Workbook
Workbook
Think Workbook
CBT Workbook
A diary and skills primer for Cognitive Behavioural Therapy
This workbook provides a structured diary and primer to support the Cognitive Behavioural Therapy (CBT) process. It is designed to be
used in conjunction with an approved CBT programme or as a self-help guide. The workbook provides a number of practical CBT exercises
and a record of key learning points throughout the CBT process.
This workbook draws on a range of established CBT tools that can be freely downloaded as separate worksheets from the Think CBT website
at www.thinkcbt.com. You can also get support and advice by contacting the Think CBT team on 01732 808626 or by emailing
info@thinkcbt.com.
Cognitive Behavioural Therapy (CBT) is a highly structured, time focused and practical approach to overcoming a wide range of psychological,
emotional and behavioural problems. CBT involves understanding and working on the links between our Cognitions; thinking patterns and
processes, our Behaviours; the things we do and avoid doing, our Emotions; feelings such as anxiety, anger or depression and Physiological
Reactions; including tension, dizziness or pain.
CBT has been found to be the most effective approach for a wide range of problems including anxiety, depression, eating disorders, insomnia,
OCD, panic attacks, phobias, relationship problems, social anxiety, trauma and low self-esteem. You can find out more about the different
problems that CBT is used to treat by visiting www.thinkcbt.com.
CBT works by identifying and altering the links between negative thinking patterns, unhelpful behaviours, distressing emotions and
physiological symptoms. This involves focusing on two main areas:
Cognitive approaches; learning how to identify, change or let go of negative or unhelpful thinking patterns.
Behavioural approaches; learning how to change or improve unhelpful and engrained patterns of behaviour and avoidance.
The basic premise behind CBT is that we can change and overcome a wide range of problems by changing how we think and what we do.
This has been rigorously tested in numerous research trials and CBT is widely acknowledged as the recommended treatment of choice for
anxiety and mood disorders. The causal relationship between thoughts, behaviours, emotions and physiological reactions can be illustrated
using the following CBT model.
Thoughts Emotions
What thoughts or images went through your mind? What
What distressing emotions did you feel – anger,
did this mean about the situation, other people or you
anxiety, depression, embarrassment, frustration,
personally? How did you interpret this and what did you
guilt, hurt, jealousy, shame.
fear would happen?
Tip: Practice noticing your thoughts, feelings and behaviours - the more you practice noticing the links between what you do, think and feel,
the more you will be able to make effective changes.
Undertaking CBT usually involves completing an initial assessment, producing a clear therapy plan and attending weekly sessions where you
will learn new techniques to tackle the problem. Your Cognitive Behavioural psychotherapist will help you to set specific goals, develop a clear
understanding of the problem, produce a structured therapy plan, teach you how to use CBT techniques and monitor your progress on a
weekly basis. In addition to attending your therapy sessions, you will be asked to undertake CBT assignments between appointments. These
assignments can involve learning about CBT approaches, thought monitoring / change exercises, planned exposures to difficult or challenging
tasks, simple experiments to test out how you think and act in certain situations and exercises to improve emotional wellbeing and resilience.
Through the course of the CBT process, you will gain an insight into the causes and maintenance factors for your problem, you will learn new
techniques to change the way you think, act and feel and you will develop an increased level of personal resilience to manage difficult and
challenging situations as they arise. Whilst you will explore and learn new approaches using the exercises in this workbook and your structured
CBT sessions, the most effective changes will take place through personal dedication and consistent practice in your daily life.
Whilst there is a wealth of self-help CBT material freely available, the research evidence shows that the most effective and long-lasting
changes are achieved by working with a professionally accredited Cognitive Behavioural Psychotherapist. Always ensure that your Therapist
is professionally accredited by the British Association of Behavioural and Cognitive Psychotherapy (BABCP). The letters BABCP (Acced)
mean that you can trust that your Therapist has demonstrated the gold standard in the practice of CBT, is professionally qualified at a post-
graduate level and is an independently accredited expert in CBT. You can perform a CBT credentials check by visiting www.babcp.com and
entering the name and geographical location of your therapist.
