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• December 19, 2023

20 Cognitive Behavioral Therapy (CBT) Techniques with Examples

Muhammad Sohail

Table of contents.

Cognitive Behavioral Therapy (CBT) stands as a powerful, evidence-based therapeutic approach for various mental health challenges. At its core lies a repertoire of techniques designed to reframe thoughts, alter behaviors, and alleviate emotional distress. This article explores 20 most commonly used cbt techniques. These therapy techniques are scientifcally valid, diverse in their application and effectiveness, serve as pivotal tools in helping individuals navigate and conquer their mental health obstacles.

Cognitive Restructuring or Reframing:

This is the most talked about of all cbt techniques. CBT employs cognitive restructuring to challenge and alter negative thought patterns. By examining beliefs and questioning their validity, individuals learn to perceive situations from different angles, fostering more adaptive thinking patterns.

John, feeling worthless after a rejected job application, questions his belief that he’s incompetent. He reflects on past achievements and reframes the situation, realizing the rejection doesn’t define his abilities.

Guided Discovery:

In guided discovery, therapists engage individuals in an exploration of their viewpoints. Through strategic questioning, individuals are prompted to examine evidence supporting their beliefs and consider alternate perspectives, fostering a more nuanced understanding and empowering them to choose healthier cognitive pathways.

During therapy, Sarah explores her fear of failure. Her therapist asks, “What evidence supports your belief that you’ll fail? Can we consider alternate outcomes?” Guided by these questions, Sarah acknowledges her exaggerated fears and explores more balanced perspectives.

Journaling and Thought Records:

Writing exercises like journaling and thought records aid in identifying and challenging negative thoughts. Tracking thoughts between sessions and noting positive alternatives enables individuals to monitor progress and recognize cognitive shifts.

James maintains a thought journal. Between sessions, he records negative thoughts about social situations. He then challenges these thoughts, jotting down positive alternatives and notices a shift in his mindset.

Activity Scheduling and Behavior Activation:

By scheduling avoided activities and implementing learned strategies, individuals establish healthier habits and confront avoidance tendencies, fostering behavioral change.

Emily, struggling with social anxiety, schedules coffee outings with friends. By implementing gradual exposure, she confronts her fear and eventually feels more comfortable in social settings.

Relaxation and Stress Reduction Techniques:

CBT incorporates relaxation techniques like deep breathing, muscle relaxation, and imagery to mitigate stress. These methods equip individuals with practical skills to manage phobias, social anxieties, and stressors effectively.

David practices deep breathing exercises when faced with work stress. By incorporating this technique into his routine, he manages work-related anxiety more effectively.

Successive Approximation:

Breaking overwhelming tasks into manageable steps cultivates confidence through incremental progress, enabling individuals to tackle challenges more effectively.

Maria, overwhelmed by academic tasks, breaks down her study sessions into smaller, manageable sections. As she masters each segment, her confidence grows, making the workload seem more manageable.

Interoceptive Exposure:

This technique targets panic and anxiety by exposing individuals to feared bodily sensations, allowing for a recalibration of beliefs around these sensations and reducing avoidance behaviors.

Tom, experiencing panic attacks, deliberately induces shortness of breath in a controlled setting. As he tolerates this discomfort without avoidance, he realizes that the sensation, though distressing, is not harmful.

Play the Script Until the End:

Encouraging individuals to envision worst-case scenarios helps alleviate fear by demonstrating the manageability of potential outcomes, reducing anxiety.

Facing fear of public speaking, Rachel imagines herself stumbling during a presentation. By playing out this scenario mentally, she realizes that even if it happens, it wouldn’t be catastrophic.

Shaping (Successive Approximation):

Shaping involves mastering simpler tasks akin to the challenging ones, aiding individuals in overcoming difficulties through gradual skill development.

Chris, struggling with public speaking, begins by speaking to small groups before gradually addressing larger audiences. Each step builds his confidence for the next challenge.

Contingency Management:

This method utilizes reinforcement and punishment to promote desirable behaviors, leveraging the consequences of actions to shape behavior positively.

To encourage healthier eating habits, Sarah rewards herself with a favorite activity after a week of sticking to a balanced diet.

Acting Out (Role-Playing):

Role-playing scenarios allow individuals to practice new behaviors in a safe environment, facilitating skill development and desensitization to challenging situations.

Alex, preparing for a job interview, engages in role-playing with a friend. They simulate the interview scenario, allowing Alex to practice responses and manage anxiety.

Sleep Hygiene Training:

Addressing the link between depression and sleep problems, this technique provides strategies for improving sleep quality, a critical aspect of mental well-being.

Lisa, struggling with sleep, follows sleep hygiene recommendations. She creates a calming bedtime routine and eliminates screen time before sleep, noticing improvements in her sleep quality.

Mastery and Pleasure Technique:

Encouraging engagement in enjoyable or accomplishment-driven activities serves as a mood enhancer and distraction from depressive thoughts.

After feeling low, Mark engages in gardening (a mastery activity) and then spends time painting (a pleasure activity). He finds joy in these activities, which uplifts his mood.

Behavioral Experiments:

This technique involves creating real-life experiments to test the validity of certain beliefs or assumptions. By actively exploring alternative thoughts or behaviors, individuals gather concrete evidence to challenge and modify their existing perspectives.

Laura believes people judge her negatively. She experiments by initiating conversations at social gatherings and observes that most interactions are positive, challenging her belief.

Externalizing:

Externalizing helps individuals separate themselves from their problems by giving those issues an identity or persona. This technique encourages individuals to view their problems as separate entities, facilitating a more objective approach to problem-solving.

Adam, dealing with anger issues, visualizes his anger as a separate entity named “Fury.” This helps him view his emotions objectively and manage them more effectively.

Acceptance and Commitment Therapy (ACT):

ACT combines mindfulness strategies with commitment and behavior-change techniques. It focuses on accepting difficult thoughts and emotions while committing to actions aligned with personal values, promoting psychological flexibility.

Sarah practices mindfulness exercises to accept her anxiety while committing to attend social events aligned with her values of connection and growth.

Imagery-Based Exposure:

This technique involves mentally visualizing feared or distressing situations, allowing individuals to confront and manage their anxieties in a controlled, imaginative setting.

Jack, afraid of flying, visualizes being on a plane, progressively picturing the experience in detail until he feels more comfortable with the idea of flying.

Mindfulness-Based Stress Reduction (MBSR):

MBSR incorporates mindfulness meditation and awareness techniques to help individuals manage stress, improve focus, and enhance overall well-being by staying present in the moment.

Rachel practices mindfulness meditation daily. By focusing on the present moment, she reduces work-related stress and enhances her overall well-being.

Systematic Desensitization:

Similar to exposure therapy, systematic desensitization involves pairing relaxation techniques with gradual exposure to anxiety-inducing stimuli. This process helps individuals associate relaxation with the feared stimuli, reducing anxiety responses over time.

Michael, with a fear of heights, gradually exposes himself to elevators first, then low floors in tall buildings, gradually working up to higher levels, reducing his fear response.

Narrative Therapy:

Narrative therapy focuses on separating individuals from their problems by helping them reconstruct and retell their life stories in a more empowering and positive light, emphasizing strengths and resilience.

Emily reevaluates her life story by focusing on instances where she overcame challenges, emphasizing her resilience and strength rather than her setbacks.

Each of these CBT techniques plays a unique role in helping individuals transform their thoughts, behaviors, and emotions. While some focus on cognitive restructuring, others emphasize behavioral modification or stress reduction. Together, they form a comprehensive toolkit empowering individuals to navigate their mental health challenges and foster positive change in their lives.

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How CBT Empowers Individuals to Overcome Mental Health Challenges

In this article

Today, the prevalence of mental health challenges is undeniable, and it affects individuals from all walks of life. Anxiety disorders, depression, obsessive-compulsive disorder ( OCD ) and post-traumatic stress disorder ( PTSD ) are just a few among the range of conditions that millions deal with daily.

According to the mental health charity Mind , 8 in 100 are diagnosed with mixed anxiety and depression in any given week in England. However, reports suggest that only 1 in 3 receive treatment (talking therapies, medication or both) for their condition. 

Fortunately for many, Cognitive Behavioural Therapy (CBT) helps. Renowned for its effectiveness, CBT offers individuals a pathway to healing, equipping them with invaluable tools to navigate and overcome the labyrinth of mental health challenges. 

In this article, we’ll explore the transformative power of CBT and how it enables individuals to confront and conquer their innermost demons, fostering resilience and reclaiming agency over their lives.

The Foundations of CBT

Cognitive Behavioural Therapy (CBT) was pioneered by Beck (1970) and Ellis (1962). So, although it seems relatively new as a concept, its origins are decades old.

At the centre of cognitive behavioural therapy (CBT) are fundamental principles that form the foundation of its transformative approach. Central to CBT is the cognitive model, a framework that elucidates the intricate interplay between thoughts, emotions and behaviours. This model underscores the notion that our interpretations of events profoundly influence our emotional responses and subsequent actions. In essence, it posits that how we perceive and interpret situations shapes our emotional state and dictates our behavioural responses.

CBT places particular emphasis on identifying and challenging negative thought patterns. It recognises them as potent catalysts for distress and dysfunction. By concentrating on these cognitive distortions—like catastrophic thinking, black-and-white thinking and over-generalisation—CBT forces individuals to scrutinise the accuracy and validity of their thoughts. Through this process of cognitive restructuring, they learn to replace maladaptive beliefs with more rational, balanced perspectives. This then alleviates emotional distress and forms adaptive behaviours.

In essence, the cognitive model guides CBT. It illuminates the delicate web of connections between our thoughts, emotions and behaviours. By harnessing the power of cognitive restructuring , CBT equips individuals with the tools to rewrite the narratives of their inner dialogue, developing resilience and empowering them to live life’s challenges with clarity and confidence.

Empowering Self-Help

One of the distinguishing features of cognitive behavioural therapy (CBT) is its emphasis on individuals taking an active role in their own recovery. Rather than passively accepting their circumstances, CBT empowers them to become agents of change. It provides them with a versatile toolkit so they can explore the complexities of their mind.

The practical application of CBT techniques allows individuals to challenge and reframe unhelpful thoughts, manage emotions effectively and make meaningful changes in their behavioural patterns. Through collaborative exploration and experimentation, individuals learn to identify cognitive distortions and erroneous beliefs that fuel their distress. With this awareness, they then engage in cognitive restructuring, systematically dismantling negative thought patterns and replacing them with more adaptive and realistic alternatives.

Moreover, CBT develops emotion regulation skills. It provides individuals with strategies to cope with intense feelings such as anxiety, sadness or anger. By learning to recognise, tolerate and modulate their emotional responses, people gain a sense of mastery over their inner workings and can reduce the grip that overwhelming emotions have on their lives.

As well as addressing cognitive and emotional dimensions, CBT places significant emphasis on behavioural change. Through structured goal setting and gradual exposure exercises, individuals confront avoidance behaviours and maladaptive coping mechanisms. They expand their comfort zones and gradually reclaim control over their lives.

In essence, CBT is a catalyst for self-empowerment. It offers individuals the tools and knowledge they need for their own mental well-being. CBT instils hope and resilience and paves the way for enduring transformation and growth.

Coping Strategies

Within the framework of CBT there is a diverse array of coping strategies introduced. These aim to empower individuals to confront and overcome their mental health challenges. These strategies aren’t just theoretical concepts, they’re practical tools that help individuals understand the complexities of their minds.

Central to CBT’s arsenal of coping strategies is cognitive restructuring. This is a process that involves identifying and challenging distorted or irrational thoughts. By examining the evidence for and against their beliefs, individuals can gradually dismantle their negative thought patterns and replace them with more balanced and adaptive perspectives. This cognitive reframing empowers individuals to reinterpret their experiences and circumstances in a way that creates resilience and promotes psychological well-being.

Besides cognitive restructuring, CBT often incorporates behavioural experiments. These involve systematically testing the validity of one’s beliefs through real-life experiences. By engaging in structured activities or interactions designed to challenge their assumptions, individuals gather concrete evidence that contradicts their negative predictions. This then undermines the power of their anxiety or distress.

Exposure therapy is another aspect of CBT. This is used for anxiety disorders, particularly phobias and PTSD. Through gradual and systematic exposure to feared stimuli or situations, individuals learn to confront and tolerate their fears. This helps them to lower their anxiety response over time. Known as desensitisation, this process allows individuals to reclaim control over their lives so that they are no longer controlled by their anxieties.

Collectively, these coping strategies exemplify the empowering nature of CBT. They provide individuals with the tools and techniques needed to confront their fears and anxieties head-on.

Goal Setting

Goal setting is an important part of CBT. It provides individuals with a plan for their recovery. These goals are specific, measurable objectives that individuals work towards with the guidance and support of their therapist.

Goal setting in CBT is about creating a sense of purpose and direction. By articulating specific and achievable objectives, individuals gain clarity about what they hope to accomplish, and the steps required to get there. This process gives their journey meaning and intentionality and it helps them to feel a level of control over their circumstances.

Setting achievable goals in CBT also promotes a sense of accountability and motivation. As individuals progress towards their objectives, they experience a tangible sense of accomplishment. This reinforces their belief in their capacity to effect change. This positive feedback loop fuels their momentum and resilience and spurs them on.

Importantly, the process of goal setting in CBT is collaborative. Individuals and therapists work together to define realistic and meaningful objectives. By aligning goals with the individual’s values, preferences and strengths, therapy becomes a personalised experience and is tailored to the unique needs and aspirations of the individual.

Setting goals for CBT isn’t just about symptom reduction; it is about reclaiming agency and authorship over your life. When patients can see a future filled with possibility and chart a course towards it, they can learn new ways of seeing themselves and their situation.

Effectiveness of CBT

According to research by the University of Bristol, 43% of people who received CBT reported a 50% reduction (or more) in their symptoms of depression. For those who didn’t receive CBT, only 27% reported reduced symptoms in the same 46-month period.

Let’s take a look at some of the specific results of CBT for different problems:

• Addiction and substance misuse: There is some evidence to suggest that CBT for cannabis use is effective compared to other interventions. It was also found that those quitting smoking were less likely to relapse with CBT.
• Schizophrenia and other psychotic disorders: There was found to be a beneficial effect of CBT on positive symptoms like delusions and hallucinations.
• Depression and dysthymia: CBT for depression was found to be more effective than control conditions. CBT and medication treatments were found to have similar effects on chronic depressive symptoms.
• Bipolar disorder: There were small effects on bipolar disorder but only if CBT is used as an adjunct to pharmacotherapy.
• Anxiety disorders: CBT for social anxiety disorder has been shown to improve this condition, and for generalised anxiety disorder (GAD), it was superior to pill placebo conditions. For post-traumatic stress disorder (PTSD), it was shown to be just as good as eye movement desensitisation and reprocessing.
• Eating disorders: For bulimia nervosa, CBT did have positive effects, but it was found to be less effective than behaviour therapy. However, it fared much better in remission response rates.
• Insomnia: CBT is well-known to be effective in reducing insomnia.
• Anger and aggression: CBT is moderately effective at reducing problems with anger. It is said to be most effective when there are issues with people expressing their anger.

Why is it effective?

At the heart of CBT’s efficacy is its emphasis on empowering individuals to adapt to challenges and setbacks. This creates a more resilient mindset among those who practise it. 

One of the key tenets of this therapy is recognising that resilience is a skill that can be developed. Through structured interventions and guided practice, individuals learn to navigate adversities with greater flexibility and resourcefulness. This means they’re less likely to succumb to feelings of despair or hopelessness.

CBT is successful because it gives individuals a range of coping strategies and problem-solving skills. These skills allow them to confront and overcome obstacles. By learning how to challenge negative thought patterns and reframe their interpretations of events, individuals learn to perceive setbacks as temporary and surmountable, rather than insurmountable barriers.

CBT encourages a more positive outlook on life. It encourages individuals to focus on their strengths and resources instead of dwelling on their perceived deficiencies or limitations. Through a process of cognitive restructuring, individuals learn to develop a mindset of gratitude, optimism and self-compassion. This enhances their resilience in the face of adversity.

CBT also focuses on the importance of behavioural activation. This means that it encourages people to engage in activities that bring them joy and fulfilment—even when they’re in the midst of difficult circumstances. By reconnecting with their interests, individuals regain a sense of purpose and meaning in their lives. This further improves their resilience and strength.

In essence, CBT offers individuals the skills and mindset needed to deal with challenges with grace and resilience. Thanks to CBT, by having a more adaptive outlook on life, individuals can overcome their struggles and imagine a future filled with hope and possibility.

Collaborative Approach

Although CBT requires a lot of effort from the individual, it is centred on a collaborative partnership between the person and their therapist. This is based on mutual respect, empathy and shared decision-making. 

Unlike traditional therapeutic approaches where the therapist assumes a more directive role, CBT embraces a collaborative ethos. It recognises the expertise and agency the individual has in their own healing journey. Individuals are active participants in the therapeutic process. They work hand-in-hand with trained therapists or counsellors to co-create their treatment plans and ensure they’re tailored to their unique needs and goals. 

This collaborative approach is grounded in the belief that individuals are the experts of their own experiences. After all, they possess invaluable insights and perspectives that can inform the direction of therapy.

From the outset, therapists engage in a collaborative dialogue with individuals. They seek to understand their concerns, aspirations and preferences. Together, they identify the specific challenges and goals to guide the course of therapy and they ensure that interventions are relevant and meaningful to the individual’s lived experience.

Throughout the therapeutic journey, individuals are encouraged to actively engage in self-reflection and experimentation. They’re expected to try to apply the skills and techniques learned in therapy to their daily lives. The therapists are guides and facilitators; they offer guidance, feedback and support throughout the process.

The collaborative nature of CBT means that it also extends beyond the confines of the therapy room. The individual’s broader support network of family, friends and other healthcare professionals should also be involved in some way. This helps create a unified approach and reinforces the progress made. 

In summary, cognitive behavioural therapy (CBT) is a powerful therapy for many individuals who undertake it.  First and foremost, CBT is a potent tool for reclaiming agency and control over one’s mental health journey. By equipping individuals with practical coping strategies and problem-solving skills, CBT allows them to challenge negative thought patterns, manage emotions effectively and make meaningful behavioural changes.

CBT also helps with the development of resilience. It enables individuals to adapt to challenges and setbacks with grace and strength. Through collaborative exploration and experimentation, individuals learn to confront their fears, overcome obstacles and cultivate a more positive outlook on life.

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About the author

Louise Woffindin

Louise is a writer and translator from Sheffield. Before turning to writing, she worked as a secondary school language teacher. Outside of work, she is a keen runner and also enjoys reading and walking her dog Chaos.

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Cognitive Behavioral Therapy

Reviewed by Psychology Today Staff

Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs. Considered a "solutions-oriented" form of talk therapy, CBT rests on the idea that thoughts and perceptions influence behavior.

Feeling distressed, in some cases, may distort one’s perception of reality. CBT aims to identify harmful thoughts, assess whether they are an accurate depiction of reality, and, if they are not, employ strategies to challenge and overcome them.

CBT is appropriate for people of all ages, including children, adolescents, and adults. Evidence has mounted that CBT can address numerous conditions, such as major depressive disorder, anxiety disorders, post- traumatic stress disorder, eating disorders, obsessive-compulsive disorders, and many others.

