The ABC anxiety worksheet is a powerful tool for managing worries and anxious thoughts.
This worksheet is suitable for children over the age of around eight or nine, as well as adults.
Children younger than this age will not have developed the ability to access their thoughts in this way.
If you have an anxious teenager, take a look at my other set of anxiety worksheets which can be used in conjunction with this one.
You can download your free ABC worksheet below.
CBT For Anxiety Worksheets: Introduction
I’m going to dive into the details of how CBT anxiety worksheets, and ABC anxiety worksheets specifically – can help you or your child manage anxiety, and improve mental wellbeing.
I’m also going to tell you a bit about CBT in general.
This will help you understand how this particular CBT worksheet fits in with the overall approach.
The ABC CBT Worksheet Explained
The ABC model of anxiety in cognitive-behavioral therapy (CBT) is a framework that helps individuals understand how their thoughts, feelings, and behaviors are interconnected.
It stands for:
A – Activating event or situation.
B – Beliefs or thoughts triggered by the event or situation.
C – Consequences: Emotional and behavioral response to the event.
The ABC worksheet is a resource to help you put your “ABCs” into writing. ABC worksheets are just one of many types of thought record used in CBT.
Why Are CBT Worksheets So Powerful?
Well, writing is a great tool to increase our self-awareness.
When you or your child use a CBT worksheet you will start to notice that some of the thoughts or beliefs you write down are not helpful or not serving you well.
They may or may not be true.
But the idea is that there is probably a more helpful angle you could take, which would prevent a spiral of negative emotions or behaviour.
The ABC model of anxiety helps us identify unhelpful or negative thoughts and beliefs (B) that are triggered by a specific event (A).
We start to understand how these thoughts lead to unhelpful or negative emotions and behaviors (C).
By recognizing this pattern, we can then develop “pattern interruptors”.
For example, we can gently challenge and adapt problematic thought patterns, which can help reduce the emotional and behavioral consequences. This is known as cognitive restructuring.
You can use these anxiety worksheets on their own without a deeper knowledge of CBT.
However, it will really help if you have some basic knowledge.
So here goes…
Cognitive-behavioral therapy (CBT) is a form of therapy that focuses on the connections between our thoughts, feelings, and behaviors.
The goal of CBT is to help us recognise and adapt negative behavioral patterns and emotional responses, through directly adapting thought patterns and changing our behaviour. This has a positive impact on emotional well-being.
There is a great deal of research showing that CBT is a helpful treatment for anxiety.
CBT is based on the idea that our thoughts (which can be triggered by external events), largely determine our emotions and behaviors.
Negative thoughts and beliefs can lead to negative emotions, such as anxiety and depression, and can also lead to negative behavioral patterns, such as avoidance or self-destructive actions.
CBT For Anxiety
CBT for anxiety typically involves working with a therapist in a structured way. There is a focus on specific problems and goals.
The therapist helps the individual identify and challenge unhelpful thoughts and beliefs.
They then teach new skills and strategies for coping with anxiety-provoking situations.
There are three main phases of cognitive behavioural therapy:
- Assessment and formulation (developing an understanding of what is causing and maintaining the problem).
- Creating and following an action plan.
- Reviewing progress and planning for the future (e.g. relapse prevention).
Generally, ABC anxiety worksheets are given as homework assignments to complete during the week, and discussed the following week in therapy.
CBT can be used to treat a wide range of mental health conditions, such as anxiety, depression, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
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CBT Worksheets & Negative Thinking
Cognitive-behavioral therapy (CBT) addresses negative thinking patterns by helping people identify and challenge their unhelpful thoughts, beliefs and behaviours.
This includes intrusive thoughts – those that are unwelcome and unwanted.
Negative thoughts are often automatic and unconscious, and can be difficult to recognize and change on our own.
CBT worksheets help people become more aware of their thoughts and to evaluate them in a more objective and logical way.
Cognitive Restructuring Worksheet
One common CBT technique for addressing negative thinking is called cognitive restructuring.
This involves identifying unhealthy thoughts and beliefs, and then evaluating them to see if they are based on accurate and rational evidence.
Using the ABC anxiety worksheet, the objective is to gently challenge negative thoughts (column B) by questioning their accuracy and looking for alternative explanations.
For example, if someone has the thought “I’m going to fail my exam”, they should question the evidence that supports this thought by looking at past experiences, grades, and the effort they have put in studying. Then they will look at evidence that doesn’t support the thought.
