Check out these CBT tools for changing thoughts, dealing with anxiety and PTSD, and more.
“Let’s look at this worksheet.” If you are a CBT therapist (or have one) then this might be a familiar phrase.
CBT worksheets are an effective way to learn and practice skills learned in therapy. You can also learn the basic CBT techniques on your own for everyday challenges, even if you’re not in therapy.
Article Highlights:
Challenging Thoughts Exercises
CBT for Anxiety Tools CBT for PTSD Worksheets
CBT Basics
CBT worksheets are typically very specific, and follow the cognitive behavioral therapy approach. The basic idea of CBT is that our patterns of thinking impact everything else. How we think about things can make life better or worse, regardless of the circumstances.
Our thoughts become our feelings, which lead to our behaviors. These exercises start with the basic approach and expand into specialized areas, such as using CBT to treat PTSD.
You’ll find multiple free CBT worksheets along with premium options on this list. Some of these I created myself based on my training and experience providing therapy, and others I have reviewed and found helpful and consistent with research and best practices.
If you are a therapist, it’s important to have basic training and experience with the CBT approach to support your use of these tools with clients.
If you are looking for self-help, then learning the basic idea of reframing negative thinking can be helpful. However, if you’re dealing with mental health issues, then make sure to seek out professional help for these conditions rather than going it alone.
CBT Triangle Handouts
The CBT triangle is a visual depiction of how thoughts impact our experience. It includes thoughts, feelings, and behaviors as a cycle that moves between points on the triangle, with the prompting event (trigger) in the middle.
The CBT triangle is a commonly used tool to describe the basic principles of this therapy. CBT itself was developed by Aaron Beck. He noticed that many people in therapy continued to suffer from mental health conditions such as depression, even as therapy progressed.
He termed the phrase “automatic thoughts,” to describe the thinking pattern many people experience. Most significantly, Dr. Beck found that how people thought about a situation resulted in how they experienced it, regardless of the situation itself.
Most significantly, Dr. Beck found that how people thought about a situation resulted in how they experienced it, regardless of the situation itself.
For example, someone may be running late for work. If they begin to think about getting fired and all of the things that would result from that, they might feel panicked or frustrated, and start driving erratically.
Alternatively, the same person may think differently, coaching themselves in a positive way. They may think, “I rarely run late, and my boss is very understanding, so it will be okay.” With this change in thinking, they are likely to think more clearly and avoid feeling anxious. They may then calmly text their boss and drive carefully but efficiently toward work.
This process demonstrates the event (running late), the thought (catastrophizing versus positive self-talk) and the behavior (erratic driving versus planning).
These worksheets use this basic process, typically in triangle form. They either explain the process or include prompts to help you or your clients recognize and change the pattern.
One page, with a descriptive diagram by TherapistAid.
Three pages, with boxes and prompts, by University of Washington.
CBT Cognitive Triangle Reflection worksheet
Two pages, with blanks and prompts, by Teachers pay Teachers.
Challenging Thoughts Exercises
The CBT triangle is a good place to start to explain how thoughts affect our feelings. The next step is to begin to challenge specific thoughts that tend to happen regularly. For example, someone may think, “I mess everything up,” or “I can’t keep any friends.” These thoughts become a habit, and are likely to affect self-esteem, and even become a self-fulfilling prophecy. Because someone thinks they can’t keep friends, they stop trying to make them.
These worksheets have these types of thought patterns in mind, and help the user begin to challenge these beliefs. Terms often used include “stuck points,” “cognitive distortions,” or “negative thoughts.”
Changing Thoughts (CBT) Worksheet
Three-pages, with explanation, examples, and prompts by The Counseling Palette.
Challenging Thoughts Worksheet
With prompts, by University of Washington.
Prompts for Challenging Negative Thoughts Worksheet
Several prompts to walk through the process, by Psychology Tools.
Core Beliefs Activities
Core beliefs exercises may go a level deeper than distorted thoughts worksheets. Negative core beliefs are thoughts that tend to pervade our everyday lives. They’re the “issues,” or “triggers,” you just can’t seem to get over. While most negative core beliefs are also distorted beliefs, the reverse isn’t necessarily true.
Negative core beliefs tend to involve shame, and how the person feels about themselves as a whole. This often relates to their abilities and worthiness.
Negative core beliefs tend to involve shame, and how the person feels about themselves as a whole. This often relates to their abilities and worthiness.
For example, a basic distorted belief might be, “I’ll never pass my algebra class,” while a negative core belief might state, “I’m too stupid to succeed at anything.”
These worksheets address thoughts from the perspective of these deep-seated, often harmful core beliefs.
Core Beliefs Worksheet One page, with blanks and prompts to challenge core beliefs from the Centre for Clinical Interventions.
Core Beliefs Worksheet One page, with infographic and a basic prompt to challenge beliefs, by TherapistAid.
Negative Core Beliefs Worksheet One page, with rating scales, by the Centre for Clinical Interventions.
CBT for Anxiety Tools
While there are multiple types of anxiety conditions, all of them relate to our thoughts. Many of them are largely caused by our way of thinking. Ruminating thoughts, catastrophizing, and assuming the worst are common symptoms of multiple conditions. These thought patterns, combined with the hypervigilance that come along with them, can make it difficult to cope day to day.
These anxious thoughts are common, and likely originate from the human need to prepare for the worst and avoid danger. After all, if our ancestors hadn’t been a bit paranoid we may not be here today.
However, frequently thinking negatively can lead to overwhelming anxiety and nearly constant feelings of anxiety. These worksheets can help with coping while also addressing the root thoughts that perpetuate these fears.
Anxiety Plan Worksheet Four pages, offers multiple coping skills including CBT prompts, by The Counseling Palette.
Anxiety Common Unhelpful Thoughts Three pages with lists and boxes, by UW Medicine.
Worry Explanation Pages One page, with prompts, by TherapistAid.
CBT for PTSD Worksheets
Many people think of PTSD as simply a result of trauma. While trauma is at the core of it, it goes beyond this. The majority of people experience trauma at some point. At first, it causes feelings of worry, confusion, and sometimes self-blame for what happened. However, within a few weeks to a month, most people come to terms with what happened. They understand that the trauma was an isolated event, and that there wasn’t anything they could do to change it.
A percentage of people, however, aren’t able to get through this process. This could be due to still being in danger, to past trauma complicating their ability to process, or simply having too much going on to deal with it initially.
This lack of processing leads to “stuck points,” or cognitive distortions relating to the trauma. They typically run along the lines of people blaming themselves, or feeling they can’t deal with difficulties in the world.
The most effective trauma therapies all deal with processing of the traumatic event. These worksheets are consistent with the CBT therapies used to help with this, including CPT, Prolonged Exposure, and TF-CBT.
Reframing Trauma Thoughts (Distortions) Three pages, explanation, examples, and prompt worksheet, by The Counseling Palette.
PTSD Symptoms Worksheet Two pages, prompts, by The Counseling Palette.
Dissociation Record One page, columns with boxes, by Psychology Tools.
Obviously worksheets can’t replace therapy. However, these tools can help you learn to identify thinking patterns, challenge everyday negative thoughts, question your anxiety thoughts, and understand your thoughts relating to PTSD. What techniques and CBT worksheets do you find helpful? Include your recommendations below.
Sources: Beck Institute for Cognitive Behavioral Therapy. 2021, https://beckinstitute.org/
Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.