cbt case study template

In this article, I use a fictitious case study to help to describe and demonstrate how CBT Therapy can be used to reduce depression and anxiety.

CBT Therapy – A Simple Case Study

Carol is a fictional character used to explain the ways in which I may work. She presented with anxiety and feelings of depression, and hopelessness. I helped her challenge her thinking and fear.

My Response

I can hear your emotional distress and the presentation seems impossible for you at the moment. Let’s see if we can break things down and work on a little at a time, to hopefully make things feel more positive and manageable for you.

Using the ABC model of CBT.

This is based on the premise that an Activating event (A)

• In your case, it is your presentation at work.

Leads to emotional and behavioural Consequences (C)

• Which you could avoid the presentation/ phone in sick, and others will not see how well you know your stuff. This is discounting the positive.

The consequences are seen as arising from your individual belief (B)

• You described self-doubt. It makes you feel nervous and afraid, you think you might feel humiliated in front of others, and they might think you are an idiot.

From past experience, you have shared some unpleasant physical symptoms: your heart racing, feeling tongue-tied, sweating.

• These inferences could be seen as jumping to conclusions, every situation is different, and you are also describing emotional reasoning. If you do your presentation, symptoms will happen because it did last time.

You have evaluated that you cannot do it, others will judge you, and others can do better. You are magnifying the negatives, discounting the positives.

Fact – You have explained that you know your subject thoroughly and the management seem to have faith in you as they have asked you to do this. Let’s focus on this and aim to achieve your presentation.

To make this more manageable, we break things down into small tasks. We work on these smaller tasks in our sessions and as homework.

• Practice your presentation in front of others, trust the feedback, work on this and practice as necessary.
• While you concentrate on your knowledge, projection, confidence, delivery, body language and professionalism, record as necessary and we can discuss.
• Tap into the emotions and physical sensations you are feeling; we could look at grading them compared to the last time you spoke publicly and each time you practiced.
• We can practice relaxation strategies and positive thinking to help with physical symptoms and nervousness. You can continue to practice alone when in times of need.
• We will look at your common cognitive errors, look for evidence of them and disregard those that do not fit.
• We can check into your self-esteem and confidence levels and record results as we go along. Assessing progress and exploring and working on sticking points.
• I would like you to list all of the facts why you can complete your presentation, and we will explore the results.

I will support you through this Carol. I have faith in this process and in you, and evidence says you can do it. We can make a plan for the sessions/homework for the time we have before your presentation.

CBT Techniques and behavioural techniques used:  The ABC Model

• Identifying faulty thoughts and feelings
• Identifying faulty thinking and looking at how it affects feelings and behaviour
• Challenging facts and focusing on positive
• Setting homework and goal and revisiting to look at progress
• Relaxation techniques
• Looking for evidence and Correcting distorted thinking
• Focusing on the client’s thoughts and feelings and underlying and irrational beliefs
• Looking at self-defeating beliefs and unrealistic beliefs
• Distinguishing between inferences and evaluations
• Teaching the client understanding and CBT method of change
• Triadic structure of CBT
• To help the client overcome blocks to change and independence
• To encourage positive thinking and change
• Looking at Schemata- underlying beliefs
• Applying distancing and decentring
• Using graded task performance
• Explaining and setting tasks/homework if the client agrees, and checking understanding.
• Explain and Test client commitment to tasks.
• Demonstrating how Carol might benefit from the sessions
• Reality testing
• Work on changing unhelpful work patterns
• Highlighting gaps between fears, experience and reality
• Review blocks and failure
• Empowering client to successfully take control
• Encouraging self-monitoring

So to summarise, for CBT therapy we work in manageable chunks. We identify the negatives and work on the fears you feel, finding strategies for you to cope and be calmer. We focus on you feeling confident and well equipped to deliver your presentation as we know you can.

About the Author:

I have many years of experience counselling individuals, young people and couples, supporting them through their struggles. I hope this article is of some help to you.

Please do get in touch through my “ Contact Me ” page to discuss your interest in CBT Therapy , or if you prefer, you are welcome to give me a call for a free introductory consultation.

Yours sincerely

BACP Accredited Counsellor Manchester

Thought Records in CBT: 7 Examples and Templates

The good news is that by helping people view experiences differently and changing how they think, we can alter how they react. This shift in perception can offer clients the opportunity to gain control and handle situations more effectively.

But first, it is vital to capture negative and unhelpful thinking accurately. In this article, we explore how to do that using Thought Records and introduce examples, tips, and techniques that can help.

Before you continue, we thought you might like to download these three Positive CBT Exercises for free . These science-based exercises will provide you with detailed insights into Positive CBT and give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is a thought record and does it work, how are thought records used in cbt, real-life example, 3 tips for thought catching, thought records for anxiety and depression, 6 template worksheets.

• Aditional PositivePsychology.com Tools

A Take-Home Message

Unlike some forms of psychoanalysis, Cognitive-Behavioral Therapy does not focus on the past. Instead, while acknowledging the importance of earlier experiences, CBT recognizes that our current  thinking shapes how events are perceived (Wilding, 2015).

Perceptions are often more crucial than actual events.

CBT addresses our current irrational, illogical, and incorrect thinking. It offers a well-researched and widely validated tool for treating anxiety, stress, and many other mental health issues (Widnall, Price, Trompetter, & Dunn, 2019).

The strength of CBT comes from it being both short term and solution focused. People also get the commonsense approach of CBT. This is essential as, according to the American Psychological Association (2017), CBT “emphasizes helping individuals learn to be their own therapists.”

While CBT can be understood by the untrained, complex and persistent problems typically require a professional’s support to make negative automatic thoughts visible and learn better ways of coping.

How do we recognize negative thinking?

Negative (and illogical and incorrect) thinking is likely to stop us from reaching short-term and life goals.

CBT does not suggest we try to block such thoughts, but rather identify them before considering their accuracy and effectiveness. Unhelpful ones can be reevaluated and replaced with thoughts that are rational and open minded.

Negative thoughts can take many forms yet often arise from specific types of thinking, for example (Wilding, 2015):

• You believe you know what others are thinking
• You expect disaster
• You tend to personalize general comments
• You generalize specific incidents
• You blame others for your thoughts and actions

As opposed to positive or even neutral thinking, such thought patterns lead us to interpret events negatively; in the long term, they can lead to depression and anxiety.