Eventually, this person may be able to replace the original automatic thought with a more positive or healthy thought.
The new thought might be something like this:
“I have worked hard and I have passed all exams in the past, so there is a good chance I will pass even though my brain is telling me I will not.”
This technique can take time and deliberate practise to master.
CBT: Behavioural Experiments
Another CBT technique is called behavioral experiments. This technique helps us test the validity of our negative thoughts by gathering data from the real world.
For example, if someone has the thought “I’m not good enough” the therapist will help the person to generate a list of activities that would challenge that belief, or people in their lives who may hold a different view.
In other words, you can deliberately aim to do something that will test your belief, and complete the CBT worksheet to help you reflect on the outcome.
For example, a person may think, “I want to socialize with my friends more but they are not interested.”
A behavioural experiment to text this thought might involve the person organising a get-together with a small group of friends.
The idea is to track their the evidence that supports or refutes the negative automatic thought, and figure out if it was actually a “cognitive distortion”. If it was, the person should find a new thought and replace the old thought with the new one whenever they think of it.
A new thought for the example above might be:
“It feels like my friends are not interested in meeting up, but actually they are just busy and a bit lazy, so they do respond if I take the lead.”
Cognitive distortions are considered to be beliefs or patterns of beliefs that are heavily biased or irrational. They can lead to inaccurate perceptions as well as negative emotions.
Exposure Techniques in CBT
Exposure-based techniques are a key part of cognitive behavioral therapy. The idea is that we gently face rather than avoid the fear.
We deliberately expose ourselves to situations that trigger anxious emotions and automatic thoughts, but in a vey gradual and controlled way.
We can do real-life exposure (for example, visiting a dog rescue centre even though we are scared of dogs).
We can also use imagery-based exposure, which involves guided visualization of anxiety-provoking situations.
Through repeated exposure where an anxious child or adult feels in control, we gradually change our view of the world and we can dispel our fearful or irrational beliefs.
For example, where once we may have thought “all dogs are terrifying”, we may now feel that “most dogs are harmless”. This allows us to have a healthier response to the trigger (in this case, dogs).
ABC Anxiety Worksheet: DOWNLOAD HERE
CBT Worksheets: How to Use the ABC Anxiety Worksheet at Home
To use your ABC anxiety worksheet, follow these steps:
- Identify an event or situation that triggers anxious thoughts, feelings, and behaviors.
- Write down the event or situation in the “A” section of the worksheet.
- Write down the thoughts and beliefs that you have (or your child has) about the event in the “B” section.
- Write down the emotional and behavioral responses that result from the thoughts and beliefs in the “C” section. In other words, what did you do as a result of the anxious feelings? How did they make you feel?
- Repeat whenever you notice anxious thoughts.
- Review the worksheets and look for patterns of negative thoughts, feelings, or behaviors.
- Challenge and replace negative thoughts with more balanced and rational thoughts, using cognitive restructuring (see above).
- Observe the changes in emotional and behavioral responses.
It is important to note that the ABC worksheet is a great way to grow your insight about negative thinking patterns but if you have moderate or severe anxiety it is best used under the guidance of a therapist trained in CBT.
The therapist will support you to identify and challenge negative thoughts and beliefs about your current problems, external events or the way you feel about yourself.
Using CBT Techniques at Home
Cognitive-behavioral therapy (CBT) techniques can be used at home to help us manage our thoughts, feelings, and behaviors more effectively.
The key to using CBT techniques at home is to become more aware of our own thoughts and beliefs, and then to practise challenging and changing them.
In addition to your ABC anxiety worksheet, some common CBT techniques that can be used at home include:
- Practicing relaxation techniques. CBT techniques such as deep breathing, progressive muscle relaxation, and visualization can help to reduce stress and anxiety. These techniques can be practiced at home to help you relax and calm yourself in difficult situations.
- Using behavioral experiments. This technique helps you to test the validity of negative thoughts by gathering data from the real world. It involves setting up a small experiment, such as taking on a small task that contradicts your negative belief, and tracking your progress.
- Mindfulness. Mindfulness is paying attention to the present moment without judgment. Mindfulness meditation can be practiced by focusing on your breath, body sensations, and thoughts.
Remember that if your anxiety is severe, you can work on these CBT strategies at home but they work best when used in conjunction with therapy.
