Cognitive Behavioral Therapy Worksheet

Patient Information

• Name: Hayden
• Age: Child
• Condition Summary: Severe anxiety and behavioral outbursts; has not attended school for a couple of years; mother (primary caregiver) dotes on him; prescribed antidepressants
• Therapy Experience: Brief (1-5 sessions)
• Emergency Contact: Mother

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Understanding Your Thoughts and Feelings

Instructions: In this section, we will explore the feelings and thoughts that contribute to your anxiety. It's important to identify what you're experiencing so you can manage it effectively.

1. Identify Your Thoughts

Think about a recent time when you felt anxious or had a behavioral outburst. Write down what you were thinking at that moment.

• Date:
• Situation:
• Thoughts:

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2. Emotional Reaction

Now, consider how those thoughts made you feel emotionally. Circle the emotions that resonate with you the most.

• [ ] Fear
• [ ] Sadness
• [ ] Anger
• [ ] Confusion
• [ ] Loneliness
• [ ] Frustration
• [ ] Other: _____

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3. Physical Reactions

Sometimes anxiety can also cause physical reactions. Take a moment to note how your body feels during episodes of anxiety or outbursts.

• Physical Reactions:
  • Heart racing
  • Sweating
  • Nausea
  • Tension in your muscles
  • Shaking
  • Other: _____

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Challenging Negative Thoughts

Instructions: Let’s work on identifying and reframing negative or unhelpful thoughts that you may have.

1. Reframe Negative Thoughts

Take any negative thought identified in the previous section and try to challenge and reframe it into a more positive or realistic statement.

• Negative Thought:
• Reframed Thought:

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2. Evidence for and Against

Evaluate the negative thought by listing evidence that supports it and evidence that contradicts it.

• Evidence For:
• Evidence Against:

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Coping Strategies

Instructions: Now, let’s explore some coping strategies that can help you manage your anxiety and improve your behavior.

1. Identify Coping Strategies

List out some coping strategies you can use when you start to feel anxious or overwhelmed.

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2. ---

3. ---

4. ---

5. ---

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2. Practice Mindfulness

Mindfulness is a great way to manage anxiety. Practice the following exercise and note how you feel afterwards.

• Mindfulness Exercise: Sit quietly and focus on your breath. Count your breaths up to ten and then start again. Do this for 5 minutes.
• Reflection: How do you feel after the exercise?

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Goal Setting

Instructions: Setting small, achievable goals can help you work on behavioral changes over time.

1. Establishing Goals

Write down one or two small goals you would like to achieve regarding your anxiety or school attendance.

• Goal 1: __
• Goal 2: __

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2. Steps to Achieve Goals

Break down your goals into smaller, manageable steps.

• Steps for Goal 1:

  1. ---

  2. ---

  3. ---

• Steps for Goal 2:

  1. ---

  2. ---

  3. ---

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Support System

Instructions: It’s important to remember that you are not alone. List out the people you can reach out to for support.

1. ---

2. ---

3. ---

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By completing this worksheet, you are taking important steps toward understanding and managing your anxiety. Remember to share what you’ve learned with your therapist and discuss your goals in your next session.

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Emergency Contact Information

In case of severe distress or emergencies, please reach out to:

• Name: Mother
• Phone Number: ___

Make sure to keep this worksheet safe and refer back to it in the moments when you need support. You're doing great, Hayden!