Cognitive Behavioral Therapy (CBT) is one of the most widely used evidence-based treatment modalities in mental health. Originally developed by Aaron Beck in the 1960s to help individuals struggling with depression, CBT has since evolved into a flexible, structured approach used to address a variety of mental health concerns, from anxiety and trauma to substance use and mood disorders. Keep reading to explore 21 Cognitive Behavioral Therapy exercises and activities that you can use with your clients in therapy, along with step-by-step instructions, implementation tips, and ways to adapt them to individual client needs.
The foundational principles of CBT emphasize that unhealthy thought patterns and learned behaviors contribute to emotional distress. By identifying, challenging, and modifying these thoughts and behaviors, practitioners can help clients reduce distress and build more adaptive coping strategies. CBT has also informed the development of other therapeutic approaches, including:
- Dialectical Behavioral Therapy (DBT) – View our DBT Worksheets
- Acceptance and Commitment Therapy (ACT) – View our ACT Worksheets
- Mindfulness-Based Cognitive Therapy (MBCT)
- Schema Therapy (ST) – View our Schema Therapy Worksheets
CBT exercises are practical, structured activities designed to reinforce these principles in session and encourage skill-building between sessions. From thought records and cognitive restructuring to behavioral experiments and mindfulness exercises, these Cognitive Behavioral Therapy exercises provide clients with hands-on tools to better understand their thoughts, emotions, and behaviors.
For more valuable resources, view our CBT Tools and Resources hub
Preparing Clients for CBT Exercises
Before introducing CBT exercises, it is essential for practitioners to thoughtfully prepare to ensure sessions are effective and supportive. This includes establishing a collaborative therapeutic relationship, providing psychoeducation about the cognitive model, assessing the client’s readiness, and ensuring that the session environment and materials (e.g., worksheets, handouts) are prepared. Doing so allows clients to engage meaningfully in exercises, practice skills outside of sessions, and approach potentially challenging tasks with confidence. CBT manuals emphasize that careful preparation enhances treatment outcomes and client engagement (Beck, 2011).
1. Establish a Collaborative Relationship
CBT is most effective when clients feel engaged and empowered in the process. Take time to explain the purpose of CBT exercises, how they relate to the client’s goals, and the expected benefits. Emphasize that these exercises are collaborative tools rather than tests or evaluations, and encourage open communication about what feels helpful or challenging.
2. Provide Psychoeducation
Many clients may be unfamiliar with CBT or may have misconceptions about therapy. Briefly review core concepts such as the connection between thoughts, emotions, and behaviors, as well as the role of cognitive distortions. This foundation will help clients understand why the exercises are structured the way they are and how they can apply them outside of sessions.
3. Set Expectations and Goals
Clarify what will happen during the exercise, how long it will take, and what outcomes are possible. Encourage clients to set realistic expectations and remind them that progress may be gradual. Discussing goals beforehand can help clients feel more motivated and oriented during exercises.
4. Assess Client Readiness
Some exercises, particularly those that explore distressing thoughts or emotions, require a certain level of emotional stability. Evaluate your client’s current mental state, coping skills, and willingness to engage before introducing more challenging activities. Modifications may be necessary for clients with trauma histories, high anxiety, or depressive symptoms.
5. Prepare Materials and Environment
Ensure that worksheets, writing materials, or other resources are readily available. Choose a comfortable and private space free from distractions, and allow sufficient time for reflection and discussion. Having all materials prepared in advance helps sessions flow smoothly and reduces client stress.
6. Introduce Coping and Grounding Skills
Before exploring challenging thoughts or behaviors, ensure clients have basic coping strategies to manage distress. Grounding exercises, deep breathing, or mindfulness techniques can be taught briefly before beginning a CBT activity, so clients feel safe and supported during the process.
7. Normalize the Process
Remind clients that CBT exercises often involve trial and error. Some exercises may feel awkward, difficult, or uncomfortable at first, and that is normal. Encourage reflection on their experience and emphasize that noticing thoughts and behaviors is a skill that develops with practice.