Such cognitive distortions are often automatic; they pop into our heads, unannounced and unwanted, and linger. They profoundly affect how we feel, with thoughts such as “I can’t cope” or “I feel awful,” and how we behave by avoiding opportunities and situations.

How do we capture negative thinking?

It can be useful to check in and ask ourselves if our thoughts are positive and constructive or negative and damaging throughout the day.

A simple example is given below (modified from Wilding, 2015):

Does it work?

Once identified, Thought Records  (TRs) provide a practical way to capture unhelpful thinking for functional analysis and review (Beck, 2011).

Indeed, TRs are potent tools for evaluating automatic thoughts at times of distress and remain a popular choice for therapists.

Research has confirmed that TRs are highly successful at effecting belief change and are recommended for CBT practitioners working with a client (McManus, Van Doorn, & Yiend, 2012).

Completing a thought record

The more often clients practice completing TRs, the greater their awareness of negative or dysfunctional thinking.

A good time to complete a TR is shortly after noticing a change in how we feel.

Begin by asking the client to consider the following questions regarding the thinking behind a recent emotional upset, difficult situation, or concern (modified from Beck, 2011):

• Is there any evidence to support this idea?
• What is the evidence for and against it?
• Are there other explanations or viewpoints?
• What is the worst that could happen, and how would I cope?
• What is the best that could happen?
• What outcome is most realistic?
• What is the result of such automatic thinking?

The following questions encourage us to start considering how we can challenge our thinking:

• What would happen if I changed my thinking?
• What would I tell a close friend if they were in this situation?
• What should I do next?

While automatic thoughts may have some supporting evidence, that evidence is typically inadequate and inaccurate and ignores evidence to the contrary.

When ready, ask your client to complete a Thought Record Worksheet , describing:

• A situation that led to unpleasant feelings (e.g., being turned down for a job)
• The negative thoughts that arose (I’m useless)
• The emotions running through your mind (I’m ashamed)
• Your response (blame interviewer, stop applying for jobs)
• A better, more adaptive response (ask for feedback from the interviewer)

Thought challenging

Our thinking style is influenced by inherited personality traits, upbringing, and meaningful events and interprets what we experience. Two people can have precisely the same encounter yet respond very differently.

CBT is a practical way to identify and challenge unhelpful thought patterns.

Thought challenging begins with focusing on the most powerful, negative thoughts captured in the TR Worksheet.

Ask your client to complete the first few columns in the Thought Record Worksheet, describing the situation in question. Here again is an example (modified from Wilding, 2015).

Is there anything you could do differently in the future? For example, rather than jumping to conclusions, challenge your thinking with questions.

With practice, such a change in thinking can become second nature. And the act of challenging thoughts will increasingly become internalized, with no need to write them down.

You don’t need to remove all negative thinking; instead, you are trying to find a more balanced outlook.

Download 3 Free Positive CBT Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to find new pathways to reduce suffering and more effectively cope with life stressors.

Download 3 Free Positive CBT Tools Pack (PDF)

By filling out your name and email address below.

Sally is with her therapist and has already been asked to consider a set of questions similar to those above to evaluate her thought “Bob won’t want to go out with me” (modified from Beck, 2011).

Taking one column at a time, she completes a TR, including percentage scores to indicate likelihood or intensity:

Sally was then asked to consider what cognitive distortion category her thinking might fall into (in this case, it’s fortune telling or mind reading ). She assumed that she knew what Bob was thinking, but she didn’t.

Next, Sally was asked to consider the following set of questions, write down her thoughts, and rate the likelihood (%) of each one:

• What is the evidence that the automatic thought is true?
• Is there a different explanation?
• What’s the worst (and best) that could happen?
• What’s the most likely outcome?
• What’s the effect of believing this automatic thought?
• How could changing my thinking help?
• What should I do about it?
• What would you say to a friend?

Adaptive responses

• I don’t really know if he wants to go or not (90%).
• He is friendly to me in class (90%).
• The worst that will happen is that he will say no, and I’ll feel bad for a while, but I could talk to my friend Alison about it (90%).
• The best is that he will say yes (100%).
• The most realistic outcome is that he will say he’s busy but still be friendly to me (80%).
• If I keep assuming he doesn’t want to go with me, I won’t ask him at all (100%).
• I should just go up and ask him (50%).
• What’s the big deal anyway (75%)?

Lastly, Sally was asked to rate how much she now  believes the automatic thought, how intense her sadness is, and what she would do next.

• Automatic thought – 50%
• Sad (emotion) – 50%
• I’ll ask him

Completing a TR will not remove all negative emotions, but even reducing their impact by a small amount makes the effort worthwhile.

1. Complete the TR in stages

Most clients find that TRs are incredibly useful for organizing their thoughts and considering their responses.

However, if less daunting or confusing, ask the client to complete the first four columns (date and time, situation, automatic thoughts, and emotions) in one session, and then the last two columns (adaptive response, outcome) in the next session (Beck, 2011).

2. TR alternative

TRs aren’t the only way to capture thoughts. The following questions can be used to replace the worksheet and more easily guide the client as they challenge a thought (modified from Beck, 2011):

• What is the situation? My friend didn’t call .
• What am I thinking? She doesn’t like me anymore.
• Why do I think this is true? She said she would call .
• Why might this not be true? She has forgotten to call in the past, and her mother is not well .
• What’s another way to look at this? Something important came up .
• What’s the worst outcome? She stops being my friend, and I focus on my other friends .
• What’s the best outcome? She will call and say she is sorry, but something came up .
• What will probably happen? She will call and tell me she lost her phone .
• What will happen if I keep reacting in this way? I will keep getting upset and push friends away .
• What could happen if I changed my thinking? I could feel better and check if she is okay .
• What would I tell a friend if this happened to them? Give the person extra time to call, or call to see if everything is okay .

3. Positive and negative event TRs

We don’t have to limit our focus to negative TRs; it can be useful to explore positive ones too (Wilding, 2015):

Choose a recent event and complete a TR that also includes:

• Positive thoughts – I’m excited about my new job .
• Neutral thoughts – What am I going to have for dinner ?
• Evaluative thoughts – I wonder where I will sit in my new job ?
• Rational thoughts – If it’s not the right job, I can always take another .
• Action-oriented thoughts – I’m determined to be good in my new job; if I need to do some extra hours to catch up, then that’s okay .

