Qualities in a partner worksheet
Anxiety is one of the most common mental health conditions. A challenging anxious thoughts worksheet, which uses techniques from cognitive behavioral therapy (CBT), can be an effective intervention for anxiety disorders.
This article provides an overview of how CBT can challenge anxious thoughts as well as examples of how to use the challenging anxious thoughts worksheet with therapy clients.
We’ve also included a free downloadable irrational thoughts worksheet that you can save to your electronic health record (EHR) for ongoing use with clients.
What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy is one of the most well-studied behavioral interventions used to treat a wide range of mental health conditions, including anxiety, depression, substance use disorders, obsessive-compulsive disorder, and even chronic pain.
The theory underpinning CBT is that our thoughts, feelings, and behaviors are interconnected.
Negative thought patterns and beliefs, called thought distortions, can lead to emotional distress and maladaptive behaviors.
By using a challenging anxious thoughts worksheet—through a process called cognitive restructuring—individuals can develop more helpful perspectives, leading to more adaptive emotions and behaviors.
How does CBT work for anxiety?
As nature’s alarm system, anxiety is a normal biological response to danger. However, in the cognitive model, anxiety can arise when you exaggerate a threat, catastrophize adverse outcomes, and underestimate resources to respond to that threat.
This can cause anxiety-related behaviors that neutralize anxious feelings.
CBT for anxiety works by:
Cognitively restructuring and modifying unhelpful thoughts
Using exposure-based strategies to face fears head-on
Strengthening coping skills for anxiety by using distress tolerance skills, relaxation techniques, and problem-solving strategies
Types of anxiety-related cognitive distortions
Cognitive distortions are skewed perceptions of reality. Also called thought errors, they negatively influence how one perceives and interprets events.
These thought errors can happen at any time, but when they are repeated, they become automatic thoughts and may cause or worsen symptoms of anxiety and other mental health disorders.
Clients may know their thoughts are irrational, but struggle to change or adapt their behaviors.
Common thought distortions include:
Mind reading: Assuming you know what others are thinking. Example: “She didn’t say hi to me. She must be mad at me.”
Catastrophizing: Expecting the worst possible outcome. Example: “If I fail this test, I’ll never get into college, and my life will be ruined.”
All-or-nothing thinking: Viewing situations in extremes. Example: “If I don’t get an A, I’m a total failure.”
Emotional reasoning: Believing that feelings define reality. Example: “I feel like a bad friend, so I must be one.”
Labeling: Defining yourself or others based on a single event. Example: “I messed up at work—I’m such a failure.”
Mental filtering: Focusing only on negatives and ignoring positives. Example: “I got five compliments today, but one person criticized me, so I must be doing terribly.”
Overgeneralization: Assuming one lousy experience will always happen again. Example: “I failed one job interview—I’ll never get hired anywhere.”
Minimizing or magnification: Exaggerating or downplaying significance. Example: “My success was just luck” (minimizing) or “One small mistake means I’m doomed” (magnification).
Personalization: Taking responsibility for things outside your control. Example: “My friend is upset—it must be because of something I did.”
“Should” statements: Holding rigid expectations that cause guilt or frustration. Example: “I should always be productive. If I’m not, I’m lazy.”
Jumping to conclusions: Making assumptions without sufficient evidence. Example: “I just know they will reject my idea.”
Blaming: Holding others responsible instead of acknowledging your role. Example: “I didn’t get the promotion because my boss hates me, not because I was late often.”
Fallacy of fairness: Believing everything should be fair. Example: “It’s unfair that I work harder than my coworker but get the same pay.”
Magical thinking: Believing your actions could have changed an unrelated outcome. Example: “If I had left home earlier, my friend wouldn’t have gotten into a car accident.”
This list is also included in our challenging irrational thoughts worksheet.
You may also find this related cognitive distortions worksheet PDF helpful.
Strategies to challenge irrational thoughts
Therapists may use several approaches to challenge irrational thinking or maladaptive thought patterns and behaviors.
Strategies that can also be found in the challenging anxious thoughts worksheet include:
Identify the distortion
Recognize the distortion, such as catastrophizing, mind-reading, or all-or-nothing thinking.
For example: “I always fail at everything.” You might identify this as an overgeneralization.
Examine the evidence
Ask yourself, “What proof do I have that this thought is true? What evidence contradicts it?”
For instance, you might reflect on your experiences when people have shown kindness or support.
Consider alternative explanations
Challenge assumptions by thinking of other possibilities.
For example: “My friend didn’t text back because they’re mad at me.” Maybe they’re just busy.
Use Socratic questioning
You might ask questions like:
“Is this thought based on facts or feelings?”
“What would I tell a friend if they had this thought?”
“What is the worst that could happen? How would I handle it?”
Replace negative thoughts with balanced thoughts
Reframe irrational thoughts into more realistic statements. For instance, if thinking, “I’ll fail this test and ruin my future,” you could tell yourself, “I might struggle, but I can study and improve.”
Test the thought with behavioral experiments
Challenge fears by testing them in real life. For example, if you fear rejection, try initiating small conversations and observe the outcome.
Reframe “should” statements
Replace rigid expectations with flexible alternatives.
For instance, if you think “I should never make mistakes,” you could instead tell yourself, “Everyone makes mistakes, and they help me learn.”
How to use the challenging anxious thoughts worksheet
You can download and use the challenging thoughts worksheet PDF in several ways:
Print or screen share the irrational thoughts worksheet and use it as a session psychoeducational prompt.
Give the worksheet to the client to remind them of what you discussed during therapy.
Ask the client to reflect on the challenging anxious thoughts worksheet between sessions, identify common thought distortions they experience, and then report their progress at their next therapy appointment. In their next session, you may work through how to challenge those cognitive distortions.
Sources
American Psychological Association. (n.d). Handout 27.5 steps of cognitive restructuring instructions.
Crum J. (2021). Understanding Mental Health and Cognitive Restructuring With Ecological Neuroscience. Front Psychiatry.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience.
Sokol, L., & Fox, M. G. (2020). The Comprehensive Clinician’s Guide to Cognitive Behavioral therapy. PESI.
U.S. National Library of Medicine. (2022). In brief: Cognitive behavioral therapy (CBT). InformedHealth.org [Internet]. American Psychological Association. (2017). What is cognitive behavioral therapy?
How SimplePractice streamlines running your practice
SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.
If you’ve been considering switching to an EHR system, SimplePractice empowers you to run a fully paperless practice—so you get more time for the things that matter most to you.
Try SimplePractice free for 30 days. No credit card required.