21 Cognitive Behavioral Therapy Exercises & Activities
Cognitive Behavioral Therapy exercises and activities are practical tools that help clients identify and challenge unhelpful thought patterns, increase self-awareness, and develop adaptive behaviors. These exercises can be used in session and practiced between sessions to reinforce learning and create lasting change. By combining thought analysis, behavioral strategies, and mindfulness, clients can develop skills to manage anxiety, depression, and other mental health challenges more effectively.
Here are 21 Cognitive Behavioral Therapy exercises that can be included in clinical sessions with your clients:
1. Thought Records
Introduce your client to thought records. Working through a thought record worksheet, like the CBT Thought Record worksheet available from TherapyByPro, can help clients become familiar with the patterns of their thoughts. This would include noting the event that led to the thought, negative automatic thoughts that they experienced, and the evidence they have that supports the thoughts. You can encourage clients to complete 2-3 thought records in between sessions that will be reviewed in their next session.
What It Is: A structured tool for tracking and evaluating automatic thoughts.
How It Helps Clients: Helps identify thought patterns and understand how thoughts influence emotions and behaviors.
How to Do It: Use a worksheet to record events, negative automatic thoughts, and evidence supporting or contradicting the thought. Encourage completing 2–3 records between sessions.
2. Cognitive Distortions Review
Spend time introducing cognitive distortions to your client, and review common distortions. Allow the client to identify with examples that they can relate to. You can then move into the process of thought challenges and provide tools that they can utilize when they recognize cognitive distortions.
What It Is: Teaching clients common thought distortions (e.g., all-or-nothing thinking, catastrophizing).
How It Helps Clients: Increases awareness of thinking errors and prepares clients for cognitive restructuring.
How to Do It: Review distortions with examples and ask clients to identify distortions they relate to. Follow with thought-challenging practice.
3. Core Beliefs Exploration
Spend time reviewing and exploring your client’s core beliefs. Spend time talking about how our core beliefs impact our mental health. Using a CBT Core Beliefs worksheet template can provide your client with a visual aid showing their core beliefs.
What It Is: Identifying deeply held beliefs that influence emotions and behaviors.
How It Helps Clients: Provides insight into long-standing patterns and maladaptive thought cycles.
How to Do It: Discuss core beliefs, their origins, and their impact. Use a CBT Core Beliefs worksheet to visualize and reflect.
4. Behavior–Feeling Exploration
Spend time exploring how your client’s behaviors make them feel. Explore behaviors that are associated with pleasurable feelings, as well as distressing emotions.
What It Is: Evaluating how behaviors affect emotions.
How It Helps Clients: Highlights the connection between actions and emotional experiences.
How to Do It: Ask clients to reflect on behaviors linked to positive or negative feelings and discuss implications.
5. Grounding Skills
Spend time reviewing the use of grounding skills and how they can help us cope with the emotional distress we feel. Ask your client to focus on their environment, by using their senses. Encourage your client to use grounding skills outside of their session to review their usefulness in managing their distress.
What It Is: Techniques to anchor clients in the present moment using the senses.
How It Helps Clients: Reduces emotional distress and increases mindfulness.
How to Do It: Practice focusing on surroundings and sensations, then encourage use outside of sessions.
6. PAUSE Acronym
Introduce your client to the acronym PAUSE (Pause, Activity, Understand, Soothe, and Exhale). Spend time practicing the associated steps in session, and encourage your client to use them when they begin to notice their anxiety or worry outside of their session. Allow time to review your client’s experience using it.
What It Is: A coping framework: Pause, Activity, Understand, Soothe, Exhale.
How It Helps Clients: Provides structured strategies to manage anxiety or worry.
How to Do It: Practice each step in session, encourage application in real-life scenarios, and review experiences.
7. Mindfulness Introduction
Introduce your client to mindfulness. With the attention that mindfulness has gotten on various media platforms, they may have their own understanding or expectation of mindfulness. Allow for time to explore their understanding of mindfulness, and how mindfulness skills can help manage anxiety and other mental health symptoms.