It’s useful to understand multiple categories of thoughts. It is then easier to spot the negative ones; for example, I will be useless in the job, and they only gave it to me because no one else showed up .

Negative thoughts are the ones that will leave you feeling upset, unhappy, and anxious.

3 Steps of thought journaling using CBT – The Lukin Center

Reviewing our TRs is a vital exercise for recognizing repeating negative (or unhelpful) behavioral patterns.

We may spot the signs of anxiety – difficulty focusing and sleeping, feeling on edge – as we review our thoughts and responses.

Perhaps rather than addressing an issue, we reduce the unwanted symptoms through avoidance. We may decline invitations to social events or refuse to apply for more senior positions at work.

While such coping mechanisms may stop us from feeling bad, they do not solve underlying problems (Wilding, 2015).

As we assess our thoughts, it can be worth asking if this will make me feel better  or get better.  If it is the former, it can be worth seeking other ways of addressing feelings of anxiety, such as relaxation  or working on our coping techniques.

Depression can leave us exhausted. Constant tiredness and staying in bed can all be signals to watch out for when reviewing TRs.

We may misguidedly think that additional rest will mean we are more ready for the world from which we are hiding. So, we avoid the effort of doing things. We call in sick, tell friends we can’t make social events, and miss the office party.

And yet, this behavior reinforces our negative feelings. If we don’t show up, we start to believe that no one notices or cares that we are absent. We are strengthening the negative.

Wilding (2015) describes this as the all-too-much error and suggests that the answer can come from adopting a do-the-opposite approach.

By first being aware of these negative thoughts while reviewing TRs, behavior can be turned on its head. Going into work and accepting the invitation can build mastery over emotions and an all-important sense of control.

Thought Record Worksheet

This Automatic Thought Record Worksheet provides an excellent way to capture faulty thinking and begin the process of cognitive restructuring .

‘Mood first’ thought record

The following variation on the TR theme provides a simple way to record feelings , situations , and automatic thoughts  in one place.

If there are multiple, automatic thoughts for the same situation, circle the strongest one (for example, I can’t take on new responsibilities ). Focus on the thoughts and feelings that upset you the most and give them a score (fearful 60% and irritated 40%).

The thought that scores the highest is the causal thought – the base thought that caused the emotions – and should be addressed first.

Assess cognitive distortions

Review the TRs and complete the Exceptions to the Problem Questionnaire to understand how each one could be responded to differently. What happened when things were better?

Finding Discrepancies

Use the Finding Discrepancies Worksheet to challenge negative thoughts.

Understanding the impact of continuing with existing behavior is extremely valuable. What happens if I continue as I am versus taking a new, healthier approach?

Cognitive Restructuring Worksheet

Use Socratic questioning in the Cognitive Restructuring Worksheet  to challenge irrational or illogical thinking. For example, ask yourself:

• Could I be misinterpreting the facts?
• How likely is this scenario?
• Could others have different perspectives?

Once complete, clients can determine whether they are misinterpreting facts or repeating a habit.

Facts or opinions

We often mistake subjective opinions for facts, leading to cognitive distortions about ourselves.

Use the Facts or Opinions Worksheet to practice how to differentiate between opinion and fact.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

Additional PositivePsychology.com Tools

PositivePsychology.com is a great source of information and help for Positive CBT .

The Positive Psychology Toolkit©  provides various worksheets and exercises designed to help individuals conquer negative thinking.

If you’re looking for more science-based ways to help others through CBT, this collection contains 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.

Cognitive-Behavioral Therapy provides a practical way to identify and challenge illogical and incorrect thought patterns.

To address a person’s unhelpful and often untrue beliefs, we must first capture their thoughts accurately and in sufficient detail. Thought Records are an invaluable and proven aid in capturing automatic thinking that can plague us and appear believable, despite being unreliable (McManus et al., 2012).

Paying attention to what is running through our minds – thoughts and pictures – when feelings and situations change can become a positive habit, helped by writing them down.

Capturing the situation, thought, and emotion to check its accuracy begins the process of changing the way we think.

Is there a more helpful way to think about myself and what has happened ? Most likely, yes .

Use Thought Records to collect data about your clients’ specific thoughts, emotions, and behaviors, and plan a strategy for overcoming their difficulties. Include problem solving and changes to thinking and behavior to help them build a better life.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond . Guilford Press.
• McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of Behavior Therapy and Experimental Psychiatry , 43 (1), 540–547.
• American Psychological Association (2017). What is cognitive behavioral therapy? Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder . Retrieved November 12, 2020, from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
• Widnall, E., Price, A., Trompetter, H., & Dunn, B. D. (2019). Routine cognitive behavioural therapy for anxiety and depression is more effective at repairing symptoms of psychopathology than enhancing wellbeing. Cognitive Therapy and Research , 44 , 28–39.
• Wilding, C. (2015). Cognitive behavioural therapy: Techniques to improve your life . Quercus.

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What our readers think.

Thank you for all the information

What happened? I was not able to download the PDF of worksheets from your newsletter. Indicated the email address had already been used. Of course it has!! I get your newsletter!!!!

Thanks for reaching out – we are sorry that you are experiencing this! If you have still not received the worksheets, please email our customer support team at [email protected] , and they will help you immediately!

Kind regards, -Caroline | Community Manager

Thank you! The article was very insightful. The process to challenge the negative thinking so beneficial. I intend to read it again.

It was very useful.I feel use of CBT will certainly help a person to think in different ways whichvwill help them to be at peace.Thank you foe providing examples to understand the process of CBT. How can we effectively use this technique to treat adults with mobile or TV addiction.

Hi Vatsala,

Glad you found the post useful. That’s a tricky question. Research on mobile and TV addiction is still in the early stages, so I’m not sure how much work is out there linking the practice of thought records to treating these addictions. You may find it helpful to do a search for CBT-IA (internet addiction), which will cover different CBT techniques that apply to internet usage (and mobile phones by extension). You’ll also find a review on treatments for television addiction here .

I hope this helps a little!

– Nicole | Community Manager

Thank you. It’s very practical skills.

I enjoy reading this article. Very insightful.

thanks so much for those examples. very easy way to understand CBT concepts.

Thank you a whole lot for reminding me of this valuable thought correction process. Have a great day and year.

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A Counselling Case Study Using CBT

Jocelyn works as a Human Resources Manager for a large international organisation. She is becoming more and more stressed at work as the company is constantly changing and evolving. It is a requirement of her job that she keeps up with this change by implementing new strategies as well as ensuring focus is kept on her main role of headhunting new employees.

She finds that she is working twelve-hour days, six days a week and doesn’t have time for her friends and family. She has started yelling at staff members when they ask her questions and when making small mistakes in their work. Concerned about her stress levels, Jocelyn decided to attend a counselling session.

Below is an extract from Jocelyn’s first session with her counsellor:

Transcript from counselling session

Counsellor: So Jocelyn, let’s spend a few minutes talking about the connection between your thoughts and your emotions. Can you think of some times this week when you were frustrated with work? Jocelyn : Yes, definitely. It was on Friday and I had just implemented a new policy for staff members. I had imagined that I would get a lot of phone calls about it because I always do but I ended up snapping at people over the phone. Counsellor : And how were you feeling at that time? Jocelyn : I felt quite stressed and also annoyed at other staff members because they didn’t understand the policy. Counsellor : And what was going through your mind? Jocelyn : I guess I was thinking that no-one appreciates what I do. Counsellor : Okay. You just identified what we call an automatic thought. Everyone has them. They are thoughts that immediately pop to mind without any effort on your part. Most of the time the thought occurs so quickly you don’t notice it but it has an impact on your emotions. It’s usually the emotion that you notice, rather than the thought. Often these automatic thoughts are distorted in some way but we usually don’t stop to question the validity of the thought. But today, that’s what we are going to do?

The counsellor proceeds to work through the cognitive behaviour process with Jocelyn as follow:

Step 1 – Identify the automatic thought

Together, the counsellor and Jocelyn identified Jocelyn’s automatic thought as: “No-one appreciates what I do”.

Step 2 – Question the validity of the automatic thought

To question the validity of Jocelyn’s automatic thought, the counsellor engages in the following dialogue:

Counsellor : Tell me Jocelyn, what is the effect of believing that ‘no-one appreciates you?’ Jocelyn : Well, it infuriates me! I feel so undervalued and it puts me in such a foul mood. Counsellor : Okay, now I’d just like you to think for a moment what could be the effect if you changed that way of thinking Jocelyn: You mean, if I didn’t think that ‘no-one appreciates me’? Counsellor : Yes. Jocelyn : I guess I’d be a lot happier in my job. Ha, ha, I’d probably be nicer to be around. I’d be less snappy, more patient.

Step 3 – Challenge core beliefs

To challenge Jocelyn’s core belief, the counsellor engages in the following dialogue:

Counsellor : Jocelyn, I’d like you to read through this list of common false beliefs and tell me if you relate to any of them (hands Jocelyn the list of common false beliefs). Jocelyn : (Reads list)Ah, yes,I can see how I relate to number four, ‘that it’s necessary to be competent and successful in all those things which are attempted’.That’s so true for me. Counsellor : The reason these are called “false beliefs” is because they are extreme ways of perceiving the world. They are black or white and ignore the shades of grey in between.

Applications of CBT

Cognitive approaches have been applied as means of treatment across a variety of presenting concerns and psychological conditions. Cognitive approaches emphasise the role of thought in the development and maintenance of unhelpful or distressing patterns of emotion or behaviour.

Beck originally applied his cognitive approach to the treatment of depression. Cognitive therapy has also been successfully used to treat such conditions as anxiety disorders, obsessive disorders, substance abuse, post-traumatic stress, eating disorders, dissociative identity disorder, chronic pain and many other clinical conditions. In addition, it has been widely utilised to assist clients in enhancing their coping skills and moderating extremes in unhelpful thinking.

• March 18, 2010
• Case Study , CBT , Counselling , Workplace
• Case Studies , Counselling Therapies , Workplace Issues

Comments: 11

I recently had a call (lifeline) from a young person with similar issues as Jocelyn so it was interresting to me to see that I was on the right track helping my client to change her thinking.

I am employed as a counselling psychologist in the dept. of professional studies for graduate students, it’s the way i had been challenging irrational beliefs students hold about themselves, & CBT helps a lot in improving their academic achievement, & helps my counselling to gain ground successfully.

it was a good case study helped a lot I as a student studying about case study on CBT patients !! thanks a lot

Thank you very much. it helped me as I am a student of basic counselling course.

I think the way the process is explained is very helpful.

It’s a very good article.Therapist explicitly challenged the automatic thought and could elicit it very well. CBT is more realistic and genuine. Great case study. Expect more such case details. Thanks.

I concur many students don’t fail exams because they don’t work hard but lack of confidence and negative self talk like I can never pass cbt is powerful in replacing the negative self talk

This type of case study is useful to know about the basic job awareness and what kind of stress the employee has. Mainly useful to know about the lot of information about counseling knowledge.

I am preparing for my internship in counseling and looking for case studies. I found this case study helpful and useful in how to utilize the CBT techniques when working with my potential clients. Thanks

what psychological theory would best help understand the client’s problems and how therapy from that theoretical standpoint will help them?

Cognitive Theory Behaviorism – Operant Conditioning Behaviorism – Classic Conditioning Psychoanalytic Theory Object Relations/Attachment Theory Existential Theory Humanistic Theory

As a psychology student this case study helped me alot in understanding the core values of CBT as well as how important of a role it is in counseling. Thank you!

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A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder and a Specific Phobia, Case Study

Contributions: AP and GT designed the protocol, administer the CBT therapy sessions, analyzed and interpreted the data, and wrote the paper.

George, a 23-year-old Greek student, was referred by a psychiatrist for treatment to a University Counseling Centre in Athens. He was diagnosed with social anxiety disorder and specific phobia situational type. He was complaining of panic attacks and severe symptoms of anxiety. These symptoms were triggered when in certain social situations and also when travelling by plane, driving a car and visiting tall buildings or high places. His symptoms lead him to avoid finding himself in such situations, to the point that it had affected his daily life. George was diagnosed with social anxiety disorder and with specific phobia, situational type (in this case acrophobia) and was given 20 individual sessions of cognitivebehavior therapy. Following therapy, and follow-up occurring one month post treatment, George no longer met the criteria for social phobia and symptoms leading to acrophobia were reduced. He demonstrated improvements in many areas including driving a car in and out of Athens and visiting tall buildings.

