How to use a thought record worksheet with clients
Help your clients understand how their negative thoughts affect their emotions and behaviors.
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How to use a cognitive distortions worksheet with clients
Together, you can begin to challenge biased, inaccurate, unhelpful (and often irrational) ways of thinking.
One of the primary tenets of cognitive behavioral therapy is recognizing — and challenging — unhelpful ways of thinking. Cognitive distortions, as you’ve probably explained to your clients, can promote negative emotions and behaviors. So it makes sense that adjusting these distortions can help improve a variety of mental health conditions.
CBT worksheets, including thinking errors worksheets, are a great way to engage your clients and help them grow. Read on to learn about when and how to use cognitive distortions worksheet with your clients, according to other CBT therapists.
What are cognitive distortions?
Cognitive distortions are biased, inaccurate, unhelpful (and often irrational) ways of thinking that can lead to negative emotions or maladaptive behaviors. “They’re essentially patterns of thought that distort our reality in a way that’s distressing,” explains Natalia Tague, a private practice therapist in Virginia.
Using a cognitive distortions worksheet, you can introduce the most common unhelpful thinking patterns to your clients and begin to challenge them. Many worksheets have eight of the same cognitive distortion patterns, while some have even more, says Anita Owusu, a Toronto-based private practice therapist.
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What types of clients benefit from using a cognitive distortions worksheet?
The cognitive distortions worksheet is essentially a list that helps clients identify thinking patterns — such as catastrophizing or all-or-nothing thinking — that may be negatively impacting their well-being. Anyone who benefits from CBT can benefit from a cognitive distortion worksheet, whether that’s clients with anxiety or depression and other mood disorders.
How to use a cognitive distortions worksheet in CBT with your clients
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.
Cognitive distortion worksheet examples
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