What It Is: Practices that enhance present-moment awareness.
How It Helps Clients: Reduces rumination, increases emotional regulation, and supports self-awareness.
How to Do It: Explore client’s understanding, discuss benefits, and practice basic mindfulness exercises.
8. Decatastrophizing Worksheet
For clients who experience catastrophizing, using a decatastrophizing worksheet can help clients evaluate their thoughts related to an event or situation that is provoking anxiety symptoms. TherapyByPro offers a worksheet that breaks down the process by identifying the event, the specific fear or worry present, and evaluating the evidence supporting or disproving the worry.
What It Is: An exercise to evaluate feared outcomes realistically.
How It Helps Clients: Reduces anxiety by challenging exaggerated worries.
How to Do It: Identify an event, note fears, and examine evidence for and against worst-case outcomes.
9. Exploring Anxiety Avoidance
Spend time exploring what your client’s anxiety has kept them from doing. What are some things that they would like to be able to do, that they have not been able to do? Use this as an opportunity to review their experience with cognitive distortions and unhealthy thoughts.
What It Is: Identifying life areas restricted by anxiety.
How It Helps Clients: Encourages exposure to avoided situations and problem-solving.
How to Do It: Discuss activities they have avoided and relate to cognitive distortions or unhelpful thoughts.
10. Three-Component Model of Emotions
Spend time reviewing the three-component model of emotions associated with CBT. This would include discussing how our thoughts have a direct impact on how we feel, which is often influencing our behaviors. You can walk through this model with a real-life example that your client has experienced. Additionally, you can use this as an opportunity to discuss when it would be most impactful to use CBT strategies.
What It Is: Examines the link between thoughts, feelings, and behaviors.
How It Helps Clients: Clarifies how cognition drives emotions and behaviors.
How to Do It: Use real-life examples to demonstrate the model and discuss where CBT strategies can intervene.
11. Mindfulness Exercises
Some clients benefit from having access to mindfulness worksheets that can walk them through mindfulness practices outside of counseling sessions. This can include a thought-dumping exercise, observing how they feel before and after a mindfulness exercise, and writing down their goals and priorities.
What It Is: Written exercises guiding mindfulness practice.
How It Helps Clients: Promotes self-reflection and consistent practice outside of sessions.
How to Do It: Use worksheets for thought-dumping, emotion tracking, and goal-setting.
12. Meditation Practices
Introduce your client to meditation practices. Similarly to mindfulness, there has been an influx of information regarding mindfulness practices which may have impacted your clients understanding of it. Take time to explore their perception of meditation, and fill in any gaps that they may be missing. Set time aside to practice different forms of meditation. Keep in mind that some clients, especially those with a history of trauma, may struggle to sit and/or close their eyes during a meditation exercise.
What It Is: Structured exercises to promote calm and awareness.
How It Helps Clients: Enhances emotional regulation and focus.
How to Do It: Introduce guided imagery, progressive relaxation, or focused attention exercises; check comfort for trauma histories.
13. Breathing Exercises
Spend time reviewing breathing exercises that can help clients manage stressful moments. This can include pranayama breathing, lengthening their exhale, abdomen breathing, breath focus, and box breathing. Encourage your client to use these breathing exercises outside of the session and talk about their experience in future sessions.
What It Is: Techniques like pranayama, box breathing, or abdominal breathing.
How It Helps Clients: Reduces physiological stress responses and anxiety.
How to Do It: Practice in session and encourage daily use; review effectiveness in follow-ups.
14. Panic Attack Diary
Clients who experience panic attacks can benefit from using a panic attack diary worksheet to note specific details of their experience. This allows them to bring the worksheet into a session to review and process. Additionally, clients may benefit from holding onto their diary entries to review their progress.
What It Is: Tracking panic episodes and responses.
How It Helps Clients: Increases insight into triggers, symptoms, and coping effectiveness.
How to Do It: Clients document events, thoughts, and physical sensations to review in therapy.
