How you use cognitive distortion worksheets with your clients ultimately depends on the clients’ needs and preferences, and your therapeutic style. Some therapists incorporate CBT principles in a regimented way, while others take a more organic approach. If you’re familiar enough with the framework, you can easily incorporate the principle in and out of session, and with or without worksheets.
Provide psychoeducation
As a first step, you can use the cognitive distortion worksheet as an introduction to unhelpful automatic thoughts and how they can affect a person’s emotions and behavior. Tague sometimes uses the worksheet in session to introduce the most common distortions and then sends it home with clients so they can notice when the distortions come up between sessions. “At the start of CBT, we focus a lot on awareness and noticing,” she says.
Integrate it with thought records
Cognitive distortions worksheets are a great add-on to thought records, says Mike Arevalo, PsyD, a private practice therapist and Headway’s clinical product lead. After having clients track their thoughts for a period of time, Arevalo often introduces the cognitive distortion list as a way to help people find patterns in their thoughts. He typically shows the list to clients and asks if they resonate with any of the patterns listed.
“It’s more effective to help them realize it rather than telling them,” he says. Owusu explains after identifying a pattern of thought errors, you’ll have a baseline for challenging thoughts with cognitive restructuring. The next step would be to challenge and reframe the distorted thought in a more accurate, supportive, and rational way.
Know your client population
You may find it helpful to focus more on certain cognitive distortion patterns, especially if you work with a client base that struggles more with one or the other. Amanda Reagan, a private practice therapist and Headway’s clinical quality lead, says many of her clients with anxiety struggle with catastrophizing; if you treat clients with depression, you may see more all-or-nothing thinking.
Labeling the thought pattern they gravitate toward can make it feel more manageable and less overwhelming. Similarly, Reagan says, labeling can help clients feel less alone — and more motivated to change — because they know other people struggle with the same patterns.
“They start to realize that the thought pattern is just that, a pattern, and not a reflection of them as a person,” she says.
