therapy homework for trauma

20 Positive Psychotherapy Exercises, Sessions and Worksheets

The word “psychotherapy” often evokes images of nerve-wracked patients reclining on couches, a stern therapist with furrowed brows and a notepad, and a deep uneasiness linked to the identification and analysis of every childhood trauma you have suffered, whether you remembered it before the session or not.

Although this is an outdated and largely inaccurate idea of psychotherapy, it still may seem counterintuitive to combine positive psychology with psychotherapy.

Psychotherapy is typically reserved for those with moderate to severe behavioral, emotional, or personality issues—not people who are often happy and healthy, and also struggle with occasional stress.

How can this type of therapy, which deals with such serious and difficult subject matter, possibly be considered “positive?”

Fortunately, many respected psychologists have been working to develop a useful and evidence-based positive approach to psychotherapy over the last two decades.

These pioneering researchers have married the research of positive psychology and the science and practice of psychotherapy into a life-affirming alternative to traditional psychotherapy—one that focuses on your strengths instead of your weaknesses, and works towards improving what is good in life instead of mitigating that which is not (Seligman, Rashid, & Parks, 2006).

It does not replace traditional psychotherapy, but can act as an extremely effective supplement to help a person move from “just getting by” to flourishing and thriving! For more on this effective ‘supplement’, we share a variety of exercises, tools and a range of therapy sessions.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

5 positive psychotherapy exercises and tools, 15 sessions – exercises and tools, a take-home message.

Here is an overview of some of the most effective exercises and tools in a positive psychotherapist’s toolbox.

1. Gratitude Journal

One of the simplest yet most effective exercises in positive psychology is a  gratitude journal . Evidence has shown that developing gratitude for the things in your life that you may otherwise take for granted, can have a big impact on your outlook and satisfaction with your life (Davis et al., 2016; Sheldon & Lyubomirsky, 2006).

The practice of keeping a gratitude journal is quite simple and easy to explain to a client who might need a boost in positive emotions.

As a therapist or other mental health professional, instruct your client to do the following:

• Get a notebook or journal that you can dedicate to this practice every day.
• Every night before bed, write down three things that you were grateful for that day.
• Alternatively, you can write down five things that you were grateful for on a weekly basis.
• Encourage them to think of particular details from the day or week, rather than something broad or non-specific (i.e., “the warm sunshine coming through the window this afternoon” rather than “the weather”).

If your client is having trouble thinking of things they are grateful for, tell them to try thinking about what their life would be like without certain aspects. This will help them to identify the things in their life they are most grateful (Marsh, 2011).

2. Design a Beautiful Day

Who doesn’t want to design a beautiful day for themselves?

This exercise is not only fun for most clients, but it also carries a double impact: the planning of the near-perfect day, and the actual experience of the near-perfect day.

As a counselor or therapist, encourage your client to think about what a beautiful day means to them.

What do they love to do? What do they enjoy that they haven’t had a chance to do recently? What have they always wanted to do but have never tried?

These questions can help guide your client to discover what constitutes a beautiful day to them. Direct your client to pick a day in the near future and design their day with the following tips in mind:

• Some alone time is fine, but try to involve others for at least part of the day.
• Include the small details that you are looking forward to in your plan, but don’t plan out your entire day. Leave some room for spontaneity!
• Break your usual routine and do something different, whether it’s big or small.
• Be aware that your beautiful day will almost certainly not go exactly as planned, but it can still be beautiful!
• Use mindfulness on your beautiful day to soak in the simple pleasures you will experience throughout the day.

3. Self-Esteem Journal

The self-esteem journal is another straightforward but effective exercise for clients suffering from feelings of low self-worth.

This Self-Esteem Journal For Adults provides a template for each day of the week and three prompts per day for your client to respond to, including prompts like:

• Something I did well today…
• Today I had fun when…
• I felt proud when…
• Today I accomplished…
• I had a positive experience with…
• Something I did for someone…

The simple act of noticing and identifying positive things from their day can help clients gradually build their self-esteem and enhance their wellbeing. Sometimes all we need is a little nudge to remember the positive things we do!

4. Mindfulness Meditation

Mindfulness meditation can be an excellent tool to fight anxiety, depression, and other negative emotions, making it a perfect tool for therapists and counselors to use with their clients.

To introduce your client to mindfulness meditation, you can try the “ mini-mindfulness exercise ,” a quick and easy lesson that only takes a few minutes to implement.

Follow these steps to guide your client through the process:

• Have your client sit in a comfortable position with a dignified but relaxed posture and their eyes closed. Encourage them to turn off “autopilot” and turn on their deeper awareness of where they are, what they are doing, and what they are thinking.
• Guide them through the process of becoming aware of their breath. Instruct them to take several breaths without trying to manipulate or change their breathing; instead encourage them to be aware of how it feels as they inhale air through the nostrils or mouth and into the lungs, as they hold the air for a brief moment, and as they exhale the air again. Direct their attention to how their chest feels as it rises and falls, how their belly feels as it expands and contracts, and how the rest of their body feels as they simply breathe.
• Direct your client to let their awareness expand. Now, they can extend their focus beyond their breath to the whole body. Have them pay attention to how their body feels, including any tightness or soreness that may be settled into their muscles. Let them be present with this awareness for a minute or two, and tell them to open their eyes and continue with the session or with their day when they are ready.

Once your client is introduced to mindfulness meditation, encourage them to try it out on their own. They may find, as so many others have, that mindfulness can be a great way to not only address difficult or negative emotions but maintain positive ones throughout the day as well.

5. Values in Action Inventory of Strengths (VIA-IS)

The VIA-IS is one of the most commonly used tools in positive psychology, and it has applications in positive psychotherapy as well. Completing this questionnaire will help your clients identify their dominant strengths— allowing them to focus their energy and attention on using their inherent strengths in their daily life, instead of getting distracted by the skills or traits they may feel they are lacking.

The VIA-IS is reliable, validated, and backed by tons of scientific research, and best of all – it’s free to use (Ruch, Proyer, Harzer, Park, Peterson, & Seligman, 2010).

Direct your clients to the VIA website to learn about the 24 character strengths and take the VIA-IS to discover their own top strengths.

These strengths are organized into six broad categories as follows:

Wisdom and Knowledge

• Creativity;
• Love of learning;
• Perspective.
• Perseverance;
• Social intelligence.
• Leadership.
• Forgiveness;
• Self-regulation .

Transcendence

• Appreciation of beauty and excellence;
• Gratitude ;
• Spirituality.

Once your client has taken the survey and identified their top 5 strengths , instruct them to bring in their results and have a discussion with them about how they can better apply these strengths to their work, relationships, recreation, and daily life.

The order of sessions outlined below is merely suggestive but there are some essential components that should be maintained to increase long term effectiveness and enhance learning.

While every session introduces new exercises and tools, it is also recommended that some form of restorative technique is used at the beginning and at the conclusion of every session.

For each session, we also suggest one homework assignment to facilitate maintenance in between sessions.

If you are a therapist who regularly assigns homework to your clients, we recommend checking out the platform Quenza to help digitize and scale this aspect of your therapy practice.

The platform incorporates a simple drag-and-drop builder that therapists can use to craft a range of digital activities for their clients to complete in between therapy sessions. These activities can include audio meditations, reflections, self-paced learning modules, and more.

Once done, the therapist can then share these activities directly to their clients’ devices, such as the Daily Reflection on the right, track their progress using Quenza’s dashboard, and send follow-up reminders to complete the activities via push notification.

Additionally, one size does not fit all when introducing any practice including mindfulness, so fit should be carefully considered and special attention should be paid to cultural considerations.

Session I – Positive Inception

Goal : Exploration of strengths and positive attributes is accomplished by inviting the client to share a personal story that shows them at their best as a form of introduction.

Tool : Positive Introduction prompt

Rationale : Initial session is intended to set a positive tone for the on-going practitioner-client interaction. Building rapport both at the outset and throughout the relationship are key factors to better outcomes from a therapeutic process.

One positive psychotherapy practice recommended for this session is a positive introduction. A positive introduction is based on principles of Appreciative Inquiry and involves asking a client to recall a positive event in his or her life that ended very well.

Positive memories can generate positive emotions and improve mood regulation. Positive narratives also help restore healthier self-concept and allow the client to build resources in terms of new ideas and perspectives (Denborough, 2014).

In-session Resources:

• Positive Introduction

Describe an event in your life where you handled a difficult situation in a positive way and things turn out well. It does not have to be a major event but try to think of something that brought out the best in you. Write about the situation in form of story with a beginning, middle and positive end: ____________

Discussion questions:

• Tell me how this event influenced how you see yourself?
• What about you specifically helped you deal with this situation?
• Are other people aware of this story in the way you described it?

Homework : As homework, clients can create anchors out of these positive memories by collecting pictures or artifacts that remind them of the pleasant memory. The practitioner can also provide the client with an option to seal this positive introduction in an envelope to be opened at a later date and kept by the practitioner for safekeeping.

Lastly, the client should be encouraged to write similar stories and keep them handy for a quick pick me up.

Practitioner can also suggest that client asks others to share their inspiring stories, that client share more stories like this one and pay attention to what they say about themselves, what themes keep recurring, how their stories change depending on audience, what role they play in their own stories and whether they are a victim or a survivor.

Clinician notes:

Pay careful attention and take notes as the narratives will tend to form sequences.

If a client has a difficulty recalling positive events, they can ask family or friends to recall for them or they can tell a story of someone they admire.

Session II – The Powers Within

Goal : To assess signature strengths and to cultivate engagement through daily activities by choosing tasks that speak to one’s strengths.

Tool : Signature Strengths Assessment

Rationale : Exercising specific strengths can facilitate goal progression and contribute to wellness and personal growth (Linley, Nielsen, Gillett, & Biswas-Diener, 2010). Psychology of motivation teaches us that there are keystone habits that spark positive changes in other areas related to the one being made, so can certain strengths support the healing and growth process. Strength assessment is given, and the concept of engagement is explained.

Preparation:

Prior to the session, the client should ask three people to report on their strengths.

In-session Worksheets:

• Your Core Values

Read carefully the descriptions of 24 character strengths below. They can be found in the VIA Institute on Character website .

Circle 5 of the strengths that you find yourself exercising most often and that you feel characterize you the most:

List your 5 signature strengths and then answer questions and prompts to determine the key markers of your signature strengths.

• Authenticity: Is this strength a part of who I am at the core?
• Enthusiasm: While using this strength I feel excited and joyous.
• Learning: Is it natural and effortless for me to use this strength?
• Persistence: I find it difficult to stop when I use this strength.
• Energy: When I use this strength, do I feel invigorated and full of zest?
• Creativity: Do I find new ways and design projects to use this strength?

Pick one or two and try to describe specific experiences or anecdotes associated with expression of that strength: _____________

Now consider the client’s peer feedback. The reports will probably not be identical, but some significant overlap is highly likely.

Circle any areas of considerable overlap and try to identify the following:

• Signature strengths – these have been mentioned several (3-4 times) by the client’s feedback providers
• Potential blind spots – strengths mentioned by others, but not the client themselves.
• How confident do you feel about knowing your signature strengths after completing the assessment?
• How well do your strengths reflect your personality?
• Which of the strengths you identified have always been there and which have you acquired at some point in your life?
• Which signature strengths stood out for you in terms of specific markers like authenticity, energy or learning?

Homework : Instruct clients to take VIA strengths survey assessment and ask that they observe if using signature strengths produces greater engagement.

Clinician notes :

Reminders are tangible cues in our environment that focus our attention on a particular commitment we made. Reminders help anchor a new habit of thought and behavior.

They can be simple or more complicated and creative like a screen saver on the clients’ phone, a bracelet or a keychain that reminds them of their signature strengths, a picture on the wall of the person who motivates them or an entry in their planner with times for a podcast that encourages them to practice and reflect.

Session III – Amplify Your Internal Assets

Goal : To gain a deeper understanding of optimal levels of usage of strengths. Use your signature strengths to be happier as well as to develop skills. Use your strengths to manage your negatives.

Tool : Optimizing Strengths exercise

Rationale : Biswas-Diener, Kashdan, and Minhas (2011) argue against just identifying one’s strengths as it represents a fixed mindset and decreases motivation. He suggests that we should treat strengths as “potentials for excellence” to foster belief in the possibility of improvement where therapy can lead us to develop them further.

Development of practical intelligence can be initiated through considering how client’s strengths can be translated into concrete purposeful actions that enhance commitment, engagement and problem-solving.

• Optimizing Strengths

Read the common scenarios below and reflect on the potential of under and overuse of strengths:

• Someone is feeling sad or appears disinterested and apathetic
• Someone obsesses over small details and worries too much about things you perceive as insignificant
• Someone is always volunteering and takes on too many commitments and projects
• Someone is often playful and humorous
• Some fail to confront another for inappropriate behavior

Discussion questions :

• What behaviors let you know you’re overusing or underusing your strengths?
• What specific circumstances trigger your overuse or underuse of strengths?
• What cultural or personal history factors could reinforce your over- or underuse of strengths?
• If you’re overusing one strength, what other strength could counterbalance that overuse?

For between sessions assignment, ask the client to describe a current challenge and then reflect on the following questions:

• Is it due to overuse or underuse of strengths?
• What aspects of this challenge would you like to change?
• What strengths can you use in this situation?
• What are the implications on others of using these strengths?
• In what way can you calibrate the use of these strengths to improve the situations?

In imparting practical wisdom strategies make sure clients perceive this as the development of a strength, not merely as use of a well-developed strength. Practical wisdom strategies are:

• Translate strengths into specific actions and observe the outcome
• Consider if strengths are relevant to the context
• Resolve conflicting strengths through reflecting on the possible outcomes of the use of these strengths
• Consider the impact of your strengths on others
• Calibrate according to changing circumstances

Session IV – You at Your Best

Goal : Visualize a better version of yourself.

Tool : You at Your Best Worksheet

Rationale : Our visions of who we wish to become in the future, be it our best selves, our ideal selves or simply our better selves, reflect our personal and professional goals and are created by imagining a better version of who we are today and then striving toward it.

