Essentials Course Manual

Essentials of CBT:
The Beck Approach
Course Manual
www.beckinstitute.org 1
Contents
Week 1 Module 1 - Socratic Questions......................................................................................................... 4
Week 1 Module 1 - Summary for the Anxious Poster .................................................................................. 5
Week 1 Module 3 - Overview of Therapy Session Structure ........................................................................ 6
Week 1 Module 3 - Overview of the Beginning of the Session .................................................................... 7
Week 1 Module 4 - The Therapeutic Relationship ....................................................................................... 8
Week 1 Module 5 - Areas Representing Key Values ..................................................................................... 9
Week 1 Module 5 - Sample schedule.......................................................................................................... 10
Week 1 Module 6 - Summary of Week 1 .................................................................................................... 11
Week 2 Module 2 - List of Negative Emotions............................................................................................ 12
Week 2 Module 2 - Viewing Your Experience Through the Cognitive Model Worksheet .......................... 13
Week 2 Module 4 - Core Beliefs ................................................................................................................. 14
Week 2 Module 5 - The Cognitive Conceptualization Diagram .................................................................. 15
Week 2 Module 5 - The Cognitive Conceptualization Diagram (Rachel) .................................................... 16
Week 3 Module 2 - Questions to Identify Automatic Thoughts ................................................................. 18
Week 3 Module 2 - Identifying Beliefs, Coping Strategies, and Assumptions ............................................ 19
Week 3 Module 3 - List of Typical Cognitive Distortions ............................................................................ 20
Week 3 Module 3 - Sample Coping Card to read after a behavioral experiment....................................... 21
Week 3 Module 3 - Summary of Clinical Roundtable - Partial list of techniques to modify thoughts and
beliefs ......................................................................................................................... 22
Week 3 Module 3 - Summary of Clinical Roundtable - Partial list of techniques to modify Core Beliefs .. 23
Week 3 Module 4 - Questions to Help Clients Draw Conclusions .............................................................. 24
Week 3 Module 4 - Testing Your Thinking Worksheet ............................................................................... 25
Week 3 Module 4 - Testing Your Thinking Worksheet Completed (Sophia) ................................................ 26
Week 3 Module 4 - Thought Record Worksheet ........................................................................................ 27
Week 3 Module 4 - Thought Record Worksheet Completed (Sophia) ....................................................... 28
Week 3 Module 4 - Sample Coping Card .................................................................................................... 28
Week 4 Module 1 - Typical Action Plan Assignments ................................................................................. 31
Week 4 Module 1 - Typical Behavioral Assignments .................................................................................. 32
Week 4 Module 1 - Activity Scheduling: Pleasure/Mastery Scale .............................................................. 33
Week 4 Module 1 - Activity Scheduling: Activity Monitor .......................................................................... 34
Week 4 Module 1 - Activity Scheduling: Activity Monitor (continued) ...................................................... 35
Week 4 Module 2 - Questions to Create an Action Plan ............................................................................ 36
Week 4 Module 2 - Tips to make therapy notes more effective ................................................................ 37
Week 4 Module 2 - Techniques to Make Behavioral Assignments More Effective .................................... 38
Week 4 Module 2 - Sample Coping Card .................................................................................................... 39
Week 4 Module 2 - Checklist to Facilitate Completion of Action Plans...................................................... 40
Week 4 Module 3 - Summary of Clinical Roundtable - Additional Techniques to Facilitate Completion of
Action Plans ................................................................................................................ 41
Week 4 Module 4 - Reviewing Action Plans ............................................................................................... 42
Week 4 Module 4 - Conceptualizing Non-Completion of Action Plans ...................................................... 43
Week 4 Module 4 - Video Notes ................................................................................................................. 44
Week 1 Module 1 - Socratic Questions
1. Whats the evidence that your thought is true, that people will be critical of you? Is there any
evidence on the other side, that people might not be critical?
2. Is there another way of looking at this situation?
3. If people are critical, how could you cope with that? But people being critical is only one
outcome, in fact, its the worst one. Whats the best possible outcome of posting on the Forum?
Whats the most realistic outcome?
4. What is the effect of telling yourself that people are likely to be critical? What could be the
effect of changing your thinking?
5. What would you tell your friend [think of a specific person] if he or she were in this same
situation and had this thought? How might that apply to you?
6. What should you do now?
2011, Beck, J.S. Cognitive Behavior Therapy: Basics and Beyond (2nd ed.).
Week 1 Module 1 - Summary for the Anxious Poster
Its possible, though unlikely, that someone would be critical of me, but so what?
Since Im only using my first name, no one will know who I am. And the faculty
monitor will take it down critical or inappropriate comments. Other people are
likely to be more critical of a criticizer than they will be of me. But having
someone criticize me is just the worst possibility. Its most likely that my comments
will actually be helpful to people plus Ill get my questions answered. Id tell my
colleague Randy that its worth doing because its potentially so useful to post. I
should go ahead and do it.
If youre concerned about posting, please read this summary in the course manual at least once day.
Week 1 Module 3 - Overview of Therapy Session Structure
Beginning
-Therapeutic Alliance
-Collect information
Middle
-Ask about problem

-Conceptualize
-Implement strategy
-Evaluate
-Summarize
-Create Action Plan
End
-Summarize
-Check on Action Plan
-Client feedback
Week 1 Module 3 - Overview of the Beginning of the Session
Beginning of Sessions
-Mood Check
-Bridge
-Agenda
-Review Action Plan
Week 1 Module 4 - The Therapeutic Relationship
Its important to be a nice human being in the room with every client.
I have to make every client feel safe.
I should treat every client the way Id like to be treated.
Clients are supposed to be difficult. Thats why theyre clients.
Week 1 Module 5 - Areas Representing Key Values
Family relationships
Other relationships
Work
Managing at home
Spirituality
Interests
Physical health
Mental health
Finances
Social justice
Week 1 Module 5 - Sample schedule
7:00 AM Wake up, morning routine
8:00 AM Exercise
9:00 AM
10:00 AM Work
11:00 AM
12:00 PM Lunch and a walk
1:00 PM
2:00 PM
3:00 PM Work
4:00 PM
5:00 PM
6:00 PM Errands
7:00 PM Dinner with friend
8:00 PM Household chores
9:00 PM Watch TV
10:00 PM Emails, computer
11:00 PM Get ready for bed
Week 1 Module 6 - Summary of Week 1
In this first week of the course, you heard about
the DEFINITION and HISTORY of CBT,
RESEARCH EVIDENCE, and
KEY COMPONENTS of treatment. We also talked about the
STRUCTURE of sessions, the
THERAPEUTIC RELATIONSHIP, and
SETTING GOALS
Week 2 Module 2 - List of Negative Emotions
Sad, down, lonely, disappointed, or unhappy
Anxious, worried, fearful, scared, or tense
Angry, mad, irritated annoyed or frustrated
Ashamed, embarrassed, or humiliated
Jealous or envious
Guilty
Hurt
Suspicious
Week 2 Module 2 - Viewing Your Experience Through the Cognitive
Model Worksheet
Situation
Automatic Thoughts
Reaction
Emotional Behavioral Physiological
Week 2 Module 4 - Core Beliefs
Helpless core beliefs
I am incompetent
I am ineffective
I cant do anything right
I am helpless
I am powerless
I am weak
I am vulnerable
I am a victim
I am needy
I am trapper
I am out of control
I am a failure
I am defective [ i.e., I do not measure up to others]
I am not good enough [in terms of achievement]
I am a loser
Unlovable core beliefs

I am unlovable
I am unlikeable
I am undesirable
I am unattractive
I am unwanted
I am uncared for
I am different
I am bad [so others will not love me]
I am defective [so others will not love me]
I am not good enough [to be loved by others]
I am bound to be rejected
I am bound to be abandoned
I am bound to be alone
Worthless core beliefs

