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What Is Therapy Homework?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program.

Astrakan Images / Getty Images

Types of Therapy That Involve Homework

If you’ve recently started going to therapy , you may find yourself being assigned therapy homework. You may wonder what exactly it entails and what purpose it serves. Therapy homework comprises tasks or assignments that your therapist asks you to complete between sessions, says Nicole Erkfitz , DSW, LCSW, a licensed clinical social worker and executive director at AMFM Healthcare, Virginia.

Homework can be given in any form of therapy, and it may come as a worksheet, a task to complete, or a thought/piece of knowledge you are requested to keep with you throughout the week, Dr. Erkfitz explains.

This article explores the role of homework in certain forms of therapy, the benefits therapy homework can offer, and some tips to help you comply with your homework assignments.

Therapy homework can be assigned as part of any type of therapy. However, some therapists and forms of therapy may utilize it more than others.

For instance, a 2019-study notes that therapy homework is an integral part of cognitive-behavioral therapy (CBT) . According to Dr. Erkfitz, therapy homework is built into the protocol and framework of CBT, as well as dialectical behavior therapy (DBT) , which is a sub-type of CBT.

Therefore, if you’re seeing a therapist who practices CBT or DBT, chances are you’ll regularly have homework to do.

On the other hand, an example of a type of therapy that doesn’t generally involve homework is eye movement desensitization and reprocessing (EMDR) therapy. EMDR is a type of therapy that generally relies on the relationship between the therapist and client during sessions and is a modality that specifically doesn’t rely on homework, says Dr. Erkfitz.

However, she explains that if the client is feeling rejuvenated and well after their processing session, for instance, their therapist may ask them to write down a list of times that their positive cognition came up for them over the next week.

"Regardless of the type of therapy, the best kind of homework is when you don’t even realize you were assigned homework," says Erkfitz.

Benefits of Therapy Homework

Below, Dr. Erkfitz explains the benefits of therapy homework.

It Helps Your Therapist Review Your Progress

The most important part of therapy homework is the follow-up discussion at the next session. The time you spend reviewing with your therapist how the past week went, if you completed your homework, or if you didn’t and why, gives your therapist valuable feedback on your progress and insight on how they can better support you.

It Gives Your Therapist More Insight

Therapy can be tricky because by the time you are committed to showing up and putting in the work, you are already bringing a better and stronger version of yourself than what you have been experiencing in your day-to-day life that led you to seek therapy.

Homework gives your therapist an inside look into your day-to-day life, which can sometimes be hard to recap in a session. Certain homework assignments keep you thinking throughout the week about what you want to share during your sessions, giving your therapist historical data to review and address.

It Helps Empower You

The sense of empowerment you can gain from utilizing your new skills, setting new boundaries , and redirecting your own cognitive distortions is something a therapist can’t give you in the therapy session. This is something you give yourself. Therapy homework is how you come to the realization that you got this and that you can do it.

"The main benefit of therapy homework is that it builds your skills as well as the understanding that you can do this on your own," says Erkfitz.

Tips for Your Therapy Homework

Below, Dr. Erkfitz shares some tips that can help with therapy homework:

• Set aside time for your homework: Create a designated time to complete your therapy homework. The aim of therapy homework is to keep you thinking and working on your goals between sessions. Use your designated time as a sacred space to invest in yourself and pour your thoughts and emotions into your homework, just as you would in a therapy session .
• Be honest: As therapists, we are not looking for you to write down what you think we want to read or what you think you should write down. It’s important to be honest with us, and yourself, about what you are truly feeling and thinking.
• Practice your skills: Completing the worksheet or log are important, but you also have to be willing to put your skills and learnings into practice. Allow yourself to be vulnerable and open to trying new things so that you can report back to your therapist about whether what you’re trying is working for you or not.
• Remember that it’s intended to help you: Therapy homework helps you maximize the benefits of therapy and get the most value out of the process. A 2013-study notes that better homework compliance is linked to better treatment outcomes.
• Talk to your therapist if you’re struggling: Therapy homework shouldn’t feel like work. If you find that you’re doing homework as a monotonous task, talk to your therapist and let them know that your heart isn’t in it and that you’re not finding it beneficial. They can explain the importance of the tasks to you, tailor your assignments to your preferences, or change their course of treatment if need be.

"When the therapy homework starts 'hitting home' for you, that’s when you know you’re on the right track and doing the work you need to be doing," says Erkfitz.

A Word From Verywell

Similar to how school involves classwork and homework, therapy can also involve in-person sessions and homework assignments.

If your therapist has assigned you homework, try to make time to do it. Completing it honestly can help you and your therapist gain insights into your emotional processes and overall progress. Most importantly, it can help you develop coping skills and practice them, which can boost your confidence, empower you, and make your therapeutic process more effective.