Cultivating and sustaining desirable action can bring us closer to that future self and it may require that we refrain from behaviors that deter us and change old habits that don’t serve us.

Ideal selves reflect our hopes, dreams, and aspirations, and speak to our skills, abilities, achievements, and accomplishments that we wish to attain (Higgins, 1987; Markus & Nurius, 1986).

Research supports this phenomenon of movement toward ideal selves and shows that it predicts many positive outcomes: life satisfaction, emotional wellbeing, self-esteem, vitality, relational stability, relational satisfaction (Drigotas, 2002; Drigotas, Rusbult, Wieselquist, & Whitton, 1999; Kumashiro, Rusbult, Finkenauer, & Stocker, 2007; Rusbult, Kumashiro, Kubacka, & Finkel, 2009).

• You At Your Best

1. Find your story.

Recall a recent time or event when you were at your absolute best. You might have been overcoming a serious challenge, or perhaps you made someone else’s life better.

Think about what made you feel happier, more alive. Maybe you were:

• more relaxed,
• more grounded,
• more enthusiastic,
• more energized,
• more engaged,
• more creative,
• more connected,
• more reflective,

Describe your story as clearly as possible, allowing the details in your narrative to demonstrate your strengths and values.

What happened? What was your part in it? How did you feel?

3. Beginning, Middle, End

Craft your narrative with a start, middle, and powerful ending. It may help to replay the experience in your mind as it happened.

Highlight or circle any words that you feel might relate to your personal strengths.

5. Find your Strengths

List the strengths you’ve identified from the exercise.

• How can you move toward this better version of you?
• How can you use your signature strengths?
• What concrete action can you commit to?
• What barriers do you see and what and who can help?
• How different is your life once you’ve made the change?

Homework : Commit to specific actions for the week. Name someone who is willing to support you. Decide on how often this person will check in on your progress and how.

Clinician notes : Remind the client that less is more, and that a long list is bound to fail because cognitive overload is likely to lead them to do nothing. Modest aspirations translate into small wins that lead to gradual change. Reinforcing new behaviors takes time and failure is a normal part of the process. Remind the client that they are more likely to succeed on their fifth or sixth attempt.

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Session V – Positive Reappraisal

Goal : Open and closed memories are reappraised through four different methods.

Tools : Open and Closed Memories Questionnaire, Positive Reappraisal exercise

Rationale : Personal written disclosure is employed to explore resentment and painful memories and to encourage cognitive processing using your strengths in order to re-file them so that they don’t drain your energy.

The purpose of positive appraisal is not to change the event or the person involved in these negative memories but to refile then in a way that does not continue to drain us emotionally or psychologically.

• Open and Closed Memories Questionnaire

Please answer the following questions to determine if you have open memories:

• Does my past prevent me from moving forward?
• Does your open or negative memory involve someone who harmed you and you find yourself thinking about this person or the consequences of their actions?
• What are the advantages and disadvantages of engaging in this processing of painful memories?
• Have you sought another person’s perspective on this issue?

Now apply the following positive reappraisal strategies to one of your memories:

• Create some distance. One way to create a psychological space between you and your negative memory is to describe from this person’s perspective to allow yourself to revise the meaning and the feelings around it. Imagine yourself as a journalist or a fly on the wall and describe your open memory from a vantage point of a third person while keeping a neutral expression.
• Reinterpret by focusing on subtle aspects of the memory and deliberately recall any positive aspects you may have missed while keeping the negatives at bay. Think of your values in life and how those can be infused in how you remember.
• Step back and observe your memory unfold with a non-judgmental receptive mind and shift focus to internal and external experiences evoked by the memory. See if you can allow your memory to pass by.
• Divert your attention to a different task that is engaging.
• Which strategy was most beneficial?
• Which strategy was difficult to do?
• How has this experience put your life in perspective for you?
• How has this event benefited you as a person?
• What personal strengths grew out of this experience?
• How has this experience helped you see differently what and who is important in your life?

Homework : Apply one of the strategies to a new challenge and reflect on it in writing before the next session.

Clinician notes : A level of caution needs to be exercised when exploring painful memories. Encourage the client to explore a memory that is not too traumatic. Start the session with a mindfulness practice and ask the client to monitor their emotional state.

Session VI – Forgiveness is Divine

Goal : Model of forgiveness is introduced, and the letter of forgiveness is assigned to transform bitterness.

Tool : REACH Forgiveness worksheet and Forgiveness Letter.

Rationale : Forgiveness is a choice, although not an easy one. It is a gradual process that requires commitment. Decisional forgiveness is only the first step. Empathy is key and ultimately forgiveness is a gift you give to yourself.

Everett Worthington (n.d.), leading research in forgiveness, designed a model that outlines the necessary components of effective emotional forgiveness and the worksheet below is based on his REACH method. You can find an extensive discussion of the psychology of forgiveness in our blog.

One model of forgiveness therapy that places empathy at its center and stresses emotional forgiveness is Worthington’s REACH forgiveness model based on the stress and coping theory of forgiveness. Each step in REACH is applied to a target transgression that the client is trying to change.

R = Recall the Hurt E = Empathize with the Person Who Hurt You A = Give an Altruistic Gift of Forgiveness C = Commit to the Emotional Forgiveness That Was Experienced H = Hold on to Forgiveness When Doubts Arise (Worthington, 2006).

• REACH forgiveness

Follow the reach model in your written narrative of forgiveness:

• R = Recall the Hurt. Close your eyes and recall the transgression and the person involved. Take a deep breath and try not to allow self-pity to take over. Write briefly about what happened: ___________
• E = Empathize with the Person Who Hurt You. People often act in hurtful ways when they feel threatened, afraid or hurt. Do your best in trying to imagine what the transgressor was thinking and feeling and write a plausible explanation for their actions. This part is supposed to be difficult: ___________
• A = Give an Altruistic Gift of Forgiveness. Remember a time when you were forgiven by another person. Describe the event and its effect on you: ____________
• C = Commit to the Emotional Forgiveness That Was Experienced. Commit to a gesture of forgiveness, public or private, either by sharing with someone your decision to forgive or by writing a forgiveness letter that you never send.
• H = Hold on to Forgiveness When Doubts Arise. Recurrence of memories will be normal but the reminder you created above will be helpful in holding onto your decision to forgive. Brainstorm ways in which you can support your resolution as well as those that may deter you.

A key to helping a person develop empathy for the transgressor is to help the client take the perspective of the other person. To assist the client, write the five Ps on a sheet of paper as a cue to the client and ask them to answer the questions using the five prompts:

• Pressures: What were the situational pressures that made the person behave the way he or she did?
• Past: What were the background factors contributing to the person acting the way he or she did?
• Personality: What are the events in the person’s life that lead to the person having the personality that he or she does?
• Provocations: What were my own provocative behaviors? Alternatively, might the other person, from his or her point of view, perceive something I did as a provocation?
• Plans: What were the person’s good intentions? Did the person want to help me, correct me, or have in mind that he or she thought would be good for me, but his or her behavior did not have that effect? In fact, it had just the opposite effect.

Homework : Leslie Greenberg and Wanda Malcolm (2002) have demonstrated that people who can generate fantasies where they vividly imagine the offender apologizing and being deeply remorseful are ones who are most likely able to forgive successfully.

Ask the client to vividly imagine the offender apologizing and then write a letter of forgiveness to this person. The client does not need to do anything with the letter itself.

Clinician notes : Although relaxation techniques should be used at the outset and at the conclusion of every session, this one, in particular, is important.

If the client has a difficulty finding compassion for the transgressor, one of the most effective ways to help a client experience empathy is to use the empty-chair technique.

The client imagines sitting across from the offender, who is imagined to be in an empty chair. The client describes his or her complaint as if the offender were there. The client then moves to the empty chair and responds from the point of view of the offender. The conversation proceeds with the client moving back and forth between chairs.

The objective is to allow the person to express both sides of the conversation personally, and thus experience empathy. In doing so, the person might imagine an apology or at least an acknowledgment of the hurt that was inflicted.

Session VII – Good Enough

Goal : To establish realistic expectations of progress. Good enough mindset and concepts of satisficing versus maximizing are introduced, and an action plan to increase satisficing is devised.

Tool : Maximizer v. Satisficer Assessment, Strategies to Increase Satisficing

Rationale : According to psychologist Barry Schwartz (2004), maximizers always aim to make the best possible choice. They take their time and compare products both before and after making purchasing decisions.

Maximizers are more prone to depression due to overly high expectations and fear of regret. Maximizers, like perfectionists, seek to achieve the best, but perfectionists have high standards that they don’t expect to meet, whereas maximizers have very high standards that they do expect to meet, and, when they are unable to meet them, they become depressed (Chowdhury, Ratneshwar, & Mohanty, 2009; Schwartz et al., 2002).

The questionnaire below will help to assess if your client is a maximizer or a satisficer. There are several techniques for increasing satisficing and developing a “good enough” mindset.

• Maximizer v. Satisficer Assessment

Read the following statements and carefully rate to what degree they are true and descriptive of who you most often are. Rate them on a scale of one to seven, where one means  completely disagree and seven means strongly agree.

Now add the scores for your answers. The average score is 50, the high score is 75 and the low score is 25 or below. If your score is below 40, you are on the satisficing end of the scale. If you scored 65 and above, it is likely you have maximizing type behaviors that may impact your wellbeing. Consider some of the strategies to increase satisficing listed below.

Strategies to Increase Satisficing

To make choices versus simply have choices means to be able to reflect on what makes a decision important, what makes particular choice say about you, or even create new options if no good options are available. To practice these skills, try the following:

• Shorten or eliminate deliberation about decisions that are not important.
• Take the time that has just become available to you to ask yourself what you really want in the areas of life where making decisions really matters.

To generally do more satisficing, try the following:

• Recall the time when you settled for good enough.
• Reflect on how you chose in those areas.
• Apply the strategy to another area.

Reflect on what pursuing all the available opportunities costs you:

• Make a decision to stick with a decision to do something unless you’re truly dissatisfied.
• Resist the urge to go after the new and improved.
• Resolve to combat the fear of missing out.
• Adopt the attitude where you don’t fix what’s not broken.

Imagine there is no going back. Make your decision irreversible and final to limit the amount of time you waste processing the alternatives:

• Make a list of reversible decisions.
• Now pick some of those decisions to be made irreversible.

Practice attitude of gratitude and being grateful for what you have and the good aspects of the choices you have made and resolve not to ruminate what was bad about them:

• Pick a few decisions you’ve made to practice this attitude.

Having regrets can influence our ability to make a decision to a point of us avoiding to make them. Make an effort to minimize regret where appropriate:

• Reduce the number of options before making a decision.
• Focus on what is good about making the decision.
• Identify yourself as a satisficer versus maximizer.

Adaptation, also known as the hedonic treadmill, robs us of satisfaction we can get from a positive experience. Combat adaptation and develop realistic expectations about how experiences change over time:

• Next time you purchase something fully consider how long the thrill of owning it will last.
• Vow to spend less time looking for a perfect match.
• Create a reminder to yourself to appreciate how good things really are versus how they are less than what they originally were.

Lower your expectations. Our satisfaction with experiences is determined to a large extent by our expectations. To increase satisfaction with results, try the following:

• Reduce the number of options you will consider.
• Allow for serendipity.
• Ask yourself what a satisficer would do in this situation.

Beware of social comparisons. Practice not comparing yourself to others as quality of experience can be significantly reduced by comparing yourself to others:

• Focus on what makes you happy and what gives meaning to your life.
• Limit the use of social media when you feel the urge to compare your life to that of others.

Appreciate constrains. Our freedom of choice and ability to decide decreases as our options increase. Our society provides rules by which we are limited in forms of laws and norms of behavior.

• Create your own list of rules that you are willing to practice to increase your ability to make effective choices.
• What does your satisficer versus maximizer score say about you?
• If you scored high, what are the emotional or physical costs of maximizing?
• In what way knowing your tendencies can help you make meaningful changes in your life?

Homework : Ask the client to practice one or more techniques of satisficing throughout the week.

Clinician notes : Repetition just like regular reminders can aid the client in creating lasting change. Together repetitive action and repetition create ritual over time. Encourage clients to build new positive habits of thinking and behaving.

Session VIII – Count Your Blessings

Goal : The notion of counting one’s blessings and enduring thankfulness is discussed, gratitude exercise is introduced, and blessings journal is assigned.

Tool : Three Good Things and Gratitude Visit

Rationale : Extensive research shows that enduring thankfulness has many health benefits (Emmons, 2007). In one clinical study, the gratitude condition participants reported significantly better mental health than those in the expressive and control conditions.

This session introduces the client to the practice of gratitude by counting one’s blessings daily and planning a gratitude visit. Clients are also asked to keep a gratitude journal between sessions.

Three Good Things

Before going to bed, write about three good things that happened to you that day. Reflect on those good things by answering the following questions:

• Why did this good thing happen and what does it mean to you?
• What lessons have you learned from reflecting on this good thing?
• How did you or others contribute to this good thing happening?

Gratitude Visit

Gratitude is oriented toward others. Think of a person to whom you would like to express gratitude. Write a letter to them. Try to be specific in describing the way in which their actions have made an important difference in your life. When finished, arrange a visit with that person without explaining the purpose. Try to make it as casual as possible.

When you see them after you settle in, read your letter slowly, with expression and eye contact. And allow the other person to react unhurriedly. Reminisce about the times and specific events that made that person important to you.

• What feelings came up as you wrote your letter?
• What was the easiest part to write and what was the toughest part?
• Describe the other person’s reaction to your expression of gratitude?
• How were you affected by their reaction?
• How long did these feelings last after you presented your letter?
• How often did you recall the experience in the days following?

Homework : Blessings journal is assigned, and client is asked to write about three good things that happened that day before bedtime every night for a week in a way that was introduced during the session.

Suggest that clients socialize with more people who are grateful and observe if that improves their mood. People who are thankful have a language of future, abundance, gifts, and satisfaction.