The first step in the CBT process is obtaining a clear understanding of the problem, setting your goals and thinking about how your personal
values and strengths can provide a driving force for change. You can work through the following exercises to help with these tasks.
Use the first column to identify the problems that you want to work on. In the second column identify unhelpful, unworkable or unsustainable
coping strategies or patterns of avoidance. In the third column, identify helpful, workable and sustainable coping strategies that are consistent
with your goals and personal values.
Use this exercise to identify 3 goals for therapy. Detail the small steps required to make each goal concrete.
Goal 1:
Goal 2:
Goal 3:
Identifying and capitalising on your strengths and personal resources is an important part of achieving change and overcoming problems.
Think about your skills, knowledge, experience, abilities and qualities. Think about what you recognise in yourself and what other people
recognise in you. Your strengths will play an important part in the development of your CBT plan.
Values provide a basis for guiding the way we act to overcome problems and achieve our goals. Use this exercise to first assess and prioritise
your personal values. Then decide which six values will be the most instrumental in achieving your CBT goals. You may find that your six
“change values” are different to your current priorities. Use the checkboxes to indicate the relative importance of each value. There are no
right or wrong answers.
Highly Moderately Less
Value Description
Important Important Important
Accepting: Open to and accepting of my own value and the value of other people.
Affectionate: Displaying and expressing love or strong feelings for others.
Aspiring: Actively seeking opportunities and striving for success.
Assertive: Respectfully standing up for my rights and balancing my needs with the needs of others.
Authentic: Being genuine, honest and true to myself.
Caring: Helpful and considerate to myself and others.
Challenging: Stretching and continuously learning how to improve myself and encourage change in others.
Compassionate: Recognising and acting to alleviate suffering for myself and others.
Conforming: Respectful and obedient of helpful rules and obligations.
Cooperating: Working collaboratively and harmoniously with others.
Courageous: Brave and persistent in the face of fear, threat or difficulty.
Creative: Imaginative, resourceful and innovative.
Curious: Open-minded, exploratory and interested in new and alternative approaches.
Emotionally aware: Open to and receptive to my own feelings and the feelings of others.
Encouraging: Promoting and rewarding behaviour that I value in myself and others.
Equality: Treating others fairly, consistently and equally.
Fairness: Just, rational and reasonable.
Fitness: Maintaining or improving my physical, psychological and emotional wellbeing.
Flexible: Adjusting and adapting readily to changing circumstances.
Forgiving: Coming to terms with or letting go of negative feelings towards myself and others.
Friendliness: Friendly and companionable towards others.
Generosity: Sharing and offering time, attention and resources to myself and others.
Now choose the six most important change values which will be instrumental in the achievement of your goals. Insert these into the following
change values table:
Priority Change Value
1.
2.
3.
4.
5.
6.
Use this exercise to identify the costs and benefits of committing to change. On the cost side of this balance sheet, Include the short-term
difficulties, personal challenges and avoidance behaviours that you will be prepared to let go of or tolerate to achieve your goals. On the
benefits side of the balance sheet, identify the advantages and opportunities that committing to change will provide. Complete this worksheet
with reference to your goals and personal values.
Costs Benefits
Use this exercise to set direction and make choices that are helpful, workable and sustainable. Use the left side of the model to identify
unhelpful thoughts, behaviours and avoidance patterns that you get caught up in. Use the right side of the model to identify your purpose,
goals, values and opportunities for change.
Unhelpful thoughts that I get caught up in, emotions that I My purpose, goals, personal values, strengths,
struggle with, counter-productive behaviours and patterns opportunities to try a different approach, things I can do to
of resistance and avoidance. improve the situation and my personal wellbeing.
Use this table to record the most important learning points from each CBT session or exercise. This will provide a structured record of your
learning that you can refer to in future:
Session What did we cover? What were the key learning points? What was the CBT assignment?
1.
2.
3.
4.
5.
6.
7.
8.
Use the following CBT exercises to support your journey through the CBT process. These tools and techniques are most effectively applied
under the guidance of a professionally accredited Cognitive Behavioural Psychotherapist. Copies of these exercises together with a wide
range of other CBT resources can be downloaded as individual worksheets from our free CBT resources page at www.thinkcbt.com.
Use this diagram to identify and map out the relationship between the thoughts, behaviours, emotions and sensations that maintain the
problem.
The Trigger
Thoughts Emotions
Use this template to identify and alter the relationship between difficult situations, negative emotions, unhelpful thoughts, counter-productive
behaviours and distressing physical reactions. Practice noticing how identifying and changing negative thinking can alter the way you react
in challenging situations.
What do I notice about my thoughts - step back and just observe what's happening? How does thinking this way help me? What's a more
realistic interpretation? Are these just thoughts? Am I really defined by my thoughts? Tolerate the uncertainty and discomfort - make the
NATs less relevant. Shift my focus on to helpful and rational things.
Use this exercise to identify how you respond when triggered by a difficult or challenging situation. Rather than attempting to change the
trigger, focus on how you can alter your appraisal of the situation to achieve a more helpful initial response and outcome.
Unhelpful – Getting caught up in distressing thoughts and emotions - Acting against my goals or personal values
Trigger Response Appraisal Consequence Knock-on Effects
What happens or what do I How do I feel emotionally What do I think, assume or What happens as a result of What are the wider or
first notice? and physically; what do I believe? this – what is the outcome? longer term implications of
do? this?
Helpful – Changing or disentangling from distressing thoughts and emotions - Acting according to my goals or personal values
The purpose of this exercise is to identify the thinking traps; perception errors, attributions and distortions that contribute to unhelpful or
negative interpretations. You can use the following list to catch, check and change the automatic thinking traps that you fall into:
Catastrophizing – Making mountains out of mole hills; automatically assuming the worst possible outcome.
Negative Filter – Focusing on the negatives and ignoring or discounting the positives.
Mind-Reading – Deciding what people are thinking and feeling without any real evidence.
Emotional Reasoning – Using feelings to make judgments; “I feel like an idiot, so I must be an idiot.”
Musts / Shoulds – Translating preferences or wishes into rigid and dogmatic demands.
Labelling – Using global labels to describe a person based on a single characteristic or situation.
Blaming – Attributing personal blame or responsibility to self or others for every negative event.
Change Fallacy – Assuming that things should always change to make us happy or suit our needs.
Fairness Fallacy – Expecting everything to be measures in fairness and showing resentment when it doesn’t work out.
Reward Fallacy – Expecting sacrifice and self-denial to pay off and feeling bitterness when the reward doesn’t happen.
Research into worry shows that 85% of the things we continuously worry about don’t happen. Of the remaining 15%, only 4% turn out to be
as challenging as predicted. Most importantly, the process of continuous worry doesn’t change the outcome and can make the situation more
difficult to handle. Shifting from worry to problem solving helps to improve the outcome of the things we can influence and reduces unnecessary
personal distress.
To undertake this exercise, you first need to set a regular daily time aside as a dedicated worry-thinking time. E.g. 4:30pm (not just before
going to bed). Once you have identified your daily worry-thinking time, use the following two-part exercise to capture, suspend and manage
worrying thoughts:
Part 1 – Identifying and Suspending My Worry
What is the specific worry?
What consequences am I predicting?
What distressing feelings am I experiencing (Rate 0-10)
What time am I suspending this worry for later consideration? (00:00:00)
Part 2 – Thinking– Problem Solving Time
What is the hard evidence supporting my predicted worry?
What is the hard evidence against my predicted worry?
What is the worst that could happen?
What is the best that could happen?
What is the most likely / realistic outcome?
What are the consequences of worrying about this?
What is a helpful way of thinking about this; what would I say to a friend?
Can I trust myself to let go of this worry now? Yes – Re-rate worry 0-10 No – Continue to next questions
What practical problem solving options are open to me?
What is the most helpful / effective course of action?
What, where, who and when?
How have my thoughts about the initial worry changed?
How distressing is this issue now? (Re-rate 0-10)
If we want to change how we feel, we need to change what we do or avoid. Use this exercise to identify eight situations or activities that are
anxiety provoking in the first two columns. In the third column identify your predictions or assumptions about the situation. In the fourth column,
rate your predicted level of distress; from 0 (no distress) to 10 (maximum distress). In the fourth column identify what happened and how this
changes your assumption. In the final column rate your actual level of distress when completing the task.
1.
2.
3.
4.
5.
6.
7.
8.
Complete this log to plan regular activities and tasks that are consistent with your personal goals and values. Record the date in the first
column. Use the middle three columns to plan out purposeful, rewarding and compassionate activities in advance. Record your mood at
the end of each day in the final column.
Use this exercise to assess the costs of attempting to avoid or control difficult or distressing thoughts and emotions.
1. Describe a thought or emotion that you have been attempting to avoid or control? This could be a feeling like anxiety, a sensation like
back-pain or thoughts and images about a distressing or traumatic event.
2. List everything that you have attempted to do to avoid or control this problem.
3. What has this level of avoidance and control cost you in terms of the things that are important to you, e.g. confidence, health,
relationships, missed opportunities, career, personal values etc.?
4. If this approach has not resolved the underlying problem in the long-run, which avoidance and control strategies are you willing to let
go of?
5. What uncomfortable thoughts and emotions will you need to make room for if you let go of the avoidance and control?
6. What will you achieve in the longer-term if you focus on what you want, rather than what you feel you must avoid or attempt to
control?
7. How will this help you to move closer to your goals and personal values?
Use this exercise to assess the costs of holding onto difficult or distressing thoughts.
1. Identify a distressing thought that you are having difficulty letting go of.
2. How do you feel emotionally and physically when you get caught up in this thought?
3. How does your behaviour change when you get caught up in this thought?
5. How does this take you away from your goals and personal values?
7. What uncomfortable feelings will you need to make room for in order to let go of this thought?
8. If you choose to do this, how will this help you to live a healthier, more enriched and fulfilling life?
Use this exercise to assess the limitations of avoiding fearful or anxiety provoking thoughts and activities.
1. Identify a fear that limits your ability to pursue your goals or live in accordance with your personal values.
2. How would you act differently and what effect would it have on your life, if you were to gradually overcome this fear and focus on what
matters?
3. Describe your thoughts and feelings when faced with this fear.
4. What small steps could you take to overcome this fear, whilst making room for some discomfort or anxiety.
5. Make an ascending list of six small things that you could do to meaningfully face up to this fear from easiest to hardest.
1.
2.
3.
4.
5.
6.
6. Once you have achieved these six small steps, what will this mean about your ability to manage this fear in future?
Use this exercise to identify and respond to some of the most common self-criticisms or doubt that cause distress and limit your potential.
1. Identify the most common “not good enough” criticisms that your mind continuously returns to.
3. How do you feel emotionally and physically when your mind uses these criticisms about you?
4. How does your behaviour change when your mind uses these criticisms about you?
5. How could you open up to these criticisms in a way that would make them less relevant and easier to let go of?
6. What can you focus on right now to add value in your life whilst first noticing and then letting go of these criticisms?
To feel good and ready for the day we need to sleep well. For some people that’s a solid 7 or 8 hours every night. For others, 5 hours is
sufficient to feel ready for whatever the day might bring. Do you sleep well? Take this quick test to find out:
If you can answer “Yes” to these four questions, and you feel rested when you wake, you are probably sleeping well. If you answered “No” to
any or all of these questions then the next exercise may help you.
To sleep well we need to get the basics right. “Sleep Hygiene” is the basics of a
good night’s sleep and means the things we do in the day and at bedtime to prepare
ourselves for a restful night’s sleep.
The exercise on the next page looks at “lifestyle factors”, the things we do in the
day to put our bodies and minds in the right position to sleep well. The factors that
have the most marked impact on our ability to sleep well include caffeine, alcohol,
nicotine, exposure to daylight, the amount of exercise we take, relaxation time, bed
comfort; noise, light and temperature. The following exercise can help to identify
and record what you are doing now and anything you may need to change to
improve your pattern of consistent and restful sleep. You can find out more about
how CBT is used to manage insomnia and other sleep problems by visiting
www.thinkcbt.com/sleepwell.