I am worthless
I am unacceptable
I am bad
I am a waste
I am immoral
I am dangerous
I am toxic
I am evil
I dont deserve to live
Week 2 Module 5 - The Cognitive Conceptualization Diagram
RELEVANT LIFE HISTORY
CORE BELIEF(S)
CONDITIONAL ASSUMPTIONS/BELIEFS/RULES
COPING/COMPENSATORY STRATEGIES
SITUATION #1 SITUATION #2 SITUATION #3
AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S)
MEANING OF A.T. MEANING OF A.T. MEANING OF A.T.
EMOTION(S) EMOTION(S) EMOTION(S)
BEHAVIOR BEHAVIOR BEHAVIOR
Week 2 Module 5 - The Cognitive Conceptualization Diagram (Rachel)
RELEVANT LIFE HISTORY
Father left family when Rachel was 4. Mom had untreated mental health condition. Rachel and
Moms finances were unstable; they moved a lot. Rachel was bullied in middle school.
CORE BELIEF(S)
I dont fit in. Im vulnerable. I'm helpless. (?)
CONDITIONAL ASSUMPTIONS/BELIEFS/RULES
If I keep to myself, Ill be okay but if I put myself out socially Ill be rejected. If I avoid, Ill be okay
but if I try to solve my problems, Ill fail.
COPING/COMPENSATORY STRATEGIES
Avoids social interaction

Avoids difficult tasks
SITUATION #1 SITUATION #2 SITUATION #3
Thinking about joining a club Thinking about school Thinking about getting up in
the morning
AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S)
People will criticize me.
MEANING OF A.T. MEANING OF A.T. MEANING OF A.T.

Im helpless ? Im helpless
I dont fit in.
EMOTION(S) EMOTION(S) EMOTION(S)

Anxious Sad ? Discouraged
BEHAVIOR BEHAVIOR BEHAVIOR

Avoid joining Avoids Math Stays in bed
Here are the most important points I hope you learned this week:
1. The Cognitive Model helps us make sense of peoples experiences.
2. The reason people react in the way that they do is related to their perception of their experience,
specifically, the spontaneous automatic thoughts they have.
3. Peoples reactions make sense once we understand their automatic thoughts.
4. Their automatic thoughts make sense once we understand the basic way they see themselves, their
worlds, and other people. Core beliefs are rigid, overgeneralized, global beliefs about the self, world,
and other people.
5. People develop certain assumptions, or rules for living, that help protect them from the activation of
their core beliefs. These assumptions get translated into actions which we understand as their
coping strategies.
Week 3 Module 2 - Questions to Identify Automatic Thoughts
1 What was just going through my mind?
2 What was I just thinking?
3 Were you thinking[provide an opposite thought]?
Week 3 Module 2 - Identifying Beliefs, Coping Strategies, and
Assumptions
Identify the CORE BELIEFS of clients
1. Do the downward arrow technique, using a number of automatic thoughts across situations.
Ask the client If this automatic thought were true, would that mean? What would that mean
about you?
2. Look at the automatic thoughts of clients and ask yourself, Which themes seem to be
consistent throughout their thoughts?
3. Provide your clients with a list of common core beliefs from the Course Manual.
4. Watch for an automatic thought that has the characteristics of a core belief. Its not situation
specific; its a broad quality that clients believe are completely characteristic of them; it is highly
negative and dysfunctional; its difficult to modify; its attached to a great deal of negative
emotion.
To identify the COPING STRATEGIES of clients
1. Look at the core beliefs of a client and ask yourself, Given these core beliefs, how has the client
coped?
2. Look over the behaviors of a client and ask yourself, What patterns of dysfunctional behavior
do I see across situations?
Heres how we can identify their assumptions
1. TRANSLATE THEIR RULES AND ATTITUDES into the IF..then.. form.
For example, Rachel told me, I shouldnt trust other people. And I think its bad to trust
people. Her assumption was, If I trust other people, Ill get hurt.
2. Look for COMMON THEMES among situation specific assumptions.
For example, Rachel thought, If I go to the photography group, people may think Im not good
enough. If I tell anyone about my mothers mental illness, theyll think badly of me. If I
socialize with kids at my new school, they could end up bullying me. These smaller, situation
specific assumptions pointed to her general assumption, If I get close to people, Ill get hurt.
3. Provide PART OF AN ASSUMPTION.
For example, I said to Rachel, How would you fill in this blank? If I dont do well on things I try,
it will mean what?
4. You can also gently HYPOTHESIZE ABOUT AN ASSUMPTION.
Rachel, are you concerned that if you start doing a number of things that youve been avoiding,
that you wont do them very well or youll open yourself up to criticism?
Week 3 Module 3 - List of Typical Cognitive Distortions
Here are some typical thinking errors, or cognitive distortions, and their definitions.
1. All-or-Nothing Thinking. You see things only in two categories. Things are black or white, with no
shades of gray. I have to do a great job on everything.
2. Fortune-Telling: You make negative predictions about what will happen when other outcomes
are more likely. Ill always have trouble figuring out my thoughts.
3. Labeling. You put a globally negative label on yourself. Im a failure for making a mistake.
4. Emotional reasoning. You believe something must be true because it feels true. I must be
incompetent.
5. Selective abstraction. You pay attention only to the negative aspects of situations instead of
considering the entire experience. I made so many mistakes.
6. Overgeneralization. You draw a general conclusion on the basis of a small amount of evidence.
I do everything wrong.
7. Mind reading. You are sure you know what others are thinking. They probably think Im
foolish.
8. Personalization. You take others actions personally when they actually have other intentions.
They did that to me on purpose.
9. Imperatives. You have an unreasonably rigid idea about how you or others should or must
behave. I should always do my absolute best.
10. Magnification and minimization. You magnify the negatives or minimize the positives. Im no
good at figuring out what to do. It doesnt matter than I have good common sense.
Week 3 Module 3 - Sample Coping Card to read after a behavioral
experiment
If it turns out the course is too hard, it doesnt mean anything bad about me. It
could be that the material wasnt presented well or that I didnt have enough
background to take the course. Maybe I just need to get some help with some parts
of the course and then it wont be so hard.
Week 3 Module 3 - Summary of Clinical Roundtable - Partial list of
techniques to modify thoughts and beliefs
1. I could normalize the experience, giving the client information that many new therapists have
the identical thought.
2. I could use SELF-DISCLOSURE, but only if its authentic, telling the client that when I was first
starting out, I often had that thought, and so did many of my peers. Id normalize the thought,
saying that its a common idea many people have but most of the time it doesnt turn out to be
true.
3. I might also have the client verbalize his EXPECTATIONS. Perhaps the client has unreasonably
high standards for himself, especially at this point in his learning.
4. I could have the client think of a ROLE MODEL. Whom do you consider to be a success? When
this person was first starting out, do you think she ever thought there was too much to learn? If
so, how do you think she responded? What did she do?
5. I could have the client look through his history, to see whether hes ever had thoughts like this
before and what happened? For example, maybe he thought there was too much to learn to get
good at a sport or learn the material for another course. Did those predictions turn out to be
true?
6. I could ask the client what he might do differently if he truly didnt believe his automatic
thought. Then wed discuss ACTING AS IF he didnt believe it and engaging in productive
activities.
7. I could give him an analogy.
Week 3 Module 3 - Summary of Clinical Roundtable - Partial list of
techniques to modify Core Beliefs
1. Metaphor
2. Core Belief Worksheet
3. Historical review
4. Changing the meaning of early experiences through imagery
5. Cognitive Continuum
6. Etc.
Week 3 Module 4 - Questions to Help Clients Draw Conclusions
1. What do you conclude?

2. Can you summarize what weve just talked about?
3. What do you want to remember?
4. What would be important for you to remind yourself this week?
5. What do you want to do this week?
Week 3 Module 4 - Testing Your Thinking Worksheet
Name: Date: __________________
This worksheet is an easier version of the Dysfunctional Thought Record and should be used in place of,
not in addition to, the DTR, for certain clients, such as adolescents.
What is the situation?
What am I thinking or imagining?
How does that make me feel? mad sad nervous other:
What makes me think the thought is true?
What makes me think the thought is not true or not completely true?
Whats another way to look at this?
Whats the worst that could happen? What could I do then?
Whats the best that could happen?
What will probably happen?
What could happen if I changed my thinking?
What would I tell my friend [think of a specific person] if this happened to him or her?
What should I do now?

Week 3 Module 4 - Testing Your Thinking Worksheet Completed (Sophia)
Name: Sophia Date: __________________
This worksheet is an easier version of the Dysfunctional Thought Record and should be used in place of,
not in addition to, the DTR, for certain clients, such as adolescents.
What is the situation? Thinking about interrupting a client.
What am I thinking or imagining? He might not like it.
How does that make me feel? mad sad nervous other:
What makes me think the thought is true? I guess I just assumed it was true. I know
some people dont like to be interrupted.
What makes me think the thought is not true or not completely true? I interrupt clients
during evaluations and they dont seem to mind.
Whats another way to look at this? Clients may appreciate the interruptions,
especially if I tell them its so I can help them better.
Whats the worst that could happen? What could I do then? The client would get mad
and not come back. Id just take on another client.
Whats the best that could happen? The client would be extremely grateful for the
interruption.
What will probably happen? The client will probably be fine if I interrupt gently.
What could happen if I changed my thinking? Id be more likely to interrupt.
What would I tell my friend [think of a specific person] JoAnn if this happened to him or her? Id
tell her interrupting is important because otherwise she wont be able to
help the client as much.
What should I do now? Interrupt my client when I need to.

