Beyond Worksheets in Cognitive-Behavioral Therapy

Cognitive-behavioral therapy has a reputation for using a lot of worksheets. These started as hardcopy pieces of paper that led a client through the steps of various cognitive and behavioral techniques. Now, these worksheets take the form of fillable electronic files, phone apps, and even chatbots. However, it’s important to note that worksheets are not the beginning and end of cognitive-behavioral therapy. Worksheets are instead supposed to be a type of scaffolding, providing support when a client feels particularly depressed or anxious (and has trouble concentrating) or when they are new to cognitive-behavioral therapy.

The worksheets in cognitive-behavioral therapy come in many forms. I tend to use a worksheet called a thought record that helps people identify a stressful situation, their emotions, their negative thoughts and then challenge those negative thoughts. Thought records can be very simple with single-word labels in four boxes (situation, emotion, negative thought, new thought). They can be more elaborate with columns including spaces for getting into the nitty-gritty of how to challenge negative thoughts and come up with more realistic thoughts. Other worksheets focus on identifying negative thoughts associated with a trauma that is keeping a person stuck. Worksheets can also be useful for tracking activities to find times for more self-care. They can also help with building a hierarchy of feared situations to conquer in the right order and at the right pace.

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Worksheets also have the benefit of making clients write down something. Research has shown that we tend to remember something more when we handwrite it or, at the very least, type it out. Worksheets have multiple uses within cognitive-behavioral therapy. The first is making the skills easier to complete both in session and between sessions and the second is making the content easier to remember.

Successful worksheet completion is not the end goal of cognitive-behavioral therapy, however. The end goal is for a client to feel better (at least less depressed or anxious) and to achieve their individual goals. Ultimately, a successful course of cognitive-behavioral therapy results in clients that are able to use the skills and techniques without the worksheets. The worksheets provide important “training wheels” until they are able to use cognitive and behavioral skills on their own or when symptoms might relapse.

Some people do like to continue to use the worksheets even after therapy has ended. There is nothing wrong with continuing to use the worksheets, of course, particularly if it helps someone remember how to use the skills. But for a lot of clients, the goal is to be able to use the skills in their head whenever it’s needed so they can focus on living their life.