CBT notes with clinical review example

CBT notes with clinical review example

Authors:	Angela Jones and Jen Clue (Senior CBT Therapists)
Date:	20/08/2025

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Treatment Session Notes

Patient First Name: James

Patients Last Name: Smith

Date of Session: 22/05/2024

Session Number: 4

Treating Clinician: A Therapist

Treatment Type: CBT

Treatment Modality: CBT

If cCBT please enter Silvercloud ID: ID number or N/A

Current Pathway: In Treatment

Current Work Status: Full duties

Primary Working Diagnosis/Primary Presentation: Depression

Agenda/Session focus:

· MDS review

· Risk review

· Review of home task

· Introduce thought challenging

· Set home task

· Client item: Nothing to bring today

· Feedback on session

Problem Statement/Formulation details:

Reports a steady decline in mood over the past few years. Struggles with thoughts of losing his job and easily becoming stressed over daily tasks. Significant levels of self-critical thinking linked with various difficult life experiences.

Goals: To focus on being more optimistic and to reduce negative thinking – by capturing the positive aspects of his day, not just the problems being faced. To reduce rumination and self-critical thinking and to be more positive about the future.

Current rating of success around goals: 4/10

Beckian longitudinal formulation completed.

Review In-between session:

James was asked to keep a thought record and identify unhelpful thinking habits.

James completed this successfully and gathered thoughts such as: “I am no good at my job and will get sacked” (belief rating 7/10) which brought about feelings of depression and hopelessness, he also identified “All of my colleagues are judging me” (belief rating 8/10) which for him lead to feelings of anxiety.

James was able to label his thoughts as ‘catastrophising’ and ‘mind reading’.

On reflection James was able to see the links between his thoughts and emotions.

Content of Session:

MDS review: James’s scores on the PHQ9 and GAD7 have remained the same since last session. We explored this further, and this appears to be an accurate reflection.

Introduced thought challenging to James, using the 7-column thought record.

Used a thought from his home task to challenge in session today:

Situation: sent a work email with a spelling mistake.

Emotion: hopeless (80%), depressed (80%).

Thought: “I am no good at my job and I will get sacked”.

Evidence for: James was not able to identify any evidence to support the thought, and was able to separate evidence from opinion.

Evidence against the thought: 1) It was a minor spelling mistake. 2) I sent the email a week ago and my manager has seen it but not called me into his office to discuss. 3) I have recently had a good annual appraisal.

Challenged thought: “I may have made a minor mistake but that does not mean I am no good at my job, everyone makes mistakes”.

Emotion: hopeless (0%), depressed (0%).

Used this challenged thought and linked it back into the formulation (Beck formulation). James was able to see how his negative automatic thoughts are driven by his core beliefs and rules for living.

Agreed between session task:

Discussed between session task and James felt he wanted to practice using this revised thought whenever he notices thoughts of being no good at his job. James also to look at repeating thought challenging process with at least one other negative thought over the course of the week. James feels able to do this and did not indicate any barriers to completing this.

Treatment Plan:

Beck cognitive model of depression.

Completed: Formulation, psychoeducation and thought challenging.

Next steps: Moving towards working on rules for living and core beliefs. We will incorporate behavioural experiments to test out new rules/beliefs.

Session feedback and Learnings:

James reported finding the above exercise “really helpful” and “interesting”. James was able to reflect on the biased nature of his thoughts and he could see the benefit of looking at factual evidence. James reported feeling “hopeful” after today’s session, he said that he is starting to see how he can gain some control over his negative thoughts.

Risk Assessment

Please do not use N/A. Please indicate that you have explored this with your client and document their response.

Suicidal Thoughts: