25 CBT Worksheets & Activities for Anxiety, PTSD, and Skill-Building

Updated: 6 days ago

CBT activities and worksheets can help you or your clients challenge thoughts, manage anxiety, and deal with conditions like PTSD. These worksheets and games are evidence-based and curated by a CBT therapist.

This anxiety and PTSD CBT worksheets bundle helps treat multiple aspects of these conditions.

“Let’s look at this worksheet.”


If you are a CBT therapist (or have one) then this might be a familiar phrase.


That's because 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.


Included below are some of the most popular tools, including worksheets, games, and activities, used by CBT therapists, along with several new tools. They can be used with clients, groups, students, and employees.


The best one(s) will depend on your needs, so feel free to scan and find what will help you the most. All items are digital, which makes them great for in-person or telehealth sessions.


Need resources right away? Skip ahead to here take a look at the CBT for anxiety and PTSD bundle.


Article Highlights:


Review of CBT Basics


Worksheets:

CBT Triangle

Challenging Thoughts

Core Beliefs

CBT for Anxiety CBT for PTSD

Emotions Wheel & Regulating Emotions

Exposure Hierarchy

Trauma Narrative

Bundled Package for Anxiety and PTSD


Games and Activities:

Grounding Stone Activity

CBT L-I-N-G-O (Bingo-Like Game)

CBT Digital Board Game (CBT Quest)


Looking for a fun, interactive way to reinforce CBT concepts? Check out our new CBT Bingo-Inspired game with 75 learning prompts. You can find it here.


CBT Basics

CBT worksheets and tools are typically very structured, and follow the cognitive behavioral therapy approach. The basic idea of CBT, or cognitive behavioral therapy, 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 ideal 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, or tools for your clients, 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.


Print these mental health handouts for yourself, your students, or your clients.

CBT Triangle

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.


You can learn more about this technique in this new article on using the triangle.


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.

This diagram of the CBT triangle shows the three points of thoughts, feelings, and behaviors.

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.

Learn and teach thoughts, behaviors and feelings with this free CBT triangle worksheet.

CBT Triangle Worksheet

Fives pages, with explanations, colorful diagrams and examples by The Counseling Palette.

Cognitive Triangle Worksheet

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

This CBT worksheet focuses on reframing thoughts. It addresses cognitive distortions, and walks the user through how to change a particular thought.

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. (Get it here free.)

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

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

This worksheet covers how to cope with anxiety symptoms. Understand what your triggers are, and develop a set of coping skills.

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.

10 Minute Worksheets (for middle/high school)

Multiple pages, by Teachers Pay Teachers


CBT for PTSD

This CBT worksheet for PTSD covers cognitive distortions, or stuck points, related to PTSD. It’s appropriate for CPT (cognitive processing therapy) or TF-CBT for teens or adults.

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.


Emotions Wheels & Regulating Emotions

Emotions are a sometimes overlooked part of CBT treatment. Sometimes people think they should or shouldn't be having certain feelings. They might also be unsure of what they're feeling and when.


These worksheets help with recognizing, regulating, and coping with emotions. Feelings wheels and emotion management worksheets can help support this difficult part of mental health.

Emotions wheels can help with the "feelings" part of the CBT triangle. This kit includes multiple versions with coping skills.

Emotion Wheel Kit

Includes multiple emotion wheels, also called feelings wheels. This set has a focus on coping skills and includes both full and blank versions to fill out. By the Counseling Palette.

Emotions Motivate Action

These worksheets focus on understanding the science behind emotions, and teaching the concept. By Psychology Tools.

Dealing with Strong Emotions

Strong feelings can be overwhelming. This guide takes a look at how to rate, ride out, or cope with difficult emotions.

Exposure Hierarchy

Many people develop avoidance as a way to deal with anxiety, phobias, and PTSD. An exposure hierarchy helps people measure which fears are the worst, and how they progress over time.


Exposure, or fear, hierarchies are commonly used in CBT, CPT, and TF-CBT therapies.


Fears are sometimes measured by numbers, called SUDS (subjective units of distress). Over time the fear is tracked, to see if it becomes better or worse.


Most often, exposure hierarchies are used along with homework assignments to help people face their fears. This exposure helps them overcome avoidance that may be interfering with their daily life.


These worksheets used a variation of exposure hierarchies.

Anxiety Hierarchy and Exposure

Three pages, with explanation, hierarchy page, and exposure homework sheet. By The Counseling Palette.

Fear and Avoidance Worksheet

One page with chart. By Oxford University Press.


This worksheet includes a client-friendly version of the anxiety, or exposure hierarchy. This method is commonly used in CBT. It also includes a homework page for exposure sessions.

Trauma Narrative

The trauma narrative is a technique commonly used in therapies like cognitive processing therapy (CPT), or trauma-focused cognitive behavioral therapy (TF-CBT). This worksheet is written with the client in mind, and should generally be used under the direction of a trained therapist. Trauma Narrative

Five pages, including writing space, which walks through the trauma narrative activity commonly used in PTSD therapies such as CPT and TF-CBT. By The Counseling Palette.

The trauma narrative is an activity that involved writing down your memories of your trauma. It’s a tool to help people face fears and overcome avoidance of memories, so they can process and heal them.

Grounding Stone Activity

If you’re looking for a fun mindfulness activity to use with CBT, the grounding stone exercise may be a good fit. This worksheet and digital kit includes prompts, posters and even an audio meditation.

Grounding Stone Kit

Five page worksheet, plus posters, audio, and templates you can change in Canva. By The Counseling Palette.

This worksheet includes the grounding stone acticitu which helps with anxiety, mindfulness, and stress.

Bundled Worksheet Package

Over the years, I've found that many of the same strategies overlap for conditions like anxiety and PTSD. At the same time, there are some additional steps necessary when processing trauma. I've bundled all of my related pages into this set.


This bundle includes 8 mental health worksheets for therapy, students, and individual use. They cover topics of anxiety, PTSD, and cognitive behavioral therapy (CBT).

CBT Lingo (Bingo-Like Game)

CBT Lingo is a fun, interactive, educational game that helps you teach concepts of CBT. It goes beyond the typical "novelty" cards often created for therapy and other classroom games. The game is compatible with real bingo, so you can actually "call" the game with numbers, either in-person or via telehealth.


CBT Lingo, which works like CBT bingo, includes 75 prompts focused on topics like thoughts, feelings, and behaviors, and skills used in cognitive behavioral therapy.


Here are some sample prompts included in the game:

  • What does all or nothing thinking mean?

  • What's one physical symptom of anxiety?

  • What are the three points of the CBT triangle?

  • What is ruminating?

Want to give it a go? You can download and use it in-person or via telehealth. Get more details here.

This interactive CBT Lingo, also called CBT Bingo, is a real, playable game with 10 playing cards and 75 prompts. It can be used as an in-person CBT activity or a telehealth game featuring CBT skills and theory.

CBT Board Game: PDF and Printable

CBT board games are another less intimidating way to teach skills. This downloadable board game, called CBT quest, can be printed and used in person, or adapted for online use. It includes 32 prompts with reusable questions, such as:

  • Give an example of a challenging thought

  • Describe or show a grounding technique

  • Describe or name a cognitive distortion

Interested in trying this fun activity? Download it here.

Obviously games and worksheets can’t replace other types of 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.


Jennie Lannette, LCSW, is a licensed, practicing therapist in Missouri, specializing in trauma, anxiety, and related mental health issues. She writes for numerous national mental health sites and publications, and recently published the book, Finding Peace from PTSD available on Amazon.



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.