Do you get exercise during the day? Exercise just before bedtime
should be avoided but, exercise during the day can help us feel
rested and ready for sleep.
Do you get daylight in the morning and have the lights dimmed in
the evening? This can help set our body clock to know when it
should be getting ready to sleep.
Do you only go to sleep when tired? This will maximise the chance
of your going to sleep and staying asleep.
Bed is best kept for sleep and intimacy – are there things that
happen in the bedroom that could happen elsewhere?
Mindfulness is a way of paying open attention to the present moment, on purpose and without external interference, judgement or criticism.
It involves bringing one’s complete attention to the present experience on a moment to moment basis. Research has consistently
demonstrated that Mindfulness can contribute to enhanced emotional resilience, lower levels of depression and anxiety, improved working
memory and concentration skills, reduced worry and rumination, increased focus of attention and reduced physiological arousal.
You can practice mindfulness by simply paying close attention to daily tasks such as feeling the temperature of the water on your hands when
washing up, by walking with a physical awareness of your legs and posture, or just using your five senses to tune into what you can see,
smell, hear, feel and taste in the situation. You can also take five-ten minutes each day to try the following simple exercises or visit
www.thinkcbt.com to find out about Mindfulness training programmes:
Abdominal Breathing
Abdominal breathing, sometimes called “Belly Breathing” is one of the first steps in beginning to relax the mind and body. This works by tuning
into the natural rhythm of the breath. The immediate benefits of this breathing are that it quiets the mind, reduces distress and relaxes the
body by balancing the nervous system. The long-term benefits are improved emotional control, enhanced perceptual sensitivity and increased
mental clarity. Practice this exercise twice daily:
• Sit quietly and comfortably in a chair, settle in, and feel the sense of gravity running down your spine and into your pelvic bones.
• Lengthen your spine. Lift, release, and relax your shoulders.
• Feel your feet flat on the floor.
• Place your hands on your belly.
• Tune into the natural rhythm of the breath.
• Follow the gentle rise and fall of the breath.
• Let the belly rise on the in breath and fall on the out breath.
• Allow the sides of your rib cage to gently expand and contract with each breath.
• Allow the breath to flow in and out by itself.
• Let go of any tension on the out breath.
• Remember that every out breath is an opportunity to let go and relax.
• Enjoy the feeling of emotional release and physical calmness.
Breath-awareness improves the ability to reduce stress and improve emotional resilience. When we are centred during breath-awareness,
we are open and receptive to our feelings. Practice the following steps:
Find a place of quiet and silence and then lie down and get comfortable:
• Start with yawn breathing; open your jaw and make some fake yawns.
• Allow the mind to wander and relax.
• Let your eyes close and soften.
• Relax and do some soft belly breathing; notice the rise and fall of the belly as you relax.
• Let go of any tension in the body and worries in the mind with each out-breath.
• Shift your focus onto your senses, feeling your body move as you breathe.
• Shift or stretch your body.
• Shift from actively thinking to noticing thoughts, feelings or sensations.
• Notice the wave or rhythm of the breath.
• Allow gravity to hold you as you relax deeply.
Use this exercise to capture any “unhelpful” thoughts or emotions that persistently interfere with your ability to pursue your goals and
values. Just noticing these thoughts and emotions without judgement or resistance can help you to defuse from them:
Use this exercise to help establish a balanced and compassionate self-perspective. Place a percentage marker on each scale:
Totally Totally
Worthless Worthwhile
0% 100%
Disrespectful Respectful
Selfish Helps Others
Lazy Works Hard
Ruthless Kind
Cold (Emotionless) Warm
Taking Giving
Unfair Fair
Pitiless Compassionate
Abusive Caring
Offensive Empathic
Insensitive Sensitive
Selfish Considerate
Unfaithful / Disloyal Faithful / Loyal
Indifferent Determined
This model can be helpful in identifying different emotional responses and finding the language to express how you feel. Try to link the feeling
to your thoughts and actions:
Feelings Thoughts Actions
Think
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