CBT is a preferred modality of therapy among practitioners and insurance companies alike as it can be effective in a brief period of time, generally 5 to 20 sessions, though there is no set time frame. Research indicates that CBT can be delivered effectively online, in addition to face-to-face therapy sessions.

• CBT in Practice
• What Conditions Can CBT Treat?
• The Origins of CBT

CBT focuses on present circumstances and emotions in real time, as opposed to childhood events. A clinician who practices CBT will likely ask about family history to get a better sense of the entire person, but will not spend inordinate time on past events. The emphasis is on what a person is telling themselves that might result in anxiety or disturbance. A person is then encouraged to address rational concerns practically, and to challenge irrational beliefs, rumination or catastrophizing .

For example, a person who is upset about being single will be encouraged to take concrete measures but also question any undue negativity or unwarranted premise ("I will be alone forever") that they attach to this present-day fact.

For more on psychotherapy in practice, visit the Therapy Center.

A typical course of CBT is around 5 to 20 weekly sessions of about 45 minutes each. Treatment may continue for additional sessions that are spaced further apart, while the person keeps practicing skills on their own. The full course of treatment may last from 3 to 6 months, and longer in some cases if needed.

In therapy, patients will learn to identify and challenge harmful thoughts, and replace them with a more realistic, healthy perspective. Patients may receive assignments between sessions, such as exercises to observe and recognize their thought patterns, and apply the skills they learn to real situations in their life.

CBT programs tend to be structured and systematic, which makes it more likely that a person gets an adequate “dose” of healthy thinking and behaviors. For example, a patient with depression may be asked to write down the thoughts he has when something upsetting happens, and then to work with the therapist to test how helpful and accurate the thoughts are. Repeated and focused practice is an integral part of CBT. CBT centers around building new habits—which we may know but need to remember and implement successfully.

Additionally, CBT programs can be standardized and tested so that the mental health field can identify which programs are effective, how long they take, and the benefits that patients can expect.

Research has found the CBT delivered virtually is often equally as effective, and sometimes more effective, than CBT delivered in person. For example, one review study found that online CBT reduced symptoms of anxiety and depression to the same extent or more than in person CBT. Online CBT was also effective in treating post- traumatic stress disorder, panic disorder, and specific phobia . Given that online therapy removes certain barriers, such as travel time or childcare, it’s a strong option to consider.

For more, see Online Therapy.

Almost everyone deals with distracting or destructive thoughts at times, but cognitive and behavioral principles can help you overcome them. The first goal is to restructure exaggerations. You can cultivate cognitive flexibility by asking questions like, “What’s the evidence for and against this idea?” “Is it possible that another perspective is more accurate?”

The second approach is to problem solve. If your beliefs are rooted in reality, fix the problem or make it more manageable, such as outlining the steps to complete a project that feels overwhelming. The third is to accept what you can’t change. You can then move forward and engage in activities that matter, without allowing your thoughts to control you.

Many people pursue therapy because their relationships are suffering. A course of CBT can lead to marked benefits not only for the person in therapy but for those close to him or her. One is less anxiety in the relationship; chronic worry in generalized anxiety disorder frequently leads to tension and irritability, causing conflict between partners. Another is greater presence, because a CBT framework can help translate one's intention to be present into a plan of action to make it happen. Positive mood, better sleep, happier children, and healthier thought patterns, are also ways in which CBT can improve a relationship .

CBT originally evolved to treat depression, but research now shows that it can address a wide array of conditions, such as anxiety, post-traumatic stress disorder, substance use disorder, and phobias. Versions have also been created to treat insomnia and eating disorders. But beyond treating clinical challenges, CBT can also provide the skills people need to improve their relationships, happiness , and overall fulfillment in life.

Yes, many studies have documented the benefits of CBT for treating depression. Research shows that CBT is often equally as effective as antidepressants ; patients who receive CBT may also be less likely to relapse after treatment than those who receive medication . CBT can provide patients with the inner resources they need to heal—and to prevent a depressive episode from recurring in the future.

CBT is an effective and lasting treatment for anxiety disorders, research shows. CBT provides the tools to alter the thoughts and behaviors that exacerbate anxiety. For example, someone with social anxiety might think, “I feel so awkward at parties. Everyone must think I’m a loser.” This thought may lead to feelings of sadness, shame , and fear, when then lead to behaviors like isolation and avoidance. CBT can help people learn to identify and challenge distorted thoughts, and then replace them with realistic thoughts, changing the cycle of anxiety.

Cognitive Behavioral Therapy for Insomnia, or CBT-I, is a short-term treatment for chronic insomnia. The therapy aims to reframe people’s thoughts, feelings, and behaviors around sleep. People with insomnia often enter a cycle of trying to make up the sleep they lost, sleeping poorly the subsequent night, and then becoming anxious about sleeping. These behaviors can include going to bed too early, taking naps, or relying on alcohol to fall asleep. The role of CBT-i is to change those patterns, through techniques such as challenging anxious thoughts and adhering to a set sleep schedule.

Enhanced Cognitive Behavioral Therapy, or CBT-E, is a form of CBT designed to treat eating disorders including anorexia, bulimia, and binge- eating disorder . CBT-E focuses on exploring the reasons the patient fears gaining weight with the goal of allowing the patient to decide for themselves to make a change. CBT-E stands in contrast to Family-Based Therapy, a leading treatment in which the patient’s family takes on an important role in addressing the disorder and the person’s eating patterns at home.

CBT was founded by psychiatrist Aaron Beck in the 1960s, following his disillusionment with Freudian psychoanalysis and a desire to explore more empirical forms of therapy. CBT also has roots in Rational Emotive Behavioral Therapy (REBT), the brainchild of psychologist Albert Ellis. The two were pioneers in changing the therapeutic landscape to offer patients a new treatment option—one that is short-term, goal-oriented, and scientifically validated.

The creator of cognitive behavioral therapy is Aaron Beck, a psychiatrist at the University of Pennsylvania. In the 1960s, Beck was practicing psychoanalysis. But he came to realize that the approach was failing to treat his depressed patients—entrenched negative thoughts prevented them from overcoming the disorder. So he developed cognitive behavior therapy, rooted in the philosophy of Albert Ellis’s rational emotive behavior therapy, to change these harmful patterns of “emotional reasoning” and spark genuine change.

In the 1950s, the psychologist Albert Ellis became discouraged by psychoanalysis. When treating his patients, he discovered that becoming aware of one’s beliefs and challenges didn’t necessarily change them. Ellis developed what is now called "rational emotive behavior therapy" (REBT). The groundbreaking therapy is based on his core philosophy: that most of our behavioral and emotional problems—from getting over a breakup to handling child abuse—stem from our own irrational beliefs about our situations and how we should be treated. By changing those beliefs, we can change our emotions and behaviors for the better.

Rational emotive behavior therapy later sparked the creation of cognitive behavior therapy. Both encompass the notion that emotions and behavior are predominantly generated by ideas, beliefs, attitudes, and thinking, so changing one’s thinking can lead to emotion and behavior change. Yet there are also a few differences between REBT and CBT. Unlike CBT, REBT explores the philosophic roots of emotional disturbances, encourages unconditional self-acceptance, and distinguishes between self-destructive negative emotions and appropriate negative emotions.

Psychoanalytic and psychodynamic therapy, as well as many other approaches, center around exploring the past to gather understanding and insight. CBT is distinct because it focuses on the present. What are you thinking right now? What were you thinking when you began to feel anxious? Are there any harmful patterns that emerge? The goal is to understand what happens in your mind and body in the present to change how you respond. 

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Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.

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“One thing is sure. We have to do something. We have to do the best we know how at the moment… If it doesn’t turn out right, we can modify it as we go along.” –  Franklin D.Roosevelt

P roblems in life can take on a variety of forms, but many of them share common characteristics that serve as cues, alerting us to the presence of a bonafide problem. The attitude that we choose to take toward the problem can serve as a powerful determinant of our ability to reduce distress and use emotional information in helpful ways. Many of the problems or chaos that we invite , create, or have thrust upon us become less intimidating and paralyzing when we take a proactive stance toward solving them. A mindfully open and alert stance can serve as a stable foundation as you begin the process of confronting the problem and moving toward a solution.

Part of the wisdom inherent in effective problem solving is discerning between solvable and unsolvable problems … and being willing to radically accept and let go of those problems which are truly out of your control. For all of the problems that you have the power to solve, remember that quite often a puzzling or painful problem is actually just a very difficult decision that is waiting to be made. It is possible that the looming “problem” in your life has taken on its imposing or frightening form due to a conscious or unconscious un willingness on your part to make a tough decision.

Brief Mindfulness Exercise:

Before you begin the following five steps of problem solving from your base of mindfulness, allow yourself a few moments to slow down and take a some slow deep breaths. Bring your full awareness to this  moment. Allow your thoughts, emotions, and sensations to naturally emerge; notice them just as they are, accept their presence, and release them with each breath that leaves your lungs. If confusing or unsettling thoughts enter into awareness, observe them with an open heart and nonjudgmental mind. Allow yourself to become disentangled from those thoughts as you notice that they are just thoughts … not “facts” or absolute truth.

Notice your emotions as they arise naturally from within. Perhaps you sense a deep-seated fear as you approach this problem. Observe this experience and direct compassion toward your fear, anxiety , or doubt. Embrace your suffering , rather than push it away. Notice what useful information is embedded within those painful disavowed experiences. Observe any physical sensations that emerge at this time, reconnecting with your body . Direct your full awareness in a nonjudgmental, accepting, and curious way toward those sensations. Perhaps there is a tightness in your throat or chest, shaking in your hands, a racing heart, or queasiness at your core.

Be kind toward yourself and notice the delicate way that your thoughts, emotions, and sensations are all coming together in a nuanced dance as you approach solving this problem. Allow wise mind to guide you, bringing together reason with emotion, as you begin to become open, reflective, and alert to the problem. When you are ready, direct your mindful awareness and focus  completely to the problem you are facing. Remember that part of being mindful involves directing your full presence toward one thing at a time , so give yourself the gift of slowing down as you go through this five step process of problem solving.

Mindful Problem Solving

R ead through the following five steps of problem solving and write down your authentic responses at each step along the way. Let go of the notion of “right” or “wrong” responses and trust yourself . As you go through these steps, make a commitment to yourself to follow through with your plan. When you take the time to move through solving a difficult problem with an open heart and awakened mind, you may begin to see that the right path out of the woods was there all along… just waiting for you to notice it and summon the courage to make the journey.

(1) State your problem

Problems cannot be solved and decisions cannot be made effectively before you have clearly and accurately identified the problem. If this step is easy for you, simply write down in simple and concise terms exactly what problem you are facing. If it seems challenging to identify the problem, try writing down some characteristics of the problem or common themes. For example, “health issues: illness, sleep, diet, mental health” or “relationship issues: conflict, loneliness, dissatisfaction.”

Once you have clearly identified and stated your current problem, take the time to engage in a bit of “ problem analysis ” to help you understand the various dimensions of the problem with greater clarity:

• What is the problem?
• Who is involved?
• What happens? What bothers you?
• Where does the problem occur?
• When does it occur?
• How does it happen? (Is there a pattern ?)
• Why do you think it happens?
• What else is important in this situation?
• How do you respond to the situation? (List your behaviors .)
• How does it make you feel?
• What outcome do you want to see?

(2) Outline your solutions

Once you have sufficiently identified the problem from various perspectives, you are ready to start identifying the best solutions available. Maintain a mindfully open attitude as you approach potential solutions from a place of creativity. Even if your “ideal” solution may not be realistic at this present moment, stay open to making the most out of the tools you do  have to work with at this point in time. Notice if any potential solutions come to you as you reflect on your responses to the last three questions from step one, regarding what you do , what you feel , and what you truly want .

Try coming up with and writing down three possible solutions based on those responses. For example, possible solutions may be worded in some of the following ways: “Figure out better ways to respond when I feel confused or frozen by the problem,” or  “Learn how to manage intense emotions more effectively when the problem occurs,” or  “Deliver painful news or express authentic feelings , no matter how scary it may feel.”

As you begin to set goals that will move you closer to your desired solution , remember to describe what you do want  to happen, as opposed to what you don’t want  to happen. For example, instead of “I don’t want to feel sad and confused,” rephrase that as, “I do want to feel happiness and a sense of clarity.” It is easier to move toward desired goals when they are stated in positive terms. If your goals feel general or vague (e.g., “I want to feel happier”), simply notice this for now – you will develop specific strategies intended to help you realize your goals in the next step.

Remember to state your intended goal from your own point of view, taking responsibility and ownership… this is what you  want to do. For example, instead of “I don’t want my friend to get angry with me so easily,” rephrase it as, “I want to learn how to develop a better relationship with my friend.” When goals are stated in these terms, you can become empowered by realizing the amount of control you have in reaching your goal, instead of depending on or wondering about the thoughts or behaviors of others.

(3) List your strategies

Maintain the creative mindful attitude that you took while generating possible solutions, as you allow your heart and mind to fully open to the process of recognizing strategies that will move you closer toward your goals. As you begin the process of coming up with ideas that may or may not help you reach your goal(s), remember: (1) don’t criticize/judge your ideas, (2) allow yourself to generate lots  of ideas/possibilities, (3) think creatively – allow yourself to be free of censorship, and (4) integrate and improve on ideas if needed – perhaps a few of your strategies have the potential to integrate into one amazing idea.

As you begin to create a brainstorm list of potential strategies, reflect back on your three possible solutions from the previous step. This exercise in brainstorming possible strategies involves the following steps:

• Write down the clearly stated/defined problem
• List your three possible solutions
• Underneath each solution, write at least 10 possible strategies

Part of engaging in this process of brainstorming from a centered place of mindfulness involves giving yourself permission to take your time, slow down your mind , and allow creative and productive strategies to emerge naturally into conscious awareness. Creative, effective, and mindful problem solving allows for strategies/ideas to be borne out of your authentic self … from your innermost sense of values , intuition, and alert wisdom.

(4) View the consequences of your strategies

At this step in the problem solving process, you have clearly stated the problem, come up with three possible solutions (think of them as solutions A, B, & C), and at least 10 possible strategies for each. Now that you are equipped with at least 30 problem-solving strategies, you are prepared to narrow down that list as you evaluate the potential (realistic) consequences of putting them into action.

• Look at the three lists of strategies you created for solutions A, B, and C. Notice which solution has generated the most strategies that appear to have the greatest chances of actually  succeeding.
• After you mindfully evaluate which of the three lists contains strategies that seem most effective (likely to bring about the desired outcome), choose the solution that you believe has the greatest chance of bringing success.
• Using the solution you chose (A, B, or C), begin to narrow down the strategies to three. These three strategies should be the best strategies for that particular solution; bear in mind you can always combine a few strategies into an even more powerful one. During the process of narrowing down your list, cross out any ideas that strike you as exceedingly unrealistic or not aligned with your true values or authentic self.
• In order to evaluate the consequences of each strategy, reflect on how each may positively and negative impact yourself, others, and your short-term/long-term goals.
• Write down each of your three narrowed down strategies in specific terms and list the positive and negative consequences in two columns underneath each strategy.
• If the best strategy does not become readily apparent to you at this point, try rating the positive and negative consequences for each of the three strategies on a scale of 1 to 4 (1 = not too important or significant, 4 = very important or significant).
• You can now go through all three strategies and add up those scores. The idea is that the most effective strategy is the one with the highest positive/lowest negative consequence score.
• If you feel at peace and content with the strategy that yielded the greatest positive consequences for yourself/others and your short-term/long-term goals, carry this knowledge and confidence with you to the final step of this problem-solving process.

(5) Evaluate your results

Now that you have selected the best strategy as a result of your deliberate, focused, and mindful process of problem solving, the time has come to put that strategy into action . It is time to take your carefully selected strategy and break it down into simple, specific, realistic steps that you will commit to enacting. Remember to insert different/specific words into the following example that allow you to connect this final step to the personal problem you are currently facing. A specific example of breaking down your chosen strategy into concrete steps can be found at step five of the following example.

General example of final outcome – “Five steps of effective and mindful problem solving” :

(1) Problem : “I’m at a major crossroads in my life and don’t know what to do.”

(2) Best solution – based on which of the three primary solutions generated the most effective list of strategies: “Figure out better ways to respond when I feel confused or frozen by the problem.”

(3) Best strategy – based on greatest/realistic chances of success and mindful weighing of potential consequences: “Practice mindfulness meditation , emotion regulation exercises , & interpersonal assertiveness .”

(4) Awareness of consequences  – accurate recognition of short-term/long-term consequences to yourself/others based on enacting the best strategy: “ Positive : feel more centered/relaxed/in touch with my authentic experience, increased ability to effectively identify/respond to emotions in myself and others, & increased confidence in ability to take a stand and speak my true feelings with healthy assertiveness ; Negative : fears of becoming lost within the process of meditation, temporary discomfort with allowing and responding to uncomfortable emotions authentically, & potential that expressing authentic thoughts/feelings may cause short-term/long-term hurt to others.”

(5)   Evaluate & break down strategy into manageable steps  – consider desired actions based on chosen strategy and commit to specific steps you will take toward putting that strategy into action: “Read about simple mindfulness exercise s and set aside 20 minutes each morning/evening to practice, write out specific emotion regulation coping skills onto flashcards and practice using them when feeling calm/centered as well as during times of emotional distress, & learn about interpersonal effectiveness and assertiveness skills – actively practice clearly stating thoughts, feelings, and needs on a daily basis.”

P roblem solving becomes significantly easier and less intimidating when you take a proactive approach toward solving the problem and become mindfully attuned with your authentic inner experience (focusing less on what others may think, want, or do as you determine what you  are feeling). Give yourself the opportunity go through this type of deliberate, thoughtful, and wise process of reaching healthy resolutions to your problems.

Remember that even when taking a mindful approach, problems aren’t always solved in the first, second, or even third attempts. This is because there are so many unknowns inherent within life’s mysteries and the only person’s behaviors you can ultimately control are your own. If your initial attempts at problem solving go awry, choose to reframe that perceived failure as a learning opportunity and a valuable chance to do things differently next time. The sooner you start taking active steps toward solving problems and recognize what works and what doesn’t work… the sooner you can shed the heavy robes of indecision and emotional paralysis and begin to live your most authentic life.

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Wood, J.C. (2010). The cognitive behavioral therapy workbook for personality disorders.  Oakland, CA: New Harbinger Publications, Inc.

Featured image: For What It’s Worth by Adam Swank / CC BY-SA 2.0

About Laura K. Schenck, Ph.D., LPC

I am a Licensed Professional Counselor (LPC) with a Ph.D. in Counseling Psychology from the University of Northern Colorado. Some of my academic interests include: Dialectical Behavior Therapy, mindfulness, stress reduction, work/life balance, mood disorders, identity development, supervision & training, and self-care.

Extremely helpful, Laura. Thank you so much.

I would so enjoy seeing more about problem-solving and decision-making.

What's On Your Mind? Cancel reply

Website Links

The links below have been carefully selected and include a vast array of free resources that you can use to support your clinical practice. Click the title for more information about each site.