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Conklin LR, Strunk DR, Cooper AA. Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression . Cognit Ther Res . 2018;42(1):16-23. doi:10.1007/s10608-017-9873-6

Lebeau RT, Davies CD, Culver NC, Craske MG. Homework compliance counts in cognitive-behavioral therapy . Cogn Behav Ther . 2013;42(3):171-179. doi:10.1080/16506073.2013.763286

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Assigning Homework in Cognitive Behavioral Therapy

It’s certainly true that therapy outcomes depend in part on the work taking place in each session. But for this progress to reach its full impact, clients need to use what they learn in therapy during their daily lives. 

Assigning therapy “homework” can help your clients practice new skills during the week. While many types of therapy may involve some form of weekly assignment, homework is a key component of cognitive behavior therapy. 

Types of Homework

Some clients may respond well to any type of homework, while others may struggle to complete or find benefit in certain assignments. It’s important for clients to step outside of their comfort zone in some ways. For example, it’s essential to learn to challenge unwanted thoughts and increase understanding of feelings and emotions, especially for people who struggle with emotional expression. 

But there isn’t just one way to achieve these goals. Finding the right type of homework for each client can make success more likely. 

There are many different types of therapy homework. Asking your client to practice breathing exercises when they feel anxious or stressed? That’s homework. Journaling about distressing thoughts and ways to challenge them, or keeping track of cognitive distortions ? Also homework.

Some clients may do well with different assignments each week, while others may have harder times with certain types of homework. For example:

• An artistic client may not get much from written exercises. They might, however, prefer to sketch or otherwise illustrate their mood, feelings, or reactions during the week. 
• Clients who struggle with or dislike reading may feel challenged by even plain-language articles. If you plan to assign educational materials, ask in your first session whether your client prefers audio or written media. 

When you give the assignment, take a few minutes to go over it with your client. Give an example of how to complete it and make sure they understand the process. You’ll also want to explain the purpose of the assignment. Someone who doesn’t see the point of a task may be less likely to put real effort into it. If you give a self-assessment worksheet early in the therapy process, you might say, “It can help to have a clear picture of where you believe you’re at right now. Later in therapy I’ll ask you to complete another assessment and we can compare the two to review what’s changed.” 

Mental Health Apps

Some people may also find apps a useful way to develop and practice emotional wellness coping skills outside of therapy. Therapy apps can help people track their moods, emotions, or other mental health symptoms. They can provide a platform to practice CBT or other therapy skills. They can also offer structured mindfulness meditations or help clients practice other grounding techniques. 

If you’re working with a client who’s interested in therapy apps, you might try using them in treatment. Just keep in mind that not all apps offer the same benefits. Some may have limitations, such as clunky or confusing interfaces and potential privacy concerns. It’s usually a good idea to check whether there’s any research providing support for—or against—a specific app before recommending it to a client. 

Trusted mental health sources, such as the American Psychological Association or Anxiety and Depression Association of America websites, may list some popular mental health apps, though they may not specifically endorse them. These resources can be a good starting place. Other organizations, including Northwestern University’s Center for Behavioral Intervention Technologies and the Defense Department of the United States, have developed their own research-backed mental health apps. 

You can also review apps yourself. Try out scenarios or options within the app to get to know how the app works and whether it might meet your client’s needs. This will put you in a position to answer their questions and help give them tips on getting the most out of the app. 

Benefits of Homework

Some of your clients may wonder why you’re assigning homework. After all, they signed up for therapy, not school. 

When clients ask about the benefits of therapy homework, you can point out how it provides an opportunity to put things learned in session into practice outside the therapy session. This helps people get used to using the new skills in their toolbox to work through issues that come up for them in their daily lives. More importantly, it teaches them they can use these skills on their own, when a therapist or other support person isn’t actively providing coaching or encouragement. This knowledge is an important aspect of therapy success. 

A 2010 review of 23 studies on homework in therapy found evidence to suggest that clients who completed therapy homework generally had better treatment outcomes. This review did have some limitations, such as not considering the therapeutic relationship or how clients felt about homework. But other research supports these findings, leading many mental health experts to support the use of therapy homework, particularly in CBT. Homework can be one of many effective tools in making therapy more successful. 

Improving Homework Compliance

You may eventually work with a client who shows little interest in homework and doesn’t complete the assignments. You know this could impede their progress in therapy, so you’ll probably want to bring this up in session and ask why they’re having difficulty with the homework. You can also try varying the types of homework you assign or asking if your client is interested in trying out a mental health app that can offer similar benefits outside your weekly sessions. 

