CBT Worksheet Evidence, Safety & Sources
How the free CBT worksheets are informed by established approaches, when to seek guidance and how to use the resources responsibly.
If you are looking for downloads rather than clinical references, visit the free CBT self-help resource library or go straight to the free CBT worksheets for panic attacks.
What these materials are for
The library supports understanding, reflection and agreed between-session practice. It covers the treatment areas already offered by Calm Breathing Therapies. A worksheet is not an assessment, diagnosis or complete treatment programme. The resources themselves have not been evaluated in clinical trials; evidence for a treatment model does not establish that a standalone worksheet will have the same outcome.
Choosing the right approach
The collections use different maintaining mechanisms and interventions. Worry work considers uncertainty; panic work explores catastrophic meanings of sensations; social anxiety work examines self-focused attention and safety behaviours. OCD resources support guided exposure and response prevention, including mental rituals. Depression resources include behavioural activation. Trauma worksheets are supportive tools for guided treatment and do not provide instructions for reliving or processing traumatic memories alone.
References appear beside the relevant resource and below. NICE recommendations inform treatment selection and intensity; the Roth and Pilling competence framework informs collaborative assessment, formulation, intervention and review. Neither NICE nor BABCP has reviewed or endorsed these materials. They should be selected and adapted by a competent therapist when used in clinical work.
Age, safety and individual circumstances
The practice works with people aged 16 and over. Many source guidelines concern adults: they should not simply be applied unchanged to 16–17-year-olds. A suitably trained practitioner needs to consider development, consent, safeguarding, family involvement where appropriate and condition-specific guidance for young people.
Keep appropriate medical assessment, prescribed treatment, necessary hygiene, accessibility aids and real safety precautions in place. Behavioural experiments are not tests of dangerous situations. Applied tension is a fainting-related technique that needs appropriate healthcare advice; it is different from relaxation. Actual danger, abuse or unsafe living conditions need practical protection and support.
Originality and use
The explanations, fictional examples and layouts were developed for this library. Established treatment ideas are attributed, but no third-party worksheet or branding has been reproduced in these downloads. You may download, print and use unchanged copies for your own learning or with clients, keeping the source and copyright footer. Please link to the library rather than selling, rebranding or redistributing edited versions.
Reading and completing the resources
Each worksheet has an editable PDF with short fictional examples and a blank PDF for A4 printing. Replace or delete the examples in the editable fields. Save a private copy in a suitable PDF reader before entering personal information. PDF viewer support varies. HTML instructions and examples are also available on every topic page; use those prompts in your own notes if that is easier. The PDFs are not certified PDF/UA documents. The website does not upload or collect completed worksheet answers.
Sources by topic
Everyday CBT tools
General cognitive and behavioural principles; collaborative formulation and practice informed by the Roth and Pilling CBT competence framework and Bennett-Levy and colleagues' behavioural experiment approach.
- Roth, A. D., & Pilling, S. (2007). The competences required to deliver effective CBT for people with depression and anxiety disorders. UCL competence framework.
- Bennett-Levy, J., et al. (Eds.). (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.
- NHS Every Mind Matters. Thought record: self-help CBT technique.
- NHS. Cognitive behavioural therapy (CBT).
- NHS Inform. Grounding exercises.
- Padesky, C. A., & Mooney, K. A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14.
Worry & anxiety
Primary framework: the intolerance-of-uncertainty model of GAD (Dugas and colleagues), including beliefs about worry and problem orientation. Worry postponement is presented separately as an optional CBT self-management adjunct.
- NICE (2011, updated 2020). Generalised anxiety disorder and panic disorder in adults: management (CG113).
- Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215-226.
- Dugas, M. J., et al. (2022). Behavioral experiments for intolerance of uncertainty: A randomized clinical trial for adults with generalized anxiety disorder. Behavior Therapy, 53(6), 1147-1160.
- NHS Every Mind Matters. Tackling your worries. Accessed 24 October 2026.
- Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436. https://doi.org/10.1016/j.cbpra.2018.07.007
Panic attacks
Clark’s cognitive model of panic: catastrophic interpretations of bodily sensations, increased threat and self-monitoring, with avoidance and safety behaviours that can restrict corrective learning.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- NICE (2011, updated 2020). Generalised anxiety disorder and panic disorder in adults: management (CG113).
- Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34(5-6), 453-458.
Health anxiety
Warwick and Salkovskis’s cognitive-behavioural model of health anxiety: threatening interpretations of health information, selective attention and repeated safety-seeking or avoidance. Medical assessment and necessary care remain distinct from therapy experiments.
- Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105-117.
- NHS. Health anxiety. Accessed 24 October 2026.
Social anxiety
Clark and Wells' cognitive model of social anxiety (1995), as recommended among the disorder-specific approaches in NICE CG159. Exercises focus on negative predictions, self-focused attention, safety behaviours, anticipatory and post-event processing.
- NICE (2013). Social anxiety disorder: recognition, assessment and treatment (CG159).
- Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). Guilford Press.
- Warnock-Parkes et al. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and Behavioral Practice, 24, 245-255.
- Leigh, E., Chiu, K., & Clark, D. M. (2021). Self-focused attention and safety behaviours maintain social anxiety in adolescents: An experimental study. PLOS ONE.
Phobias
Exposure-based CBT for specific phobias, informed by inhibitory learning principles (Craske et al., 2014). Blood-injection-injury fears require separate consideration of vasovagal fainting and appropriate applied tension.
- Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
- Guy’s and St Thomas’ NHS Foundation Trust. (2024). Needle phobia and overcoming your fear.
- NHS. Phobias. Accessed 24 October 2026.
OCD
Cognitive-behavioural understanding of OCD informed by Salkovskis (1985), combined with exposure and response prevention as recommended in NICE CG31. The focus is on meanings, responsibility, uncertainty, rituals, avoidance and how short-term relief can maintain the cycle.
- NICE (2005). Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31).
- Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571-583.
- NHS. Treatment: Obsessive compulsive disorder (OCD).
Depression & low mood
Behavioural activation and cognitive-behavioural approaches to depression, informed by Martell, Dimidjian and Herman-Dunn, and NICE NG222. Activity, avoidance, rumination and personal meaning guide practice; thinking exercises are used when they serve the person's formulation rather than as a universal requirement.
- NICE (2022). Depression in adults: treatment and management (NG222).
- Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2022). Behavioral activation for depression: A clinician’s guide (2nd ed.). Guilford Press.
- Dimidjian et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658-670.
- NICE (2019). Depression in children and young people: identification and management (NG134).
Trauma & PTSD
Supportive exercises consistent with Ehlers and Clark’s (2000) cognitive model of PTSD and NICE NG116. They cover selected between-session tasks, not the full trauma-focused CBT treatment protocol.
- Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345.
- NICE. (2018). Post-traumatic stress disorder (NG116).
- Oxford Centre for Anxiety Disorders and Trauma. PTSD therapy materials: clinical guidance on trigger discrimination and rebuilding life.
- Thew, G. R., Wild, J., & Ehlers, A. (2023). Early intervention in post-traumatic stress disorder without exposure to trauma memories using internet-delivered cognitive therapy: A pilot case series. British Journal of Clinical Psychology, 62(2), 459-470.
Stress & overwhelm
Individualised CBT formulation, behavioural experiments and practical problem solving. Stress is treated as a response to demands rather than a separate diagnosis; HSE guidance informs consideration of real workplace pressures.
- NHS. Every Mind Matters: Stress.
- NHS. Every Mind Matters: Problem solving.
- Health and Safety Executive. Work-related stress and how to manage it: Causes of stress at work.
- Health and Safety Executive. Management Standards: Control.
- Health and Safety Executive. What are the Management Standards? Accessed 24 October 2026.
- Bennett-Levy, J., et al. (Eds.). (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford University Press.
Maintenance and feedback
The model diagrams were revised in version 4.0 on 27 October 2026. Other resources retain their version 3.0 content. The PDFs place usable templates first, with guidance afterwards; the website previews are rendered from those exact documents. Clinical references and website links should be reviewed at least annually and sooner if guidance changes or a problem is reported. Contact Calm Breathing Therapies to flag an error or request a different format. Please keep any initial message free of detailed clinical information.