A Hopeful Space

A Hopeful Space is an excellent free resource for psychological practitioners. It contains information, worksheets, and videos about a range of topics, for example, grounding techniques, suicide awareness, anxiety to name a few. You can explore the comprehensive collection of free information and courses offered in the library.

https://ahopefulspace.com/

CBT for Children

Brought to you by SDS Seminars

This innovative and comprehensive modular Certificate provides participants with skills to use the core principles of CBT with Children and Adolescents. It was designed exclusively for SDS Seminars Ltd by Dr Andrew Beck, Consultant Clinical Psychologist, Honorary Senior Lecturer at the University of Manchester, Senior Lecturer on the Children and Young People’s Talking Therapies programme, a member of the BABCP Scientific Committee, a Past President of BABCP in cooperation with Paul Grantham, Consultant Clinical Psychologist, SDS Founder.

BPS Approved Certificate in CBT for Children and Adolescents

BPS Approved Certificate in CBT For Working With Adolescents

CEDAR Resources

The University of Exeter’s Clinical Education Development and Research (CEDAR) applied psychological practice centre of excellence is a world leading centre for evidence based psychological practice. They have a wide range of free resources available including translated resources, and resources specifically for children and young people. 

https://cedar.exeter.ac.uk/resources/iaptinterventions/

Get Self Help Resources

Get Self Help provides CBT self-help resources including worksheets, information, videos and mp3s. You can search for materials by probelms or solutions which makes easy to navigate the site.  Most materials are free and the site is easy to navigate.

https://www.getselfhelp.co.uk/

Man Confidence

Junaid Hussain is on a mission to provide an alternative way to access mental health care specifically tailored to men. Currently he is already offering a free course for suicide awareness and several other paid courses on a range of mental health topics that will be expanding soon. 

https://manconfidence.co.uk/

MindEd Resources

MindEd is suitable for all adults working with, or caring for, infants, children or teenagers, adults and older people, including people with a learning disability and autistic people; all the information provided is quality assured by experts, useful, and easy to understand. We aim to give adults who care for, or work with people:

the knowledge to support their wellbeing

• the understanding to identify a child, young person or adult at risk of a mental health condition
• the confidence to act on their concern and, if needed, signpost to services that can help

MindEd is multi-professional, and can be used by teachers, health and mental health professionals, police and judiciary staff, social workers, youth service volunteers, school counsellors among others to support their professional development.

https://www.minded.org.uk/

Moya CBT Resources

Helen Moya has a long a distinguished career in mentla health and CBT.  SHe has a wide range of helpful and downloadable resources and she also hosts regualr CPD sessions to compliment her resources. 

https://www.moyacbt.co.uk/resources/

SDS Video Library

The PWP Training Library is a growing video on-demand training catalogue opening with 30 topics and more added to each month. Its initial content has been specifically chosen with reference to two geographically diverse PWP Regional surveys and we welcome further suggestions. Let us know what you need [email protected].

These on-demand trainings are typically between 15-45 minutes each in length and provided by experienced PWPs, PWP academics and PWP specialists. This is for a number of reasons.

SDS are now offering an annual individual subscritions to all of their videos for £100 (+VAT) or a Team PWP subscription for £950 (+VAT)

Sign up to our mailing list to recieve a 10% discount code on the price of individual videos using the code Hub10%

https://sds-seminars.online/product-category/pwp/?orderby=price

TalkPlus Resources

TalkPlus has a wide range of fantastic free to use resources,  information packs, videos and worksheets. 

https://www.talkplus.org.uk/resources

We Heart CBT Resources

WeHeartCBT is a collection of resources aimed at helping children and young people who are struggling with symptoms of anxiety and/or low mood. Resources are based on a Cognitive Behavioural Therapy (CBT) approach and are for mental health professionals, schools and parents/families.

https://weheartcbt.com/practitioner-resources

Due to copyright laws, we are not able to host or share specific materials. We simply provide freely available links that are located in one handy space in an attempt   to make our psychological professionals lives a little easier!

Low Intensity CBT Information

Low Intensity Cognitive Behaviour Therapy (LICBT) is a form of self-guided help for those experiencing mild to moderate symptoms of depression and or anxiety, and is usually supported by a Psychological Practitioner. LICBT is often offered as the first step in the NHS Talking Therapies approach and is usually  6-8, 30 minute sessions, which are delivered weekly or fortnightly. Sessions usually focus on one or two key techniques due to the limited time of the treatment. LICBT uses a 'here and now' approach to support individuals to identify and address throughts and behaviours that are maintaing their problems. 

What are some of the benefits of low intensity CBT across different settings?

The difference between High intensity and low intensity CBT

NHS Talking Therapies Manual

The NHS Talking Therapies (formerly known as Improving Access to Psychological Therapies (IAPT)) manual and its resources have been produced to help the NHS Talking Therapies programme improve the delivery of, and access to, evidence-based psychological therapies within the NHS.

Anyone interested in a career as a psychological practitioner should make themselves aware of the manual:

NHS Talking Therapies Manual Link

Helpful Books, Resources & Links

Here you will find links to some helpful resources. Lots of people are selling some of the books on the Facebook Groups at a discounted rate. 

Low-Intensity Cognitive Behaviour Therapy; A Psychological Wellbeing Practitioner (PWP) Handbook

A Pragmatic Guide to Low Intensity Psychological Therapy: Care in High Volume

Oxford Guide to Low Intensity CBT Interventions

A Clinician’s Guide to

Low Intensity Psychological

Interventions (LIPIs) for

Anxiety and Depression

Low Intensity Cognitive Behaviour Therapy: A Practitioner's Guide

Low-intensity CBT Skills and Interventions

a practitioner's manual

Reach Out Guide

Test Your Mental Health Assessment Skills

Triage a Virtual Patient

You are an NHS Talking Therapies practitioner. You are about to meet Matthew Walker for a triage assessment following a referral from his GP. The referral states that Mr Walker has declined medication and that he would rather seek therapeutic support.   

The purpose of this exercise is to ensure that you are able to assess the patient and to be able to gather enough information in order to provide a probable diagnosis. The patient has brought their PHQ9 and GAD7 questionnaires with them; you must structure the session to enable meaningful integration of these. Key skills here are around 1) the assessment of his suitability for IAPT, 2) exploration of symptoms and the impact for a patient, 3) moving towards a shared plan of care.

Assess a Virtual Patient

You are an NHS Talking Therapies practitioner. You are about to meet Matthew Walker for an appointment  following a brief triage assessment you completed with him last week. From his triage assessment, he presented with low mood following a fall, intermittent mild weakness and numbness, pain and tingling on his right side. A neurologist has confirmed he has a functional neurological disorder, as expected all the tests were normal and he doesn’t need any more investigations. His GP is confident that his symptoms are functional.

The purpose of this exercise is to ensure that you are capable of providing information to the patient that moves them towards therapeutic action. The patient has brought their PHQ9 and GAD7 questionnaires with them; you must structure the session to enable meaningful integration of these. You should start to be able to develop a shared management plan with the patient including the creation of a collaborative five areas formulation. Key skills here are around 1) the interplay between physiological and psychological health 2) symptom explanation for a functional illness, 3) exploration of symptom impact for patient 4) moving towards a shared plan of care.

Interventions & Resources

Acceptance & Commitment

Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach that helps individuals better cope with emotional and psychological issues. ACT is based on several core principles, including accepting one's thoughts and feelings without judgment, practicing mindfulness, clarifying personal values, and taking committed action based on those values. ACT has been used to address a wide range of psychological and emotional issues, including anxiety, depression, stress, addiction, chronic pain, and more. It aims to promote psychological flexibility, allowing individuals to adapt and respond to life's challenges with greater resilience and a deeper sense of purpose.

Act Mindfully Website Free Resources

Acceptance & Commitment Therapy for Anxiety & Depression Video

Activity & Exercise

Increasing activity and exercise with Cognitive Behavioural Therapy (CBT) is a therapeutic approach that combines principles of CBT with strategies to promote physical activity and exercise. This approach is particularly useful for individuals dealing with mental health conditions like depression or anxiety, where physical inactivity can exacerbate symptoms. The combination of CBT and exercise helps individuals break the cycle of inactivity and negative thought patterns that can contribute to mental health issues like depression and anxiety. By setting achievable goals and addressing cognitive barriers, clients are more likely to maintain regular exercise routines, which, in turn, can have a positive impact on their mental well-being. This approach not only improves physical health but also fosters a more positive and adaptive mindset.

PDF & Links: 

TalkPlus: Physical Activity and our Mental Health

CEDAR: Get Active, Feel Good! Helping yourself to get on top of low mood

Webinar: Improving Your Mental Wellbeing by Increasing Physical Activity

Benefits of Physical Activity on Mental Health 2019

Anxiety: Fight or Flight

The "fight or flight" response, also known as the "acute stress response," is a physiological reaction that occurs in response to a perceived threat or danger. It's an innate and automatic reaction that prepares the body to either confront the threat (fight) or escape from it (flight). The fight or flight response is an evolutionary adaptation that helped our ancestors respond quickly to physical threats. In modern times, it can still be triggered by various stressors, both physical and psychological. While this response is crucial for survival in dangerous situations, chronic or excessive activation can lead to health issues, including anxiety and related physical symptoms. Teaching client's how to manage the fight or flight symptoms can be a powerful tool to support recovery. 

PDF & Links

The Physical Effects of Anxiety and How to Manage Them

Mood Juice: Anxiety 

Videos: 

Justin Caffrey: How to Manage Fight Flight Response. Step-by-Step Neuroscience

The Fight Flight Freeze Response

Self Help Toons: Guided Breathing & Walking Relaxation Meditation: Panic Anxiety Stress

TalkPlus: Muscle Relaxation

Anger Management

Anger is often considered a secondary emotion because it typically arises as a response to underlying primary emotions or triggers. In this context, primary emotions are the more basic and immediate feelings that can give rise to anger when they are not effectively processed or expressed. Anger, in this context, acts as a secondary response to these primary emotions, often serving as a protective mechanism. It can provide individuals with a sense of control, power, or an outlet for the distress caused by the primary emotions. Recognising and understanding the primary emotions that lead to anger can be important for managing anger in a healthier and more constructive way. By addressing the underlying emotions, individuals can develop more effective strategies for dealing with anger and its triggers.

NHS Scotland: Problems with Anger Self Help Guide

Moodjuice Anger Self Help Guide

CNTW: Controlling Anger

Get Self Help: Anger

Get Self Help: CBT Self Help for Anger

YoungMinds: Talking about Anger

The ASMR Psychologist: How to control your anger

Behavioural Activation

Behavioural activation (BA) is a time-limited, evidence-based psychotherapy for depression. Based on a behavioural model of depression, BA aims to increase behaviours that are positively reinforced by the environment and decrease behaviours that function to maintain depression. As a practitioner, BA is one of the most commonly used low intensity CBT interventions.

PDF &Links:

CEDAR: Lift your Mood

TalkPlus: Behavioural Activation

Greater Manchester NHSFT: Behavioural Activation

University of Michigan: Values Based Behavioural Activation

Behavioural Activation for PWPs by Josh Cable

Values Based Behavioural Activation for PWPs Video by Josh Cable

Talk Plus Behavioural Activation MP3

Oxford University Podcast: Introducing CBT for Low Mood and Depression: doing more of what matters to you

Adapted Resources:

Translated Materials at CEDAR

SignHealth resources for deaf people including a library of BSL supported recordings

Behavioural Experiments

Behavioural experiments in Cognitive Behavioural Therapy (CBT) are structured activities or tests designed to help individuals challenge and modify unhelpful beliefs or assumptions, particularly those related to anxiety, depression, and other emotional or psychological difficulties. Behavioural experiments are a practical and hands-on component of CBT that encourages individuals to challenge and reframe their negative beliefs. They provide concrete evidence to support cognitive restructuring and help individuals develop a more adaptive and balanced way of thinking. These experiments are tailored to each individual's specific challenges and are an essential tool in the process of change and personal growth.

CEDAR: Unhelpful Thoughts: challenging and testing them out

CEDAR: Behavioural Experiments

Carepatron Behavioural Experiment Worksheet

Changing Negative Beliefs with Behavioural Experiments in CBT: Self Help Toons

How To Use CBT Behavioural Experiments: Lewis Psychology

Cognitive Restructuring

A major component of any emotional state is the thinking that accompanies the physical and behavioural symptoms. Most thoughts are automatic and many of these are ‘unhelpful’. Key features are that these thoughts are automatic, seem believable and real at the time they appear, and are the kind of thoughts that would upset anybody. These thoughts act powerfully to maintain mood states. Cognitive restructuring is a way of changing unhelpful thoughts by identifying, examining and challenging them. 

PDF & Links:

CEDAR: Unhelpful Thoughts: Challenging them and Testing Them Out

TalkPlus: Cognitive Restructuring

Get Self Help: Thought Challenging

Cognitive Restructuring for PWPs by Josh Cable

CBT and Reframing Thoughts with Cognitive Restructuring

CBT for Anxiety & Cognitive Restructuring

Talk Plus Cognitive Restructuring MP3

Distress Tolerance

Distress intolerance is a perceived inability to fully experience unpleasant, aversive or uncomfortable emotions, and is accompanied by a desperate need to escape the uncomfortable emotions. Difficulties tolerating distress are often linked to a fear of experiencing negative emotion. Often distress intolerance centres on high intensity emotional experiences, that is, when the emotion is ‘hot’, strong and powerful (e.g., intense despair after an argument with a loved one, or intense fear whilst giving a speech).  Overall, distress tolerance skills in CBT are valuable for individuals who struggle with intense emotional reactions or impulsive behaviours when faced with distressing circumstances. They empower individuals to navigate crises and difficult emotions more effectively, ultimately leading to better emotional regulation and a higher quality of life.

Centre for Clinical Interventions: Tolerating Distress

Get Self Help: Distress Tolerance

Self Help Toons: Distress Tolerance & Crisis Survival

Dr Tracey Marks: How to Deal with Negative Emotions - Distress Tolerance

NICABM: Three Steps to Help Clients Better Tolerate Distress

Exp Resp. Prev. for OCD

Exposure and Response Prevention (ERP) is a cognitive-behavioral therapy technique commonly used to treat individuals with obsessive-compulsive disorder (OCD) and related anxiety disorders. It is based on the idea that people with these disorders experience distressing obsessions (persistent, intrusive, and distressing thoughts) and engage in compulsions (repetitive behaviors or mental acts) to reduce the anxiety and distress associated with these obsessions. The goals of ERP include helping individuals learn to tolerate the anxiety and discomfort triggered by their obsessions without resorting to compulsions. Over time, as they repeatedly face these fears without performing rituals, the anxiety typically diminishes, and they begin to recognize that their obsessions are less threatening than they initially believed.

OCD UK: Exposure and Response Prevention

Obsessive Compulsive Disorder: A Self Help Book

Crufad Obsessive Compulsive Disorder Patient Treatment Manual

Exposure and Response prevention (ERP) for OCD: George Maxwell

ERP Therapy for OCD | A Complete Guide: Paige Pradko

BSL - Treatment of obsessive compulsive disorder (OCD)

Goal Setting in LICBT

Goal setting is an important component of low intensity CBT. Setting clear and achievable goals helps individuals identify what they want to change and provides a framework for working towards those changes. Goal setting in LICBT helps individuals focus on specific, meaningful changes they want to make in their lives, and it provides a structured approach to achieving those changes. It's a collaborative process between the practitioner and the client, and it plays a key role in the overall success of CBT treatment.

Get Self Help: Goal Setting

CEDAR: Goal Setting in Low Intensity CBT

CBT Demo Goal Setting

How to set SMART CBT goals in 2021

Beck Institute: Clinical Tip: Setting Goals

Translated Materials:

Get Self Help

Graded Exposure

Exposure therapy is a psychological treatment technique used to help individuals confront and overcome various anxiety disorders, phobias, and post-traumatic stress disorder (PTSD). The central premise of exposure therapy is to systematically expose the individual to the source of their fear or anxiety in a controlled and gradual manner. Exposure therapy is evidence-based and has been shown to be highly effective in treating various anxiety disorders, phobias, and trauma-related conditions. It helps individuals confront and gradually overcome their fears, leading to a reduction in anxiety and an improved quality of life. This therapy is often conducted under the guidance of a trained therapist who ensures the safety and effectiveness of the exposure process.

CEDAR: Facing your Fears

TalkPlus: Graded Exposure

Get Self: Graded Exposure

Flinders University: Graded Exposure

Graded Exposure: Dr Paul Stone

Graded Exposure for PWPs

Face your Fear & Reduce Anxiety: Self Help Toons

TalkPlus Graded Exposure MP3

https://cedar.exeter.ac.uk/resources/nhstalkingtherapiestranslated/

Pacing (Boom & Bust)

Pacing  in CBT refers to the practice of setting and maintaining a consistent and sustainable level of activity and effort. It involves breaking down tasks and activities into manageable portions, avoiding overexertion or rushing, and finding a comfortable, steady rhythm. Pacing is especially relevant for individuals dealing with mental health conditions like anxiety, depression, or chronic pain, as it helps prevent burnout and exhaustion by distributing energy and focus more evenly over time.

The boom-and-bust cycle is a pattern where individuals alternate between periods of high activity (the "boom") and periods of low activity or inactivity (the "bust"). This cycle can be counterproductive and often leads to stress, anxiety, and decreased overall productivity. In CBT, therapists work with individuals to recognize and modify this pattern by encouraging more consistent and balanced engagement in activities. The goal is to avoid extremes and find a more sustainable approach to daily life, which can improve overall well-being and mental health.

Get Self Help: Chronic Pain & Fatigue

Oxford University Hospitals: Pacing - How to Manage Your Pain and Stay Active

M.E. Association: Pacing - Activity and Energy Management

Action for M.E: Pacing for People with ME

Long Covid Physio: Pacing

Manchester NHSFT: Pacing Pain Management

Panic Management

Panic management in Cognitive Behavioral Therapy (CBT) is a structured approach designed to help individuals who experience panic attacks or panic disorder. It involves several key components: Psychoeducation, Identification of Triggers and Symptoms, Cognitive Restructuring, Exposure, Breathing and Relaxation Techniques. Overall, panic management CBT equips individuals with the skills and strategies needed to understand, cope with, and ultimately reduce the frequency and intensity of panic attacks. It empowers individuals to regain a sense of control and improve their quality of life.

CEDAR: Panic Not: Managing Panic Disorder

Crufad: Anxiety and Panic Disorder Patient Treatment Manual

Centre for Clinical Interventions (CCI): Panic

Sheffield Hallam University: Managing Panic

Self Help Toons: Calm Your Panic Attacks with CBT

CCI: Developing a Panic Formulation

Adapted Materials:

Cedar Translated Materials

Problem Solving

Problem-Solving is a therapeutic approach that focuses on teaching individual’s practical skills to effectively identify, analyse, and resolve problems in their lives.  Problem-solving specifically targets the development of problem-solving skills and strategies to manage life challenges and reduce emotional distress. Problem-Solving is often used to address a wide range of emotional and psychological issues, including anxiety, depression, stress, and interpersonal conflicts. It empowers individuals to take an active role in managing their problems and improving their overall well-being. Therapists using this approach provide guidance and support to clients as they develop and apply problem-solving skills to their real-life situations.

CEDAR: From Problems to Solutions

TalkPlus: Problem Solving

Get Self Help: Problem Solving

Dr Alison K Ventura: Problem Solving Series (follow links on YouTube for other parts)

Family Doctor: Structured Problem Solving (Role Play)

Self Help Toons: Problem Solving and Action Plans in DBT and CBT

Get Self Help  Translated Materials

Resilience & Wellbeing

Resilience is the ability to adapt and bounce back from adversity, stress, or challenging situations. It involves mental, emotional, and sometimes physical fortitude to face life's difficulties and maintain a sense of well-being. Resilience is not an innate trait but a skill that can be developed and strengthened over time. Developing resilience is an ongoing process, and it may take time to build these skills. The key is to approach challenges with a growth mindset and a willingness to learn and adapt. Resilience can be strengthened through practice and self-awareness, helping you navigate life's difficulties with greater ease and effectiveness.