Directions: When you notice your mood getting worse, ask yourself, Whats going through my mind right now? and as soon as possible
jot down the thought or mental image in the Automatic Thought Column.
27
DATE/ SITUATION AUTOMATIC EMOTION(S) ALTERNATIVE RESPONSE OUTCOME
TIME THOUGHTS
www.beckinstitute.org
1.What actual event 1.What thought(s) 1. What emotion(s) 1. (optional) What cognitive distortion did you make? (e.g., all-or- 1. How much do you
of stream of and/or image(s) (sad, anxious, nothing thinking, mind-reading, catastrophizing, etc.) now believe each
thoughts, or went through angry, etc.) did automatic
daydreams, or your mind? you feel at the 2. Use questions at bottom to compose a response to the automatic thought?
recollection led to time? thought(s0> 2. What emotion(s)
the unpleasant 2. How much did do you feel now?
emotion? you believe 2. How intense (0- 3. How much do you believe each response? How intense (o-
each one at the 100%) was the 100%) is the
2. What (if any) time? emotion? emotion?
distressing physical 3. What will you do?
sensations did you (or did you do?)
have?
Week 3 Module 4 - Thought Record Worksheet
Questions to help compose an alternative response: (1) What is the evidence that the automatic thought is true? Not true? (2) Is there an
alternative explanation? (3) Whats the worst that could happen? Could I live through it? Whats the best that could happen? Whats
the most realistic outcome? (4) Whats the effect of my believing the automatic thought? What could be the effect of changing my
thinking? (5) What should I do about it? (6) If _______ (friends name) was in the situation and had this thought, what would I tell him/her?
Directions: When you notice your mood getting worse, ask yourself, Whats going through my mind right now? and as soon as possible
jot down the thought or mental image in the Automatic Thought Column.
28
DATE/ SITUATION AUTOMATIC EMOTION(S) ALTERNATIVE RESPONSE OUTCOME
TIME THOUGHTS
1.What actual event 1.What thought(s) 1. What emotion(s) 1. (optional) What cognitive distortion did you make? (e.g., all-or- 1. How much do you
Week 3 Module 4 - Thought Record Worksheet Completed (Sophia)
of stream of and/or image(s) (sad, anxious, nothing thinking, mind-reading, catastrophizing, etc.) now believe each
thoughts, or went through angry, etc.) did automatic thought?
daydreams, or your mind? you feel at the 2. Use questions at bottom to compose a response to the automatic
recollection led to time? thought(s0> 2. What emotion(s)
the unpleasant 2. How much did do you feel now?
emotion? you believe 2. How intense (0- How intense (o-
3. How much do you believe each response? 100%) is the
each one at the 100%) was the
2. What (if any) time? emotion? emotion?
distressing physical
sensations did you 3. What will you do?
have? (or did you do?)
Thinking Theres too Anxious 75% Cognitive distortion Jumping to conclusions. 1. 20%
about the much to 1) There is a lot to learn but maybe there is not too much. I
2. Anxious (20%)
can take notes and ask questions on the forum.
course learn.
2) I dont have to learn everything perfectly the first time 3. Keep going
through.
3) If I dont learn enough Ill still have another month to
review. The best outcome is Ill understand 100% of the
material the most realistic outcome is that Ill understand
most of the material and I can use my resources to
understand it better.
4) Believing the thought just makes me anxious. Changing my
thinking will make me more relaxed and Ill get more done.
5) Id tell my friend, Susan, not to worry so much. Shes done
this before so shes likely to be able to do it again.
6) I should prioritize my time and focus on what I need to
study.
Questions to help compose an alternative response: (1) What is the evidence that the automatic thought is true? Not true? (2) Is there an
alternative explanation? (3) Whats the worst that could happen? Could I live through it? Whats the best that could happen? Whats
the most realistic outcome? (4) Whats the effect of my believing the automatic thought? What could be the effect of changing my
thinking? (5) What should I do about it? (6) If _______ (friends name) was in the situation and had this thought, what would I tell him/her?
Week 3 Module 4 - Sample Coping Card
When I think, Theres too much to learn, remind myself that I dont have to
learn it all over night. I have lots of time. Most likely Ill be able to learn the basics
and then I can keep learning more. When I tell myself theres too much to learn, I
get overwhelmed. Its better just to focus on what I need to learn that day. Ill also
feel less overwhelmed if I block out time in my schedule so I can see when Im going
to study.
1. Conceptualization is essential so youll know what to do within a session and across sessions.
2. The cognitive model has many variations.
3. Automatic thoughts are peoples most superficial level of cognition. Their underlying
assumptions and core beliefs give rise to their automatic thoughts.
4. Peoples assumptions help us understand their unhelpful patterns of behavior.
5. A number of techniques help change cognition at the intellectual level and at the emotional
level.
Week 4 Module 1 - Typical Action Plan Assignments
1. They read their therapy notes every day
2. They try out the solutions we came up with to solve their problems.
3. They monitor how theyre feeling and what theyre doing so they can identify their unhelpful
thinking and behavior.
4. They respond to their negative cognitions in some way.