You can also ask clients to find ways to express gratitude directly to another person. While doing so, ask them to avoid saying just thank you and express gratitude in concrete terms.

Clinician notes : Considerable effort and time to manage the logistics are required to write a letter and arrange a visit. Be sure to provide clients adequate time and support to complete this practice over the course of therapy. You can discuss the timeline, periodically remind them, and even encourage clients to read their Gratitude Letters so they can make changes and rehearse the experience of writing it and reading it out loud.

Be sure clients have the opportunity to share their experiences of the Gratitude Visit.

Session IX – Instilling Hope and Optimism

Goal : One Door Closes, One Door Opens exercise is introduced and the client is encouraged to reflect on three doors that closed and what opportunities for growth it offered.

Tools : One Door Closes, One Door Opens, and Learning Optimism prompts

Rationale : Essentially, hope is the perception that one can reach the desired goals (Snyder, 1994). Hopeful thinking comes down to cultivating the belief that one can find and use pathways to desired goals (Snyder, Rand, & Sigmond, 2002).

Optimism can be learned and can be cultivated by explaining setbacks in a way that steers clear of catastrophizing and helplessness. Optimistic people see bad events as temporary setbacks and explain good events in terms of permanent causes such as traits or abilities.

Optimists also tend to steer away from sweeping universal explanations for events in their lives and don’t allow helplessness to cut across other aspects of their lives (Seligman, 1991).

Painful experiences can be re-narrated as it is the client who gets to say what it all means. Like a writer, a sculptor or a painter the client can re-create his or her life story from a different perspective, allow it to take a different shape and incorporate light into the dark parts of their experience.

• One Door Closes, Another Door Opens

Think of times when you failed to get a job you wanted or when you were rejected by someone you loved. When one door closes, another one almost always opens. Reflect and write about three doors that closed and what opportunities for growth it offered. Use the following questions to help with your reflections:

• What was the impact of doors that closed?
• Did this impact bring something positive to you? What was it?
• What led to a door closing, and what or who helped you to open another door?
• How did you grow from doors that opened?
• If there is room for more growth, what might this growth look like?

Learning Optimism

Think of something that happened recently that negatively impacted your life. Explore your beliefs about the adversity to check for catastrophizing.

• What evidence do you have that your evaluation of the situation is correct?
• What were the contributing causes to the situation?
• What does this mean and what are the potential implications?
• How is the belief about the situation useful to you?
• When a door closes, how do you explain the causes of failure to yourself?
• Regarding your happiness and wellbeing, what were the negatives and positives of this adversity?
• Was the impact of this setback all-encompassing or long-lasting?
• Was it easy or hard for you to see if a door opened, even just a crack?
• What does the closed door represent for you now?
• How did the One Door Closes, Another Door Opens practice enhanced your flexibility and adaptability?
• Do you think that deliberate focus on the brighter side might encourage you to minimize or overlook tough realizations that you need to face?
• Would you still like the door that closed to be opened, or do you not care about it now?

Homework : As a weekly exercise explain and write down your broad outlook on life in one or two sentences and then monitor if daily stressors have an impact on your overall perspective. If so, brainstorm ways to help your perspective remain constant.

Alternatively, to practice hope, ask the client to reflect on one or two people who helped to open the doors or who held the opened doors for them to enter.

And to practice optimism, ask the client to help a friend with a problem by encouraging him or her to look for the positive aspects of the situation.

Clinician notes : The benefits of optimism are not unbounded, but they do free us to achieve the goals we set. Our sense of values or our judgment is not eroded by learning optimism , it is enhanced by it.

Suggest to your clients that if rumination keeps showing up, they consider positive distraction and volunteer the time they normally spend analyzing problems to endeavors that make an impact on the world. Not only will they distract themselves in a positive way but may also gain a much-needed perspective on their problems.

Session X – Resilience

Goal : Posttraumatic growth (PTG) is introduced and practiced through writing therapy.

Tool : Expressive Writing

Rationale : Many patients following trauma develop Posttraumatic Stress Disorder (PTSD), but many also experience Posttraumatic Growth (PTG). Without minimizing the pain and while respecting clients’ readiness, exploration of the possibility for growth from trauma can help them gain insight into the meaning of life and the importance of relationships.

Research shows that PTG can lead clients to:

• mitigate the feelings of loss or helplessness (Calhoun & Tedeschi, 2006)
• develop a renewed belief in their abilities to endure and prevail
• achieve improved relationships through discovering who they can really count on
• feel more comfortable with intimacy (Kinsella, Grace, Muldoon, & Fortune, 2015)
• have a greater sense of compassion for others who suffer
• develop greater appreciation for life (Jayawickreme & Blackie, 2014; Roepke, 2015)
• enhanced personal strength and spirituality (Fazio, Rashid, & Hayward, 2008)

Positive reinterpretation, problem-focused coping, and positive religious coping facilitate PTG. Although time itself doesn’t influence PTG as it remains stable over time, intervening events and processes do facilitate growth.

James Pennebaker’s strategy, known as the Writing Therapy, showed that writing about a traumatic or upsetting experience can improve people’s health and wellbeing (Pennebaker, & Evans, 2014).

While assuring complete confidentiality, clients are asked to write for 15 to 30 minutes for three to five consecutive days about one of their most distressing or traumatic life experiences in detail and to fully explore their personal reactions and deepest emotions.

• Expressive Writing

Using a note pad or journal, please write a detailed account of a trauma you experienced. In your writing, try to let go and explore your deepest thoughts and feelings about the traumatic experience in your life. You can tie this experience to other parts of your life, or keep it focused on one specific area.

Continue to write for at least 15 to 20 minutes a day for four consecutive days. Make sure you keep your writings in a safe, secure place that only you have access to. You can write about the same experience on all four days or you can write about different experiences.

At the end of four days, after describing the experience, please write if the experience has helped you with the following:

• understand what the experience means to you.
• understand your ability to handle similar situations.
• understand your relationships in a different light.
• What was the most difficult part of writing?
• Do you agree that even though it may have been difficult, it was still worth writing?

Some reactions to the trauma, adversity, or losses can be so strong that we deliberately avoid associated feelings.

• Did the writing process help you see this avoidance if any?
• Did writing help you to visualize growth in terms of your perspective on life?
• Did you experience healing or growth, despite having the lingering pain of the trauma or loss?

Homework : Ask the client to continue writing for three more consecutive days for 15 to 30 minutes each time. Remind the client to make sure to keep their writings in a safe, secure place that only he or she has access to. They can write about the same experience on all four days or they can write about different experiences.

Clinician notes : To better understand the context in which clients are living, the practitioner should continue discussing therapeutic changes with clients without necessarily asking about growth. It also helps to accept the fact that it may be difficult to pinpoint the start and end that marks when growth from trauma occurs.

Focusing on themes of change may help identify when additional support is needed to amplify PTG while keeping in mind that some clients for reasons outside of their control will not continue to experience long-term growth.

Session XI – Taste for Life

Goal : Tendencies toward busy behavior are assessed and savoring exercise is assigned based on the client’s preference and strategies to safeguard against adaptations are discussed.

Tool : Busy Behavior Assessment and Savoring Techniques

Rationale : According to Carl Honoré (2004), we live in a multitasking era where we have become addicted to speed. Evidence shows that people who are cognitively busy are also more likely to act selfishly, use sexist language, and make erroneous judgment in social situations.

On the other hand, research also shows that when people are in a relaxed state, the brain slips into a deeper, richer, more nuanced mode of thought (Kahneman, 2011). Psychologists actually call this “Slow Thinking,” and one method for achieving this cognitive state it to practice what is known as savoring .

Fred Bryant, a pioneer in savoring, defines it as a mindful process of attending to and appreciating the positive experiences in one’s life (2003). Bryant describes four types of savoring: basking, thanksgiving, marveling, and luxuriating. Research shows that savoring fosters:

• positive emotions
• increases wellbeing
• deepens a connection to the meaningful people in our lives.

Savoring requires effort that involves deliberately working against the pressures to multitask. Learning to savor requires time and becomes more natural the more we practice it.

Kinds of Savoring Experiences:

• Basking  is about taking great pleasure or satisfaction in one’s accomplishments, good fortune, and blessings
• Thanksgiving is about expressing gratitude and giving thanks
• Luxuriating is about taking great pleasure and showing no restraint in enjoying physical comforts and sensations
• Marveling is about becoming filled with wonder or astonishment: beauty often induces marveling and exercising virtue may also inspire it
• Mindfulness is a state of being aware, attentive, and observant of oneself, one’s surroundings and other people.
• Busy Behavior Assessment

Reflect on whether or not you find yourself constantly busy and how this manifest in your daily life by answering the following questions:

• Do you multitask or find yourself constantly short on time?
• What are some of the signs of being busy and living life in the fast track: information overload, time crunch, overstimulation, underperforming, anxiety, and multitasking?
• Which ones of these do you experience?
• Reflect on what drives your busy behavior.
• Do you believe that these drivers are internal, external, or a combination of both?

Savoring Techniques

Practice the following strategies to increase savoring. All of the strategies to slow down mentioned here require active engagement. Select one or two of the following Savoring Techniques:

• Sharing With Others: Seek out others to share an experience. Tell them how much you value the moment (this is the single strongest predictor of pleasure.)
• Memory Building: Take mental photographs or even a physical souvenir of an event and reminisce about it later with others.
• Self-praise: Share your achievements with others and be proud. Do so in a way that is authentic and honest in celebrating your persistence in maintaining focus in achieving something meaningful to you.
• Sharpening Perceptions: Focus deliberately on certain elements and block out others. For example, most people spend far more time thinking about how they can correct something that has gone wrong than they do basking in what has gone right.

Brainstorm specific actions you will take to practice one or more of these techniques and think about who will support you or what can inhibit your progress.

Discussion questions : When, where, and how frequently can you use it to increase positive emotions in your daily life?

Homework : Pick a favorite or a different savoring technique and practice it between sessions. Reflect and write your personal list of actions which can sustain and enhance savoring.

Clinician notes : Savoring requires practice and some clients may struggle with savoring practices because they overthink the experience which tends to interfere with their ability to notice and attend to their senses.

The focus of the Savoring practices is positive but if the clients are feeling distressed, see if they are able to put aside their negative thoughts and feelings by using the diversion strategy from Session Five: Open and Closed Memories to optimally benefit from this exercise.

Clients should attend mindfully to all aspects of a savoring experience, including its cognitive, affective, and behavioral aspects. However, tuning in too much to feelings or thoughts may backfire and could interfere, eventually dampening the savoring experience so encourage the client to monitor their experiences for adaptation.

Session XII – People Matter

Goal : Seeing best in others and developing strategies for cultivation of positive relationships

Tool : Strength Spotting Exercise

Rationale : Recognizing the strengths of one’s loved ones has been proven to have significant positive benefits on relationships and wellbeing of those who practice it actively.

Understanding one another’s strengths foster a greater appreciation for each person’s intentions and actions and promote empathy. Ultimately, positive relationships buffer us against stress. The central positive psychotherapy (PPT) practice covered in this session is learning to see strengths in others and creating a Tree of Positive Relationships.

• Strengths Spotting

Answer the following questions about people you have close relationships with:

• Who in your immediate or extended relationships always appears to be the most hopeful and optimistic person?
• Who in your relationship circles has the most humorous and playful disposition?
• Who in your relations is the most creative person?
• Who is always cheerful, bubbly, and smiley?
• Who is the most curious person?
• Who always treats others fairly and squarely?
• Who is the most loving person in your family or friends?
• Who among your loved ones loves to create new things?
• Who is a good leader?
• Who in your relations is the most forgiving person?
• Who among your loved ones shows balanced self-regulation?
• What behaviors, actions, or habits does your partner exhibit to denote the strengths you identified?
• Do you share strengths with each other?
• Discuss any you share as well as ones you don’t.
• In what ways do your strengths complement each other?
• Did you also look at your partner’s and your bottom strengths?
• What can you learn from those?

Homework : If practical, ask your family and friends to take the VIA strengths survey. Create a Tree of Positive Relationships to help you and people you are close to gain greater insight into each other’s strengths.

Encourage clients to have uninterrupted, quality conversations with their loved ones at least once per week.

Clinician notes : To maintain progress, suggest that clients brainstorm a way to celebrate each other’s strengths. Suggest they focus on bonding activities that establish communication patterns, routines, and traditions both through daily, casual ways of enjoying each other’s company as well as more elaborate planned celebrations and vacations.

Session XIII – Politics of Wellbeing

Goal : Positive communication is addressed through learning about Active Constructive Responding and client is encouraged to look for opportunities to practice.

Tool : Active Constructive Responding (ACR)

Rationale : Shelly Gable and her colleagues found that sharing and responding positively to good events in our lives increases relationship satisfaction and strengthens our bonds (2004). When we capitalize on positive events in our lives by allowing others to partake in the good news not only do we amplify it, but also increase feelings of being valued and validated.

• Active Constructive Responding (ACR)

Read carefully the following descriptions of different styles of responding to good news. Check off which type of responses you identify with most of the time.

• When I share good news, my partner responds enthusiastically.
• Sometimes my partner is more excited about my wins than I am.
• My partner shows a genuine interest and asks a lot of questions when I talk about good events.
• My partner is happy for me but does not make a big deal out of my sharing positive news.
• When good things happen to me, my partner is silently supportive.
• Although my partner says little, I know she is happy for me.
• Often when I share good news, my partner finds a problem with it.
• My partner often sees a downside to the good events.
• My partner is often quick to point out the downside of good things.
• I’m not sure my partner often cares much.
• I often feel my partner doesn’t pay attention to me.
• My partner often seems uninterested.

Now let us try ACR in session. We will take turns sharing good news and then allowing the other person to respond. Think of something positive and recent that happened to you and tell me about it.

• What can you learn about yourself from identifying your response style?
• Are there any barriers that hinder you in engaging in ACR? They can be subjective or objective such as your personality style, preferences, and family of origin, culture, beliefs, or interpersonal dynamics.
• Should you already engage in some sort of ACR, what can you do to take it to a higher level?
• If you find that ACR doesn’t come naturally to you, what small steps can you take to adopt some aspects of this practice that are consistent with your disposition?
• Identify individuals or situations that display all four responding styles.
• What effects do you notice of each style both on sharer and responder?