Mind: Managing stress and building resilience

Mind Tools: Developing Resilience 

CEDAR: Bounce Back - Finding your Inner Strength

CEDAR: Enhancing Resilience: Finding Inner Strength To Manage The Demands of Clinical Practice

Better Health: Bouncing back from life's challenges

10 Ways to Build and Develop Resilience

Rumination: Overthinking

Rumination, in a psychological context, refers to the repetitive and passive focus on one's negative thoughts, feelings, or problems, often without reaching a resolution. It involves dwelling on the same distressing thoughts or issues repeatedly, which can contribute to and exacerbate emotional distress. Rumination is commonly associated with conditions such as depression and anxiety.

Rumination is thought to be a cognitive vulnerability factor in the development and maintenance of certain mental health disorders. In the context of cognitive-behavioral therapy (CBT), therapists work with individuals to help them recognize and challenge these negative thought patterns, promoting more adaptive ways of thinking and coping. Developing mindfulness and self-awareness are also common components of interventions aimed at reducing rumination.

Bristol CBT: Dealing with Rumination

Living CBT: Dealing with Unhelpful Thoughts

Dr Nae: Rumination Focused CBT for Depression

TalkPlus: Unhelpful Thinking Habits

Kelly Watkins: Learn the difference between rumination and worry and CBT skills to manage them.

Magnus Nordmo: Self-help for depression 5: Strategies against rumination

Better Thinking #38 — Prof Edward Watkins on Treatment of Depression & Rumination

Sleep Interventions

Cognitive Behavioural Therapy for Insomnia (CBT-I) is a structured and evidence-based psychotherapeutic approach designed to help individuals overcome insomnia and improve their sleep quality. It is widely recognized as the first-line treatment for chronic insomnia and has been found to be effective in addressing both primary insomnia (insomnia without an underlying medical or psychiatric condition) and secondary insomnia (insomnia linked to another medical or psychiatric issue). The overall goal of CBT-I is to improve sleep quality and duration, reduce the time it takes to fall asleep, and decrease night time awakenings. It has been shown to be effective for many individuals with insomnia and is considered a safe and lasting treatment option without the side effects associated with sleep medications.

Free and open access CBTi to help with insomnia.

CEDAR: Resting Well: Steps to a Good Night's Sleep 

TalkPlus: CBT for Insomnia

Matt Walker: The 6 Sleep Hacks You NEED!

ADAA Webinar: Cognitive Behavioural Therapy for Insomnia (CBT-I)

Podcasts: The Sleep Diplomat - Matt Walker 

Free and open access CBTi to help with insomnia. Information provided in English, Korean, Spanish, Italian and Chinese.

CEDAR: Translated Materials

Stress Management

Stress management refers to a wide range of techniques and strategies that individuals can use to effectively cope with and reduce stress in their lives. Stress is a natural response to challenging situations, but chronic or excessive stress can have negative impacts on physical and mental health. Effective stress management can help individuals better handle stressors and lead a more balanced and healthier life. It's important to note that there is no one-size-fits-all approach to stress management. Different strategies work for different people, and it's often beneficial to use a combination of techniques to effectively manage stress. Experimenting with various methods and regularly practicing stress management techniques can lead to a more balanced and less stressful life.

PDF and Links:

Mind: Stress

Stress Management Society

Mental Health Foundation: How to manage and reduce stress

TalkPlus: Stress

Practical Psychology: 13 Stress Management Techniques

Self Help Toons: Stop Stress: Tips for Stress Management and Stress Reduction

Self Help Toons: 6 Tips to Reduce COVID-19 Stress & Anxiety

Translated Materials

It is important that we consider the wide range of individuals that we encounter as a psychological practitioner. This section links to resources that will be useful for individuals who may require adapted materials to aid with their recovery. 

Materials in Different Languages

Cedar Translated Materials Weblink

Royal College of Psychiatrists Translated Mental Health Information

Get Self Help Materials

PHQ Screeners: PHQ & GAD translated into many languages

Materials for Deaf Individuals

University of Manchester BSL translated questionnaires: PHQ9, GAD7, WSAS

NTW NHSFT Self Help Leaflets (available in BSL)

Materials for Blind Individuals

Royal National Institute of Blind People (RNIB) mental health resources

NTW NHSFT Self Help Leaflets (available in easy read and audio)

NHS Mental Wellbeing Audio Guides

Wellbeing Maintenance

A wellbeing maintenance plan typically involves creating a structured set of strategies and techniques aimed at sustaining and enhancing an individual's overall mental health and wellbeing. This plan is personalised to the individual's needs and focuses on maintaining progress made during therapy. By implementing these components into their daily lives, individuals undergoing CBT can proactively manage their mental health and minimse the risk of relapse while promoting overall wellbeing. The plan is adaptable and evolves with the individual's progress and changing life circumstances.

Cheshire & Wiral W.R.A.P

Get Self Help Relapse Prevention

Personal Recovery & Maintenance Plan: Claire Attwood

Worry Management

Worry management refers to the strategies and techniques individuals can use to effectively cope with and reduce excessive or unproductive worrying. Excessive worrying, also known as generalised anxiety or chronic worry, can have a negative impact on mental health and overall well-being. Managing worry is essential for maintaining emotional balance and reducing the associated stress and anxiety. Worry management is not about eliminating all worry, as some level of concern is a natural part of life. It's about developing the skills and strategies to keep your worry in check, preventing it from dominating your thoughts and emotions. Effective worry management can lead to improved mental health, increased resilience, and a better overall quality of life.

TalkPlus: Worry Management

CEDAR: Managing your Worries

Centre for Clinical Interventions (CCI): Worry and Rumination

CRUfAD: Generalised Anxiety Disorder: Patient Treatment Manual

CAMHS Nottingham City: Worry Management - aimed at Children, Young People & Families

TalkPlus: Worry Video Modules

Self Help Toons: Turn Worrying Into Problem Solving with CBT for Anxiety

Self Help Toons: Best Strategy to Reduce Worrying and GAD with CBT

Other Helpful Resources

ChatGPT: AI in Therapy

ChatGPT can be used in therapy as a supplementary tool to enhance the therapeutic process, gather information, or provide additional support. 

However, it's important to recognise that ChatGPT is not a substitute for professional therapy or mental health treatment.  

While ChatGPT can be a valuable tool, it should complement professional therapy, not replace it. Always encourage clients to discuss their interactions with ChatGPT during therapy sessions to ensure that it aligns with their therapeutic goals and strategies. Additionally, it's important to prioritise clients' data privacy and the ethical use of AI in therapy, respecting confidentiality, and security.

https://chat.openai.com/

Computerised CBT

Computerised Cognitive Behavioral Therapy (cCBT) refers to the use of digital technology, such as software or web-based applications, to deliver cognitive-behavioral therapy to individuals. Computerised CBT can be used as a standalone intervention or as a complement to face-to-face therapy. It is not a replacement for traditional therapy but can be a valuable option, especially for individuals who may have limited access to mental health services or prefer a more self-directed approach. 

Numerous cCBT programs and apps are available, and some are evidence-based, meaning they have been tested in research studies and shown to be effective in reducing symptoms of various mental health conditions. It's important to choose a program that has been developed with input from mental health professionals and to consult with a healthcare provider to determine if cCBT is an appropriate treatment option.

https://www.getselfhelp.co.uk/online-computerised-cbt-external-links/

Positive Practice

Positive & Good Practice Guides

This section contains positive practice guides that may be useful to your practice. Again, this is not an exhaustive list but these are guides that I have found helpful in my own practice.  Admittedly, it is difficult to remain up to date on all the guides available (although I do try my best). 

If you are aware of new or updated positive practice guides, please let me know using the content recommendations button above.

Armed Forces Veterans Positive Practice Guide (2022)

Black, Asian, and Minority Ethnic Service User Positive Practice Guide (2019)

Children & Families  Good Practice Guide (2021)

Guide to support reasonable adjustments and

adaptations when working with autistic adults (2024)

Learning Disabilities: IAPT Positive Practice Guide (2015)

Lesbian, gay, bisexual, trans and queer good practice guide (Mindout, 2016)

Talking Therapies for Anxiety & Depression: LGBTQ+ Positive Practice Guide (2024)

Offenders (2013)

Older People (2024)

Perinatal (2023)

Trauma Informed Perinatal (2021)

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The Psych Ward: What is a Psychiatric Hospital Really Like?

What to expect when calling a helpline, emdr therapy for trauma, ptsd, anxiety, and panic.

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• Exposure Therapy: What is it and How Does it Help?
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• Meet Our Team
• What is CBT?
• How CBT works

Benefits of CBT

• Types of CBT

What to expect from CBT

How to know if cbt is working.

• Get the most from CBT

Cognitive Behavioral Therapy (CBT) What CBT is and How it Helps

Treatment for anxiety, depression, PTSD, substance abuse, and other mental health issues often involves breaking free of negative thought and behavior patterns. Here’s how CBT or “talk psychotherapy” can help.

What is cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy (CBT) is a form of “talk therapy” that focuses on developing healthier ways of managing your thoughts, emotions, and behavior. The main principle of CBT is to increase awareness of your negative thinking and unhelpful behaviors so you can respond to challenges in a more productive way.

CBT is conducted through a series of structured sessions in collaboration with a mental health professional. The goal is to provide tools that can be applied to manage unhealthy thinking and behavioral patterns in order to reduce distress.

Cognitive behavioral therapy can be useful for treating many different issues, including depression , anxiety, PTSD , substance abuse, and eating disorders. It can also help with emotional trauma, dealing with grief and loss , managing physical symptoms of a chronic illness, or coping with the stressful circumstances of daily life. CBT alone may be recommended if medication isn’t the best option, or it may be used in combination with other treatments and lifestyle changes.

Taking the first step towards change is often the hardest part. If you’re hesitant about trying CBT, keep in mind that it is a short-term technique which involves minimal risk or side effects. CBT can be delivered in person, either individually or in a group setting with family members or other people with similar concerns. Online therapy sessions have become increasingly popular, particularly during the pandemic, and can be a great option if you don’t have access to local mental health resources or feel more comfortable talking from home.

How cognitive behavioral therapy works

As the name implies, cognitive behavioral therapy is formulated on two different components: thoughts (cognition) and behaviors.

The cognitive aspect of CBT

The cognitive aspect is applied to what we think about and how this is processed. This is composed of core beliefs, dysfunctional assumptions, and negative automatic thoughts.

Negative core beliefs are learned early in life, primarily based on childhood experiences. For example, you may have formed negative views about yourself, the world around you, or how you see the future. You may also have negative core beliefs about other people, assuming they can’t be trusted or always have ulterior motives.

Dysfunctional of false assumptions about yourself could include the belief that you’re somehow inadequate or “My worth is connected with what others think of me.”

One of the primary cognitive components of CBT is to increase awareness of these types of views and how your thinking is based on long standing, negative assumptions. To accomplish this, your therapist may suggest:

Keeping thought records to help you recognize negative thinking patterns (known as cognitive distortions ) that may not actually be true. For example, you may think “Nobody cares about me,” or “If I don’t do well, it means I’m a failure.” As you become more aware of these negative thoughts, you can learn to reframe or replace them with more positive views, such as “Nobody is perfect. We all make mistakes, but that doesn’t mean I’m a failure.” Reframing your thoughts can also help you learn to view problems as challenges, rather than dwelling on them and feeling overwhelmed.

Role-playing . Your therapist may take on the role of another person in order to re-enact an anxiety-provoking situation. For example, if you’re fearful about going to the doctor for a check-up, the therapist will assume the role of the doctor and act out the scenario with you. Over time, this can help you build your confidence and find the best way to handle this type of situation in the future. The next time you see your doctor, you’ll have a less stressful experience because you’ve already worked out the issues that were making you feel worried or afraid.

The behavioral aspect of CBT

The behavioral component of CBT is most often used for anxiety-related disorders. This usually involves:

Activity scheduling . Planning each day in advance can make it seem more manageable, improve your decision-making, and reduce worry. Activity scheduling also helps you look forward to activities you enjoy to boost your mood and outlook—whether it’s taking a leisurely walk, getting involved in a community group, going out with friends, or visiting a museum.

Graded task assignments are manageable steps to decrease apathy and procrastination and overcome anxiety-provoking situations. If you’re depressed or anxious, for example, but want to plan an outing with a friend to go to a movie, the first step might be deciding which friend to go with. The next steps could involve calling your friend and choosing which movie to see. The final step would be following through and actually going to the movie theatre with your friend.

Testing out anxiety-producing predictions . These types of tasks are introduced gradually so that you learn to tolerate anxiety over time. For example, if you’re fearful about leaving the house, you may be asked to walk down the street and see if something bad actually happens. This technique can also help address avoidance behaviors that prevent you from facing your fears .

Learning relaxation and breathing techniques can be extremely useful for minimizing anxiety or alleviating a panic attack. Deep breathing exercises and mindfulness meditation are effective ways to relieve stress, focus on the present moment, and disconnect yourself from obsessive or negative thoughts. Your therapist may recommend listening to a guided meditation or practicing relaxation techniques whenever you’re feeling anxious.

CBT has been referred to as the “gold standard” of treatment because it is considered to be a highly effective approach for numerous problems. Research studies have shown that CBT can greatly improve quality of life and overall functioning.

With CBT, you can achieve more self-awareness and take control of negative self-talk. At the completion of your CBT treatment, you should be able to reframe negative thinking patterns and change your behavior. Since you will no longer be stuck in an unproductive mindset, you will feel less anxious and depressed. This will enable you to find more enjoyment in your daily life and feel motivated to make healthier lifestyle choices such as exercising regularly , eating more nutritious foods , and making sleep a priority .

Along with improving coping skills, CBT can also be effective for building self-esteem and self-confidence. The problem-solving abilities you’ll gain can be applied to all areas of your life. This also facilitates better decision-making and less procrastination when faced with challenges. CBT can also teach you how to communicate more effectively and manage your emotions to improve your relationships.

While the benefits are numerous, CBT is not suitable for everyone, so it’s important to consider both the pros and cons of talk therapy.

Advantages of CBT

• CBT can be tailored to the individual in order to target specific goals or problems.
• It can provide everyday skills and coping strategies that are easy to use.
• It offers support and accountability as you work in conjunction with a therapist or other mental health professional.
• Can be just as effective as medication in treating many mental health issues in the long-term.
• The treatment can be completed in a relatively short period of time, as compared to other types of therapy.
• Various tools can be incorporated to enhance the process, such as books, videos, apps, and computerized programs.

Disadvantages

• As with any type of therapy, finding the right therapist that you trust and feel comfortable with may take some work.
• CBT may bring up issues that make you feel uncomfortable. This may initially create additional anxiety or worsen existing behavioral problems.
• The focus of CBT is on addressing the issues you are currently facing, not causes or symptoms stemming from the past.

Types of cognitive behavioral therapy

There are various types of CBT that may be recommended by your therapist, depending on the specific issues you are dealing with. The goals remain the same for all types—to modify your negative ways of thinking and develop more effective coping skills.

Some of the main types of CBT include:

Dialectical behavior therapy (DBT) was developed mainly to treat people with borderline personality disorder (BPD) , but is now used for a variety of mental health issues, including ADHD, eating disorders , substance abuse, and PTSD . DBT is similar to CBT, but is more focused on coming to terms with uncomfortable feelings, emotions, and behaviors. This can improve coping skills and problem-solving abilities to cultivate more resilience .

Mindfulness-based cognitive therapy (MBCT) combines CBT with meditation to treat anxiety, depression, and bipolar disorder . You may be familiar with mindfulness techniques for stress reduction or as part of a yoga practice. The goal of MBCT is to help you become less-judgmental and concentrate more on a present-moment mindset.

Acceptance and commitment therapy (ACT) utilizes strategies related to acceptance and mindfulness to increase the ability to concentrate on a present-oriented state of being. With ACT, you will be working towards behavior change by dealing with thoughts, feelings, and memories that you have been avoiding.

Rational emotive behavior therapy (REBT) was the foundation for CBT and is based on how our thoughts influence our behavior. The three principles are activating events, beliefs, and consequences. We often have irrational thoughts and beliefs that shape our behavior on a daily basis, even though we may not be consciously aware of these thoughts. This therapy promotes the development of more rational thinking to foster healthier behaviors and responses to situations.

Exposure therapy is a type of CBT used for obsessive-compulsive disorder (OCD) , post-traumatic stress disorder (PTSD), and various phobias and irrational fears . The triggers for your anxiety are identified and specific techniques are applied to reduce these sensations. One method of exposure therapy targets these triggers all at once time (flooding). The other strategy is a more gradual process of dealing with different triggers over a period of time (desensitization).

[Read: Therapy for Anxiety Disorders]

Interpersonal therapy (IPT) is most often used to treat depression , but is also effective for other mental health conditions. In these sessions, a therapist will help you examine your relationships with other people and work on developing better social skills to improve interactions with others.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

During CBT sessions with a therapist, you will work together to identify problems and find workable solutions to manage these problems. The goals you will focus on the ‘SMART’ model: Specific, Measurable, Achievable, Realistic, and Time-limited.

Your therapist will help you prioritize these goals and set up incremental steps to achieve them. If you’re feeling depressed, for instance, you may have a hard time setting goals or believing that you can attain them. Having the support of a mental health professional can enable you to develop more realistic goals and maintain your motivation throughout the course of treatment.

You may also be given “homework” assignments to guide you during therapy, such as journaling to record your disturbing thoughts or practicing breathing exercises when you’re feeling anxious. All of these components will be important steps in the healing process.

Your first CBT sessions

CBT is a time-limited treatment that is usually completed in 5-20 sessions. You will generally meet with a therapist once-a-week or once every two weeks. Each session lasts about 30-60 minutes.

The first session is primarily an assessment of your current situation. The therapist will ask questions about the challenges you’re facing and how any feelings of anxiety or depression are interfering with your family life, work, or personal relationships. They may also go over a treatment plan that will benefit you.

This is also a time to begin evaluating whether there is a good rapport between you and the therapist.

[Read: Finding a Therapist Who Can Help You Heal]

During your early sessions, the therapist will outline the expectations related to the course of treatment. You will work as a team with the therapist to break down problems into more manageable parts.

Your thoughts, feelings, and behaviors will be addressed through various tasks and exercises. While the aim will be to change specific thoughts and behaviors that are not serving you well in your life, rest assured that you will not be expected to do anything you don’t feel comfortable with.

In subsequent sessions, you will focus on applying these desired modifications to your daily life. By practicing coping techniques and other helpful skills, you will be better able to function independently once the CBT sessions have been completed. This will increase the likelihood that your anxiety, depression, and other symptoms will not resurface.

During the course of treatment, you will be able to assess whether CBT is having a positive impact. Here are a few indications:

• You are developing new skills that are modifying negative thinking and behaviors in your life.
• You are making headway towards achieving long-term goals by breaking them down into smaller steps.
• Your therapist is able to measure results and provide evidence of your progress with specific tests and exercises.
• You are feeling more optimistic and connected to friends and family members.
• Others have observed and commented on the progress you’re making and are supportive of your efforts.
• You look forward to your CBT sessions and feel motivated to continue with the work.