Introduction

Social anxiety disorder (SAD), also known as social phobia, is one of the most common anxiety disorders. Social phobia can be described as an anxiety disorder characterized by strong, persisting fear and avoidance of social situations. 1 , 2 According to DSMIV, 3 the person experiences a significant fear of showing embarrassing reactions in a social situation, of being evaluated negatively by people they are not familiar with and a desire to avoid finding themselves in the situations they fear. 4 , 5 Furthermore people with generalized social phobia have great distress in a wide range of social situations. 6 The lack of clear definition of social phobia has been reported by clinicians and researchers because features of social phobia overlap with those of other anxiety disorders such as specific panic disorder, agoraphobia and shyness. 7

According to ICD-10, 8 phobic anxiety disorders is a group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient’s concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation.

Prevalence of social phobia varies from 0-20%, depending on differences in the classification criteria, culture 9 , 10 and gender. 11-13 The onset of the disorder is considered to take place between the middle and late teens. 14 The NICE guidelines for social anxiety disorder, describe it as one of the most common of the anxiety disorders. Estimates of lifetime prevalence vary but according to a US study, 12% of adults in the US will have social anxiety disorder at some point in their lives, compared with estimates of around 6% for generalized anxiety disorder (GAD), 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-use disorder (17%), GAD (5%), panic disorder (6%), and PTSD (3%). 15

Social phobia is also developed and maintained by complex physiological, cognitive, and behavioral mechanisms. Biological causes of social anxiety/phobia have been reported by some researchers while others look on behavioral inhibition 16 and the effects of personality traits such as neuroticism and introversion 17 as the mediators between genetic factors and social phobia.

Apart from the biological factor, the role of cognition in the acquisition and maintenance of social anxiety/phobia is very important. The main cognitive factor is the fear of negative evaluation. 18 Beck, Emery, and Greenberg 19 associated the possibility of negative evaluation by others with beliefs of general social inadequacy, concerns about the visibility of anxiety, and preoccupation with performance or arousal. 20

Specific phobia situational type, is described as a persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object or situation such as public transportation, tunnels, bridges, elevators, flying, driving or enclosed places. This subtype has a bimodal age-at-onset distribution with one peak in childhood and another peak in mid-20s. 21

Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response which may take the form of a situational bound or situational predisposed panic attack. The phobic situation usually is avoided or else is endured with intense anxiety or distress. The avoidance interferes often with the person’s normal routine occupational functioning, social activities or relationships. 21 Fear of heights, or acrophobia, is one of the most frequent subtypes of specific phobia frequently associated to depression and other anxiety disorders. 22 It is one of the most prevalent phobias, affecting perhaps 1 in 20 adults. Heights often evoke fear in the general population too, and this suggests that acrophobia might actually represent the hypersensitive manifestation of an everyday, rational fear. 23

From a behavioral perspective, feared situations negatively maintain phobias. Anxiety disorders have been shown to be effectively treated using cognitive behavior therapy (CBT) and therefore to better understand and effectively treat phobias. The CBT model used in the present case, was based on Clark and Wells 24 model that places emphasis on self-focused attention as social anxiety is associated with reduced processing of external social cues. The model pays particular attention to the factors that prevent people, who suffer from social phobias, from changing their negative beliefs about the danger inherent in certain social situations.

The following case it is a good representation of this model.

Case Report

George, was a 23-year-old single, Caucasian male student in his last academic year and was referred to a University Counseling Centre in Athens. The Centre provides free of charge, treatment sessions to all University students requiring psychological support.

George was diagnosed with Social Anxiety Disorder and with Specific phobia, Situational Type i.e . acrophobia. He was living alone in Athens, as his parents live in a different region of Greece. He was an only child. When asked about his childhood, he said that he had been happy and did not report any traumatic events. He described a close relationship with both his parents and when asked, he did not report any family history of psychiatric or psychological disorders or substance abuse problems.

He complained of severe symptoms of anxiety and phobias during the last six months. He began experiencing severe heart palpitations, flushing, fear of fainting and losing control, when travelling by plane, when crossing tall bridges while driving or when being in tall buildings or high places, however he did not experience symptoms of vertigo. Additionally, he reported significant chest pain and muscle tension in feared situations. His fear of experiencing these symptoms worsened and led him to avoid these situations which made his everyday life difficult. He also experienced similar symptoms when introduced to people or meeting people for the first time. He repeatedly went to see various doctors many times in order to exclude any medical conditions. George stated that he didn’t experience any symptoms of depression, had no prior psychological or psychiatric treatment and/or medication, and had first experienced this problem in the course of the previous year.

At the time of the intake, George was in his final exams which he wanted to finish successfully, and continue his studies abroad. Due to his condition, he decided not to apply for a postgraduate degree in the United Kingdom, which he always wanted, and started looking for alternative postgraduate courses in Greece.

Assessment and treatment

George was referred by a private psychiatrist. The psychiatrist used the Mini International Neuropsychiatric Interview, 25 which is a structured interview based on DSM-IV diagnostic criteria. George met the criteria for a Social anxiety disorder. He also met the criteria for specific phobia limited-symptom, which was secondary to his social phobia. The psychiatrist suggested to George, to better help him with his current symptoms to take selective serotonin reuptake inhibitors (SSRIs). George however refused to take any medication and the psychiatrist referred him to the Counseling Centre. For the specific case we decided to give individual cognitive behavior therapy based on Clark and Wells model for Social Anxiety Disorder, 24 as referred into the NICE guidelines. 26 To better assist conceptualization and treatment and also monitor his progress, two therapists were assigned to George and two assessment measures (STAI and SPAI) were given, prior to the course of treatment, following therapy and at one month follow-up. He also had to complete a self-monitoring scale through-out the 20 weeks of treatment.

Monitoring progress measures

State-trait anxiety inventory.