Homework : Ask the client to practice ACR beyond his intimate relationships and use it with family member and friends.

Clinician notes : If the client is proficient in ACR, consider expanding the practice of positive communication into positive affirmations where partners offer each other words and actions that confirm the partners’ beliefs about themselves and behave in ways that are congruent with their partner’s ideal self (Drigotas, 2002).

Ask the client to practice perceptual affirmations where partners’ general view of each other is aligned with their ideal self, where we perceive our partners as trying their best, where we are forgiving of shortcoming and sympathize with the pain of failure, and finally, where we shine the light on qualities.

Ask the client to also practice behavioral affirmations where partners elicit behaviors that are in congruence with the other person’s ideal selves as well as create opportunities for expression of those ideal selves while decreasing situations that can negate them and behaviors that conflict.

This paves the way toward movement in the direction of being the most valuable self through skill development and reflection on aspirations congruent with deeply help hopes and dreams.

Session XIV – Gift of Time

Goal : Therapeutic benefits of helping others are introduced and the client is encouraged to Give the Gift of Time in a way that employs their strengths.

Tool : Gift of Time

Rationale : Helping others and practicing altruistic behavior has been shown to significantly increase a sense of meaning and purpose in life. In addition to making a difference, we also benefit from shifting our focus away from ourselves and indulging in our own thoughts (Keltner, 2009).

Research shows that material gifts lose their charm and value over time, but positive experiences and interactions continue to pay dividends through increased confidence that you can, in fact, do good (Kasser & Kanner, 2004).

• Gift of Time

Think of ways in which you could give someone you care about a Gift of Time. Brainstorm ways of doing something that requires a fair amount of time and involves using your strengths. Using your strengths to deliver the gift will make the exercise more satisfying.

• If creativity is your strength, write an anniversary note or make a gift by hand.
• If kindness sets you apart, prepare a dinner or run errands for a sick friend.
• If your humor is your strength, find a way to cheer someone up.

Write about your experience, recalling the details of what was involved in planning and reflect on how it made you feel.

• What feeling came up as you were giving your gift?
• How did you feel after giving your gift?
• What was the reaction of the recipient of your gift?
• What were the positive or negative consequences resulting from giving your gift?
• Did you use one or more of your signature strengths? If so, which one?
• Have you undertaken such an activity in the past? What was it?
• Did you find that it was different this time around? If so, what differences did you notice?
• Have there been times in the past when you were asked to give the Gift of Time and you didn’t want to?
• Have you been a recipient of someone else’s Gift of Time? What was it?
• Are you willing to give the Gift of Time regularly for a particular cause? What cause might this be?
• Do you anticipate any adaptation, and do you think the Gift of Time might not provide as much satisfaction as it did the first time?
• If so, what steps can you take to address this?

Homework : To maintain progress, suggest that the client performs a few random acts of kindness or consider volunteering for a cause they care about in a way that would allow them to use their strengths.

Clinician Note : Exercise caution if the self-care of clients is already compromised and make sure that their altruistic endeavors don’t negatively impact their self-care needs. To help clients decide on the scale of their altruistic endeavors, explore carefully client’s level of distress and wellbeing as it may reveal their exposure to a potential vulnerability.

Session XV – A Life Worth Living

Goal : The concept of a full life is explained as an integration of enjoyment, engagement and meaning and ways of sustaining positive change in the future are devised.

Tools : From Your Past Toward Your Future and Positive Legacy

Rationale : Cultivation of meaning helps us articulate our life goals in a way that integrates our past, present, and future. It provides a sense of efficacy, helps create ways to justify our actions and connects us to other people through a shared sense of purpose.

Cultivating long term life-satisfaction is closely tied to meaningful pursuits and our lives provide opportunities for meaningful stretches if one is willing to look.

In this final session, we combine the positive introduction with a better version of the self, and the hope of leaving a positive legacy.

• From Your Past Toward Your Future

If available, please read your Positive Introduction from Session I. If not, simply recall your story of resilience from our first session. Answer the following questions:

• From the experience of resilience in your Positive Introduction story, what meaning do you derive today? ____
• Which character strengths are most prominent in your story now that you have explored them further? _____
• Do you still use these strengths in everyday life? If so, how? ______
• What does your story of resilience tell you about your life’s purpose? ____
• What creative or significant achievements would you like to pursue in the next 10 years? ____
• If you were to pick one, what makes it most important for you and why? ____
• In what way will this goal make a difference for others? ____
• What steps do you need to take over the next 10 years to accomplish it? Describe what you need to do year by year? ______
• Which of your signature strengths will you use in accomplishing this goal? ____

Positive Legacy

Envision your life as you would like it to be and how you would want to be remembered by others. What accomplishments and strengths would they mention? What would you like your legacy to be? Describe in concrete terms. _____

Now look back at what you wrote and ask yourself if you have a plan that is both realistic and within your ability to do so.

• What was like it to re-read your story of resilience again?
• Would you write it the same way today? If not, what would you change?
• How has your thinking about the purpose and meaning of life changed over the course of our sessions?
• What was the process like for you of reflecting on and then writing about your goals for the future?
• What will your life look like when you accomplish your goals?
• What might happen if you do not accomplish your goals?
• Think of ways you can use your signature strengths to do something that would enable you to leave a Positive Legacy.
• What specific actions would you take to accomplish your short and long-term goals? What is the timeline for completion of these actions?

Homework : Resolve to keep this in a safe place and read it again a year from now. At that point ask yourself if you made progress, if you need to revise your goals, or if new goals have emerged for you.

Clinician notes : Some client may struggle to find purpose and meaning in their life, especially if they are struggling with a significant loss, trauma or severe depression. Nevertheless, it is very important for the client to be asked about meaning. Irvin Yalom (2020), the author of Existential Psychotherapy states that every one of his clients expressed concerns about the lack of meaning in their lives.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

We hope that you found this overview of effective positive psychotherapy tools to be helpful.

What has your experience been using these positive psychotherapy exercises? Leave a comment below. We would love to hear and learn from you.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

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I am very happy to see this post because it really a nice post. Thanks

This article is very informative and comprehensive. It has broadened my knowledge and perspective on Positive Psychotherapy. The exercises can benefit my clients as well as myself in the pursuit of happiness.

This is indeed one of the most rarely well thought and designed positive therapy/ coaching exercises which I am certain that will have a good impact on the client. Millions of thanks

This article has made me more effective in my work and I thank you dearly!

you are a genius!!!!!!

Beautifully executed. Focused on the positive. Clients would feel enthused to pursue it. A positive psychology CBT.

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The Counseling Palette

Mental health activities to help you and your clients thrive, 1. purchase  2. download  3. print or share with clients.

• Nov 27, 2021

11 New Therapy Worksheets for Anxiety, PTSD, and More

Updated: Sep 5, 2023

Download worksheets on CBT, anxiety, PTSD, self-care and more

T herapy worksheets can make all the difference. While it’s great to talk through new concepts, having a physical tool to share or send home can reinforce all the work done in sessions.

Fortunately, PDF worksheets can work just as well for telehealth as in-person therapy. You can print them out, or share them electronically on-screen or via e-mail.

Here’s a little about how these worksheets were developed, along with descriptions of each.

Article Highlights Background

CBT Triangle

Anxiety Plan

Understanding PTSD

Strong Emotions

Challenging Thoughts

Reframing trauma thoughts, anxiety hierarchy.

Trauma Narrative Making Meaning

Grounding Stones

Using These Tools

I developed each of the worksheets below based on my CBT and PTSD training, as well as my real-life experience in the field.

I find many of the mental health worksheets online cover key concepts, but they aren’t always user-friendly.

For example, a “cognitive distortion,” really just refers to an unhelpful thought. “Exposure,” means facing a fear that’s making your life difficult.

(And sometimes all those charts in traditional worksheets just make me dizzy.)

My worksheets and tools generally try to avoid this kind of psychological jargon, especially in the prompts and descriptions for clients. (I do sometimes keep these tech terms in the titles, mainly so that therapists recognize them at a glance.)

While we teachers and counselors like terms like “evidence-based,” many clients simply want to know what these skills mean for their lives, and how they can feel a little better.

They don't necessarily need to know any of the psychology terms to overcome specific symptoms or problems.

With that in mind, here are the worksheets I’ve developed based on concepts like anxiety management, mindfulness, grounding, PTSD treatment, exposure , and self-care.

To get started, my CBT triangle worksheet is available here for free . You can get the rest of these in a bundle at a nominal price. (Use coupon code 1110 for 10% off any of the worksheet kits and downloads.)

If you’re struggling with cost, send me a message and I’ll keep you updated when I run deals or promotions in the future.

Now, let’s get into some therapy worksheets !

CBT Triangle Worksheet

The cognitive behavioral triangle, or CBT triangle , is a quick and easy tool to teach the idea of changing our thoughts.

While feelings are natural, and many thoughts are automatic, we can change negative patterns over time.

For example, if someone tends to beat themselves up anytime they struggle at work, there may be a pattern in place.

They may believe their colleagues or boss don’t like them. This could lead to them feeling anxious or discouraged.

This discouragement could then make it harder to work, repeating the cycle.

With the CBT triangle, you can chart these patterns. The thought, “I’m bad at this job,” connects to the feeling, “discouragement, fear,” which leads to the behavior (taking more time on projects).

This then reinforces the original thought of, “I’m bad at this job,” and the triangle goes round and round.

The most basic step in CBT is to practice changing that original thought.

In a therapy session, we might try changing it to, “I’m still learning this job, but I get a little better each day.”

This would lead to the feeling of hopefulness, and the behavior of asking for help when needed, or getting a project done a bit faster.

This then leads to more positive thoughts, feelings, and behaviors.

This worksheet walks through this process, gives examples, and prompts for your students or clients to practice. (Or you can use it for yourself! I do that plenty.)

Download the CBT triangle worksheet here for free , and get news and freebies in the future.

Anxiety Plan Worksheet

I most often work with problems like anxiety, post-traumatic stress disorder (PTSD), phobias, and panic disorders. These bring nasty symptoms that can lead to staying at home, missing work, and distancing from relationships.

While some anxiety is normal, there’s typically an underlying cause if it’s gotten this bad. While we work on dealing with that main issue, my clients need some relief in the moment .

While there are a handful of skills that work for many people, each of us are unique. That’s why I suggest clients try multiple options to see what works best for them. Simply having one to three tools can help someone get through a very difficult situation.

This worksheet covers the basics of anxiety, and walks the reader through developing a plan to use when things get bad.

You can get the anxiety plan worksheet here, as part of this bundle .

Understanding PTSD Worksheet

There are three main types of PTSD therapy I’ve used with clients. These included prolonged exposure (PE), cognitive processing therapy (CPT), and trauma-focused CBT (TF-CBT). In each of these, the first step is psychoeducation, or learning about the condition .

This worksheet is straightforward and includes the four categories of PTSD symptoms. It then walks you and your client through identifying their symptoms so they can better understand what’s going on.

This is a good tool to use at the beginning of trauma treatment. You can access it as part of the worksheet bundle. Check it out here.

Strong Emotions Worksheet

Feelings are normal. We’re all human, and we all have them in one way or another. Some of us struggle either temporarily or permanently with super-strong emotions.

Many therapies, like DBT (dialectical behavioral therapy) or TF-CBT have elements relating to emotion regulation. We want a balance of facing difficult feelings, accepting them, and decreasing them when they cause us problems.

This worksheet covers those concepts, including elements of exposure and regulation. It also includes tips to use when emotions connect to suicidal ideation or self-harm. This is a great tool to have on hand for yourself or your clients during times of overwhelm.

Get the strong emotions worksheet here as part of this set .

This worksheet builds on the idea of the CBT triangle, but takes it a step further. While the triangle is a place to start for everyday struggles, the process can be a bit harder for deeper issues.

One way to tackle these more difficult thoughts is through the socratic questioning process. This is a technique where a therapist guides the client in thinking through a belief, rather than simply telling them what to believe.

For example, if something thinks, “I’m a failure at everything I try,” it’s easy to answer, “No you’re not, and here’s why ...”

While that could be helpful, it can sometimes backfire. Many people hear that type of response all the time, but still don’t accept it. They may even try to defend the reasons they’re a failure, reinforcing the idea.

With questions, we can guide our own brains to come to new conclusions. This worksheet walks through a common process of challenging this type of thought.

Rather than jumping to the end, you or your client ask questions like, “Why do I believe this thought?” and “What is the evidence against this?”

Not only does this get us thinking differently about a particular belief, it can reprogram the way our brain responds to these thoughts in general.

This worksheet can be a great tool all on its own, or can be a starting place for you and your clients or students to begin to think differently.

Download it here as part of the anxiety set.

The previous worksheets build up to this more challenging one, which is why I developed them as a set.

When someone has PTSD, it means they have particular thoughts about the trauma that are holding them back. In CPT, they call these “stuck points.”

These thoughts usually include ones of self-blame for the trauma, and beliefs by the client that they can no longer be safe in the world.

This feeling of being unsafe is what leads the body to respond with other symptoms, such as hypervigilance, and intrusive memories. It’s trying to keep the person on alert, so they’ll be prepared for the next dangerous situation.

However, in most cases the individual is not in constant danger once the traumatic event has passed. However, their stuck points continue to convince them they are.

This worksheet covers common PTSD-related beliefs, often called “cognitive distortions,” relating to the trauma. It includes examples, and how one might challenge these thoughts.

This type of worksheet is likely to be used over several sessions in therapy. It fits particularly well with the processes of TF-CBT and CPT. It could also be used as an adjunct to PE and EMDR (eye movement desensitization reprocessing) therapy.

You can download the worksheet right away, and part of the anxiety and PTSD set here .

It’s harder to get around this particular technical term. The anxiety hierarchy is sometimes called gradual exposure. I like to call it mindful exposure, because adding the mindfulness element makes it work even better.