5. They practice new behavioral skills
Week 4 Module 1 - Typical Behavioral Assignments
1. Activity scheduling (including social activities, self-care activities, exercise, and activities that can
bring a sense of pleasure and/or achievement), especially for depressed clients
2. Exposure techniques, especially for anxious clients

3. Bibliotherapy
4. Interpersonal skills, such as social skills, communication skills, assertiveness skills
5. Emotional regulation, mindfulness or relaxation techniques
6. Problem solving
7. Using techniques to improve sleep, regulate eating, or decrease the use of harmful substances
Week 4 Module 1 - Activity Scheduling: Pleasure/Mastery Scale
Pleasure Scale Mastery Scale
0= 0=
1= 1=
2= 2=
3= 3=
4= 4=
5= 5=
6= 6=
7= 7=
8= 8=
9= 9=
10= 10=
DATE: ACTIVITY MONITOR
34
Day of
Week
MORNING
6-7
7-8
Week 4 Module 1 - Activity Scheduling: Activity Monitor
9 - 10
10 -
11
11 -
12
12 - 1
AFTERNOON
1-2
2-3
3-4
.
DATE: ACTIVITY MONITOR
35
Day of
Week
Week 4 Module 1 - Activity Scheduling: Activity Monitor (continued)
AFTERNOON
4-5
5-6
6-7
7-8
8-9
EVENING
9 - 10
10 -
11
11 -
12
12 - 1
.
Week 4 Module 2 - Questions to Create an Action Plan
NOW THAT WEVE TALKED ABOUT THIS, WHAT DO YOU WANT TO REMEMBER? WHAT DO YOU WANT
TO DO?
Week 4 Module 2 - Tips to make therapy notes more effective
1. Give clients the choice of whether they want to write down their summary or if they want you
to. The ADVANTAGE of their writing it down is that it immediately reinforces the ideas in their
mind and keeps them actively involved. The disadvantage is that they may write slowly or in
handwriting that is hard for them to read back. Occasionally Ill be more directive and ask, Is it
okay if I write that down for you? or How about if you write that down.
2. If theyre doing the writing, make sure they have told you what theyre going to write before
they write it. You want them to write only the most important ideas in clear, full sentences. Left
on their own, clients sometimes write phrases which will not be very meaningful to them in the
coming week, much less at a later date. Also, clients often dont know which ideas are most
important. If they write down unimportant ideas, the important ones can get lost in the shuffle.
3. See whether you have any additional ideas for them to consider to make their therapy notes
more robust. You can sometimes make their initial summary much stronger. You can say,
Would you also want to remember.?
4. Ask them to read their therapy notes every morning and on an as-needed basis. If they read
their notes 7 times in the coming week, the new ideas will be reinforced much more strongly
than if they read their notes only on an as-needed basis.
5. Some clients need only the suggestion to read their therapy notes every morning but some need
a lot more direction, as Sophia did.
CLINICAL TIP: If clients think they wont have time to read their therapy notes, ask them to read them in
session and time them. Usually it takes under 30 seconds to read therapy notes.
Week 4 Module 2 - Techniques to Make Behavioral Assignments More
Effective
1. Make sure the assignments they suggest sound reasonable and are likely to result in a good
outcome. Occasionally clients come up with something seems destined to fail. One client I
treated initially decided he would ask his teenage children to stay home all weekend so he could
spend more time with them. After some discussion, he agreed to ask them to spend an hour
with him on either Saturday or Sunday.
2. Predict potential obstacles, such as lack of time or opportunity. Solve those problems in
advance.
3. Do covert rehearsal, having the client do the assignment, as youll see in the next video.
4. Consider having a plan B. For example, one of my depressed clients agreed to call his sister and
set up a lunch date. But if shes unavailable, hell call his cousin instead.
Week 4 Module 2 - Sample Coping Card
If I think, I wont be able to finish the Course, remind myself that this thought
may be 100% true or 0% true or some place in the middle. If I assume its 100%
true, Ill give up. The only way Ill really find out is by doing the experiment of
continuing to take the Course.
Week 4 Module 2 - Checklist to Facilitate Completion of Action Plans
Which of the following do you already do? Which do you need to add to your repertoire?
o Tailor assignments to the individual.