The state-trait anxiety inventory (STAI), 27 the appropriate instrument for measuring anxiety in adults, differentiates between state anxiety , which represents the temporary condition and trait anxiety , which is the general condition. The STAI includes forty questions, with a range of four possible responses. In each of the two subscales scores range from 20 to 80, high scores indicating a high anxiety level. Higher scores correspond to greater anxiety.

Social Phobia and Anxiety Inventory

The Social Phobia and Anxiety Inventory (SPAI) 28 is a 45 item self-report measure that assesses cognition, physical symptoms, and avoidance/escape behavior in various situations. It includes two subscales: Social Phobia and Agoraphobia. A difference score above 60 indicates a potential phobia, and a cut off score of 80 maximizes this identification rate.

George’s pre-treatment scores were, SPAI:126, State Anxiety: 64 and Trait Anxiety: 63. The ultimate goal in each situation was to reduce the client’s level of anxiety.

Cognitive-behavior techniques such as self-monitoring, cognitive restructuring, relaxation, breathing retraining, and assertiveness training were employed to reduce anxiety and fear.

Cognitive behavior therapy techniques

Self-monitoring.

Self-monitoring refers to the systematic observation and recording of one’s own behaviors or experiences on several occasions over a period of time. 29 Self-monitoring can be used as a therapeutic intervention, because it helps the patient to evaluate his/her thoughts, emotions, and behaviors, recognize the feared situations and find appropriate solutions. Kazdin 30 states that self-monitoring can lead to dramatic changes, while Korotitsch and Nelson-Gray 29 add that although the therapeutic effects of self-monitoring may be small, they are rather immediate. George was asked to monitor his thoughts, feelings, and behaviors and record any changes.

George had to complete an Every Day Self-Monitoring Scale for 20 weeks measuring feelings of anxiety (0=no anxiety to 10= most anxiety) and phobia (0=no feelings of phobia to 10=most feelings of phobia), ( Figure 1 ).

Every day self-monitoring scale score.

Cognitive restructuring

Beck and Emery, 19 have identified three phases in cognitive restructuring: i) identification of dysfunctional thoughts ii) modification of dysfunctional thoughts and iii) assimilation of functional thoughts. During cognitive restructuring, the client starts recognizing his/her automatic or dysfunctional thoughts and emotions that derive from this thoughts. For example, one of George’s thoughts was that: it is dangerous to drive at night , which made him feel very anxious and frightened. However, an adaptive thought could be that: that sometimes is dangerous but also a lot of times are not, due the fact that at night there is less traffic in the streets . Therefore, throughout the sessions he was taught how to substitute several automatic negative thoughts with adaptive ones. He also kept a dysfunctional thought record for 6 sessions, which he discussed with his therapist every week.

Muscle relaxation

Relaxation techniques were used for the treatment of George’s symptoms and more specifically for the physiological manifestations of anxiety and panic. 31

George was trained in breathing and muscle relaxation exercises, based on Jacobson’s technique and he was given 8 relaxation training sessions, in order to establish a sense of control over his physical symptoms. The client learned to apply brief muscle relaxation exercises in his daily life and especially every time he had to face an uncomfortable situation.

Assertiveness training

Assertiveness training can be an effective part of treatment for many conditions, such as depression, social anxiety, and problems resulting from unexpressed anger. Assertiveness training can also be useful for those who wish to improve their interpersonal skills and sense of self-respect and it is based on the idea that assertiveness is not inborn, but is a learned behavior. Although some people may seem to be more naturally assertive than others are, anyone can learn to be more assertive. In the specific case the therapists helped George figure out which interpersonal situations are problematic to him and which behaviors need the most attention. In addition, helped to identify beliefs and attitudes the client might had developed, that lead him to become too passive. The therapist used role-playing exercises as part of this assessment.

Clinical sessions

George completed 20 individual, 50 min therapy sessions that took place within a period of 5 months. During the first session the rationale of the cognitive-behavioral treatment was analyzed and special emphasis was given to educate the patient on Social Anxiety disorder and Specific phobias. An introduction was made to the role that automatic thoughts play in our cognitions and helped him to recognize automatic negative thoughts and feelings. A self-monitoring diary of anxiety was given to him as homework. Emphasis was also given to establishing good rapport and collaboration in the therapeutic relationship. During the second session, George narrated stressful life events and reported specific cases in which the anxiety symptoms increased. He was also taught how to identify the three phases of cognitive restructuring and was given the dysfunctional thought record as homework. The third session was based on teaching him breathing exercises and muscle relaxation. Relaxation techniques were taught by a different therapist, with expertise in stress management and relaxation techniques. George was given 8 such sessions, each lasting 20 minutes while he also practiced the sessions daily at home and completed a Daily-form for progress monitoring.

Sessions 4 to 9 were devoted to ways of challenging dysfunctional thoughts by resorting to adaptive responses. At first we tried to recognize negative automatic thoughts during specific situations and record George’s mood in that situation. After recognizing George’s negative thoughts, emotions and behaviors, we worked on the evidence that supported these thoughts.

The next three sessions (10-12) were devoted to teach him assertiveness skills to learn to socialize with people more effectively. We explored what assertiveness meant for George, what prevented him from being assertive and what were the differences between assertive, submissive and aggressive behavior, which he found really helpful and role-playing exercises were initiated to exercise these skills.

Sessions 13-20 were devoted identifying anxiety provoking situations which were hierarchically classified according to the degree of anxiety they produced. An example is shown in Table 1 . Exposure to feared situations was performed by facing in vivo each level of the hierarchy and gradually practice each step, until he was confident enough to go on to the next.

Fear hierarchy for visiting tall buildings.

Accordingly, situations such as driving, crossing bridges etc were also explored.

During the last session, George referred to overcoming challenging experiences, such as meeting new people, visiting friends living in tall apartment buildings and crossing two high bridges, while driving to visit his parents in a different part of Greece. He effectively challenged his cognitions in all relevant situations and utilized muscle relaxation and breathing exercises to control feelings of anxiety. Last session was also devoted to discuss relapse prevention, ways to avoid it and how to overcome past failures and difficulties. Finally, we discussed how he could modify and apply the skills and techniques that he had learned, in his daily routine.

The post-treatment scores of STAI and SPAI obtained by George at termination indicated an improvement. The Social Phobia score dropped to 100, the Anxiety State score was 41 and the Trait score was 42.