An anxiety hierarchy can be used when someone has a phobia, or a particular fear related to their anxiety or PTSD.

When someone continues to avoid the fear, it gets worse over time. Even if they are facing it, they may be powering through, or “white knuckling” it. This can also make the fear stronger, because the body stays on alert for danger.

Mindfully exposing to the fear will help decrease it. Sometimes this takes a while, and other times it only takes once.

For example, if someone has a fear of all dogs, they may start by simply walking near dogs. Over time, this could advance to walking with a friendly dog, all the way up to cuddling up with one.

At some point, the person is likely to replace their unrealistic fear of all dogs with a more balanced one. Rather than believing, “all dogs are dangerous,” they might come to believe, “many dogs are friendly and safe.”

This worksheet walks the reader through that process, and includes a homework sheet they can take with to fill out each time they practice.

Trauma Narrative

If you’re a mental health professional, you may be familiar with the term “trauma narrative, or “written account of the trauma.”

This simply means writing what happened during and after the trauma.

This is often used in therapies like CPT and TF-CBT. In PE, it’s typically done verbally, rather than in written form.

While it can be one of the most difficult parts of recovery, nearly all of my clients who do it say it was the most helpful part of their therapy.

Originally, the trauma narrative was always used in CPT. Over time, the therapists found that some people got better without it , although many clients still choose to do it.

The narrative is a type of mindful exposure in and of itself. Sometimes people struggle with facing their negative beliefs about themselves and the trauma. It may seem too scary to face them head on.

The trauma narrative helps people overcome this roadblock, so they can begin to get better. It also gives some power back. Rather than being controlled by having to avoid memories and fears all of the time, someone can take the reins of their life back.

The trauma narrative worksheet explains this process, and provides the space and structure to complete the narrative. This is generally done with the guidance of a therapist.

This is so that the therapist can help the client work through this challenging step. They can also provide some structure that encourages the survivor to actually do this, rather than always putting it off.

To get the worksheet as part of the set, click here .

Making Meaning

So many people hate the phrase, “everything happens for a reason.” I definitely get that. I’d like to rephrase it to, “We can make meaning of everything that happens.”

This can be a helpful part of recovery, and it seems to help people make peace with bad things. The alternative is to believe that all of life stinks, and will continue to until the end. This is a pretty tough way to live.

This worksheet keeps that step in mind. It’s meant to be used towards the end of working through PTSD symptoms. It looks at the big picture, and looking forward in life. It’s a great tool for those finishing up this portion of their therapy.

To get this worksheet along with the set, visit here .

Grounding Stone Worksheet and Kit

I recently developed this kit in response to our popular grounding stones article . This is a fun and tangible activity that helps teach the concept of mindfulness.

This worksheet includes education about grounding itself, and teaches the steps behind the process.

The steps of using a grounding stone are included in the worksheet. The kit also includes bonuses of posters, an audio meditation of the grounding stone exercise, and editable files to update the documents.

Check it out here , to see what’s included.

Self-Care Guide

It’s great to tackle problems and develop coping skills. Often we also need to look at the big picture as well.

Once we overcome problems like anxiety and PTSD, where do we go from there?

This worksheet takes a broader look at overall wellness. It includes prompts about one’s own strengths, as well as a brainstorming page on how to improve self-care.

This can be a great supplement to any other type of therapy group, class, or event. Download it as an individual worksheet here.

Making Use of Tools

When our lives are focused on helping clients, students, family, and others, things can get hectic. Therapy tools can help take a bit of that pressure off, while still offering evidence-based practices for real issues.

If you’re looking to make progress with your group or clients, stay on track, and use well-supported techniques, I’ve got you covered.

Our most popular product is our anxiety and PTSD bundle of worksheets, which you can download right here , and start using today.

Cohen, J. A., & Mannarino, A. P. (2015). Trauma-focused Cognitive Behavior Therapy for Traumatized Children and Families. Child and adolescent psychiatric clinics of North America , 24 (3), 557–570. https://doi.org/10.1016/j.chc.2015.02.005

Walter, K. H., Dickstein, B. D., Barnes, S. M., & Chard, K. M. (2014). Comparing effectiveness of CPT to CPT-C among U.S. Veterans in an interdisciplinary residential PTSD/TBI treatment program. Journal of traumatic stress , 27 (4), 438–445.

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Processing Trauma and Stress

After a traumatic experience, it can be helpful to get your thoughts outside of your head. Writing down your experiences can help you gain perspective about your situation and help to reduce how distressing they are.

This worksheet comes from Mental Health America’s Mental Health Month 2021 Toolkit .

Here’s a web-friendly version of the activity from the worksheet:

Begin by writing down anything that comes to mind related to your traumatic experiences.

When you’ve been through multiple traumatic experiences, or carried trauma for a long time, it can shape the way you see yourself, the world, and others. These changes in beliefs are there to protect you from future harm, even when threats are gone. They can change the way you relate to others, whether or how you take risks, or how you feel positively about yourself.

How have your traumatic experiences shaped the way you see:

Reflecting on your writing experience above, do you notice how your body has changed in response to your feelings? Take a minute to identify the feelings you experience while reflecting on your story. Draw lines to the corresponding area of your body where you experience that emotion.

Practicing grounding techniques can help you get unstuck from your mind and your body. Use the Keep Your Mind Grounded worksheet to learn and practice staying grounded as a coping skill for your unwanted thoughts and feelings. Use the Stopping Stupid Thoughts worksheet to reflect on and change the beliefs above.

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What Is Therapy Homework?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program.

Astrakan Images / Getty Images

Types of Therapy That Involve Homework

If you’ve recently started going to therapy , you may find yourself being assigned therapy homework. You may wonder what exactly it entails and what purpose it serves. Therapy homework comprises tasks or assignments that your therapist asks you to complete between sessions, says Nicole Erkfitz , DSW, LCSW, a licensed clinical social worker and executive director at AMFM Healthcare, Virginia.

Homework can be given in any form of therapy, and it may come as a worksheet, a task to complete, or a thought/piece of knowledge you are requested to keep with you throughout the week, Dr. Erkfitz explains.

This article explores the role of homework in certain forms of therapy, the benefits therapy homework can offer, and some tips to help you comply with your homework assignments.

Therapy homework can be assigned as part of any type of therapy. However, some therapists and forms of therapy may utilize it more than others.

For instance, a 2019-study notes that therapy homework is an integral part of cognitive-behavioral therapy (CBT) . According to Dr. Erkfitz, therapy homework is built into the protocol and framework of CBT, as well as dialectical behavior therapy (DBT) , which is a sub-type of CBT.

Therefore, if you’re seeing a therapist who practices CBT or DBT, chances are you’ll regularly have homework to do.

On the other hand, an example of a type of therapy that doesn’t generally involve homework is eye movement desensitization and reprocessing (EMDR) therapy. EMDR is a type of therapy that generally relies on the relationship between the therapist and client during sessions and is a modality that specifically doesn’t rely on homework, says Dr. Erkfitz.

However, she explains that if the client is feeling rejuvenated and well after their processing session, for instance, their therapist may ask them to write down a list of times that their positive cognition came up for them over the next week.

"Regardless of the type of therapy, the best kind of homework is when you don’t even realize you were assigned homework," says Erkfitz.

Benefits of Therapy Homework

Below, Dr. Erkfitz explains the benefits of therapy homework.

It Helps Your Therapist Review Your Progress

The most important part of therapy homework is the follow-up discussion at the next session. The time you spend reviewing with your therapist how the past week went, if you completed your homework, or if you didn’t and why, gives your therapist valuable feedback on your progress and insight on how they can better support you.

It Gives Your Therapist More Insight

Therapy can be tricky because by the time you are committed to showing up and putting in the work, you are already bringing a better and stronger version of yourself than what you have been experiencing in your day-to-day life that led you to seek therapy.

Homework gives your therapist an inside look into your day-to-day life, which can sometimes be hard to recap in a session. Certain homework assignments keep you thinking throughout the week about what you want to share during your sessions, giving your therapist historical data to review and address.

It Helps Empower You

The sense of empowerment you can gain from utilizing your new skills, setting new boundaries , and redirecting your own cognitive distortions is something a therapist can’t give you in the therapy session. This is something you give yourself. Therapy homework is how you come to the realization that you got this and that you can do it.

"The main benefit of therapy homework is that it builds your skills as well as the understanding that you can do this on your own," says Erkfitz.

Tips for Your Therapy Homework

Below, Dr. Erkfitz shares some tips that can help with therapy homework:

• Set aside time for your homework: Create a designated time to complete your therapy homework. The aim of therapy homework is to keep you thinking and working on your goals between sessions. Use your designated time as a sacred space to invest in yourself and pour your thoughts and emotions into your homework, just as you would in a therapy session .
• Be honest: As therapists, we are not looking for you to write down what you think we want to read or what you think you should write down. It’s important to be honest with us, and yourself, about what you are truly feeling and thinking.
• Practice your skills: Completing the worksheet or log are important, but you also have to be willing to put your skills and learnings into practice. Allow yourself to be vulnerable and open to trying new things so that you can report back to your therapist about whether what you’re trying is working for you or not.
• Remember that it’s intended to help you: Therapy homework helps you maximize the benefits of therapy and get the most value out of the process. A 2013-study notes that better homework compliance is linked to better treatment outcomes.
• Talk to your therapist if you’re struggling: Therapy homework shouldn’t feel like work. If you find that you’re doing homework as a monotonous task, talk to your therapist and let them know that your heart isn’t in it and that you’re not finding it beneficial. They can explain the importance of the tasks to you, tailor your assignments to your preferences, or change their course of treatment if need be.

"When the therapy homework starts 'hitting home' for you, that’s when you know you’re on the right track and doing the work you need to be doing," says Erkfitz.

A Word From Verywell

Similar to how school involves classwork and homework, therapy can also involve in-person sessions and homework assignments.

If your therapist has assigned you homework, try to make time to do it. Completing it honestly can help you and your therapist gain insights into your emotional processes and overall progress. Most importantly, it can help you develop coping skills and practice them, which can boost your confidence, empower you, and make your therapeutic process more effective.

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Conklin LR, Strunk DR, Cooper AA. Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression . Cognit Ther Res . 2018;42(1):16-23. doi:10.1007/s10608-017-9873-6

Lebeau RT, Davies CD, Culver NC, Craske MG. Homework compliance counts in cognitive-behavioral therapy . Cogn Behav Ther . 2013;42(3):171-179. doi:10.1080/16506073.2013.763286

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How Trauma Therapy Works

• How It Helps
• Types of Treatment

If you or someone you love has experienced trauma, the content and descriptive information featured in this article may be triggering. For mental health resources, including a list of links and hotline numbers, see our  National Helpline Database .

Trauma therapy is a branch of psychotherapy (talk therapy) designed to manage the impact of traumatic events on people's lives. Also called trauma-focused therapy or trauma-informed care, it helps people process abusive, dangerous, frightening, or life-threatening experiences.

Witnessing or experiencing trauma can permanently impact a person's psychological and emotional functioning and lead to post-traumatic stress disorder (PTSD). Evidence-based treatments include cognitive processing and behavioral therapies, prolonged and narrative exposure therapies, and eye movement desensitization and reprocessing (EMDR).

This article discusses trauma therapy. It explains the different types of trauma-informed treatments and how they can help you heal from trauma.

SDI Productions / Getty Images

What Is Trauma Therapy?

Trauma therapy focuses on helping people with a past experience of trauma or a diagnosis of post-traumatic stress disorder (PTSD) manage their traumatic experiences.

When a person experiences trauma, it triggers heightened activity in the part of the brain known as the amygdala . This is involved in the regulation of emotions and memory processing.

Research shows the amygdala can be slow to recover from high-intensity trauma. This leads to heightened reactions to everyday stimuli, even in people who seem to recover and don't develop PTSD.

Trauma therapists have additional training in trauma and use skills and strategies that are designed to help people overcome the effects of traumatic events without re-traumatizing.

Trauma therapy can help you process your feelings about traumatic events and learn to prioritize self-care, be patient with yourself, and find ways to enjoy yourself again.

When Is It Time to See a Trauma Therapist?

When trauma disrupts your daily life and functioning, it may be time to seek the expertise of a trauma-informed therapist. A skilled trauma therapist may be beneficial if you are experiencing:

• Repeated flashbacks
• Insomnia or trouble sleeping
• Frequent nightmares
• Isolation or other symptoms that indicate trauma is impacting your daily life

What Trauma Therapy Can Help With

People seek trauma therapy for any number of different issues. Some of the reasons people might need trauma-informed therapy include:

• Combat trauma
• Assault or attack
• Domestic violence or intimate partner violence
• Community violence
• Natural and man-made disasters
• Medical trauma
• Injuries, including traumatic brain injuries (TBI)
• Physical abuse
• Emotional or psychological abuse
• Sexual abuse or assault
• Early childhood trauma , abuse, or neglect
• Traumatic grief
• Bullying in schools or workplaces
• Witnessing trauma or experiencing secondary trauma

When Trauma Becomes PTSD

It's important to note that trauma does not always lead to a diagnosis of PTSD. When anyone experiences a traumatic event, this sets off emotional, physical, and brain-based responses. If this continues beyond a month timespan, and you experience flashbacks, nightmares, or any symptoms that are causing significant distress or dysfunction, see a healthcare provider about PTSD. A diagnosis of PTSD often occurs when people have experienced chronic trauma , such as first responders, or have a past history of trauma.

Types of Trauma Therapy Treatments

There are many types of trauma therapy treatments. Evidence-based treatments are backed by research supporting their effectiveness. The following are a few of the main types of evidence-based therapies for treating trauma.

Prolonged Exposure (PE)

Prolonged exposure (PE) is a treatment in which a person is gradually exposed to their trauma-related memories, fears, emotions, and feelings about the event(s) to learn that these are no longer dangerous or need to be avoided. Patients typically meet with a therapist once a week for three to four months.

PE is strongly recommended by the American Psychological Association as a first-line intervention for PTSD. In one study, 71% of participants experienced a decrease in PTSD symptoms with PE treatment.