o Set assignments collaboratively.
o To create therapy notes, when youre finished discussing a problem, ask clients what they want
to remember and record a good, robust summary.
o In addition, ask them what they want to do.
o Make suggestions about assignments if clients are unsure what would be helpful or if you have
additional ideas.
o Provide a rationale for each assignment.
o Make sure clients have explicit instructions: how, when, where, for how long.
o When clients set ambitious assignments, coach them to set a range of how often theyll do an
activity, or how much time theyll spend on an assignment, or how much of a large task theyll
get done.
o Ask clients, How likely are you to do this assignment? If less than 90%, change assignment or
elicit potential automatic thoughts and obstacles.
o If possible, have clients start the assignment in your office.
o Use self-disclosure when relevant and genuine, e.g., that you find that the first couple of
minutes in starting a difficult task are often the hardest and then it gets easier.
o Make sure clients have the necessary skills to do an assignment. For example, have them fill out
a worksheet independently in your office before sending it home.
o To help clients remember to do assignments, suggest they:
o schedule the assignments on an activity monitor sheet. (Theres one in this Course
Manual.)
o set reminders on their phones
o set alarms
o have a visual reminder, e.g., putting a wristwatch on their opposite wrist or wearing a
rubber band or bracelet on their wrist; or putting post-its (which can be blank) in clear
view in places theyre sure to see them; carrying around a flashcard.
o Acknowledge how courageous clients are to be willing to do difficult assignments, especially

ones that are associated with anxiety.
o Have clients give themselves credit for doing their assignments.
Week 4 Module 3 - Summary of Clinical Roundtable - Additional
Techniques to Facilitate Completion of Action Plans
Facilitating Completion of Action Plans
1. If indicated, have clients call to report that theyre about to do an assignment or have just
finished doing an assignment.
2. If possible, start the assignment in the session together.
3. Have clients do worksheets in session, first with you and then on their own, before sending the
worksheet home.
4. When asking clients to do an exposure activity between sessions, consider having them write
down the rationale.
5. Use motivational interviewing questions. 0-100%, how likely are you to do this assignment?
If client says less than 100%, e.g, if client says 70%, ask What makes you 70% and not 40%?
and write down the reasons. Also, ask, Whats keeping you at 70% instead of 95%?
6. Have clients imagine doing the assignment and question them about what thoughts, feelings,
and obstacles might arise.
7. When assignments are difficult, acknowledge theyre being courageous in doing something that
lies outside their comfort zone.
8. To help clients remember to do assignments, suggest they

schedule them on an activity monitor sheet. (Youll find one in the Course Manual.)
set reminders on their phones
set alarms
have a visual reminder, e.g., putting a wristwatch on their opposite wrist or wearing a
rubber band or bracelet on their wrist; or putting post-its (which can be blank) in clear
view in places theyre sure to see them; carry around a flashcard.
Week 4 Module 4 - Reviewing Action Plans
1. Give positive reinforcement for completion of assignments
2. Check to see if clients gave themselves credit
3. Ask clients to read therapy notes aloud and note the degree to which they agree with what they
wrote
4. Ask client what they learned