15. Body-Focused Anxiety Check-In
If your client is feeling anxious while in your presence, ask them where they feel anxious within their body. Encourage your client to stay present at the moment, and work with you to evaluate the distressing thoughts they are feeling. This allows them to recognize if their symptoms are appropriate for their concern. Once you evaluate their thoughts, check in on their current experience with anxiety within their body.
What It Is: Identifying where anxiety manifests physically.
How It Helps Clients: Increases somatic awareness and distinguishes realistic vs. exaggerated symptoms.
How to Do It: Guide clients to notice bodily sensations and evaluate associated thoughts.
16. Goal-Setting Strategies
If you have a client who is struggling with setting, planning, or working towards goals, it may be beneficial to review helpful goal-setting strategies. This includes breaking larger goals into smaller, and more manageable tasks and being mindful of realistic expectations. You can then spend time exploring a current goal that they have or to formulate a new goal they can work towards.
What It Is: Structuring achievable goals.
How It Helps Clients: Encourages realistic planning and reduces overwhelm.
How to Do It: Break goals into smaller steps, set timeframes, and track progress.
17. Engagement in Enjoyable Activities
Provide your client with a list of enjoyable activities and hobbies. Ask your client to identify 1-2 new activities or hobbies that they would be willing to try. Allow time to follow up regarding their experience in future sessions.
What It Is: Introducing new hobbies or pleasurable tasks.
How It Helps Clients: Improves mood, motivation, and overall well-being.
How to Do It: Provide a list of activities, ask clients to try 1–2, and follow up on experiences.
18. Negative Self-Talk Exploration
Explore your clients experience with negative self-talk. How does their inner voice speak to them, and how has this impacted them? Explore ways that your clients can challenge their negative self-talk and replace these thoughts with those that show more compassion and kindness.
What It Is: Examining critical internal dialogue.
How It Helps Clients: Increases awareness of unhelpful self-talk and promotes compassionate alternatives.
How to Do It: Identify patterns, challenge negative thoughts, and develop supportive self-statements.
19. Reassurance vs. Information Seeking
Explore the difference between information gathering and reassurance seeking. If your client can identify with needing reassurance, explore where this need is coming from in their life. Is there an area of their life that they are not confident or sure about? Do they have a history of trauma, abuse, or neglect that is influencing their behaviors?
What It Is: Differentiating unhelpful reassurance-seeking from adaptive information gathering.
How It Helps Clients: Reduces anxiety-driven behaviors and fosters independence
How to Do It: Explore areas where reassurance is sought, its origins, and healthier strategies.
20. Gratitude Practice
Encourage your client to practice gratitude daily, specifically identifying 3 things daily that they are grateful for. Encourage them to bring their lists into the session.
What It Is: Daily reflection on positive experiences or things to be thankful for.
How It Helps Clients: Enhances mood and cognitive reframing.
How to Do It: Encourage clients to list 3 things they are grateful for each day and review in sessions.
21. Thought-Challenging
Spend time introducing the process of thought challenges and provide tools that they can utilize when they recognize cognitive distortions.
What It Is: Systematic evaluation of negative thoughts.
How It Helps Clients: Reduces cognitive distortions and strengthens adaptive thinking.
How to Do It: Identify negative thoughts, challenge accuracy, and replace with balanced alternatives.
Frequently Asked Questions About Cognitive Behavioral Therapy (CBT) Activities
Below are the practical questions clinicians ask when facilitating Cognitive Behavioral Therapy (CBT) exercises and structured activities to identify core beliefs, challenge cognitive distortions, and introduce behavioral modifications.
How can a clinician effectively structure a collaborative thought record exercise to bridge the gap between sessions?
When introducing a thought record worksheet, the clinician should complete the initial entries collaboratively in-session, guiding the client to isolate a specific activating event, negative automatic thoughts, and immediate emotions. The therapist then teaches the client to document the underlying cognitive distortions and evaluate the factual evidence supporting or contradicting the thought. To build independence and ensure skill generalization, the clinician should assign 2 to 3 thought records as homework, reviewing the entries during subsequent check-ins to monitor cognitive restructuring progress.