During the follow-up session one month later, George talked about his improvement, he mentioned that his progress continued and that he was not experiencing any of the averse symptoms of the past, while driving, visiting tall buildings/bridges and meeting new people. He continued the relaxation and the cognitive restructuring exercises. The STAI & SPAI scales were administered again. The assessment revealed maintenance of gains in terms of reduced anxiety and fear symptoms with State anxiety score: 38, Trait anxiety score: 39 and SPAI score: 77 ( Figure 2 ).

STAI and SPAI Scores.

Treatment implications

In the present clinical case, George attended 20 individual sessions of CBT, in order to reduce his anxiety levels and phobias and learn how to monitor his progress in his daily life. His anxiety levels were reduced in social situations and also he managed to overcome his fear of heights in specific provoking situations. His progress was inevitable which was confirmed by the anxiety scores of the STAI and SPAI. The follow-up session that took place a month later, showed that his progress was sustained. The Every Day Self-Monitoring Scale during the 20 weeks period, showed a gradual reduction in self monitoring feelings of anxiety and phobias ( Figure 1 ).

However although we based our CBT model on Clark and Wells model for Social Anxiety, we had certain variations from the original model. For example, the Clark and Wells model suggests, that individual therapy for social anxiety disorder should consist of up to 14 sessions of 90 minutes’ duration over approximately 4 months. In our case study, the duration of each session lasted 50 minutes and we gave 20 sessions of individual therapy to our client over a period of 5 months, thus trying to tailor our client’s needs and requirements for treatment.

A good rapport was developed with George and that helped the entire treatment process. Working on a list of feared hierarchies in combination with relaxation training skills, George was able to manifest his high level anxiety visiting tall buildings, crossing tall bridges etc. Furthermore, the fact that George learned to identify his automatic thoughts, helped him to reduce his unpleasant feelings by alternating his thoughts. Role-playing exercises in order to acquire assertiveness training skills helped him in relation to meeting new people. It is also worth mentioning that George was motivated and completed his CBT homework every week, something that helped the therapeutic outcome.

Conclusions: recommendations to clinicians and students

Cognitive behavioral therapy is very effective in treating anxiety. It is a structured intervention that follows a general framework that is modified for each individual. For the successful treatment of social phobia, the cognitive behavior therapy must be thorough and comprehensive. Sometimes is needed to use combinations of techniques, like in this case we used traditional CBT techniques in combination with assertiveness skills training. Collaboration with other specialists is also advised for ultimate results, as in this case two therapists were involved, one main therapist and one specialist on stress management techniques. The cognitive-behavior therapist is important to adapt the session, on the basis of his/her client’s needs, for example in the case of George we used exposure based techniques and although the Counseling center offers a maximum of 6 therapeutic sessions, in the case of George we decided on 20 sessions, in order to fully accommodate his problem. It is also very important for the therapist to explain the rationale behind each CBT session and help the patient understand each session’s agenda up to the point he/she feels comfortable to set their own agenda during the session. However, despite the therapist’s best efforts, the patient often hesitates to carry out the everyday homework, thus sometimes delaying the therapeutic progress. Therefore, the good rapport established with the patient will almost certainly add greatly to his/her adherence during the treatment.

Therapist-client relationship, play a fundamental role in the therapy process. It is important for the client to trust the therapist and feel comfortable within the therapy context. Creating a safe and empathetic environment is important from the first therapy session. Furthermore as CBT is directive, a strong therapeutic alliance is necessary to allow the client to feel safe engaging in this type of therapy. It is also important to mention that therapists need to refer to the widely accepted guidelines and recommendations for treating Social anxiety disorders and specific phobias, from widely accepted national institutes, such as the National Institute for Health and Care Excellence that covers both pharmaceutical and psychotherapeutic approaches. However, it is necessary sometimes to tailor-made therapy around client’s needs, as each case must be seen individually . There are too many manuals on CBT and there is the danger for the therapist to work in such a program that can lose creativity, individual thought, imagination and contact with the client. The crucial role of any therapeutic intervention, is not only to help people to acquire the techniques, but to feel comfortable to apply them daily in situations they feel discomfort.

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Guidance for assessing case studies

The BABCP Minimum Training standards require that at least four training cases must be presented and formally assessed as case studies. Case studies must meet our standards for formal assessment listed below.

The BABCP case study marking criteria (formerly known as Criteria for Evaluating Academic Case studies 2013) can be downloaded here .

Case studies are normally assessed as part of post-graduate CBT training. However, not all courses include all four we require. If this applies to you, or you do not have evidence of all the passed case studies, this document provides guidance on both how to write and assess case studies marked independently for accreditation. 

Details of Training Cases

The criteria for BABCP CBT Practitioner Accreditation are set out in our Minimum Training Standards (MTS 2021) - 

• at least four of the eight training cases must be presented and formally assessed as case studies, a further three must have received close supervision
• written case studies should be between 2000-4000 words (or 3-5000 if extended).
• the case studies can cover the same cases that are closely supervised or they can be different
• two of your formally assessed case studies may be delivered as a ‘live’ case report or presentation instead of a written study – if so, there should be supporting information such as slides or a written summary as part of the formal assessment
• case studies must be marked as a ‘pass’ 
• the marker must have experience of marking CBT case studies in an academic setting
• the completed mark sheet for the case study should be submitted along with an application for accreditation

A Suitable Assessor

The assessor should be accredited by BABCP or be a CBT therapist who is trained and qualified in CBT to postgraduate diploma level or equivalent (or would meet Minimum Training Standards ). 

In addition, they should have experience of marking as a lecturer or tutor on an academic post-graduate CBT training course or equivalent. The assessor may, however, currently be independent of an academic institution.

If possible, we recommend that you contact assessors from your course, local courses or through other contacts. Otherwise, you can download a list of independent assessors  here .  It will be your responsibility to check that they still meet the criteria for a suitable assessor and to negotiate fees, timescale and, if appropriate, reasonable adjustments with them.

Assessors are asked to confirm that the case study has passed– this means that it is of an acceptable standard for a competent CBT therapist. Feedback should be given to the candidate and expectations of quality, content, layout, writing style and structure should be of a similar standard as case studies marked in a post-graduate programme.

Reasonable adjustments should be made where appropriate where the applicant can provide evidence of relevant additional needs.