Your mental health provider should give you an estimated time frame for when you will begin to see results. Some conditions will improve after only about 12 sessions, but others may take a few months.

If you are uncertain about whether the treatment is working, be sure to share your concerns with your therapist. There’s no shame in asking for additional help. Your therapist may recommend combining CBT with medication or trying another type of talk therapy or counseling. The most important thing is to make sure you’re receiving the help you need.

Getting the most from cognitive behavioral therapy

CBT is a commitment that takes work on your part for a successful outcome. You will be entering into a partnership with a therapist, and how you incorporate their guidance to your advantage is up to you. Whether you opt for in-person or online therapy , you will reap the most benefit if you:

Follow through with all the sessions as outlined by your therapist and complete any homework, graded task assignments, or activity scheduling exercises.

Openly share your feelings with your therapist . This includes letting your therapist know if you feel the therapy is not working or is not the right fit for you. You should feel comfortable and have a good rapport with your therapist in order to move forward. There are many therapists to choose from and various types of therapies that can be tailored to your individual needs.

Are ready and willing to change . CBT can be highly effective if you are willing to devote the necessary time and effort it takes to apply these skills to your daily life.

One of the most significant outcomes of CBT is understanding that you have the ability to make changes in your life. CBT can help you realize that other people and outside situations are not responsible for your problems—but rather, it’s often your own thoughts and reactions that create these negative perspectives.

When you change your thoughts, you also change the way you feel and behave. By eliminating “black and white” (all-or-nothing) thinking, you can expand your horizons and embrace a more holistic view of the world. These changes can support the effort you put forth in therapy and offer greater fulfillment in your life.

More Information

• How it works – Cognitive behavioural therapy (CBT) - Guide to CBT. (NHS)
• Evaluating Outcomes: 5 Signs Cognitive Therapy Is Working for Someone with Schizophrenia or Other Mental Illness - Tips on assessing how well therapy is working for you. (RtoR.org)
• Fenn, Kristina, and Majella Byrne. “The Key Principles of Cognitive Behavioural Therapy.” InnovAiT 6, no. 9 (September 1, 2013): 579–85. Link
• David, Daniel, Ioana Cristea, and Stefan G. Hofmann. “Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy.” Frontiers in Psychiatry 9 (January 29, 2018): 4. Link
• https://www.apa.org. “What Is Cognitive Behavioral Therapy?” Accessed April 11, 2022. Link
• “Psychotherapy | NAMI: National Alliance on Mental Illness.” Accessed April 11, 2022. Link
• Twohig, Michael P., Michelle R. Woidneck, and Jesse M. Crosby. “Newer Generations of CBT for Anxiety Disorders.” In CBT for Anxiety Disorders: A Practitioner Book , 225–50. Wiley Blackwell, 2013. Link
• Turner, Martin J. “Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes.” Frontiers in Psychology 7 (September 20, 2016): 1423. Link
• “Overview of IPT | International Society of Interpersonal Psychotherapy – ISIPT.” Accessed April 11, 2022. Link
• “ACT | Association for Contextual Behavioral Science.” Accessed April 11, 2022. Link
• Lopez, Molly A., and Monica A. Basco. “Effectiveness of Cognitive Behavioral Therapy in Public Mental Health: Comparison to Treatment as Usual for Treatment -Resistant Depression.” Administration and Policy in Mental Health 42, no. 1 (January 2015): 87–98. Link
• Hofmann, Stefan G., Anu Asnaani, Imke J.J. Vonk, Alice T. Sawyer, and Angela Fang. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses.” Cognitive Therapy and Research 36, no. 5 (October 1, 2012): 427–40. Link

More in Therapy & Medication

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Cognitive Distortions

Put an end to negative thinking

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How hotlines, crisis lines, and peer support services work

Using Eye Movement Desensitization and Reprocessing

Support Groups

Is a support group right for you?

Exposure Therapy

Benefits, types, getting the most from treatment

Professional therapy, done online

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• Cognitive conceptualisation (excerpt from Basics and Beyond) | J. Beck Download Archived Link
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• A case formulation approach to cognitive-behavior therapy | Jacqueline Persons | 2015 Download Primary Link Archived Link
• The case formulation approach to cognitive behavior therapy | Jacqueline Persons | 2014 Download Primary Link Archived Link

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• Cognitive- behavioural therapy An information guide | Neil Rector | 2010 Download Primary Link Archived Link
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Presentations

• The role of a case conceptualization model and core tasks of intervention | Donald Miechenbaum | 2014 Download Primary Link Archived Link
• Transdiagnostic treatments for anxiety disorders | Martin Anthony | 2013 Download Primary Link Archived Link
• The unified protocol for the transdiagnostic treatment of emotional disorders | Ellen Frank, Fiona Ritchey | 2015 Download Primary Link Archived Link
• Making CBT Work (Working with your CBT therapist / Making your CBT therapist work with you) | Paul Salkovskis Download Archived Link

Treatment Guide

• A manual of cognitive behavior therapy for people with learning disabilities and common mental disorders | Hassiotis, Serfaty, Azam, Martin, Strydom, King | 2012 Download Primary Link Archived Link
• CBT case formulation | Jacqueline Persons Download Primary Link
• Cognitive Interpersonal Cycle Worksheet | Stirling Moorey | 2007 Download Primary Link Archived Link

Recommended Reading

• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research, 36(5), 427-440 Download Primary Link
• Schema change processes in cognitive therapy | Padesky | 1994 Download Primary Link Archived Link
• Wright, B., Williams, C., & Garland, A. (2002). Using the Five Areas cognitive–behavioural therapy model with psychiatric patients. Advances in Psychiatric Treatment, 8(4), 307-315. Download Primary Link
• Williams, C., & Garland, A. (2002). Identifying and challenging unhelpful thinking. Advances in Psychiatric Treatment, 8(5), 377-386. Download Primary Link
• Garland, A., Fox, R., & Williams, C. (2002). Overcoming reduced activity and avoidance: a Five Areas approach. Advances in Psychiatric Treatment, 8(6), 453-462. Download Primary Link
• Williams, C., & Garland, A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8(3), 172-179. Download Primary Link
• A provider’s guide to brief cognitive behavioral therapy | Cully, Dawson, Hamer, Tharp | 2021 Download Primary Link Archived Link
• Padesky, C. A., Mooney, K. A. (1990). Clinical tip: presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14 Download Primary Link Archived Link
• Arch, J. J., & Craske, M. G. (2009). First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatric Clinics of North America, 32(3), 525-547 Download Primary Link Archived Link

What Is Cognitive Behavioral Therapy?

Assumptions of cbt.

• people actively process information;
• our appraisals (the way that we think and interpret events) determine how we feel;
• dysfunctional thinking and biases in information processing (cognition/​thinking) are responsible for the problems that people experience;
• different problems are associated with different cognitive themes (cognitive specificity theory): depression is associated with loss and defeat; anxiety is associated with danger and threat; obsessive-compulsive disorder is associated with inflated responsibility; substance abuse is associated with permissive beliefs; eating disorders are associated with self-criticism; social anxiety is associated with fear of evaluation; and PTSD is associated with appraisals of immediate threat;
• the thoughts that we have can be ‘distorted’ or biased . Common biases include over-generalization, arbitrary inference, selective abstraction, and catastrophizing;
• changing how we think and act will impact how we feel: cognition, emotion, and behavior interact in a reciprocal manner;
• psychopathology is a result of an interaction between stress and vulnerability;
• cognition happens at multiple levels (Alford & Beck, 1997) and all can influence the way that we feel and behave: preconscious, unintentional, automatic (e.g., negative automatic thoughts); the conscious level (e.g., if a patient is asked to explain the meaning of an automatic thought); and the metacognitive level (beliefs about beliefs);
• experiences, memories, thoughts, attitudes, and beliefs are encapsulated as ‘schemas’ and which may become activated and influence our perceptions and behaviors.

Principles of CBT

Judith Beck (1995) identified 11 principles of the practice of cognitive behavioral therapy, and these were expanded by Wills (2009):

• cognitive behavioral therapists use formulation to focus their therapeutic work
• cognitive behavioral therapists use formulation to tackle interpersonal and alliance issues
• cognitive behavioral therapy requires a sound therapeutic relationship
• cognitive behavioral therapists stress the importance of collaboration in the therapeutic relationship
• cognitive behavioral therapy is brief and time-limited
• cognitive behavioral therapy is structured and directional
• cognitive behavioral therapy is problem- and goal-oriented
• cognitive behavioral therapy initially emphasizes a focus on the present
• cognitive behavioral therapy uses an educational model
• homework and self-practice is a central feature of cognitive behavioral therapy (incorporating the use of CBT worksheets)
• cognitive behavioral therapists teach clients to evaluate and modify their thoughts
• cognitive behavioral therapy uses various methods to change cognitive content including thought records, behavioral experiments, surveys
• cognitive behavior therapy uses a variety of methods to promote behavioral change including exposure, behavioral experiments, role-play.

Procedures and Techniques of CBT

• Data gathering and symptom monitoring   are used to understand problems and to measure change. CBT is an evidence-based approach that relies upon accurate data gathering regarding symptoms and experiences.
• Behavioral activation   is a set of techniques for encouraging engagement in meaningful activity and is an effective treatment for depression.
• Case formulation   is a method for understanding the origin and maintenance of a problem in cognitive and behavioral terms. CBT therapists may use a mixture of cross-sectional formulation to understand difficulties in the here-and-now, longitudinal formulation to understand the origins and precipitants of a problem, and cognitive behavioral models to understand the mechanisms underlying a problem.
• Cognitive restructuring   describes techniques for changing what we think. It often involves the use of thought records, behavioral experiments, data gathering, or psychoeducation.
• Exposure   is a technique from behavior therapy that is extensively used by CBT therapists, particularly for the treatment of anxiety. ‘Facing your fears’ is an essential behavioral component of CBT.
• Problem solving   describes a series of techniques that are often taught as part of a CBT intervention. Effective problem solving helps people to make adaptive choices.
• Socratic methods are used by CBT therapists to help their clients explore what they know, and to form their own opinions on a topic. Aaron Beck encouraged the use of Socratic-like technique in his original treatment manual “use questioning rather than disputation and indoctrination … it is important to try to elicit from the patient what he is thinking rather than telling the patient what the therapist believes he is thinking” (Beck et al, 1979).
• Alford, B. A., & Beck, A. T. (1997). The relation of psychotherapy integration to the established systems of psychotherapy.  Journal of psychotherapy integration ,  7 (4), 275-289.
• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford.
• Beck, J. S. (1995). Cognitive therapy: Basics and beyond . New York: Guilford.
• Wills, F. (2009). Beck’s cognitive therapy . CBT Distinctive Features Series. New York: Routledge.
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Therapy Worksheets and Handouts for CBT, DBT, ACT, and More

Worksheets are excellent learning tools that can help gauge a child’s understanding of certain topics, put learnings into practice, and build logic. DBT, CBT, and ACT are prominent therapeutic approaches, all of which you can reinforce through worksheets. But with so many worksheet options, how do you know which is right for you?

This guide will provide a list of therapy worksheets that can help you manage intense emotions, improve thought patterns, and live a more fulfilling life aligned with your values. Discover the best worksheets for your child’s specific needs.

Cognitive Behavioral Therapy Worksheets and Handouts

CBT can help individuals who feel stuck in their negative thought patterns. Here are a few CBT worksheets, handouts, and posters to help identify and challenge negative thinking.

The Cognitive (CBT) Triangle

The CBT triangle illustrates the interconnectedness of thoughts, emotions, and behaviors, emphasizing how these three elements influence one another. It typically places thoughts at the top and emotions and behaviors at the bottom corners.

Understanding the CBT triangle provides a framework for identifying unhelpful thinking patterns and developing strategies for managing them.

Download the handout here

Cognitive Distortions Handout

CBT centers around cognitive distortions , which are inaccurate thinking patterns that negatively bias how you see yourself and the world [ * ]. Our handout outlines common cognitive distortions, such as catastrophizing , magnification/minimization, emotional reasoning , and jumping to conclusions . It helps individuals increase their self-awareness and reflect on their behaviors.

Common Cognitive Distortions Handout

Part of overcoming cognitive distortions is learning to identify them. Use this handout of 15 common cognitive distortions to reflect on which ones you might be displaying.

Our handout lists thinking errors like emotional reasoning, magnification/minimization, blaming, and personalization.

Cognitive Restructuring Handout

Cognitive restructuring is a technique that helps you notice, challenge, and replace your negative thinking patterns with more realistic or helpful thoughts. There are several techniques that help you to effectively utilize cognitive restructuring, including “thought record,” “reattribution,” “cognitive rehearsal,” and “cost-benefit analysis.”

Decatastrophizing Handout

Decatastrophizing is a crucial technique for challenging and modifying distorted thinking patterns, specifically those that lead to excessive worry or anxiety. Our handout encourages clients to identify the catastrophic thought, examine the evidence, consider alternatives, and develop a coping plan to reduce stress and improve problem-solving.

Challenging Negative Thoughts Poster

Negative thought patterns act like distorted lenses, coloring our perception of reality and fueling negative emotions. Challenging these patterns allows us to see situations more realistically, reducing emotional distress and empowering us to respond with healthier behaviors.

Use our handout on challenging negative thoughts as a reminder to stay grounded and fight against cognitive distortions.

Download the poster here

Anxious Thoughts Breakdown Worksheet

Anxious thoughts often snowball, leading to fear and avoidance. Breaking them down allows you to examine their validity. By questioning their accuracy and considering alternative perspectives, you can calm your emotions and make more rational decisions.

Our anxious thoughts breakdown worksheet asks clients to replace anxious thoughts with truthful, calm ones, which is especially helpful in CBT for teens .

Download the worksheet here

Exploring My Emotions Worksheet

Children, especially younger ones, may have trouble identifying and reflecting on their emotions. Thankfully, our worksheet makes this process simpler and more palatable. It provides visuals for children to learn more about how a specific emotion looks and feels. It asks them to reflect on their thoughts when they feel a particular emotion and how they act upon it.

Changing Negative Thoughts Worksheet

Negative thoughts act like broken records, playing on repeat and fueling negativity. Changing them disrupts this cycle.

Use our worksheet to develop a more positive mindset and observe your thoughts without judgment.

Dialectical Behavioral Therapy Worksheets and Handouts

It’s common to feel overwhelmed by emotions, especially when undergoing something stressful. Dive into our DBT worksheets and handouts to learn skills for managing stress, regulating emotions, and building healthier relationships.

DBT Cheat Sheet Handout

It takes time to grasp DBT for kids and teens fully, but our DBT cheat sheet can provide essential and easy-to-reference material as you go on your healing journey. It outlines vital DBT strategies, such as self-soothing and emotion regulation, which clients can use to improve their coping mechanisms.

Wise Mind Worksheets

Developing a wise mind means finding a balance between emotional and reasonable—an essential component of DBT for teens and kids. With our wise mind worksheets, clients can practice making rational decisions by acknowledging their emotions without judgment.

This collection of worksheets asks clients to recount stressful experiences and how they dealt with them, encouraging them to find more productive ways of reacting and coping.

Download the worksheets here

DBT STOP Skill Handout

The DBT STOP skill encourages individuals to step back, evaluate the situation, and find a productive response. Our worksheet provides methods for staying in control and acting less impulsively, leading to better decision-making.

DBT TIPP Skills Worksheet

While developing long-term coping strategies in DBT is important, knowing short-term solutions like TIPP is just as essential. Our DBT TIPP skills worksheet outlines tips for regulating emotions and behavior, replacing dysfunctions that could harm them.

Subjective Units Of Distress Scale (SUDS) Handout

The Subjective Units of Distress (SUD) Scale is a simple tool that measures the intensity of your distress on a scale from 0 (completely calm) to 100 (unbearably upset). Our handout helps people struggling with strong emotions become more aware of their emotional state. By assigning a number to their distress, they gain a more objective perspective and can track their progress in managing difficult emotions.

Urge Surfing Worksheets

Urge surfing entails “riding out” the wave of emotions, encouraging individuals to approach stressors mindfully. Our urge surfing worksheets ask clients to reflect on their triggers and brainstorm mindfulness methods.

DBT House Worksheet

The DBT house model represents an individual’s inner world—their values, hopes, emotions, and coping mechanisms. Our DBT house worksheet asks clients to explore different aspects of their lives, increasing self-awareness by reflecting on what influences them.

DBT Coping Statements Handout

DBT coping statements are short, positive affirmations you can repeat to yourself during emotional distress. They challenge negative thinking patterns and promote acceptance. By focusing on these statements, you can calm your emotions and shift your perspective towards more effective ways of coping with challenging situations.

Walking The Middle Path Skills Handout

If you struggle with all-or-nothing or black-and-white thinking, walking the middle path can teach you balance. Our handout encourages individuals to reflect on how they can practice self-care while caring for others, disagreeing with someone while remaining friends, and conveying their opinions without disrespect.

Self-Soothe With 6 Senses Worksheets

Self-soothing with the six senses can train the body to reach a calm, peaceful place, thus establishing emotion regulation. Our worksheets suggest calming activities and motivate clients to reflect on triggers that affect each sense.

Acceptance and Commitment Therapy Worksheets and Handouts

Acceptance and Commitment Therapy (ACT) helps you accept complex thoughts and feelings without judgment while committing to acting toward living a valued and meaningful life. Below are some ACT worksheets and handouts to help you begin the process. Here are some acceptance and commitment therapy worksheets to study:

• How Does Emotion Affect Your Life?
• Values and Problems

Mindfulness-Based Cognitive Therapy Worksheets and Handouts

Mindfulness in CBT involves cultivating present-moment awareness without judgment. By observing your thoughts and feelings with the help of these worksheets, you can gain a clearer perspective on their validity and influence on your behavior. Here are some mindfulness-based cognitive therapy worksheets and handouts to study:

• The Five Senses Worksheet
• Funeral Meditation
• Mindfulness: The Present Moment

Schema Therapy Worksheets and Handouts

Schema therapy focuses on identifying early childhood experiences that led to unhealthy thinking, feeling, and behavioral patterns. These schemas can be unhelpful in adulthood, and schema therapy worksheets and handouts aim to replace them with healthier coping mechanisms and more balanced ways of relating to yourself and the world. Here are some schema therapy worksheets and handouts to study:

• Schemas, Needs, and Modes Reference Sheet
• Coping Styles and Responses
• Adding Up Inferences

Narrative Therapy Worksheets and Handouts

Narrative therapy views problems as separate from the person experiencing them. It focuses on helping individuals rewrite their life stories, emphasizing their strengths and resilience in overcoming challenges. By crafting a new narrative with the help of our worksheets, you can improve your sense of agency and foster a more positive outlook on life. Here are some narrative therapy worksheets and handouts to study:

• Life Story Worksheet
• Useful Narrative Therapy Questions
• Narrative Therapy: What’s Your Story?

Solution-Focused Brief Therapy Worksheets and Handouts

Problem-solving is a core skill because it empowers individuals to take control of challenging situations. By identifying the problem, brainstorming solutions, evaluating their effectiveness, and implementing the most promising option, our worksheets can help navigate difficulties practically and effectively. Here are some solution-focused brief therapy worksheets and handouts to study:

• Motivation and Ambivalence
• Top Five Strengths
• Problem-Solving

The Bottom Line

Psychotherapy offers a diverse toolbox for addressing mental health challenges. By understanding the core principles of DBT, CBT, ACT, and other approaches through our worksheets, you can embark on a journey of self-discovery and emotional well-being.