If you’re struggling with mental health issues, it’s important to speak with a qualified professional.
They will help you develop a personalized plan for managing your symptoms.
Self Help Resources Which Complement Your CBT Worksheet
Using your ABC anxiety worksheet is a great way to get started if you’re interested in self-help for you or your child.
If you’re keen to access resources which will grow your knowledge and give you some other CBT exercises to use, take a look at these CBT therapy resources:
- Here’s a summary guide to CBT by the American Psychological Association (APA).
- Therapist Aid contains some great free CBT worksheets.
- Mind Over Mood is an excellent book and website for adults.
- Think Good, Feel Good is a CBT workbook for children which I can highly recommend.
CBT Therapy In Addition to Self-Help
During CBT sessions, a therapist will work with a patient to identify specific thoughts and beliefs that may be contributing to their difficulties. Over time they will then help the patient develop new, healthier ways of thinking and behaving.
This may involve techniques such as problem-solving, goal-setting, and exposure therapy (gradually confronting feared situations or triggers).
The therapist and patient will also work together to develop strategies for managing symptoms and maintaining progress outside of therapy sessions.
The goal of CBT is to help patients feel better and function more effectively in their daily lives.
How Does Going to CBT Therapy Work?
In general, CBT sessions will follow a structured format that includes the following steps:
Assessing the problem. The therapist works with the patient to understand what the problem is. For example, the patient has been increasingly anxious about leaving the house. The assessment process may involve completing questionnaires as well as discussing specific examples.
Identifying negative thought patterns. The therapist helps the patient to identify negative thought patterns contributing to their difficulties. This may include identifying automatic thoughts (quick, unconscious thoughts that pop into the mind) and biases in thinking.
Developing a treatment plan. Together, the therapist and patient develop a treatment plan that addresses the specific problems identified in step one.
Teaching coping strategies. The therapist teaches the patient coping strategies, such as the techniques I have explored above, addressing unhelpful beliefs and behaviours. The patient then practises the skills in real-life situations.
Maintenance and relapse prevention. The therapist works and patient develop a plan for maintaining progress and preventing relapse after therapy has ended.
Finding a CBT Therapist
CBT Therapists are qualified mental health professionals. Often they have a specific profession, for example clinical psychologists are all trained to deliver CBT.
But it’s also possible to train purely as a “CBT therapist”.
For people with anxiety disorders the most important thing is that there is a good fit between patient and therapist.
However, always check that your therapist is fully accredited and insured.
In the UK, you can find a CBT therapist by searching the BABCP register (the British Association for Behavioural & Cognitive Therapies). For children the ACHiPPP register is a great resource (the Association of Child Psychologists in Private Practice).
If you’re in the USA, Psychology Today has a directory of CBT therapists.
The Limitations of CBT for Anxiety
Cognitive-behavioral therapy (CBT) is a widely accepted and effective form of psychotherapy, but like all treatments, it has its limitations.
Some of the limitations of CBT include:
- Time-limited: CBT normally involves a set number of sessions so it is time-limited. This means people may need additional sessions later on, if their symptoms persist or return.
- Requires active participation: CBT requires active participation from the individual. This means that it may not be effective for people who are unwilling or unable to engage in the therapy process. For example, if a parent brings their child to therapy but the child is not engaged, CBT for anxiety will not work.
- May not address underlying issues: CBT primarily addresses symptoms and negative patterns of thinking and behavior. It may not resolve underlying issues such as past traumatic experiences.
While CBT is effective for many people, it may not work for everyone.
Some people may respond better to different interventions or a combination of treatments.
It’s important to keep in mind that while CBT has limitations, it is still widely accepted as an effective form of psychotherapy and is recommended by many mental health professionals. If you’re considering CBT, it’s important to speak with a therapist to determine if it’s the right treatment for you.
Summary: Your ABC Anxiety Worksheet
The ABC anxiety worksheet is a great resource for learning about our thoughts, what triggers them, and how they make us feel and behave.
If you or your child have mild to moderate anxiety, you can use them at home as a standalone technique or combined with other CBT strategies.
If the anxiety is more severe, CBT worksheets are best used in combination with therapy sessions led by a qualified CBT therapist.
Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years.
In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.
Lucy is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.
To learn more tips for helping your child manage stress, join my Facebook group, Parent Tips For Positive Child Mental health UK.