Cognitive Processing Therapy (CPT)

Cognitive processing therapy (CPT) is a trauma-focused therapy designed to treat PTSD. It helps patients challenge and modify unhelpful beliefs related to the trauma. Writing a detailed account of the traumatic event allows patients to re-conceptualize the event to reduce its impact on one's current life.

Patients typically meet with a therapist for about 12 sessions. CPT is considered a first-line intervention for PTSD and is strongly recommended by the APA.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) focuses on thoughts, feelings, and behaviors, and the relationship between them. A trauma-focused therapist might help a client understand how they are thinking about their trauma and how to shift it into more helpful thinking.

CBT usually takes 12 to 16 sessions. This treatment is strongly recommended by the APA for the treatment of PTSD.

There is also trauma-focused cognitive behavioral therapy, or TF-CBT, which is also evidence-based. It's designed for children and adolescents but includes their caregivers as part of the therapy.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) was developed as a treatment for PTSD. It involves processing the memory and the way it is stored in the brain, which reduces problematic triggers and symptoms.

During this therapy, rhythmic eye movements are combined with focus on memories of the trauma. EMDR usually involves six to 12 weekly or twice-weekly sessions.

Narrative Exposure Therapy (NET)

Narrative exposure therapy (NET) focuses on the stories people tell themselves about their lives, which impacts their well-being and how they view themselves.

With the help of a therapist who is actively listening, offering connection and positive feedback, the patient creates a chronological narrative of their life, including both traumatic experiences and positive experiences. This helps reframe how they perceive their life and memories overall.

Treatments That May Also Help Trauma

There are some complementary and alternative treatments that may also be helpful for people with trauma:

• Somatic therapy : This is a body-centered therapy designed to heal trauma stored in the body and help with stress disorders.
• Acupuncture : Part of traditional Chinese medicine, acupuncture with a trained practitioner is designed to restore balance within the body's systems.
• Clinical hypnosis : Under the care of a clinically trained provider, hypnotherapy allows trauma survivors to process trauma in a controlled way.
• Mindfulness-based cognitive therapy (MBCT) : MBCT incorporates cognitive therapies with the concepts of mindfulness meditation.

Self-care strategies, such as engaging with art and music, relaxation, yoga, journaling, mindfulness meditation, and spending time in nature, can also help.

Trauma and the Mind-Body Connection

Trauma is not just experienced emotionally but in the body as well. During a traumatic event, the mind and body become activated. For some people, after the threat has passed, the mind and body will return to normal. For others, hyperarousal and hyperreactivity remain and become chronic. The chronic stress response can dysregulate the stress system in the body, causing stress-related physical conditions to develop, such as chronic fatigue, fibromyalgia , and high blood pressure .

Benefits of Trauma Therapy

Traumatic experiences can impact a person's life and relationships, as well as cause difficulties at work, school, and in social settings. Trauma therapy can improve quality of life.

Although it can be challenging to face those difficult events, with support and psychotherapy, symptoms can lessen over time.

Some other benefits of trauma therapy include:

• Learning coping skills to handle distorted or negative thoughts and feelings
• Reframing the traumatic experience and making sense of it
• Improving close relationships and connections with people
• Reducing irritability, anger, and frustration, and increasing peace of mind
• Eliminating or reducing triggers and symptoms of PTSD

Why Is Trauma Therapy so Difficult?

Trauma therapy can be challenging. However, living with unprocessed trauma can be very emotionally debilitating. At first, looking into past traumatic experiences can cause symptoms of trauma to surface. One study found that those who experienced an increase in symptoms experienced significant improvement by the end of treatment.

How Effective Is Trauma Therapy?

Research shows trauma therapy can be highly effective. A 2018 review of studies compared PE, CPT, and CBT for the treatment of PTSD. While results varied, the study found the following ranges of patients no longer met PTSD diagnostic criteria after completing treatment:

• CBT : 61% to 82.4%
• CPT : 30% to 97%
• PE : 41% to 95%

Adding Medication May Improve Results

In some cases, medication may be used alongside trauma therapy in people with PTSD. Research shows the most effective medications for PTSD include:  

• Effexor XR (venlafaxine) 
• Paxil (paroxetine) 
• Prozac (fluoxetine) 
• Zoloft (sertraline)

These treatments may be augmented with Remeron (mirtazapine) to help with sleep. Minipress (prazosin) may also be prescribed for nightmares in people with PTSD. However, there isn’t strong evidence to support the use of either medicine.

Medications not recommended in the treatment of PTSD include atypical antipsychotics, antiseizure medicines, benzodiazepines, and cannabis.  

Help Is Available

If you or a loved one is struggling with trauma, you can contact the  Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline  online or call  1-800-662-4357  for more information on how to find support and treatment options specific to your geographic area.

Trauma-informed therapy helps people overcome the effects of traumatic events. It can be especially beneficial for people with post-traumatic stress disorder (PTSD). There are several types of evidence-based trauma therapies and treatments that can improve a person's quality of life.

Northwestern University Center for Child Trauma Assessment, Services, and Interventions. What is childhood trauma?

American Psychological Association. Exposure to trauma can affect brain function in healthy people several years after event; may increase susceptibility to mental health problems in the future .

American Psychological Association. How to cope with traumatic stress .

The National Child Traumatic Stress Network. Trauma types .

American Psychiatric Association.  What is post-traumatic stress disorder? .

American Psychological Association. Prolonged exposure (PE) .

Hendriks L, Kleine RA de, Broekman TG, Hendriks GJ, Minnen A van. Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts .  European Journal of Psychotraumatology . 2018;9(1). doi:10.1080/20008198.2018.1425574

Roberge EM, Weinstein HR, Bryan CJ. Predicting response to cognitive processing therapy: Does trauma history matter? Psychol Trauma . 2022;14(5):871–82. doi:10.1037/tra0000530

Hagerty SL, Wielgosz J, Kraemer J, Nguyen HV, Loew D, Kaysen D. Best practices for approaching cognitive processing therapy and prolonged exposure during the COVID-19 pandemic . J Trauma Stress . 2020;33(5):623-633. doi:10.1002/jts.22583

American Psychological Association. Cognitive behavioral therapy (CBT) .

American Psychological Association. Eye movement desensitization and reprocessing (EMDR) therapy .

American Psychological Association. Narrative exposure therapy (NET) .

U.S. Department of Veterans Affairs: National Center for PTSD. Complementary and alternative treatments for PTSD .

U.S. Department of Veterans Affairs National Center for PTSD. Why get treatment?

Larsen SE, Wiltsey Stirman S, Smith BN, Resick PA. Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion . Behaviour Research and Therapy . 2016;77:68-77. doi:10.1016/j.brat.2015.12.009

Watkins LE, Sprang KR, Rothbaum BO.  Treating PTSD: a review of evidence-based psychotherapy interventions .  Front Behav Neurosci . 2018;12:258. doi:10.3389/fnbeh.2018.00258

Schrader C, Ross A. A review of PTSD and current treatment strategies . Mo Med . 2021;118(6):546–51. 

By Michelle C. Brooten-Brooks, LMFT Brooten-Brooks is a licensed marriage and family therapist based in Georgia. She has been covering health and medical topics as a journalist for over 20 years.

Revolutionize Your Healing: Discover Therapy Homework Worksheets that Work

The power of therapy homework.

Therapy homework is an integral part of the therapeutic process, offering individuals the opportunity to continue their healing journey outside of therapy sessions. By engaging in structured activities and exercises, clients can reinforce what they have learned and apply therapeutic concepts to their daily lives. This section will explore what therapy homework is and the benefits of using therapy homework worksheets.

What is Therapy Homework?

Therapy homework refers to assignments or tasks that therapists provide to their clients to complete outside of therapy sessions. These assignments are tailored to the individual’s specific needs and therapeutic goals. Therapy homework can take various forms, including worksheets, journaling exercises, or other activities designed to promote reflection, skill development, and personal growth.

Therapists assign homework to help clients integrate new insights, strategies, and coping skills into their daily routines. It serves as a bridge between therapy sessions, allowing clients to actively engage in their own healing process between appointments. By participating in therapy homework, individuals can take ownership of their progress and contribute to their overall well-being.

Benefits of Using Therapy Homework Worksheets

Using therapy homework worksheets offers numerous benefits for both clients and therapists. These worksheets provide structure and guidance, ensuring that clients have a clear direction for their therapeutic work. Here are some key benefits of incorporating therapy homework worksheets into the therapeutic process:

• Reinforcement of therapeutic concepts:  Completing therapy homework worksheets reinforces the concepts discussed in therapy sessions. It allows clients to apply what they have learned, increasing the likelihood of long-term change and growth.
• Continuity of progress:  Therapy homework provides a continuous link between therapy sessions, offering clients the opportunity to maintain momentum in their progress. By actively engaging in therapeutic activities outside of sessions, clients can build upon their achievements and work towards their goals.
• Enhanced self-awareness:  Therapy homework encourages self-reflection and introspection. Worksheets prompt clients to explore their thoughts, emotions, and behaviors, leading to increased self-awareness and insight into their own patterns and experiences.
• Skill development: Many therapy homework worksheets focus on developing specific skills or coping strategies. By engaging in these activities, clients can practice and refine their skills, ultimately enhancing their ability to manage challenges and navigate their lives more effectively.
• Empowerment and self-efficacy:  Completing therapy homework instills a sense of empowerment and self-efficacy in clients. It allows them to take an active role in their own healing process, fostering a sense of control and autonomy.
• Tracking progress:  Therapy homework worksheets enable clients and therapists to track progress over time. By regularly reviewing completed assignments, both parties can observe growth, identify patterns, and adjust treatment plans as needed.

By utilizing therapy homework worksheets, therapists can enhance the effectiveness of their interventions and empower clients to take an active role in their healing journey. These worksheets provide structure, guidance, and opportunities for growth, supporting clients in achieving their therapeutic goals.

In the next section, we will explore how therapists can find the right therapy homework worksheets for their clients by understanding their needs and considering different types of worksheets.

Finding the Right Therapy Homework Worksheets

To effectively incorporate therapy homework into your practice, it’s essential to  understand your client’s needs  and tailor the worksheets accordingly. Each client is unique, with different goals, challenges, and preferences. By considering their individual situation, you can select therapy homework worksheets that are most relevant and beneficial.

Understanding Your Client’s Needs

Before prescribing therapy homework, take the time to have an open and honest conversation with your client. Understand their specific concerns, treatment goals, and areas they want to focus on. This will help you identify the most appropriate therapy homework assignments that align with their needs and objectives.

By gaining insight into their preferences and learning style, you can select worksheets that will resonate with them. Some clients may prefer written exercises, while others may respond better to visual or experiential activities. Understanding these preferences will enhance engagement and increase the likelihood of successful outcomes.

Types of Therapy Homework Worksheets

Therapy homework worksheets come in various formats and cover a wide range of therapeutic techniques. Here are some common types of therapy homework worksheets that you may find helpful:

These are just a few examples, and there are many more therapy approaches and corresponding worksheets available. Depending on your client’s needs, you may explore other therapy approaches such as Solution-Focused Brief Therapy, Dialectical Behavior Therapy, or Narrative Therapy. Each approach offers unique worksheets that can be tailored to address specific concerns.

By incorporating a variety of therapy homework worksheets, you can provide your clients with a diverse and comprehensive treatment experience. This allows for a more personalized approach that caters to their specific needs and promotes better therapeutic outcomes.

As you introduce therapy homework to your clients, it’s important to  set clear expectations  and explain the purpose and benefits of completing the assignments. Encourage them to actively engage with the worksheets and track their progress over time. This will help both you and your client assess the effectiveness of the therapy homework and make any necessary adjustments. For more ideas on therapy homework assignments, you can explore our article on  therapy homework assignments .

Remember, therapy homework is a collaborative process between you and your client. By understanding their needs and preferences and selecting appropriate worksheets, you can empower them to take an active role in their healing journey.

Cognitive-Behavioral Therapy Worksheets

Cognitive-Behavioral Therapy (CBT) is a widely used therapeutic approach that focuses on identifying and changing negative thought patterns and behaviors. Therapy homework worksheets based on CBT principles can be valuable tools in helping clients make progress outside of therapy sessions. Here are three common CBT worksheets that can be incorporated into therapy homework assignments.

Thought Records

Thought records are powerful tools for challenging and restructuring negative thinking patterns. These worksheets involve identifying and examining negative thoughts, emotions, and associated situations. Clients are encouraged to explore evidence for and against their negative thoughts, as well as alternative, more balanced perspectives. By completing thought records, individuals can develop a more realistic and positive outlook. For additional therapy homework ideas, including thought records for specific concerns, check out our article on  therapy homework ideas .

Behavior Activation

Behavior activation worksheets are designed to help individuals increase their engagement in enjoyable and fulfilling activities. By identifying activities that bring a sense of pleasure or accomplishment, clients can overcome feelings of apathy or low motivation often associated with depression or other mental health challenges. These worksheets help clients set specific goals, plan and schedule activities, and track their progress. By gradually increasing their involvement in positive activities, individuals can experience a boost in mood and overall well-being.

Challenging Negative Thoughts

Challenging negative thoughts worksheets assist clients in identifying and challenging distorted, negative thinking patterns. These worksheets encourage individuals to examine the evidence supporting their negative thoughts and consider alternative interpretations. By replacing negative thoughts with more realistic and positive ones, clients can change their emotional responses and behaviors. This practice can be particularly effective for individuals struggling with anxiety, depression, or low self-esteem. For specific therapy homework worksheets on challenging negative thoughts related to anxiety or depression, visit our articles on  therapy homework for anxiety  and  therapy homework for depression .

By incorporating these cognitive-behavioral therapy worksheets into therapy homework assignments, practitioners can empower their clients to actively participate in their own healing process. It’s important to remember that therapy homework should be tailored to individual clients’ needs and goals. Regularly tracking progress and adjusting the homework as needed ensures that clients are receiving the most effective treatment. Additionally, setting clear expectations and providing guidance on how to complete the worksheets can enhance their effectiveness.