Explore our entire collection of worksheets to improve your coping mechanisms and discover new tips and tricks.

• Fortune, E. “Cognitive distortions as a component and treatment focus of pathological gambling: A review.” Psychology of Addictive Behaviors, 2012.

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Open Access

Peer-reviewed

Research Article

Validation of new tablet-based problem-solving tasks in primary school students

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany, Institute for Child and Youth Education, University of Kaiserslautern-Landau, Landau, Germany

Roles Conceptualization, Investigation, Writing – review & editing

Affiliation Institute for Child and Youth Education, University of Kaiserslautern-Landau, Landau, Germany

Roles Conceptualization, Funding acquisition, Resources, Writing – review & editing

Roles Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Writing – review & editing

Affiliations Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany, Center for Research on Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany

• Jonas Schäfer, 
• Timo Reuter, 
• Miriam Leuchter, 
• Julia Karbach

• Published: August 29, 2024
• https://doi.org/10.1371/journal.pone.0309718
• Peer Review
• Reader Comments

Problem-solving is an important skill that is associated with reasoning abilities, action control and academic success. Nevertheless, empirical evidence on cognitive correlates of problem-solving performance in childhood is limited. Appropriate assessment tools are scarce and existing analog tasks require extensive coding. Thus, we developed and validated new tablet-based versions of existing analog tasks assessing technical problem-solving with gear construction tasks. To validate these tasks, 215 children (6–8 years) performed the problem-solving tasks in both modalities (analog, digital). To investigate whether performances in both modalities were correlated with other cognitive abilities, participants performed three additional tasks assessing language, reasoning and problem-solving. Structural equation modelling showed that performance was substantially correlated across modalities and also correlated with language, reasoning and another problem-solving task, showing the convergent validity of the digital tasks. We also found scalar measurement invariance across task modalities indicating that both task versions can be used interchangeably. We conclude that both versions (analog and digital) draw on similar cognitive resources and abilities. The analog tasks were thus successfully transferred to a digital platform. The new tasks offer the immense benefits of digital data collection, provide a valid measuring tool advancing problem-solving research in childhood and facilitate the application in the field, e.g., in the classroom.

Citation: Schäfer J, Reuter T, Leuchter M, Karbach J (2024) Validation of new tablet-based problem-solving tasks in primary school students. PLoS ONE 19(8): e0309718. https://doi.org/10.1371/journal.pone.0309718

Editor: Adel Tekari, Centre of Biotechnology of Sfax: Centre de Biotechnologie de Sfax, TUNISIA

Received: March 12, 2024; Accepted: August 16, 2024; Published: August 29, 2024

Copyright: © 2024 Schäfer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data that support the findings of this study are openly available from the GitHub database in the repository GTT_Validation under the following URL: https://github.com/jonato-bit/GTT_Validation.git .

Funding: This work was supported by the Ministry of Science, Further Education, Research and Culture, Rhineland-Palatinate, Germany. The funders awarded ML and JK (without grant number). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Problem-solving refers to the process of achieving a goal state that is different from an initial state by performing a series of cognitive or motor actions [ 1 ]. This process is typically characterized by the following interdependent phases: (a) understanding and mentally representing the problem, (b) developing plans and strategies to solve it, (c) practically implementing the plans and (d) evaluating (intermediate) outcomes [ 2 ]. Aside from minor variations, there is much agreement on these four phases of problem-solving across different domains [ 3 – 5 ]. Problem-solving skills develop significantly during the pre- and primary school years and benefit many important life outcomes, e.g., academic success and social skills [ 6 ]. Understanding, structuring and intentionally solving a problem requires perceptual, motor and creative resources [ 7 ]. Exposure to problem-solving challenges promotes reasoning and learning processes in children [ 8 ] and is associated with systematic and critical thinking [ 9 ]. Therefore, problem-solving abilities are considered major educational learning outcomes [ 4 ]. Furthermore, problem-solving is closely related to higher-order cognitive functions, such as fluid intelligence [ 10 ] and executive functions [ 11 ].

Technical problem-solving is considered a prototypical subtype of general problem-solving [ 4 ], since it implements the four phases of problem-solving by performing manual actions (phase c) with observable effects (phase d) that are clearly different from the cognitively-based planning (phases a and b) [ 2 , 12 ]. Therefore, technical problems have often been applied in recent empirical research on problem-solving in pre- and primary school children [ 13 – 15 ].

Since problem-solving relies on various higher-order cognitive processes [ 7 , 16 ], the requirements for age-appropriate measures assessing problem-solving skills and strategies in children are high [ 17 ]. The design cognition framework focusses on the cognitive processes involved in technical designing and problem-solving and is commonly applied in pre- and primary school research [ 15 ]. Design cognition research identifies the problem-solving phases based on participants’ think-aloud utterances during design task performance (e.g., “Design and build a bug box that does not allow frogs in but allows bugs in/out” [ 15 ]). Thus, conclusions on cognitive processes during technical problem-solving are commonly drawn from protocol-coding of children’s actions and their own verbal reasoning on them [ 15 ].

To examine technical problem-solving skills in preschool children, previous studies applied gear turning tasks ( GTT ) with toy-like gears, propellers and a plastic pegboard [ 18 ]. In these tasks, children were to assemble gears and propellers according to specific instructions in terms of their turning direction and turning speed (e.g., assembling gears so that they would turn in the same direction). In contrast to protocol-based evaluation methods, this study design provided the advantage that correct target states were clearly defined and the phases of problem-solving could be observed by analyzing the way participants organized, moved, interconnected and turned the gears and propellers [ 18 ]. Moreover, it integrated relevant scientific knowledge with logical understanding and goal-directed behavior. However, the analog implementation of the GTTs required considerable time in terms of set-up, coding and data processing.

Compared to analog testing, digital assessment methods offer numerous advantages [ 19 ]. Performance data, such as reaction times, can be saved more precisely and reliably. Moreover, coding algorithms can process data efficiently, rendering the need for the very time-consuming analog coding obsolete. Only a terminal device is needed to perform the experiment, instead of large quantities of analog materials. Instructions can be presented more standardized and their timing is more comparable across subjects, while the tasks can be designed in a child-friendly way [ 20 ]. In current research, digital measurement is increasingly preferred over analog measurement. For instance, formerly paper-based tests are successively digitized in neuropsychological contexts to enable more efficient diagnostic assessments [ 21 ]. Similarly, problem-solving skills in adolescents are assessed by means of digital paradigms, such as microworlds , simulating real-life problem situations [ 22 , 23 ], and classic cognitive tests such as the Corsi Block-Tapping task, the Stroop task and the Trail-Making test are routinely administered digitally across a wide range of ages [ 24 ].

However, newly digitized test instruments require thorough validation [ 24 ], which is usually achieved by demonstrating convergent validity of the digital test against the analog counterpart [ 25 ]. Convergent validity of digital multiple-choice tests is usually shown by significant medium-sized correlations with the paper-and-pencil version [ 26 ]. When measuring more complex digitized tests assessing higher-order cognitive skills, like the Trail-Making test [ 27 ], evidence for convergent validity is additionally provided by testing the strength of associations between related cognitive measures and both the digital and the analog versions of the test [ 28 ]. Moreover, the convergent validity is demonstrated via structural equation modelling assessing measurement invariance across latent factors of the analog and digital tests [ 29 ].

In this study, we developed digital, tablet-based versions of technical problem-solving tasks for children. We chose the GTTs that were applied in previous studies using analog test materials because they are appropriate for assessing five- to eight-year-old children’s technical problem-solving [ 18 ]. Our aim was to validate the newly developed digital GTTs in six- to eight-year-old children. We therefore tested (1) whether performances on both modalities (analog and digital) were correlated with each other and with related measures (a language task, a reasoning task and another problem-solving task), (2) whether performance was measurement invariant across modalities, (3) whether performances on both modalities were predicted by related measures and (4) whether these predictive values differed between modalities. We expected substantial correlations between modalities, significant predictive values of related measures, that did not differ between modalities and that performances on both modalities (i.e., both task versions) were measurement invariant at the scalar level.

Materials and methods

Participants.

A power-analysis (parameters: r = .25, α = .05, 1- β = .90) for correlational analyses resulted in a required sample size of n = 164. Power-analyses (parameters: r = .25, α = .05, 1- β = .90) for structural equation modeling analyses resulted in a required sample size of n = 43 for the highest degrees of freedom ( df = 7) and n = 54 for the lowest degrees of freedom ( df = 5). In sum, 215 children between six and eight years of age ( M = 7.18 years, SD = 0.78; 89 female) participated in the study voluntarily and with written informed consent of their parents or caregivers. The recruitment period started on October 11, 2021 and ended on January 20, 2022. The study was approved by the local ethics committee (application #361). Participants were recruited in a town in southwestern Germany with a heterogeneous and diverse population [ 30 ]. The inclusion criterion was age (6–8 years; established prior to data analysis). We established no further exclusion criteria in order to minimize any selectivity of the sample.

Participants completed ten tasks across two 30-minute sessions with a 60-minute break. During both sessions, the child worked individually with a trained experimenter at the lab. In session one, children completed a language task, a reasoning task and a problem-solving task ( stabilization task ) to assess the convergent validity of the newly developed digital problem-solving tasks. Children also completed three conceptual knowledge tasks that are not relevant for the present analyses. Session two served to validate the new digital version of the problem-solving gear turning tasks (GTTs) against the analog version. It therefore included both GTTs ( carousel and propeller ) in both modalities (analog, digital). Task modality (analog, digital) and task type (carousel, propeller) were counterbalanced across participants. Sessions were video recorded and tasks were instructed in German language.

All digital tasks were administered on a 10.1-inch sized tablet (Samsung Galaxy Note 10.1, Android version 5.1.1). The tablet program was developed in Unity (2020.3.17f1) and built via Android SDK (compression method LZ4). The digital GTTs were processed by single-point swipe control in a two-dimensional response space ( Fig 1A ). Each gear had an inner and an outer radius. The inner radius was defined as the distance between a gear’s center and the closest point of the notches between two gear teeth. The outer radius extended to the outer end of the gear teeth. The gears and propellers were moved via drag-and-drop with the currently selected object slightly protruding in perspective. When a gear was dropped onto the board, its new position was aligned with a grid that exactly mimicked the analog pegboard (20x14 plug-in options). Since the inner radii of two gears on the board could not overlap, gears released at an invalid position snapped in at the position with the smallest possible distance to the release position that was not less than the sum of the two overlapping inner gear radii. Gears located on the board could be turned by circularly swiping in the area between the inner and the outer radius. Whenever the distance between two gears was less than the sum of their outer radii and greater than the sum of their inner radii, they were considered to be connected and, thus, drove each other when turning. Propellers were dragged to the center of a gear to attach them to it and consequently moved and turned uniformly with this gear. Children had sufficient time to familiarize with the tablet handling. The analog version of the GTTs, carousel and propeller, was administered with a pegboard and plastic gears ( Fig 1B ).

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

(A) Experimental set-up of the digital carousel task, (B) experimental set-up of the analog carousel task, (C) experimental phase 1 of the carousel task, (D) experimental phase 2 of the carousel task, (E) experimental phase 3 of the carousel task, (F) experimental phase 1 of the propeller task, (G) experimental phase 2 of the propeller task, (H) experimental phase 3 of the propeller task. GTT = Gear turning task.

https://doi.org/10.1371/journal.pone.0309718.g001

Language: Receptive vocabulary (Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV)) [ 31 ].

Participants saw consecutive displays with four pictures on a tablet screen and had to point to the picture named by the experimenter. The task included two practice trials and up to 35 test trials. It was aborted after three consecutive errors. The dependent variable was the number of correctly solved items.

Reasoning: Matrix reasoning (WPPSI-IV [ 31 ]).

Participants saw a 2x2 matrix on a tablet screen containing three pictures and one question mark. They were instructed to pick one out of four or five figurative response options to complete the matrix pattern. The task included three practice trials and up to 26 test trials. It was aborted after three consecutive errors. The dependent variable was the number of correctly solved items.

Problem-solving: Stabilization task (cf. [ 32 ]).

Participants saw instable constructions of rectangular and triangular wooden blocks. Participants had up to three attempts to place another color-coded block stabilizing the construction. The task included one practice trial and eight test trials. The dependent variable was scored according to the number of required stabilizing attempts (items successfully solved at the first attempt: three points; one point less for each failed attempt; scoring range: 0–24).

Problem-solving: Carousel task [ 18 ].

Participants saw a rectangular board with a driving gear and a target gear (introduced as a carousel) on it ( Fig 1C ). Both were marked by a circular arrow indicating a clockwise turning direction. Participants had to make the target gear turn clockwise when turning the driving gear clockwise by using other gears of four different sizes to connect driving and target gear. After three minutes or when participants indicated that they had finished constructing, the first experimental phase was over. In the second experimental phase, the experimenter removed the pegboard (analog modality) or the tablet (digital modality) temporarily and showed a printed picture of the initial state of the board to the participants (i.e., the state shown in Fig 1C ). Subsequently, participants were asked to repeat the task requirements. If they were not able to repeat them correctly, the experimenter repeated them. The accuracy of the participants’ responses was coded video-based, but not analyzed in this study. Afterwards, participants saw their construction and decided whether they wanted to make further changes to it or to end the task if they felt that it was completed. If they continued, they had up to two minutes to finish the construction (third experimental phase; Fig 1E ). The dependent variable was the solution quality of the final construction state (scoring system: no gear was connected to either of the fixed gears (driving and target gear): 0 points; one of the fixed gears was connected to at least one other gear: 1 point; both fixed gears were connected to at least one other gear: 2 points; the two fixed gears were connected, but did not turn in the same direction: 3 points; they turned in the same direction: 4 points).

Problem-solving: Propeller task [ 16 ].

Participants saw a rectangular board with an unmarked driving gear on it. In addition to different-sized gears, two propellers were provided ( Fig 1F ). Children had to attach them to gears in a way that one propeller would turn as fast as possible and the other one as slow as possible without touching each other when the driving gear was turned. Subsequently, the second and third experimental phase (shown in Fig 1G and 1H ) proceeded in the same way as in the carousel task. The dependent variable was the solution quality of the final construction state. It was defined as the sum of two variables: turning speed (scoring system: at least one propeller was not attached to any gear: 0 points; both propellers were attached to the same gear type (i.e., gears of the same size): 1 point; both propellers were attached to different gear types, but not largest and smallest: 2 points; propellers were attached to the largest and smallest gear type: 3 points) and contact (scoring system: at least one propeller was not driven by the driving gear: 0 points; propellers touched when turning the driving gear: 1 point; they did not touch: 2 points).

Performance on the GTTs was evaluated by two trained raters coding the solution quality by rating the same dependent measures that were collected and calculated by the tablet program in the digital version. The mean inter-rater reliability between the raters for data of 20 randomly selected participants was very good for each dependent variable (Cohen’s Kappa = .82-.97). Given that the correlation between the manually coded data of the digital GTTs and the data measured by the tablet app was very substantial (carousel: r = .87, p = .00; propeller: r = .94, p = .00), we calculated the analyses based on the data measured by the tablet app.

Data of the analog GTTs of twelve participants was missing due to missing video recordings. Data of the analog propeller task of 21 participants was excluded because at least one propeller was not attached to the center but to the edge of a gear rendering the coding of turning speed impossible.

Statistical analyses were performed using R version 4.3.0 [ 33 ]. To analyze the manifest association between performances on both GTT modalities and other tasks, we used Spearman rank correlation analyses. As the main analysis, we estimated a model comprising two latent modality factors (analog and digital), each represented by performances on both GTTs (carousel and propeller task) of the respective modality. We fitted the covariance-based structural equation model with the R package lavaan [ 34 ] using only complete data sets. We evaluated goodness of fit based on the comparative fit index ( CFI ) [ 35 ] and the root mean square error of approximation ( RMSEA ) [ 36 ]. According to Hu and Bentler (1999), we considered CFI values >0.95 and RMSEA values <0.06 to indicate good model fit [ 37 ]. Additionally, we evaluated the standardized root mean square residual ( SRMR ) and the Tucker-Lewis index ( TLI ). According to Vermeent et al. (2022), we assessed longitudinal measurement invariance to control for configural (equal factor structure), metric (equal factor loadings) and scalar (equal intercepts) invariance across modalities using the likelihood ratio test [ 29 ]. Additionally, we included regression paths from the manifest indicators of language ability, reasoning ability and stabilization task performance to both modality factors in order to test their predictive value for GTT performance (convergent validity). We then imposed equality constraints on the regression paths in order to check for differences in this predictive value between modalities.

Descriptives and correlation coefficients for the dependent variables are presented in Table 1 .

https://doi.org/10.1371/journal.pone.0309718.t001

Correlations between GTT modalities and other tasks

On the manifest level, we found significant associations between modalities in both tasks (carousel: r = .33, p = .00; propeller: r = .50, p = .00). Performance across all four GTTs correlated significantly with performance on the language task (carousel analog: r = .31; carousel digital: r = .34; propeller analog: r = .20; propeller digital: r = .38; all p < .01). Performance on all GTTs was also significantly correlated with performance on the reasoning task (carousel analog: r = .31; carousel digital: r = .43; propeller analog: r = .24; propeller digital: r = .34; all p < .01). Moreover, performance on the GTTs was significantly correlated with performance on the stabilization task (carousel analog: r = .32; carousel digital: r = .28; propeller analog: r = .42; propeller digital: r = .36; all p < .01).

Measurement invariance across GTT modalities

The latent factor model provided an excellent fit to the data (see Fig 2 ). Likelihood ratio tests revealed configural, metric and scalar measurement invariance across the modality factors (analog and digital; see Table 2 ).

The squares represent manifest variables and the circles represent latent variables. Single-headed arrows from manifest variables to latent variables indicate regression paths, single-headed arrows from latent variables to manifest variables indicate factor loadings, double-headed arrows indicate correlations. The model was estimated with weighted least square mean and variance adjusted (WLSMV) for ordinal data. GTT = Gear turning task; * p < .05, ** p < .01.

https://doi.org/10.1371/journal.pone.0309718.g002

https://doi.org/10.1371/journal.pone.0309718.t002

Predictive value of performance on related tasks for GTT performance (convergent validity)

Regression paths in the model (see Fig 2 ) were significant for language and stabilization performance across modalities. Reasoning was a significant predictor of digital GTT performance, but not of analog GTT performance. Imposing equality constraints on the regression paths between modalities did not significantly change the model fit for language and stabilization performance, but for reasoning (see Table 3 ). Thus, language and stabilization performance contributed equally strong to GTT performances across modalities, whereas reasoning contributed more strongly to digital than to analog GTT performance.

https://doi.org/10.1371/journal.pone.0309718.t003

Our aim was to validate new, digital versions of gear-based problem-solving tasks against the traditional analog tasks. Six- to eight-year-old children performed both the analog and the digital version of two GTTs as well as a number of related validation measures. First, we compared performance between both modalities (digital, analog). As expected, we found significant correlations between task performances across modalities. These results are consistent with findings from earlier studies [e.g., 24 , 27 , 38 ] that showed medium-sized correlations between digitized and analog versions of cognitive tests, indicating that both versions are comparable. Second, we found measurement invariance across the digital and the analog GTT versions on the configural, metric and scalar level. This indicates that both task versions had an equal factor structure, equal factor loadings and an equal scale level (i.e., equal intercepts), which also provides evidence for convergent validity. Third, we found the expected predictive value of language, reasoning and a problem-solving task performance for GTT performances on both modalities, providing further evidence for convergent validity of the tasks. Fourth, this predictive value was comparable across task modalities for language and stabilization performance, but larger in the digital modality for reasoning. The association between GTT performance and language ability indicates that children substantially relied on verbal processes to solve the GTT problems. In fact, this is in line with the assumption that children use subvocal verbal self-instruction to solve complex tasks [ 39 – 42 ]. The substantial association between GTT performance and stabilization task performance indicates that the new tasks are construct valid and might be representative for multiple problem-solving domains [ 43 ]. However, reasoning contributed more strongly to the digital than to the analog GTT performance. Since previous studies have shown that reasoning is an essential component of problem-solving [ 22 , 44 ], this positive association confirmed the construct validity of the new digital measurement. The fact that reasoning was not predictive for the analog GTT performance might have been caused by a modality effect, since the reasoning test was also assessed digitally on a tablet.

