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Table 2 CBT exercises

From: A randomized controlled trial to improve psychological detachment from work and well-being among employees: a study protocol comparing online CBT-based and mindfulness interventions

Name of the exercise

Brief description of the exercise

CBT/MindfulnessMe (IQR)

On-site/RemoteMe (IQR)

Suitable/NotsuitableMe (IQR)

1. Fact or opinion

The activity involves defining facts and opinions as well facilitating the differentiation between them. This is a critical skill in CBT, as it helps participants understand that their thought processes are not facts about the world, but their opinions or assumptions. The activity is a useful starting point when one wants to challenge the validity of negative thoughts [57].

1.00 (0.75)

3.00 (0.75)

Me (IQR)

1.00 (0.75)

2. ABC belief monitoring

ABC belief monitoring, originally developed by Ellis [58], is a type of functional analysis and thus explores the links between stimuli and responses. During the exercise, participants explore the antecedents or activating events (A), beliefs (B) and consequences (C). The exercise helps participants identify thoughts or beliefs which occur in a particular situation and identify the consequences of holding those beliefs. It is one the key exercises as it introduces the cognitive model.

1.00 (0.00)

3.00 (0.75)

1.00 (0.00)

3. Rumination diary

The rumination diary, similarly to other kinds of diaries used in CBT (e.g., worry diary), encourages participants to record (repetitive) thoughts and images. Participants are asked to record the triggers for the rumination as well as accompanying emotions, their ruminative content and the consequences of ruminations. They are also encouraged to think about what stopped the rumination [59].

2.00 (0.00)

3.00 (0.00)

1.00 (0.75)

4. Thought record

This exercise is one of the essential exercises in CBT. During the exercise, participants are encouraged to identify negative automatic thoughts, deepen their understanding of the relationship between thoughts and emotions, examine the evidence for and against a selected negative automatic thought, challenge a negative automatic thought and generate more realistic alternatives to a negative automatic thought. As such, the exercise helps participants evaluate their negative automatic thoughts for accuracy and bias [57, 60].

1.00 (0.00)

3.00 (0.75)

1.00 (0.00)

5. Thought distortion monitoring record

This activity is an expanded version of the thought record exercise described above. It is administered to help participants identify negative automatic thoughts, notice associations between events and cognitions, help clients understand the links between thoughts, emotions and body sensations, and, most importantly, begin to identify cognitive distortions in their thinking (e.g., jumping to conclusions, “should” statements, …). It is designed to increase participants’ awareness of biases or distortions in their thinking [57, 61].

1.00 (0.75)

3.50 (1.00)

1.00 (0.00)

6. Decatastrophizing

The exercise is a cognitive restructuring technique, normally used to reduce or challenge catastrophic thinking (also known as magnification). Participants are first asked to identify the catastrophe that they are worried about and to rate how awful they believe the catastrophe would be. They are then encouraged to rationally think about how likely it is that the catastrophe would actually happen, how awful it would be if it did happen and, supposing the worst would happen, what would they do to cope. They are also encouraged to fill out what positive and reassuring things they want to say to themselves about the catastrophe now. The exercise promotes cognitive restructuring and the elaboration of balanced responses [62, 63].

1.00 (0.00)

3.00 (0.00)

1.00 (0.75)

7. Modifying rules and assumptions

The exercise can be used to explore participants’ assumptions (a stage of cognition between core beliefs and automatic thoughts), which can be dysfunctional. During the exercise, participants explore the origins, advantages and disadvantages of a rule or assumption. The participants are then encouraged to make adjustments and generate a more flexible alternative rule [64].

1.00 (0.00)

2.50 (1.00)

1.00 (0.75)

8. Belief driven formulation

This exercise is a core belief-driven cognitive behavioral case conceptualization. Such formulations can help to illustrate the critical role of underlying beliefs (i.e., how do their core beliefs influence their thoughts, feelings and behaviors in specific situations). As a result, participants gain an insight into how beliefs can bias their perception of situations, which, in turn, motivates and informs schema change (e.g., [65, 66]).

1.00 (0.00)

3.00 (0.75)

1.00 (0.00)

9. Positive belief record

This exercise is generally used as a schema change technique. During the exercise, participants identify unhelpful core beliefs and formulate a more positive alternative. They are then asked to write down specific examples which support the new belief. This helps individuals to reduce the impact of negative core beliefs while strengthening positive ones [60, 67].

1.00 (0.75)

2.50 (1.00)

1.00 (0.75)

10. Alternative action formulation

This exercise represents a specific version of functional analysis. Participants are encouraged to describe a particular situation and then write down their thoughts, emotions, and behaviors in that situation. In the next step, they are asked to think about alternative responses to the situation: what else could they think in response to the situation, what would they feel if they had these thoughts instead of the actual ones, and what would their behavior be in this case. The exercise helps participants develop more functional responses in terms of thoughts, emotions and behaviors and choose more appropriate coping strategies (adapted from [65, 66, 68]).

1.00 (0.00)

3.00 (0.00)

1.00 (0.00)