5. If relevant ask clients if they want to continue the assignment(s) in the coming week
Week 4 Module 4 - Conceptualizing Non-Completion of Action Plans
Was there a practical problem?
Did the client have interfering thinking?
Or both?
Week 4 Module 4 - Video Notes
What did I say to:
1. Check Rachels mood?
2. Do an update?
3. Set the agenda?
4. Increase the possibility that Rachel would read her therapy notes about thoughts not always
being true?
5. Find out about the problem Rachel is having at school?
6. Help Rachel see that some parts of school are better than math class?
7. Evaluate the idea that she doesnt have enough energy to get out of bed?
8. Make it more likely that Rachel will do homework after school?
9. Figure out how to narrow down the problem of making friends?
10. Elicit feedback?
SUMMARY: Heres what I want you to remember about this weeks material:
1. The way people get better is by making small changes in their thinking and behavior every day,
thats why Action Plans are so important.
2. Research shows that clients who do self-help assignments between sessions have better
outcomes than those who dont.
3. Action plans usually include reading therapy notes daily, implementing solutions to problems,
responding to dysfunctional thinking and practicing behavioral skills.
4. After collaboratively creating an Action Plan, ask clients, How likely are you to do this? If not
close to 100%, either change the plan or address interfering cognitions or practical problems.
5. Review action plans toward the beginning of each session.
6. If clients havent completed their action plans, conceptualize whether dysfunctional cognitions
or a practical problem was involved.

Essentials Course Manual

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Essentials of CBT:

The Beck Approach

2. Is there another way of looking at this situation?

6. What should you do now?

-Ask about problem

-Review Action Plan

I have to make every client feel safe.

I should treat every client the way Id like to be treated.

Clients are supposed to be difficult. Thats why theyre clients.

7:00 AM Wake up, morning routine

12:00 PM Lunch and a walk

7:00 PM Dinner with friend

8:00 PM Household chores

10:00 PM Emails, computer

11:00 PM Get ready for bed

Emotional Behavioral Physiological

Unlovable core beliefs

Worthless core beliefs

SITUATION #1 SITUATION #2 SITUATION #3

AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S)

MEANING OF A.T. MEANING OF A.T. MEANING OF A.T.

EMOTION(S) EMOTION(S) EMOTION(S)

BEHAVIOR BEHAVIOR BEHAVIOR

Avoids social interaction

SITUATION #1 SITUATION #2 SITUATION #3

AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S)

People will criticize me.

MEANING OF A.T. MEANING OF A.T. MEANING OF A.T.

EMOTION(S) EMOTION(S) EMOTION(S)

BEHAVIOR BEHAVIOR BEHAVIOR

1. The Cognitive Model helps us make sense of peoples experiences.

3. Peoples reactions make sense once we understand their automatic thoughts.

To identify the COPING STRATEGIES of clients

Heres how we can identify their assumptions

1. TRANSLATE THEIR RULES AND ATTITUDES into the IF..then.. form.

2. Look for COMMON THEMES among situation specific assumptions.

3. Provide PART OF AN ASSUMPTION.

4. You can also gently HYPOTHESIZE ABOUT AN ASSUMPTION.

7. I could give him an analogy.

1. What do you conclude?

What is the situation?

What am I thinking or imagining?

How does that make me feel? mad sad nervous other:

What makes me think the thought is true?

Whats another way to look at this?

Whats the worst that could happen? What could I do then?

Whats the best that could happen?

What will probably happen?

What could happen if I changed my thinking?

What should I do now?

Name: Sophia Date: __________________

What is the situation? Thinking about interrupting a client.

What am I thinking or imagining? He might not like it.

How does that make me feel? mad sad nervous other:

What could happen if I changed my thinking? Id be more likely to interrupt.

What should I do now? Interrupt my client when I need to.

4. They respond to their negative cognitions in some way.

2. Exposure techniques, especially for anxious clients

o Tailor assignments to the individual.

o Acknowledge how courageous clients are to be willing to do difficult assignments, especially

Facilitating Completion of Action Plans

2. If possible, start the assignment in the session together.

8. To help clients remember to do assignments, suggest they

4. Ask client what they learned