The many advantages of digital testing [ 45 ] include that it can provide more accurate and detailed data and record multiple measurements without the need for trained personnel to perform video-based data coding (also eliminating the need to film hours of testing and get parental consent for video recordings, increasing the efficiency of testing). The reliability of the digital data processing is clearly documented by very high correlations between human-coded data and data measured by the app. Furthermore, digital assessment methods are much easier to implement outside of the lab (e.g., in schools or daycare centers) and reduce test administrator influence on the assessment results [ 46 ]. Although the benefits of digital problem-solving assessment have been known for a long time [ 19 ], so far only very few digital assessment tools for children are available.

Regarding the framework of problem-solving, our study focused on solution quality rather than on the individual problem-solving phases [ 2 ]. Many previous studies lacked valid quantitative measures of solution quality, which may be of particular importance for the design of intervention studies and educational support programs. The digital GTTs automatically track both the solution quality as well as data providing information on the process of problem-solving, including the number and timing of gear turnings, gear displacements and processing time. This process data provides opportunities to closer investigate the cognitive processes (e.g., reasoning processes) involved in the different problem-solving phases. Therefore, the new tasks provide a significant improvement in the measurement of technical problem-solving strategies beyond qualitative approaches [ 15 , 18 ] and extend current quantitative accuracy-based research on children’s problem-solving [ 22 , 23 ]. The digital GTTs could furthermore be adapted for the assessment of older children and adolescents by adjusting the difficulty level of the tasks, for example, by increasing distances between fixed gears or reducing the number of available gears. A limitation of our study is the lack of more specific information about the sample, such as the socio-economic status of the participants’ caregivers.

We conclude that the new digital GTTs are a valid adaptation of the traditional analog tasks for assessing problem-solving in six- to eight-year-old children. Given the substantial advantages of digital assessment instruments, the development of this tablet app contributes to research on cognitive development in problem-solving skills and strategies in early and middle childhood. The new tablet-based tasks also provide opportunities to investigate the contribution of higher-order cognitive abilities, such as executive functions, to problem-solving abilities in childhood [ 47 ]. Further studies are needed to collect representative normative data for the digital GTTs considering, for example, the effects of age, grade and gender.

Acknowledgments

We especially want to thank Steffen Pohl and Rebekka Morath for their valuable assistance in the preparation of the study. Furthermore, we would like to thank the student research assistants for their support in data collection.

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Effects of decision-based learning on student performance in introductory physics: The mediating roles of cognitive load and self-testing

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• Published: 29 August 2024

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• Soojeong Jeong   ORCID: orcid.org/0000-0001-8476-2501 1 ,
• Justin Rague 2 ,
• Kaylee Litson 3 ,
• David F. Feldon 4 ,
• M. Jeannette Lawler 5 &
• Kenneth Plummer 6  

DBL is a novel pedagogical approach intended to improve students’ conditional knowledge and problem-solving skills by exposing them to a sequence of branching learning decisions. The DBL software provided students with ample opportunities to engage in the expert decision-making processes involved in complex problem-solving and to receive just-in-time instruction and scaffolds at each decision point. The purpose of this study was to examine the effects of decision-based learning (DBL) on undergraduate students’ learning performance in introductory physics courses as well as the mediating roles of cognitive load and self-testing for such effects. We used a quasi-experimental posttest design across two sections of an online introductory physics course including a total N  = 390 participants. Contrary to our initial hypothesis, DBL instruction did not have a direct effect on cognitive load and had no indirect effect on student performance through cognitive load. Results also indicated that while DBL did not directly impact students’ physics performance, self-testing positively mediated the relationship between DBL and student performance. Our findings underscore the importance of students’ use of self-testing which plays a crucial role when engaging with DBL as it can influence effort input towards the domain task and thereby optimize learning performance.

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1 Introduction

Students’ experience and performance in introductory STEM (science, technology, engineering, and mathematics) courses have been identified as one of the most influential factors on STEM major attrition in college (Hunter, 2019 ; Seymour & Hewitt, 1997 ; Watkins & Mazur, 2013 ). Many students perceive these introductory courses as a difficult hurdle, because they deal with a variety of complex concepts and quantitative problem-solving skills (Ornek et al., 2008 ), which highlights the need for adequate instruction. However, current instructional practices remain largely lecture-based, thematic approaches and thus are limited in their ability to help students understand the relevance of complex concepts and the abstract relationships between these concepts in various problem-solving situations (Plummer et al., 2020 ).

Decision-based learning (DBL) is a novel pedagogical approach that organizes instruction around the decision-making processes of experts during complex problem-solving (Plummer et al., 2020 ; Sansom et al., 2019 ). In DBL, students are exposed to a sequence of learning decisions in which the result of each decision depends upon the level of prior knowledge and the previous decision, resulting in an observable decision tree. This decision tree allows students to make important connections between salient features of a problem and the conditions under which to execute beneficial schema patterns to solve problems effectively (Plummer et al., 2020 ; Sansom et al., 2019 ). However, few studies have investigated the effects of DBL in college STEM classrooms (e.g., Sansom et al., 2019 ).

To better understand mechanisms underlying the effects of DBL on student learning and performance, it is also imperative to consider other factors that may be associated with the pathway from DBL to student outcomes. For example, cognitive load—defined as the mental resources devoted to completing a task (Sweller, 1988 )—can be hypothesized as a mediating factor for DBL effects since students are exposed to isolated steps intended to increase the proportion of information processing of salient problem-solving features (Plummer et al., 2020 ). Within the DBL framework, students are expected to experience less extraneous cognitive load, which may lead to more effective and efficient learning as discussed in several previous studies on DBL (e.g., Plummer et al., 2020 ). However, this claim has not previously been empirically tested.

In addition, self-testing is a special form of self-monitoring, defined as “deliberate attention to some aspect of one’s behavior” (Schunk, 1983 , p. 89). Self-testing is a well-documented self-regulatory strategy (Boekaerts, 1996 ; Schunk, 1983 ; Zimmerman, 1990 ), which may also play an important role in mediating the relationships of DBL to cognitive load and learning performance. For instance, if DBL reduces cognitive load, this may leave students more cognitive capacity for using effective learning strategies to regulate their own learning process (e.g., self-monitoring through practice quizzes) and thereby increase the likelihood of successful learning (de Jong & Ferguson-Hessler, 1986 ; Seufert, 2018 ). The relationship between self-regulated learning and cognitive load has been receiving much attention recently, but empirical investigations on this issue are just emerging (Seufert, 2018 ).

Using a path analysis mediation framework, the present study examined the effects of DBL instruction on student performance in introductory physics, while considering cognitive load and self-testing as potential mediators.

2 Literature review and hypothesis development

2.1 decision-based learning (dbl).

Decision-based learning (DBL; Plummer et al., 2020 ) is a novel instructional practice focused on developing conditional knowledge (i.e., knowing under which circumstances to deploy a given strategy during problem solving) to help promote student problem-solving skills. DBL posits that instructors, as experts in their domain, often fail to provide adequate instructional explanations to their students, who are novices in the field, due to a phenomenon called ‘the expert blind spot’ (Feldon, 2007 ; Plummer et al., 2020 ; Swan et al., 2020 ). That is, experts acquire automaticity for their skills through extensive practice, which allows them to perform those skills unconsciously and effortlessly (Nathan & Petrosino, 2003 ). As a result, experts often cannot view problem-solving processes from a novice’s perspective and thus omit critical information or procedures when describing their processes, which can hinder student learning (Hinds et al., 2001 ; Zhu et al., 1996 ; Walsh, 2007 ; Gobet, 2005 ). To overcome the expert blind spot, DBL unpacks experts’ decision-making processes during complex problem-solving, also called an expert decision model , and structures instruction around the decision model (Cardenas et al., 2020 ; Plummer et al., 2020 ).

DBL also posits that experts’ automated skills are largely based on their abundant repertoire of conditionalized knowledge (Cardenas et al., 2020 ; Plummer et al., 2020 ; de Jong & Ferguson-Hessler, 1986 ; Frederiksen, 1984 ). Experts process a vast body of conceptual and procedural knowledge, but, more importantly, they know when and under what conditions their conceptual and procedural knowledge applies to solving problems (Amolloh et al., 2018 ; Lorch et al., 1993 ; Swan et al., 2020 ; Swan, 2021 ). However, conventional instruction, which often relies heavily on lectures and assigned readings, tends to focus largely on conceptual and procedural knowledge with less emphasis on conditional knowledge (Swan et al., 2020 ; Swan, 2021 ). In contrast, the primary focus of DBL is to make conditional knowledge explicit in instruction. DBL guides students through experts’ decisions, allowing them to recognize the conditions that dictate when and why such decisions are made (Plummer et al., 2022 ).

One of the teaching methods known to enhance students’ problem-solving skills is problem-based learning (PBL) (Hmelo-Silver, 2004 ). Both DBL and PBL share foundational similarities but differ significantly in their instructional approaches. DBL provides a structured decision model that systematically guides students through the necessary conditions for making informed decisions. In contrast, PBL allows a relatively higher degree of exploration, letting students discover what they need to know to solve problems with less initial guidance. This greater reliance on exploration in PBL can sometimes impose an unnecessary cognitive load on students, resulting in less effective learning outcomes (Kirschner et al., 2006 ). Conversely, the highly structured scaffold in DBL can help students not only understand what decisions to make but also the specific conditions under which various decisions would be appropriate, offering more direct and stepwise guidance compared to PBL’s more open-ended exploration. However, DBL and PBL are not entirely opposite or competing methods; instead, they can complement each other (Plummer et al., 2022 ). Fischer et al. ( 2021 ) argue that the effects of DBL instruction may be enhanced when followed by PBL activities.

While the implementation of DBL is still in its infancy, studies have provided promising initial evidence of the effects of DBL on student learning (e.g., Pixton, 2023 ; Plummer et al., 2020 , 2022 ; Sansom et al., 2019 ; Tesseyman et al., 2023 ; Vogeler et al., 2022 ). Sansom et al. ( 2019 ), for instance, examined whether DBL instruction helped improve undergraduate students’ performance on heat and enthalpy problems in a general chemistry course and found that students who were taught with DBL performed significantly better than their peers who received business-as-usual instruction. Additionally, their survey findings indicated that the majority of students perceived that using DBL helped them analyze a given problem and choose the correct equation to solve the problem, which suggests that DBL was conducive to developing students’ conditional knowledge.

Similarly, Vogeler et al. ( 2022 ) evaluated the implementation of DBL in a graduate-level introductory statistics course by measuring students’ learning gains through pre/post/follow-up assessments. Results indicated that students’ conditional knowledge, related to statistical analysis (i.e., selecting appropriate statistical methods for given research problems), increased significantly between pre- and post-assessments. Significant improvement was also maintained between post and follow-up. More research is needed to determine the effectiveness of DBL on student learning across a variety of disciplines. In this study, we examined whether DBL instruction helped improve undergraduate students’ problem-solving performance in introductory physics. Based on the findings of previous studies, we hypothesized that:

DBL instruction has a positive effect on student performance in introductory physics.

2.2 Cognitive load

Cognitive load is considered an indexed summation of the experienced mental load within a learning environment and the intentional mental resources applied toward a task (Paas, 1992 ; Sweller et al., 1998 ). According to cognitive load theory (CLT; Sweller et al., 2011 ), successful learning and performance require the cognitive load imposed during instruction to remain within the capacity of the learner’s working memory. CLT also posits that unnecessary or ineffective cognitive load is caused largely by inappropriate instruction, which “requires learners to engage in either a search for a problem solution or a search for referents in an explanation” (Paas et al., 2003 , p. 2). Many studies have demonstrated that instructional methods that provide explicit, step-by-step procedural guidance on how to solve a problem or complete a task (e.g., worked examples), yielded better learning and performance, compared to other methods with incomplete explanations or limited guidance (Atkinson et al., 2000 ; Sweller et al., 1998 ; Tofel-Grehl & Feldon, 2013 ).

In DBL, learners engage in a complete sequence of conditional decisions required to solve a problem by focusing on one decision at a time, which can result in a reduction in potential cognitive overload (Sansom et al., 2019 ). At each decision point, learners are also provided with sufficient information or instruction (i.e., just-enough-just-in-time instruction ) necessary to make the current decision, which can also help them manage their cognitive load (Cardenas et al., 2020 ). Furthermore, DBL is designed to help learners understand how parts are related to the whole of solving a problem by structuring a process for accessing information without having to go through the nuanced processes of critical examination (Plummer et al., 2020 ). As such, we argue that DBL instruction can decrease unnecessary cognitive load during learning. While this notion may be theoretically acceptable, no study has explicitly examined the relationship between DBL and cognitive load. Taken together, we hypothesize that students using DBL will experience less cognitive load than those taught with traditional instruction, which will in turn lead to their greater learning performance in physics.

DBL instruction has a negative effect on cognitive load.

Cognitive load has a negative effect on student performance in introductory physics.

Cognitive load mediates the effect of DBL on physics performance.

2.3 Self-testing

Self-testing is a learning technique to assess one’s own knowledge and understanding of instructional materials, such as testing oneself with questions or using practice problems (Carpenter et al., 2017 ; Hartwig & Dunlosky, 2012 ). Practice testing in general, including being tested by others and self-testing, has long proved to be effective in enhancing student learning (Carpenter et al., 2016 , 2017 ; Dunlosky et al., 2013 ; Hartwig & Dunlosky, 2012 ; McDaniel et al., 2007 ). From a self-regulated learning perspective, self-testing is a special form of self-monitoring, which involves students’ ongoing efforts to deliberately observe their own processes and products of learning (Lan, 2005 ; Zimmerman & Paulsen, 1995 ). Zimmerman and Paulsen ( 1995 ) argue that self-monitoring improves learning by allowing learners to obtain more accurate information about their learning progress and thus make better self-regulatory decisions about their subsequent study.

The relationship between DBL and self-testing has not previously been investigated. More broadly, however, Plummer et al. ( 2022 ) found initial evidence that supports the occurrence of self-regulation (i.e., monitoring one’s cognitive activities) during DBL. Their findings indicated that DBL promoted students’ self-regulation by enabling them to see the bigger vision of the content. The authors also state that a decision model helps learners “identify strategies that are conducive to resolving a variety of knowledge gaps” (p. 726). Similarly, Seufert ( 2018 ) argues that instructional approaches that provide explicit guidance and support (e.g., worked examples or process worksheets) can foster students’ regulation by “providing rules of thumb for the decision on adequate strategies depending on crucial factors” (p. 124). As such, we argue that students learning physics through DBL will become more aware of their understanding of the content and will more actively seek and engage in ways to monitor and regulate their own learning, such as self-testing, compared to their peers not using DBL, thereby achieving better performance in physics. Thus, the following are hypothesized:

DBL instruction has a positive effect on self-testing.

Self-testing has a positive effect on student performance in introductory physics.

Self-testing mediates the effect of DBL on physics performance.

While there is limited evidence directly examining the relationship, we expect that students’ perceived cognitive load would be negatively related to their use of self-testing strategy while learning physics with DBL. A possible theoretical account for this argument is that, when learners are cognitively overloaded and lack internal (e.g., working memory capacity) or external resources (e.g., scaffolds), they might not be able to invest additional effort in self-regulatory processes (Seufert, 2018 , 2020 ). In DBL, learners are provided with explicit instruction and sufficient scaffolds, which can help them avoid unnecessary cognitive load and thus can free up their cognitive resources to monitor and regulate their subsequent study more effectively and thereby increase their performance. Thus, we hypothesize as follows:

Cognitive load has a negative effect on self-testing.

Figure 1 depicts the hypothesized relationships among variables used in the study.

Hypothesized path model of DBL, cognitive load, self-testing, and learning performance

3.1 Research design

This study used a quasi-experimental posttest design with nonequivalent groups to examine the effects of DBL on learning performance. Two learning conditions, a DBL condition and a non-DBL condition, were randomly assigned to one of two sections of an online physics course. Although students were allowed to self-select the course in which they were enrolled, making this study quasi-experimental rather than a true experimental design, they were unaware of the specific instructional condition (DBL or non-DBL) to which they would be assigned. This means that while students chose the course section based on their preferences or schedules, they did not know whether they would be experiencing the DBL or the non-DBL condition. This approach helps to control for selection bias to some extent because the students’ choice of section was not influenced by the specific instructional method used. Both condition groups had the same instructor and received identical instruction and assessments, ensuring that any differences in learning outcomes could be attributed to the instructional method rather than to other external factors. The only difference between the groups was the implementation of the DBL approach for two specific lessons (Chap. 2 and 5).

3.2 Participants

Participants included N  = 390 undergraduate students enrolled in an online introductory physics course, called Physical Science 100, at a large private religious university in the western United States. Students were spread across two subsections of the same online course. One section contained n  = 180 students who were taught using DBL instruction while the other section contained n  = 210 students who received standard instruction.

Demographic information was not collected for participating students within the study. However, at the time of the study, university-reported undergraduate demographics suggest approximately 81% of students are white, 7% are Hispanic or Latinx, 4% are two or more races, 3% are Asian or Pacific Islander, and fewer than 1% are either Black or Indigenous Americans. Further, approximately 50% of students at this university are men while 50% are women.

3.3 DBL software

The fundamental principles of DBL do not require a high-tech platform or system to be applied to instruction (Cardenas et al., 2020 ) and earlier implementations, in fact, often utilized simple technologies, such as PowerPoint or handouts (e.g., Plummer et al., 2020 ). Recently, however, software was developed to fully optimize the specific affordances relevant to DBL (Cardenas et al., 2020 ). In this study, we implemented the DBL software in introductory physics courses. The software facilitates the development of expert decision models (see Fig.  2 ), populating a problem bank with conditionally organized problems or scenarios, creating questions to decision paths, adding just-enough-just-in-time instruction for each decision point, and creating interleaved assignments (Cardenas et al., 2020 ).

Example of a decision model developed for the course

Figure  3 presents the first two screens of the DBL software used in our study. The first problem guides students through the process of using the software. Students are given a series of scenario problems (e.g., “A book sitting on a table. Gravity is balanced by the upward force from the table, and no other forces act on it. Describe its motion.”) and in each problem students are asked to choose an answer in each decision point (e.g., “How do the forces compare?”) until the problem is solved.