The case study should demonstrate theoretical understanding and a research-based rationale for choosing a specific approach and knowledge of alternative options, which is consistent with evidence-based CBT practice. There should be a reflective element which identifies new learning.

All the areas described below should be covered where relevant.

Evidence of structured assessment, including the following areas -

• risk assessment
• current circumstances
• details of current presenting problem(s) and/or diagnosis, including co-morbidity and reason for seeking treatment at this point
• relevant personal history including development of the problem, previous treatment(s) and current coping
• use of appropriate standardised psychometric and idiographic measures
• suitability for CBT and socialisation to the model
• identified treatment goals
• assessment of diversity and relevant socio-cultural factors

Literature Review

• detailed description, explanation and critical evaluation of relevant CBT model(s) with rationale for choice of model
• knowledge of evidence base underpinning the theoretical model and chosen intervention(s)
• any adaptations to the model needed for the case

Case Formulation

The report should outline a coherent, concise formulation developed collaboratively over treatment with explicit input from client and include- 

• evidence of individualised formulation at maintenance or cross-sectional level in keeping with diagnosis specific or generic CBT model, which is appropriate to the presentation and justified by the evidence base
• explanation of links between elements in maintenance cycle
• diagrams of maintenance cycles (and longitudinal formulation, if appropriate)
• identification of a trigger or critical incident/explanation of onset of problems (precipitating factors)
• underlying beliefs/assumptions (predisposing cognitive vulnerability factors) and explanation of links between these and maintenance cycles
• explanation of how past events may have contributed to/reinforced the beliefs
• awareness of any missing elements

Course of Therapy and Outcome

• Identification of theoretical aims of treatment according to the model used, and in relation to client’s presenting difficulties and goals for treatment
• treatment plan explicitly linked to formulation
• clear identification and description of the main phases of treatment and detail on at least two specific change processes, including the cognitive and/or behavioural interventions utilised and the rationale for their use
• examples of written materials used (may be in appendices)
• justification of any deviation from model or protocol used
• identification of client’s learning
• continued refinement of formulation (if necessary)
• evaluation of outcome including progress towards treatment goals
• changes in psychometric and idiographic measures, changes to client’s general functioning and client’s evaluation of therapy relapse prevention plan
• reflection on the progress of therapy and outcome of therapy, and the therapist’s learning. Including identification of therapist and client factors that helped or hindered therapy, use of supervision, the role of the therapeutic relationship and likelihood of treatment gains being maintained 
• comment on the therapeutic alliance (interpersonal process) and if relevant how difficulties in treatment or the therapeutic relationship are understood in terms of the formulation, and how these were managed
• identification of what therapist may have done differently given another chance
• broader implications for the model or evidence base
• reflection on diversity and relevant socio-cultural factors

Structure, Presentation, References

The overall presentation should include -

• coherent structure with logical flow 
• clarity of communication, grammar and spelling
• use of diagrams, tables and/or figures where appropriate
• quality of referencing in text and in reference list
• limited, judicious use of appendices 

Additional guidance for verbally presented case studies

The criteria for written case reports above should be applied to marking verbally presented case studies, including the assessor criteria and the requirement for the report to pass. In addition -

• the presentation should include the opportunity for assessor(s) to give feedback and ask questions
• the presentation should be a minimum of 30 minutes’ duration (which may include the time for questions)
• there should be supporting information such as slides or a written summary
• any marking criteria that relate to the written aspect of the presentation should be used to assess the verbal aspect of a verbally presented report e.g. adhering to the word count would be equivalent to adhering to the allocated time
• as with written reports, the presentation should meet the standards expected of a healthcare profession with a post-graduate level qualification e.g. accurate and detailed slides, clarity of expression, logical sequence covering the areas outlined above, clarity and coherence of the content, respect for client confidentiality, effective use of tables and figures, lack of grammatical and spelling errors, appropriate links to evidence base and referencing 

Marking and Feedback

A BABCP case study feedback sheet is available here . It is optional and assessors can use a different system of ensuring and demonstrating that the case studies have met all of the requirements. 

A copy of the feedback sheet should be sent to the applicant for them to include with their accreditation application.

If the case study is not marked as a pass, please provide the applicant with constructive feedback. 

We may request a copy of the report in order to moderate the marking. 

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Case Study on CBT

Cbt case study:.

Cognitive behavioural therapy is a general term which describes a set of the various psychotherapies, in the basis of which lies the idea that the psychological disorders (phobias, depressions, etc) appear because of the dysfunctional believes. There are several key aims of cognitive behavioural therapy. The first is to defeat or reduce the symptoms of the disorder. The second is to prevent the relapse of the disorder after the course of treatment.

The most important one is to solve the psychosocial problems which caused the psychological disorder (if the problem is not solved, the disorder can occur again and again).Finally, the aim of the therapy is to change the dysfunctional schemes and behaviour of the patient resulting from the disorder to the regular standards. In order to achieve the set goals the psychotherapist helps the patient solve a few problems. First of all the patient should understand the impact of thoughts on the emotions and behaviour. Then, the patient should learn to detect the negative thoughts, observe them and look for the suggested ways out to cope with them or calm them down without anybody’s help. After that it is important to analyze the negative ideas soberly.

We Will Write a Custom Case Study Specifically For You For Only $13.90/page!

The patient should think them over objectively and define their pluses and minuses. Next, after the analysis the patient should substitute the wrong cognitions with the rational ideas and solutions which do not awake negative emotions. In the end, the patient should detect and get rid of the dysfunctional schemes which provoke the wrong cognitions. The described problems are the object of the research of psychotherapists who chose the best techniques and methods to solve these problems (the choice of the method depends on the level and type of the disorder).A CBT case study can be called a successful one if a student analyzes the topic deeply, introduces high-quality data and evidence which support his point of view and composes a logical structure for the paper.

It is obvious that a case study is a specific puzzle which requires effective solutions, so a student should find out about the origin of the problem, its cause and effect and provide the professor with the professional analysis and solutions to the suggested problem.Many students do not know how to compose a successful case study because they require a good example paper written by an expert. A free example case study on CBT found online can be a reliable piece of help for every student who is looking for the professional writing assistance. Due to the Internet and a free sample case study on depression CBT one will learn about the ways of formatting and the required style of writing.

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