Mindfulness-Based Therapy Worksheets

Incorporating mindfulness-based techniques into therapy can be highly beneficial, particularly for individuals seeking to enhance their self-awareness and overall well-being. Mindfulness-based therapy worksheets provide structured exercises that guide clients through various mindfulness practices. Here are three commonly used worksheets:

The body scan exercise is a mindfulness practice that involves systematically directing attention to different parts of the body, noticing sensations, and bringing awareness to the present moment. This practice helps individuals cultivate a deeper connection with their physical sensations, promoting relaxation and grounding. The body scan can be particularly helpful for reducing stress and increasing body awareness. To access a body scan worksheet, check out our article on  therapy homework for relaxation .

Mindful Breathing

Mindful breathing exercises focus on bringing attention to the breath as it moves in and out of the body. By observing the breath without judgment, individuals can develop a sense of calm and present-moment awareness. Mindful breathing exercises can be used as a tool to manage anxiety, stress, and emotional reactivity. Encourage clients to practice mindful breathing daily to cultivate a greater sense of calm and centeredness. For more mindfulness-based therapy worksheets, explore our  therapy homework for mindfulness  article.

Loving-Kindness Meditation

Loving-kindness meditation, also known as metta meditation, involves directing well-wishes and compassion towards oneself and others. This practice cultivates feelings of love, kindness, and connection. By repeating positive phrases or mental images, individuals can foster a sense of empathy and understanding towards themselves and those around them. Loving-kindness meditation can be particularly beneficial for individuals struggling with self-compassion or developing positive relationships. To access a loving-kindness meditation worksheet, visit our article on  therapy homework for self-compassion .

By incorporating mindfulness-based therapy worksheets into sessions, therapists can empower their clients to develop mindfulness skills, enhance self-awareness, and promote personal growth. These worksheets can serve as valuable resources to support clients in their therapeutic journey. Remember to tailor the worksheets to each individual client’s needs and track their progress over time.

Acceptance and Commitment Therapy Worksheets

Acceptance and Commitment Therapy (ACT) is a therapeutic approach that focuses on accepting difficult thoughts and feelings while committing to actions aligned with personal values. ACT worksheets provide practical exercises and tools to help individuals develop psychological flexibility and enhance their well-being. Here are three commonly used ACT worksheets:

Values Clarification

Values clarification is a fundamental aspect of ACT. This worksheet assists individuals in identifying their core values, which serve as guiding principles for their actions and decisions. By clarifying personal values, individuals can align their behavior with what truly matters to them, leading to a more meaningful and fulfilling life.

The values clarification worksheet involves reflecting on different areas of life, such as relationships, work, health, and personal growth. It prompts individuals to identify specific values that resonate with them and rank their importance. This exercise helps individuals gain clarity about what they value most and provides a foundation for making choices in line with those values.

Defusion Techniques

Defusion techniques in ACT aim to help individuals observe and distance themselves from their thoughts, rather than getting entangled in them. This worksheet introduces various defusion exercises that allow individuals to create psychological space between themselves and their thoughts.

One common defusion technique is the “leaves on a stream” exercise. This exercise involves imagining thoughts as leaves floating down a stream. Individuals are encouraged to observe their thoughts without judgment, allowing them to come and go freely. By practicing this exercise, individuals can reduce their attachment to unhelpful thoughts and develop a more flexible relationship with their thinking patterns.

Committed Action Planning

Committed action planning is a crucial component of ACT that emphasizes taking steps toward valued goals and engaging in meaningful action. This worksheet helps individuals identify specific actions they can take to align with their values and move closer to their desired outcomes.

The committed action planning worksheet involves setting SMART goals (Specific, Measurable, Achievable, Relevant, and Time-bound) and breaking them down into actionable steps. Individuals are prompted to consider potential barriers and develop strategies to overcome them. This process empowers individuals to create a roadmap for taking consistent and purposeful action in line with their values.

Using these acceptance and commitment therapy worksheets, therapists can guide clients in developing greater psychological flexibility and resilience. Whether through values clarification, defusion techniques, or committed action planning, these worksheets provide practical tools for individuals to navigate life’s challenges and live more authentically.

Incorporating Therapy Homework into Your Practice

As a mental health professional, integrating  therapy homework  into your practice can enhance the effectiveness of your sessions and empower your clients to actively participate in their healing journey. To make the most of therapy homework, it is essential to  set clear expectations ,  tailor worksheets to individual clients , and  track progress and adjust as needed .

Setting Clear Expectations

When introducing therapy homework to your clients, it is crucial to establish clear expectations from the beginning. Clearly communicate the purpose and benefits of therapy homework, emphasizing that it is an integral part of their therapeutic process. Explain how completing assignments outside of sessions can reinforce the work done in therapy and accelerate progress. Encourage open communication and address any concerns or questions your clients may have.

By setting clear expectations, you create a foundation of understanding and collaboration. This clarity helps clients commit to the homework and understand its importance in their therapeutic journey. For more ideas on therapy homework assignments, you can refer to our article on  therapy homework assignments .

Tailoring Worksheets to Individual Clients

Every client is unique, and their therapy homework should reflect their specific needs and goals. Tailoring worksheets to individual clients allows for a more personalized and effective therapeutic experience. Take the time to assess your client’s preferences, learning style, and therapeutic objectives. This information will guide you in selecting or creating worksheets that resonate with their needs.

Consider exploring a wide range of therapy homework options to address various concerns. From worksheets for anxiety and depression to self-esteem, assertiveness, mindfulness, relaxation, self-reflection, self-care, boundaries, forgiveness, self-compassion, self-acceptance, problem-solving, self-awareness, self-confidence, resilience, journaling, self-expression, creativity, communication skills, anger management, stress management, goal setting, emotional regulation , relationship building, trauma recovery, and coping skills, there are numerous possibilities to explore. You can find more ideas in our extensive library of articles on  therapy homework .

Remember, the more tailored the therapy homework is to your client’s individual needs, the more engaged and motivated they will be in completing the assignments.

Tracking Progress and Adjusting as Needed

Monitoring your clients’ progress with therapy homework is crucial for evaluating their growth and making any necessary adjustments to their treatment plan. Regularly review completed assignments, discuss the insights gained, and encourage clients to share their experiences and challenges. This feedback loop enables you to identify patterns, track progress, and adapt the therapy homework accordingly.

Keep detailed records of each client’s therapy homework journey. Use a tracking system to note their assignments, progress, and any modifications made along the way. This documentation will serve as a valuable resource for future sessions and help guide the direction of their therapy.

Additionally, be open to feedback from your clients. Actively listen to their thoughts and feelings about the therapy homework process. This feedback will inform your decision-making and allow you to refine the therapy homework approach to best meet their evolving needs.

By incorporating therapy homework into your practice and following these guidelines of setting clear expectations, tailoring worksheets to individual clients, and tracking progress, you can revolutionize the healing journey for your clients. Therapy homework is a powerful tool that empowers clients to actively engage in their own healing process, leading to more effective and transformative therapeutic outcomes.

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Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD)

Resource type

Therapy tool.

Am I Experiencing Depersonalization And Derealization?

Am I Experiencing Post-Traumatic Stress Disorder (PTSD)?

Arbitrary Inference

Information handouts

Audio Collection: Psychology Tools For Overcoming PTSD

Autonomic Nervous System

Barriers Abusers Overcome In Order To Abuse

Before I Blame Myself And Feel Guilty

Behavioral Experiment

Behavioral Experiment (Portrait Format)

Catastrophizing

Coercive Methods For Enforcing Compliance

Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)

Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)

Critical Care And PTSD

Critical Illness Intensive Care And Post-Traumatic Stress Disorder (PTSD)

Dependence/Incompetence

Disqualifying Others

Dissociation - Self-Monitoring Record

EMDR Negative And Positive Cognitions

EMDR Protocol (Standard)

EMDR Protocol (With Interweave Guidance)

Emotional Deprivation

Emotional Reasoning

Externalizing

Fight Or Flight Response

Flashbacks - Self-Monitoring Record

Fortune Telling

Grounding Objects (Audio)

Grounding Statements (Audio)

Grounding Techniques

Grounding Techniques Menu

Habituation

Hindsight Bias

Hindsight Bias (Archived)

Hotspot Record

How Trauma Can Affect You (CYP)

Intrusive Memory Record

Maximizing The Effectiveness Of Exposure Therapy

Nightmare Exposure And Rescripting

Nightmare Rescripting (Audio)

Personalizing

Pie Charts (Archived)

Progressive Muscle Relaxation (Audio)

Prolonged Exposure Therapy For PTSD (Second Edition): Therapist Guide

Treatments That Work™

Properties Of Trauma Memories

PTSD And Memory

PTSD Film Projection Metaphor

PTSD Linen Cupboard Metaphor

Reactions To Trauma

Reclaiming Your Life From A Traumatic Experience (Second Edition): Workbook

Recognizing Complex Post Traumatic Stress Disorder

Responses To Threat: Freeze, Appease, Flight, Fight

Responsibility Pie Chart

Rewind Technique

Sensory Grounding Using Smells (Audio)

Sensory Grounding Using Your Five Senses (Audio)

Social Comparison

Stimulus Discrimination (Audio)

Therapy Blueprint (Universal)

Therapy Blueprint For PTSD

Trauma And Dissociation

Trauma, Dissociation, And Grounding (Archived)

Understanding Depersonalization And Derealization

Understanding Post-Traumatic Stress Disorder (PTSD)

Links to external resources.

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

• Scale Download Primary Link Archived Link
• DES-B (Dalenberg C, Carlson E, 2010) modified for DSM-5 by C. Dalenberg and E. Carlson.

Resources related to the assessment of post-traumatic stress disorder (PTSD)

• Wilson, J.P., & Keane, T.M. (Eds.). (2004). Assessing psychological trauma and PTSD: A practitioner’s handbook (2nd ed.). New York, NY: Guilford Press.
• Scale (English) Download Primary Link Archived Link
• Scale (German) Download Primary Link Archived Link
• Scale (Norwegian) Download Primary Link Archived Link
• Reference Schalinski, I., Schauer, M., & Elbert, T. (2015). The Shutdown Dissociation Scale (Shut-D). European Journal of Psychotraumatology, 6
• Carlson, E.B. & Putnam, F.W. (1993). An update on the Dissociative Experience Scale. Dissociation 6(1), p. 16-27.

Screening, diagnostic, and outcome-measurement tools for post-traumatic stress disorder (PTSD)

• Brewin, C. R, Rose, S., Andrews, B., Green, J., Tata, P., McEvedy, C. Turner, S, Foa, E. B. (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry, 181, 158-162.
• DePrince, A. P., Zurbriggen, E. L., Chu, A. T., & Smart, L. (2010). Development of the trauma appraisal questionnaire.Journal of Aggression, Maltreatment & Trauma,19(3), 275-299. Download Primary Link Archived Link
• Scale – Adult Download Primary Link Archived Link
• Scale – Child Age 11-17 Download Primary Link Archived Link
• Foa, Edna B.,McLean, Carmen P.,Zang, Yinyin,Zhong, Jody,Rauch, Sheila,Porter, Katherine,Knowles, Kelly,Powers, Mark B.,Kauffman, Brooke Y. (2016) Psychological Assessment, Vol 28(10), 1159-1165
• Scale Download Archived Link
• Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489-498. doi: 10.1002/jts.22059
• Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Standard. [Measurement instrument].
• Manual Download Primary Link Archived Link
• Scale (Standard) Download Primary Link Archived Link
• Scale with criterion A Download Primary Link Archived Link
• Scale with life events checklist and criterion A Download Primary Link Archived Link
• Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5) – Standard. [Measurement instrument].
• Weiss, D. S., & Marmar, C. R. (1996). The Impact of Event Scale – Revised. In J. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford.
• Scale archived version Download Primary Link
• Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2015). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) – Past Week [Measurement instrument].

Guides and workbooks

• Your very own TF-CBT workbook | Alison Hendricks, Judith A. Cohen, Anthony P. Mannarino, Esther Deblinger Download Primary Link Archived Link
• Posttraumatic stress disorder: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD) Download Primary Link Archived Link
• Trauma And Substance Use | NDARC: Mills, Ewer, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Trimmingham | 2011 Download Primary Link Archived Link
• Abuse – Information For Adults Physically, Emotionally, Or Sexually Abused As Children (An NHS Self-Help Guide) | Lesley Maunder, Lorna Cameron | 2020 Download Primary Link Archived Link

Information Handouts

• A collection of soothing activities wwu.edu Download Archived Link
• Grounding techniques list Download Primary Link
• Detaching from emotional pain e-tmf.org Download Archived Link
• Grounding Techniques Download Archived Link
• Coping with trauma | Dr Jim White | 2006 Download Archived Link
• Was it my fault? Self-blame and survivors | PANDYS / Shannon | 2007 Download Archived Link
• The Power and Control Wheel diagram: for understanding abusive and violent behaviors | National Centre on Domestic and Sexual Violence Download Primary Link Archived Link
• After the event: supporting children after a frightening event | Trickey, Bailie, Serpell | 2010 Download Primary Link Archived Link
• Explaining the rationale for trauma focused work: why it’s good to talk (children & young people) | Trickey | 2012 Download Primary Link Archived Link
• Processing trauma: the factory metaphor | Hawkins Download Primary Link Archived Link
• Surviving torture: understanding the nature and purpose of torture | Christian Peacemaker Teams Download Archived Link
• Post-traumatic stress disorder (PTSD) patient handout | Royal College Of Psychiatrists | 2005 Download Archived Link
• Coping with trauma (workbook) | Good Thinking Download Primary Link Archived Link

Information (Professional)

• Understanding traumatic intrusions (OCTC Practical Guides) | Helen Kennerley | 2016 Download Primary Link Archived Link
• Prolonged Exposure (PE) | Edna Foa Download Primary Link
• Narrative Exposure Therapy (NET) | Shauer, Neuner, Elpert Download Primary Link