Screenshots of the DBL software

Students interested in more detailed instruction could click on the “How Do I Decide” link, which took them to a short lesson with multiple slides, including some video and audio clips. Figure  4 presents part of the short lesson (5 out of 17 slides) for the “how do I decide” on identifying balanced and unbalanced forces.

Short lesson example for “How Do I Decide”

3.4 Instructional context

The course was an asynchronous course delivered fully through a learning management system (LMS) over 15 weeks. The course covered introductory physical science topics, such as Newton’s Laws, forces, and motion. It focused on six specific course outcomes related to a conceptual understanding of the fundamental ideas of modern scientific theory, as outlined in the course syllabus:

Apply Physical Principles. Students will be able to recognize and apply the fundamental principles presented in this course to simple physical situations.

Express Scientific Ideas. Students will be able to express their thoughts (in oral, graphical, and written formats) on scientific topics clearly, including appropriate use of basic scientific vocabulary and effective interpretation of quantitative data.

Scientific Observations. Students will be able to explain how scientific observations led to the development of these few principles and the models built on them.

Further Scientific Questions. Students will be able to explain how these principles and models in turn lead to further scientific questions.

Science and Religion. Students will be able to reflect rationally upon the interface between science and religion.

Issues of Public Policy. Students will be able to evaluate scientific data and claims in order to make rational decisions on public policy issues that affect their community.

Course materials included the textbook Physical Science Foundation (edition 5.0) by J. Ward Moody. Students were expected to participate in 34 lessons, 34 homework activities, and 9 article essays throughout the course. Lessons were meant to replace lectures and included a mix of text, video, animations, and practice exams. Homework materials were designed to allow students to practice difficult content. Article essays were designed to provide students with the opportunity to read and write about an assigned article and discuss it with other students. Students were further expected to take four midterm exams and one final exam. Midterm and final exams were open book, timed, and all administered in the LMS. Students’ final grades in the course were based on lessons (15%), homework activities (20%), article essays (10%), midterm exams (30%), and the final exam (25%).

3.5 Implementation process

The DBL software was used in two lessons (Chap. 2 and 5) designed to teach Newton’s laws of motion, were provided to the intervention group during the first week of the class. There were 23 DBL problems in Chap. 2 and 20 problems in Chap. 5. Students were provided with an external link to instructions on using the software, but these instructions were not required. Students in the control group were taught the same three lessons using standard instruction methods. In this traditional approach, they were given the same set of problems as the DBL group, but the learning process differed significantly. Instead of engaging in the DBL software, the control group students learned how to solve the problems through the instructor’s usual explanations and demonstrations. The instructor employed a lecture-based format, providing detailed solutions and theoretical explanations to illustrate the concepts.

At the end of each lesson session, both groups of students were asked to respond to three self-report cognitive load items. After completing the first nine lessons and before taking the first midterm exam, students were required to complete a practice exam consisting of 30 questions. Students were able to take it as many times as they wanted; they were able to redo it until they received full credit, but that meant redoing the entire assignment and answering all the questions again. Students were then given a midterm exam.

3.6 Data collection and measures

Data collection included using self-reported responses of cognitive load items, the number of practice exam attempts, and midterm exam scores. Students’ cognitive load was measured using 3 items adapted from previous cognitive load scales (e.g., Paas, 1992 ). Responses were rated on a 9-point Likert scale. The question items were “How much mental effort did you invest in this chapter?” (1 = very, very low mental effort, 9 = very, very high mental effort), “How easy or difficult did you find this chapter?” (1 = very, very easy, 9 = very, very difficult), and “How complex was the material in this chapter?” (1 = very, very simple, 9 = very, very complicated). The 3 items were averaged to create a composite score for cognitive load, with McDonald’s omega showing high reliability for the present sample (𝜔 = 0.80). Cognitive load was measured during the lesson (Chap. 5) directly preceding the practice and midterm exams.

Students’ self-testing was defined by summing the number of practice exam attempts per student. These attempts were determined by extracting time stamps recorded through the LMS where the courses mainly took place. The time stamp records were coded to count the number of practice exam attempts for each student, ensuring an accurate reflection of self-testing behavior. These data were collected after the midterm exam had concluded to ensure that all practice attempts were accounted for.

Physics learning performance was measured using their midterm scores (total possible points = 33). The midterm exam scores used are derived from established assessments routinely employed by the instructor and have consistently aligned with course objectives and content. The exams have a history of accurately reflecting students’ understanding of the material and have been used over multiple terms to ensure consistency in assessing learning outcomes.

3.7 Data analysis

To examine the effects and mechanisms of how DBL instruction affects students’ learning performance in physics, we evaluated a path model depicted in Fig.  1 that includes both direct and indirect effects. Path models are useful for examining a series of linear relationships among variables; in the present context, path analysis was used to evaluate the relationship between the DBL intervention and learning performance, through self-reported cognitive load and self-testing. Within this model, multiple direct and indirect relationships among variables were examined. The model included 6 direct relationships among variables (shown in the arrows in Fig.  1 ) as well as 4 indirect relationships: (1) intervention → cognitive load → learning, (2) intervention → self-testing → learning, (3) cognitive load → self-testing → learning, and (4) intervention → cognitive load → self-testing → learning. The indirect effects were computed by multiplying the path coefficients present in the indirect relationship. For example, the indirect effect of intervention → cognitive load → learning was computed by multiplying the direct relationship between intervention and cognitive load with the direct relationships between cognitive load and learning. Multiplying coefficients in this manner leads to asymmetrical standard errors of the estimated indirect coefficient, which must be addressed before examining statistical significance.

Bootstrapping methods are commonly used in mediation analysis to correct asymmetrical standard errors and produce unbiased confidence intervals (MacKinnon, 2008 ). In the present study, we evaluated the statistical significance of indirect effects using 5,000 bias-corrected bootstraps, and reporting 95% confidence intervals. If the confidence interval for the effect did not contain zero, the effect was considered statistically significant and was further interpreted. Analyses were evaluated in Mplus version 8.4. Missingness was handled using full-information maximum likelihood estimation.

Table  1 shows the descriptive statistics of the variables of interest across intervention conditions. The mean scores for cognitive load were slightly above the 5.0 scale midpoint in both DBL and control groups. Students in the DBL group had non-significantly higher mean scores for cognitive load than those in the control group. The means for self-testing and learning performance were non-significantly higher in the DBL group than the control group. Across the entire sample, cognitive load was correlated negatively with self-testing ( r  = − .12, p  = .03) and learning performance ( r  = − .22, p  < .001). Self-testing was positively correlated with learning performance ( r  = .23, p  < .001).

The direct effects are shown in Fig.  5 . Results indicated that there was no statistically significant difference in students’ physics learning performance between the DBL and control groups. In other words, DBL instruction did not directly impact student learning ( β  = 0.04, 95% CI [− 0.06, 0.15]) and thus Hypothesis 1 was rejected. Similarly, DBL did not have a direct effect on cognitive load ( β  = 0.04, 95% CI [− 0.06, 0.14]) and self-testing ( β  = 0.10, 95% CI [− 0.00, 0.19], rejecting Hypotheses 2 and 5, respectively. In contrast, several significant direct effects were observed. Students’ perceived cognitive load had a negative effect on their use of self-testing ( β = − 0.12, 95% CI [− 0.23, − 0.02]) and learning performance ( β = − 0.20, 95% CI [− 0.29, − 0.09]), supporting Hypotheses 3 and 8, respectively. Consistent with Hypothesis 6, self-testing has a positive effect on student performance in physics ( β  = 0.20, 95% CI [0.10, 0.30].

Standardized path coefficients. Solid lines indicate significant paths while dashed lines indicate non-significance

To examine the mediating roles of cognitive load and self-testing, we tested the significance of indirect effects among variables (see Table  2 ). Cognitive load did not mediate the relationship between DBL instruction and physics learning performance (IE = − 0.01, 95% CI [− 0.035, 0.010]) and thus Hypothesis 4 was not supported. Notably, however, self-testing had a significant mediating effect on the relationship between DBL and students’ learning performance (IE = 0.02, 95% CI [0.002, 0.045]), indicating that the intervention impacted student performance through self-testing, as was previously predicted (Hypothesis 7). The other two indirect effects of DBL examined (DBL → Cognitive load → Self-testing, DBL → Cognitive load → Self-testing → Performance) were not statistically significant.

5 Discussion

Few studies have empirically determined the effects of DBL instruction on student learning. Even fewer have explored the underlying mechanisms driving these effects. This study contributes to this limited body of literature by examining both the outcomes and the underlying processes of DBL in an introductory physics course. Our findings offer mixed evidence regarding the effectiveness of DBL as an instructional method for improving students’ problem-solving skills. We will now discuss the main findings of our study, followed by the practical implications and limitations.

Our findings showed no direct impact of DBL on students’ performance in their study of physics, contrary to previous studies that have reported favorable effects of DBL on student learning (e.g., Plummer et al., 2022 ; Sansom et al., 2019 ; Vogeler et al., 2022 ). This discrepancy highlights a crucial point for discussion; while prior research often posits beneficial impacts of DBL, our empirical evidence suggests these effects may not be as straightforward or universally applicable. For example, studies by Sansom et al. ( 2019 ) and Vogeler et al. ( 2022 ) found significant improvements in student performance with DBL, indicating that step-by-step guidance for problem-solving contributes to these improvements. However, our study did not replicate these results, highlighting potential variability in DBL’s effectiveness across different contexts and implementations.

DBL did not directly impact students’ cognitive load, and cognitive load did not mediate the relationship between DBL instruction and physics learning performance, both contrary to our expectations. Descriptive statistics indicated that the DBL group reported higher cognitive load compared to the control group, but this difference was not statistically significant. The absence of a direct connection between DBL and cognitive load in our study suggests that DBL, as implemented, may not have sufficiently reduced extraneous cognitive load to allow students to utilize their cognitive resources effectively for learning. However, it is also important to note that DBL did not increase cognitive load, which is a positive aspect. These findings stand in contrast to existing theoretical assumptions and empirical evidence, which suggest that highly structured instructional methods like DBL should reduce cognitive load and thus improve learning outcomes (Sansom et al., 2019 ; Sweller et al., 1998 ).

One potential explanation for these findings could be associated with the novelty of the DBL model and its software. DBL itself is a novel instructional model that requires students to understand a new method of problem-solving using conditional knowledge. Implemented within a computer-based environment, the DBL software may add to the challenge. The dual task of learning this new pedagogical approach and mastering the accompanying software could present significant challenges for students. Researchers have pointed out that until students gain experience in navigating a new learning environment, the environment itself may incur an additional cognitive load, which may impede learning (Atkinson et al., 2000 ; Choi et al., 2014 ; Carpenter et al., 2016 ). In fact, in Sansom et al. ( 2019 )’s study, which found positive effects of DBL, participants did not use DBL software as it had not been developed. Instead, they applied the DBL model in a traditional classroom setting. Consequently, the dual adaptation process might have diminished the overall effectiveness of the intervention in our study.

Another possible explanation is that presence or absence of certain DBL critical features can impact performance (Vogeler et al., 2022 ). In their study, Vogeler et al. ( 2022 ) found that when students had an equal amount of practice problems within and outside of the decision model that their mastery of the conditional knowledge-related learning outcome increased. In addition, apart from Sansom et al. ( 2019 ), those studies which found an increase in student performance used DBL activities to interleave old and new material on a regular schedule. The DBL intervention for this study was more like Sansom et al. ( 2019 ) study where the DBL activities were sprinkled across a few lessons during an entire semester.

Next, we discuss key findings of our study related to self-testing. The hypothesis that DBL instruction positively predicts self-testing was rejected; no significant difference was found in students’ frequency of use of practice exams between the DBL and control groups. This unexpected result suggests that DBL may not have influenced students’ engagement with self-testing practices as hypothesized. One possible explanation for this finding is related to the diverse motivations and behaviors of students regarding practice exams. It is likely that students who engaged with practice exams fewer times fell into one of two groups: those who were content with their knowledge in the course and felt no need for additional practice, and those who were struggling with the course material and chose to avoid practice due to a lack of confidence or motivation. This dichotomy in student behavior highlights the complexity of predicting educational outcomes based solely on instructional methods.

However, despite the lack of a direct relationship between DBL and the frequency of self-testing, the data revealed that the frequency of students’ self-testing was a significant determinant of their midterm scores. Additionally, DBL had an indirect effect on student performance through self-testing. These findings underscore the critical role of self-testing in academic performance. Self-testing is widely recognized as an effective learning strategy that enhances memory retention and understanding of the material (Hartwig & Dunlosky, 2012 ). When students test themselves, they engage in retrieval practice, which strengthens their ability to recall and apply knowledge, thereby improving their academic performance (Dunlosky et al., 2013 ). These results are also generally in line with previous studies showing significant effects of self-monitoring (e.g., Lan, 1996 ; Chang, 2007 ). Chang ( 2007 ) also demonstrated that self-monitoring techniques, including self-testing, positively affected students’ academic performance by helping them identify areas of weakness and focus their study efforts more effectively. According to theories of self-regulated learning, students regulate subsequent learning behaviors based on their assessment of their current status of learning, possibly leading to better learning performance (Boekaerts, 1996 ; Schunk, 1983 ; Zimmerman, 1990 ). Although DBL did not directly increase the frequency of self-testing, it may have promoted an environment where students felt more empowered to engage in self-regulatory behaviors, which then positively impacts performance.

Lastly, we highlight another key finding of our study: the impact of cognitive load on self-testing. Our findings revealed that cognitive load negatively impacted self-testing, aligning with our initial expectations. High levels of cognitive load may diminish the cognitive resources necessary for engaging in self-regulatory activities (Seufert, 2018 , 2020 ). More importantly, our results showed a structural relationship among cognitive load, self-testing, and learning performance. Specifically, we found that cognitive load impacts learning performance indirectly through self-testing. This mediation effect underscores the pivotal role of self-testing in translating cognitive load into improved academic performance. Given the increasing interest in understanding how cognitive load affects self-regulation (Seufert, 2018 , 2020 ), our findings are particularly encouraging. They suggest that managing cognitive load is crucial for fostering self-regulatory behaviors that ultimately enhance learning outcomes.

Our findings offer important implications for the practice of DBL, emphasizing the crucial role of instructors. The following practical implications primarily focus on providing guidance for instructors who want to implement DBL. First, instructors should encourage self-testing by providing ample opportunities within the course. Instructors can offer various methods for self-testing, such as quizzes, practice exams, and interactive activities, to enhance the effectiveness of DBL. While self-testing is often voluntary, incorporating incentives or rewards can motivate students to engage more frequently in this practice. By fostering a culture of self-assessment and providing diverse opportunities for self-testing, instructors can help students optimize their learning and fully realize the potential benefits of DBL. Second, to manage students’ cognitive load, instructors should provide students with explicit instruction on how the DBL software works as well as substantial practice opportunities in order to become accustomed to the software. Likewise, instructors should consider integrating DBL gradually, starting with simpler tasks and progressively increasing complexity as students become more comfortable with the system. These efforts would help prevent the potential cognitive overload that students might experience while adapting to the new learning environment. Third, continuous support is essential for the successful implementation of DBL. It is crucial to monitor students’ progress and cognitive load regularly to identify and address any issues promptly. By creating a structured and supportive learning environment, instructors can maximize the benefits of DBL and improve overall student performance and engagement. Lastly, as important as emphasizing the role of instructors is the issue of how to support these instructors effectively. Providing comprehensive training on the DBL software and its pedagogical applications is essential for teachers to successfully integrate it into their teaching practices. This training should include both technical aspects of the software and strategies for managing and supporting students’ cognitive load. Ongoing professional development opportunities can help teachers stay updated with the latest DBL advancements and best practices, ensuring sustained success in DBL implementation.

While this study sheds light on our understanding of the mechanisms underlying the effects of DBL, our findings should be interpreted with caution due to several limitations—related to sample homogeneity, instructional contexts, motivational variables, and measurement tools. First, the homogeneity of our sample poses a limitation. Our study was conducted at a single university in the western United States, with a predominantly white student population, which may limit the generalizability of our findings to other educational contexts and populations. The absence of comprehensive demographic data, such as students’ socioeconomic backgrounds and prior educational experiences, further limits our ability to assess how these factors might influence the effectiveness of DBL. Future studies should include more diverse samples and collect detailed demographic information to enhance the generalizability of the results. Second, the focus of our study on introductory physics courses taught by a single instructor may limit the applicability of our findings to other educational settings. By concentrating on a specific course and instructor, we may have overlooked variations in instructional approaches and contexts that could impact the effectiveness of DBL. Expanding research to include different types of courses, instructors, and institutional environments will provide a more comprehensive understanding of DBL’s potential benefits and limitations. Additionally, exploring how DBL integrates with other pedagogical approaches, such as flipped classrooms and collaborative learning, could offer valuable insights into its broader applications. Third, our study did not account for potentially influential motivational variables. Research has shown that motivational beliefs, such as students’ self-efficacy, goal orientation significantly impact their use of self-testing strategies (e.g., Chang, 2007 ) and perceived cognitive load (e.g., Feldon et al., 2018 ). By excluding these variables, we may have missed critical aspects of the psychological processes underlying DBL. Future research should incorporate these motivational and psychological factors to better explain the mechanisms driving the effects of DBL and to identify factors that may enhance or hinder its effectiveness. Lastly, the measurement tools used in this study may not have fully captured the complexity and dynamic nature of cognitive load and self-testing. Future studies should employ advanced tools such as real-time analytics and interactive assessments. Additionally, integrating qualitative methods, such as in-depth interviews and observational studies, could provide deeper insights into students’ subjective experiences and strategies during learning.

Although DBL has great potential for the improvement of student learning, this assertion remains largely theoretical (Cardenas et al., 2020 ). Our findings provide empirical evidence regarding the educational benefits of DBL on self-testing practices, and self-testing’s impact on midterm scores. However, much remains unclear about the impact of DBL on student learning behaviors and ultimately, student learning performance. Overall, the results suggest that DBL can be an effective instructional tool for students to acquire complex, conditional knowledge and develop self-regulatory skills that may transcend beyond learning specific knowledge and instead help students engage differently with the process of learning (Plummer et al., 2020 ). Findings also provide valuable insight into the interactions that can explain DBL effects on student learning, highlighting the importance of considering relevant cognitive processes, such as mental workload and use of self-regulation strategies in research and practice in DBL.

Data availability

All data used in this study will be made available upon request.

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Soojeong Jeong

Center for Teaching and Learning, Ogden-Weber Technical College, 200 N Washington Blvd, Ogden, UT, 84403, USA

Justin Rague

Department of Psychology, University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX, 77204-5022, USA

Kaylee Litson

Department of Instructional Technology and Learning Sciences, Utah State University, 2830 Old Main Hill, Logan, UT, 84322, USA

David F. Feldon

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Correspondence to Soojeong Jeong .

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Jeong, S., Rague, J., Litson, K. et al. Effects of decision-based learning on student performance in introductory physics: The mediating roles of cognitive load and self-testing. Educ Inf Technol (2024). https://doi.org/10.1007/s10639-024-12962-y

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Received : 31 January 2024

Accepted : 07 August 2024

Published : 29 August 2024

DOI : https://doi.org/10.1007/s10639-024-12962-y

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