What clinical adjustments should a therapist implement if a decatastrophizing exercise triggers an escalation in physiological anxiety?
If evaluating worst-case scenarios on a decatastrophizing worksheet causes a client’s autonomic arousal to spike, the therapist should pause the cognitive work and introduce immediate breathing exercises or grounding skills. Forcing a highly anxious individual to confront core fears can cause severe emotional overload if they lack somatic stability. Practicing tools like box breathing, abdominal breathing, or external five-senses grounding lowers the physiological stress response, returning the client to their window of tolerance before they re-engage in cognitive restructuring.
How does a CBT core beliefs exploration fundamentally differ from standard, everyday thought-challenging activities?
While standard thought-challenging activities target transient, surface-level negative automatic thoughts tied to specific daily events, a core beliefs exploration targets deeply held, long-standing rules that shape a client’s entire self-narrative and identity. Automatic thoughts are the immediate cognitive expressions of these underlying core assumptions. Exploring core beliefs requires looking into childhood origins and pervasive life themes using tools like a core beliefs schema map, shifting the focus from situational coping to changing structural maladaptive cognitive frameworks.
Why are unstructured mindfulness or deep meditation practices sometimes contraindicated during an acute panic attack or intense bodily distress?
Unstructured practices like deep meditation or closed-eye body scans direct acute awareness inward, which can inadvertently amplify catastrophic interpretations of racing heart rates or shortness of breath for a panicked client. When a client exhibits high physiological distress, therapists should avoid interoceptive focus and instead utilize structured cognitive pacing or external tracking tools, such as the PAUSE acronym or a panic attack diary. These exercises provide the logical scaffolding needed to track symptoms objectively without getting consumed by somatic panic.
How can a therapist objectively measure behavioral progress when utilizing strategies like engagement in enjoyable activities or goal-setting?
Progress should be evaluated by tracking the client’s direct behavioral compliance and self-reported emotion logs outside the clinical container rather than merely checking for verbal agreement during sessions. Using a behavior-feeling exploration log, clinicians can monitor whether a client is consistently scheduling, initiating, and completing 1 to 2 new hobbies or manageable action steps. Observable growth is demonstrated when a client shows a measurable increase in pleasurable emotional states, a reduction in anxiety-driven avoidance, and an expanded capacity to break down complex challenges independently.
Final Thoughts on Selecting CBT Exercises and Activities for Your Clients
Thank you for reading our resource on 21 Cognitive Behavioral Therapy Exercises and Activities you can do with your clients in therapy. Cognitive Behavioral Therapy activities can provide counselors with an opportunity to educate clients about the mental health concern that they are struggling with and how they can work towards managing their distress in a healthy manner. Additionally, your client has an opportunity to practice skills associated with CBT activities that they can apply to their real-life experiences.
Cognitive Behavioral Therapy is one of the go-to therapeutic approaches for Counselors due to the positive impact it can have on our client’s well-being. It is important to remember that we are ethically bound to practice within the limits of our knowledge and experience. If you would like to learn more about Cognitive Behavioral Therapy exercises and how they can fit into your clinical work, speak with a supervisor or colleague about available opportunities that can build your skill set.
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References
- Seligman, L., & Reichenberg, L. W. (2010). Theories of counseling and psychotherapy: Systems, strategies, and skills (3rd ed.). Pearson Education, Inc.
- Beck, J. S. (2021). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press.
- Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://pmc.ncbi.nlm.nih.gov/articles/PMC3584580/
- Chand, S. P., & Grossberg, G. T. (2023). Cognitive behavior therapy. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/
- Cuijpers, P., et al. (2025). Cognitive behavior therapy for mental disorders in adults: A network meta-analysis of 375 trials. JAMA Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2832696
- Beck Institute for Cognitive Behavior Therapy. (n.d.). What is cognitive behavior therapy (CBT)? https://beckinstitute.org/about-cbt/