Presentations

• PTSD as a shame disorder | Judith Herman | 2014 Download Archived Link
• A trauma-focused cognitive behavioral therapy case conceptualization: from assessment to termination | Alison Hendricks Download Archived Link
• Using exposure to treat PTSD: why, when, and how? | Fyvie Download Archived Link
• Introduction to traumatic stress | Kitchiner & Roberts Download Archived Link
• Using compassionate imagery in shame based flashbacks in PTSD | Deborah Lee | 2009 Download Primary Link
• Dissociation and PTSD | Fiona Kennedy | 2010 Download Archived Link
• Beyond reliving in PTSD treatment: advanced skills for overcoming common obstacles in memory work | Hannah Murray, Sharif El-Leithy Download Archived Link
• Cognitive therapy for PTSD | Nick Grey | 2016 Download Primary Link Archived Link
• Dissociative phenomena in the everyday lives of trauma survivors | Janina Fischer | 2001 Download Archived Link
• Modulation, mindfulness, and movement in the treatment of trauma-related depression (window of tolerance) | Pat Ogden | 2009 Download Archived Link

Treatment Guide

• CBT-3M (Meanings, Memories and Management) - A trauma- based cognitive therapy protocol for young children aged 3-8 years | Based on the treatment developed by Smith, Yule, Perrin, & Clark (2006) Download Primary Link Archived Link
• Trauma focused CBT for chronic whiplash Download Primary Link
• Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014 Download Primary Link Archived Link
• Guideline for the treatment and planning of services for complex post-traumatic stress disorder in adults | UKPTS: McFetridge, Hauenstein Swan, Here, Karatzias, Greenberg, Kitchiner, Morley | 2017 Download Archived Link
• Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents | International Society for the Study of Trauma and Dissociation (ISST-D) | 2003 Download Primary Link Archived Link
• Guidelines for Treating Dissociative Identity Disorder in Adults | International Society for the Study of Trauma and Dissociation (ISST-D) | 2011 Download Primary Link Archived Link
• Clinical practice guideline for the treatment of PTSD | American Psychological Association (APA) | 2017 Download Primary Link Archived Link
• Post-traumatic stress disorder (PTSD) | National Institute for Health and Care Excellence (NICE) guidelines | 2018 Download Primary Link Archived Link
• Cognitive Processing Therapy (CPT) Veteran/Military Version | Patricia Resick, Candice Monson, Kathleen Chard | 2006 Download Primary Link
• Absolutely not: an other thoughts you might have about mental health support (Animation) | UK Trauma Council | 2023 Download Primary Link
• Coping with scary and distressing memories (Animation) | UK Trauma Council | 2023 Download Primary Link
• What is trauma-focused CBT? (Animation) | UK Trauma Council | 2023 Download Primary Link
• What is post-traumatic stress disorder? (Animation) | UK Trauma Council | 2023 Download Primary Link

Recommended Reading

• Grey, N., Young, K., & Holmes, E. (2002). Cognitive restructuring within reliving: a treatment for peritraumatic emotional “hotspots” in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30, 37-56 Download Primary Link Archived Link
• Ehlers, A., Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345 (The canonical reference for the treatment of PTSD: Trauma-Focused Cognitive Behavioural Therapy [TF-CBT]. This model is suitable even for more complex PTSD, within a phased approach) Download Primary Link Archived Link
• Brewin, C. R., Gregory, J. D., Lipton, M., Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment. Psychological Review, 117(1), 210-232 Download Primary Link Archived Link
• Brewin, C. R., Dalgleish, T., Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103, 670-686 (Useful for understanding the neural basis of memory in PTSD) Download Primary Link Archived Link
• Schauer, M., Elbert, T. (2010). Dissociation following traumatic stress. Journal of Psychology, 218(2), 109-127 Download Primary Link Archived Link

Other papers

• Medford, N., Sierra, M., Baker, D., David, A. S. (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, 11, 92-100 Download Primary Link Archived Link
• Read, J., Hammersley, P., Rudegeair, T. (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment, 13, 101-110 Download Primary Link Archived Link
• Levin, R. J., & van Berlo, W. (2004). Sexual arousal and orgasm in subjects who experience forced or non-consensual sexual stimulation–a review.Journal of Clinical Forensic Medicine,11(2), 82-88. Download Primary Link Archived Link
• Chessell, Z. J., Brady, F., Akbar, S., Stevens, A., & Young, K. (2019). A protocol for managing dissociative symptoms in refugee populations. The Cognitive Behaviour Therapist, 12. Download Primary Link
• Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37(8), 715-740 Download Primary Link

Complex PTSD

• Terr, L. C. (1991). Childhood traumas: An outline and overview. American journal of psychiatry, 148(1), 10-20 Download Primary Link
• Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377-391 Download Primary Link
• Finalizing PTSD in DSM-5: Getting here from there and where to go next. Journal of Traumatic Stress, 26, 548-556 | Friedman, M. J. | 2013 Download Primary Link Archived Link
• ISTSS guidelines position paper on complex PTSD in adults | ISTSS | 2017 Download Archived Link

What Is Post-Traumatic Stress Disorder?

Symptoms of ptsd.

The DSM criteria for PTSD require that an individual has experienced a traumatic event and include symptoms in four categories:

• re-experiencing memories of the trauma
• heightened anxiety and hypervigilance
• avoidance of reminders of the trauma
• negative beliefs or feelings

People who develop complex PTSD have typically experienced prolonged and repeated trauma and may experience symptoms in addition to PTSD including:

• dissociative symptoms such as depersonalization or derealization
• difficulty managing emotions
• loss of the sense of self
• finding relationships very difficult

Incidence, Prevalence, and Predictors of PTSD

Depending upon the type of trauma experienced, approximately 10% to 30% of trauma survivors will develop PTSD (Santiago et al., 2013). Some of the strongest predictors of whether an individual will develop PTSD is how severe they perceived the trauma to be, and levels of social support post-trauma (Brewin, Andrews & Valentine, 2000).

Psychological Models and Theory of PTSD

One of the most influential models of PTSD is the cognitive model published by Anke Ehlers and David Clark in 2000. They propose that distress in PTSD is maintained by:

• A disturbance of autobiographical memory characterized by poor elaboration and contextualization, strong associative memory, and strong perceptual priming. (The ‘unprocessed’ qualities of trauma memories makes them particularly intrusive.)
• Excessively negative appraisals of the trauma and events surrounding it. (The thoughts and beliefs that survivors of trauma hold about themselves, others, and the world may be inaccurate or counterproductive.)
• Problematic behavioral and cognitive strategies. (The avoidance and safety behaviors which people with PTSD engage in can act to perpetuate distress in PTSD.)

Other theories of particular relevance to PTSD include:

• Emotional processing theory (Foa & Kozak, 1986) which proposes that emotions are information structures in memory (i.e., fear is associated with a ‘fear structure’). Changes in a structure require the integration of information that is incompatible with some elements of the fear structure.
• The dual-processing model of memory in PTSD (Brewin, Dalgleish, & Joseph, 1996) which helps to explain some of the important and unusual properties of memory in PTSD such as ‘nowness’ and sensory vividness.

Evidence-Based Psychological Approaches for Working with PTSD

A variety of different therapeutic approaches have demonstrated effectiveness in the treatment of PTSD. A common factor in all of these approaches is that they are trauma-focused: at least some of the work in therapy addresses what happened to the patient. Evidence-based treatments for PTSD include:

• cognitive behavioral therapy ( CBT ) / trauma-focused CBT
• cognitive processing therapy (CPT)
• eye movement desensitization and reprocessing ( EMDR )
• narrative exposure therapy ( NET )
• prolonged exposure therapy (PE)

Resources for Working with PTSD

Psychology Tools has an extensive library of therapy resources devoted to the effective treatment of PTSD. Many patients report finding the Psychology Tools for Overcoming PTSD Audio Collection helpful in teaching a set of skills that can help them to feel more stable and to approach subsequent phases of trauma treatment. There are also a range of information handouts, exercises, and worksheets for working with PTSD. Psychology Tools resources available for working therapeutically with PTSD may include:

• psychological models of post-traumatic stress disorder (PTSD)
• information handouts for post-traumatic stress disorder (PTSD)
• exercises for post-traumatic stress disorder (PTSD)
• CBT worksheets for post-traumatic stress disorder (PTSD)
• self-help programs for post-traumatic stress disorder (PTSD)
• Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology , 68 (5), 748–766.
• Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review , 103 (4), 670.
• Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy , 38 (4), 319–345.
• Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin , 99 (1), 20–35.
• Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S., Spiegel, D., Lewis-Fernandez, R., … & Fullerton, C. S. (2013). A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: Intentional and non-intentional traumatic events. PloS one , 8 (4), e59236. doi: 10.1371/journal.pone.0059236
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Work on the Body as a Pathway to Healing Trauma

Insight-based therapy on its own is often insufficient for healing trauma..

Posted September 4, 2023 | Reviewed by Davia Sills

• What Is Trauma?
• Find a therapist to heal from trauma
• The body and mind are intricately connected.
• There has recently been a renewed focus on bodywork to heal trauma.
• Somatic experiencing (SE) and yoga have received attention as body-based practices for healing trauma.

Great advancements have been made in research regarding how to treat trauma. In particular, a renewed focus has assessed how working on the body can offer benefits not gained by more traditional talk, reflection, or insight-based therapies. Moreover, the research suggests that patients in traditional talk therapies can greatly benefit from also introducing bodywork as an additional therapeutic modality.

For instance, somatic experiencing—commonly referred to as SE—is one such bodywork that is making headlines. This summer, The New York Times had a cover story in their magazine entitled, “Want to Fix Your Mind? Let Your Body Talk,” which offered an exhaustive overview of the philosophy behind SE, as well as anecdotal accounts from individuals who are undergoing such a practice.

Much of the theory behind SE is consistent with the work promoted by The Body Keeps the Score , a bestselling book on trauma that has spent over 140 weeks on The New York Times’s bestseller list. Its author has been in hot water—rightly so—for allegations of his harmful treatment of female co-workers, but the work presented in the book endures despite such revelations. The crux of the research suggests that the pathway to healing trauma goes beyond talk therapy—that individuals need to reconnect with their bodily and emotional systems in ways that enable them to integrate their sense of self.

Perhaps a more reputable source with less problematic behaviors is that of Nadine Burke Harris, who has been a pioneer in tracing the relationship between early childhood trauma and later negative health outcomes in adulthood. For a fascinating overview of adverse childhood experiences (ACEs) and their impact on later health outcomes, listen to her TED Talk.

Despite our cultural prominence of “logic” and the brain over all else—the brain (mind) and body are intricately connected, as is our emotional system. Trauma manifests both in the body and in the mind. One cannot be healed without the other, as anyone who has tried to work through their problems based exclusively by going over them in their head has likely experienced.

Another excellent scholarship on bodywork as a pathway to healing is Overcoming Trauma Through Yoga: Reclaiming Your Body —regular readers of my blog likely have seen other posts where I promote the ways in which mindfulness -based practices like yoga and meditation can play a significant role in enabling wellness and effective stress management . In the book, Emerson & Hopper (2011) write:

The cutting edge of trauma treatment today involves alternative and integrative intervention strategies that move beyond traditional verbal therapies… Many newer interventions focus on the development of resources and use a "bottom-up" approach that integrates the body into treatment. For instance, sensorimotor psychotherapy is a type of therapy that uses the body as an entryway to exploring a client’s resources and unprocessed traumatic memories. Newly emerging creating therapies—including application of art, dance, music, and theatre-based approaches to intervention—focus on the integration of the mind and body for healing. Similarly, the practice of yoga offers a platform for body-based intervention with trauma survivors. (p. 17-18)

Another prominent pioneer in trauma research, Judith Herman, has noted that “the guiding principle of recovery is restoring a sense of power and control to the survivor” (as quoted by Emerson & Hopper, 2011, p. 23). Body-based therapies, such as yoga, can facilitate a pathway of healing by allowing patients to explore and reconnect with their bodies safely.

The impact of trauma is both explicit and unconscious and has reverberations not only for the individual who has survived trauma but also on many people who interact with or cross paths with them. Everyone deserves the opportunity to live a whole and joyful life. Integrating body-based therapies into traditional insight-based talk therapies—or even trying them without traditional talk therapy—can go a long way as a pathway toward healing.

Copyright Azadeh Aalai 2023

Emerson, D., Hopper, E. (2011). Overcoming Trauma Through Yoga—Reclaiming Your Body. North Atlantic Books: Berkley, CA.

Azadeh Aalai, Ph.D., is an assistant professor of Psychology at Queensborough Community College in New York.

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FDA panel to consider MDMA for PTSD treatment

The Food and Drug Administration's panel of independent advisers will on June 4 deliberate whether they should recommend approval for the first MDMA-assisted therapy for post-traumatic stress disorder, Lykos Therapeutics said on Monday.

This would be the first FDA panel of outside experts to review a potential new PTSD treatment in 25 years.

PTSD is a disorder caused by very stressful events and can significantly disrupt patients’ lives.

Decades of studies has shown that psychoactive ingredients, whether derived from cannabis, LSD or magic mushrooms, have long captivated mental health researchers in their quest for treatments.

In support of its application, Lykos Therapeutics, formerly known as Multidisciplinary Association for Psychedelic Studies (MAPS), studied the party drug MDMA, more commonly called ecstacy or molly, in two late-stage studies.

More news on psychedelic research

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The drug is intended to be used in combination with psychological intervention, which includes psychotherapy, or talk therapy, and other supportive services provided by a qualified healthcare provider.

No psychedelic-based therapy has been approved yet in the U.S., but MAPS and companies such as Compass Pathways are testing such drugs to find cures for a range of mental health disorders.

US FDA panel to discuss first psychedelic-assisted PTSD treatment next month (May 6)

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Reporting by Pratik Jain in Bengaluru; Editing by Krishna Chandra Eluri

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Target to pull LGBTQ-themed items from some stores during Pride Month, Bloomberg News reports

Target is planning to cut LGBTQ-themed merchandise from some of its stores during Pride Month this June, Bloomberg News reported on Thursday, after a backlash hit sales of the retailer last year.