitive behavioral therapy, you may have uncertainties or fears of what to expect. In many ways, the first session begins much like your first appointment with any new healthcare provider.

During the first session, you'll likely spend some time filling out paperwork such as HIPAA forms (privacy forms), insurance information, medical history, current medications, and a therapist-patient service agreement. If you're participating in online therapy, you'll likely fill out these forms online.

Also be prepared to answer questions about what brought you to therapy, your symptoms , and your history—including your childhood, education, career, relationships (family, romantic, friends), and current living situation.

Once the therapist has a better idea of who you are, the challenges you face, and your goals for cognitive behavioral therapy, they can help you increase your awareness of the thoughts and beliefs you have that are unhelpful or unrealistic. Next, strategies are implemented to help you develop healthier thoughts and behavior patterns.

During later sessions, you will discuss how your strategies are working and change the ones that aren't. Your therapist may also suggest cognitive behavioral therapy techniques you can do yourself between sessions, such as journaling to identify negative thoughts or practicing new skills to overcome your anxiety .

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our  National Helpline Database .

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

The 8 Types of Cognitive Behavior Therapy

Rather than a specific type of therapy, Cognitive Behavior Therapy (CBT) is better understood as an umbrella term. Many of the approaches that fall under the CBT umbrella focus on understanding the interaction between one’s thoughts, feelings, and behaviors. A CBT therapist works to help clients assess, recognize, and deal with problematic and dysfunctional ways of thinking, feeling, and behaving. 8 types of cognitive behavioral therapy

Generally speaking, CBT tends to be goal-oriented and short-term. However, the length of treatment depends on various factors,  including the severity of symptoms and consistency of treatment compliance, and practiced learned therapy skills between sessions. Depending on the specific type of CBT, different interventions may be used.

The following evidence-based interventions fall under the CBT umbrella and have successfully treated numerous mental health conditions, including anxiety, depression, alongside others.

Cognitive Therapy is one of the earliest therapies to be considered CBT. It focuses on identifying and changing the unhelpful or distorted thinking patterns commonly experienced by individuals suffering from depression. Cognitive Therapy utilizes collaborative elements like agenda-setting and homework assignments between sessions, emphasizing the correction of cognitive distortions or thinking errors as well as maladaptive behaviors.

Dialectical Behavior Therapy (DBT) was developed by Dr. Marsha Linehan and is heavily based on CBT with one exception: it highlights validating or accepting uncomfortable thoughts, feelings, and behaviors instead of fighting them. By accepting and coming to terms with discomfort, DBT encourages change through a mindful and present stance. Initially designed to treat individuals with Borderline Personality Disorder (BPD), DBT is one of the most commonly utilized treatment interventions today. Anyone who frequently experiences extreme, unpredictable, negative emotions can benefit from DBT.

Motivational Interviewing (MI) is an evidence-based approach that is directive and goal-directed. MI recognizes that people start therapy with varying levels of commitment and willingness to change. Motivational Interviewing facilitates the internal motivation needed for behavior change while resolving any existing ambivalence towards change. Although initially developed to help people overcome substance use problems, MI is now used to explore and enhance motivation for changing almost any behavior.

Acceptance and Commitment Therapy (ACT). The central premise of ACT is that people’s thoughts and feelings are affected by events, the people around them, and their environment. ACT focuses on increasing tolerance for emotional pain, especially when avoiding pain prevents one from living a fulfilling and meaningful life. ACT promotes alternative ways to cope with and relate to emotional pain while clarifying a person’s values. Techniques from ACT help individuals get “unstuck” from their emotions so they can pursue more value-consistent actions.

Rational Emotive Behavior Therapy (REBT) involves identifying irrational beliefs, actively challenging these beliefs, and recognizing and changing maladaptive thought patterns. Albert Ellis created REBT based on the idea that each person holds a unique set of basic assumptions about themselves and the world, influencing their actions and reactions and influencing their perspective on situations.

Mindfulness-Based Stress Reduction (MBSR). MBSR utilizes the principles of mindfulness meditation to manage stress and related symptoms. Although it’s primarily used in treating anxiety-related disorders and chronic pain, those who don’t have a diagnosis may find MBSR beneficial as they can learn to manage stress much more effectively.

Mindfulness-Based Cognitive Therapy (MBCT). MBCT is a relatively new form of CBT riding the crest of its third wave is Mindfulness-Based Cognitive Therapy (MBCT). The essential element of MBCT is mindfulness. The focus doesn’t lie on changing thoughts like in other forms of CBT, but rather the way a person reacts to these thoughts. Research suggests that those who live with a significant amount of stress, anxiety, or chronic pain can benefit from MBCT. The goal is to help people make healthy choices with each new day and improve life on a moment-to-moment basis.

Exposure Therapy. Exposure therapy is a type of cognitive-behavioral treatment most frequently used to treat OCD, PTSD, and phobias. Through treatment, a person and their therapist work together to identify anxiety triggers and learn relaxation techniques to manage anxiety-induced distress. In a controlled, safe environment, the person would then confront those triggers while simultaneously implementing relaxation techniques. While some can encounter distressing memories at once or via flooding, others need to work up to them over time to avoid re-traumatization. In this case, a therapist will help ease one into the exposure process by leveraging relaxation techniques, typically starting with the more manageable memories.

Getting Started With Cognitive Behavioral Therapy

While each type of cognitive-behavioral therapy takes a different approach, all work to address the underlying thought patterns that contribute to psychological distress. Treatment progress is dependent on each individual’s unique circumstances and needs. You and your therapist will actively check in to ensure that progress is being maintained and that your treatment goals, values, and hopes are being accomplished.

At Washington Psychological Wellness, we actively work with and consult with outside providers, teachers, clergy, and family members to coordinate care. If you’d like to learn more about CBT and how it can help you achieve holistic mental wellness, contact us at Washington Psychological Wellness today.

Related Content

The Benefits of Cognitive Behavioral Therapy (CBT) For Children

References:

https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747#types-of-cognitive-behavioral-therapy

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