When you ask a client about homework non-compliance, it’s important to do it in a way that doesn’t anger them, make them feel defensive, or otherwise damage the relationship you’re working to develop. Here are some tips for having this conversation:

• Let them know homework helps them practice their skills outside of therapy. In short, it’s helping them get more out of therapy (more value for their money) and may lead to more improvement, sometimes in a shorter period of time than one weekly session would alone. 
• Bring up the possibility of other types of homework. “If you don’t want to write anything down, would you want to try listening to a guided meditation or tips to help manage upsetting emotions?” 
• Ask about it, in a non-confrontational way. You might say something like, “Is something making it difficult for you to complete the homework assignments? How can I help make the process easier for you?” 

The prospect of homework in therapy may surprise some clients, but for many people, it’s an essential element of success. Those put off by the term “homework” may view “skills practice” or similar phrasing more favorably, so don’t feel afraid to call it something else. The important part is the work itself, not what you call it.    References:

• Ackerman, C. (2017, March 20). 25 CBT techniques and worksheets for cognitive behavioral therapy. Retrieved from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets
• ADAA reviewed mental health apps. (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/finding-help/mobile-apps
• Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34 (5), 429-438. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939342
• Mental health apps. (n.d.). The American Institute of Stress. Retrieved from https://www.stress.org/mental-health-apps
• Novotney, A. (2016). Should you use an app to help that client? Monitor on Psychology, 47 (10), 64. Retrieved from https://www.apa.org/monitor/2016/11/client-app
• Tang, W, & Kreindler, D. (2017). Supporting homework compliance in cognitive behavioural therapy: Essential features of mobile apps. JMIR Mental Health, 4(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481663

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• Jan 30, 2023
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19 Tips to Motivate Clients With Therapy Homework- (Infographic)

Updated: Sep 14, 2023

Our team reached out to a group of therapists to find out what tips they had to offer on how to get clients to do their therapy homework. The infographic below is a collection summary of the quotes we received from 19 therapists.

While many of the interventions are known among professionals, each participant offers unique insight while answering the same question. The sessions that each therapist has with their clients are fantastic opportunities for discovery and figuring things out. The truth is that much of the learning and growth often come from the application of what has been discovered and figured out. In other words, you never get the full value of your in-person sessions without doing the homework!

Here are what our contributors recommended (you can find the full transcript and a link to the official article down below).

19 Therapists Weigh in On How to Motivate Clients Who Don’t Do Their Therapy Homework

Therapy sessions bring people to many new realizations. However, real learning takes place when a client attempts to apply these new ways of thinking and acting to their everyday life and to the goals they wish to accomplish. A big part of the process is the homework or exercises a therapist assigns to a client. If a client doesn’t do their homework, does this make the therapist's job much harder?

Below you will find the testimony of 19 different therapists that are weighing in on this very real and common occurrence. Each therapist gives their two cents on whether this issue is counter-productive, ways to get around, and more importantly ways to motivate their clients!

Tina Marie Del Rosario, LCSW, MSW, Adjunct Professor @ Pepperdine University

Owner of Healing Collective Therapy Group

https://healingcollectivetherapy.com

A common theme I see in people who lack motivation is the absence of self-compassion. Clients who show up faithfully are clearly displaying a form of motivation. But when it comes to doing the work, there are clients who meet resistance and acts of avoidance. .

What interventions have you found to be helpful in motivating clients?

I find that starting with a psychodynamic approach is necessary. Exploring what is coming up for the client when resistance and avoidance are present is often helpful. The thoughts, attitudes and emotions attached to these feelings have come from some past experience.

Identifying where it is coming from can help the client process said past experience(s) and recognize the lack of relevance it has to present day. More often than not, self-critical narratives are attached to the feelings of resistance.

These criticisms evoke both somatic symptoms and self-protection motivations that lead to avoidance. Becoming aware of what is coming up and how it is showing up is necessary to combat lack of motivation. Once identified, we can then work together to process it all and begin to change the narrative.

When clients realize their lack of motivation is not coming from “laziness” or “a character flaw,” they then can begin to remove the self-critical narratives and replace them with self-compassion.

With this new internal dynamic and the absence of self-criticism, clients find it easier to begin to motivate themselves to do the work.

Ellie Borden, BA, RP, PCC

Registered Psychotherapist, Clinical Director and Clinical Supervisor.

https://www.mindbydesign.ca

Resistance can be a common part of any change process. Some people struggling with different challenges may appear not to want to change. Even those clients who attend therapy loyally and recognize the need for change in their lives may fail to complete their homework or take the necessary steps outside therapy to modify their behavior.

This is a powerful moment in therapy and can give a therapist the insight necessary to recognize the deeper issues affecting someone's motivation to take the necessary steps toward the change they seek. Often, recognizing avoidant patterns or behavior is an opportunity to identify unresolved matters and the core elements that require healing.

Moreover, a therapist can help an individual reformat their why for change. It is important that someone's why is emotionally driven and leads to effortless motivation. The responsibility for change is the client's alone. However, a trained professional can give someone the objective perspective needed to get them moving in the right direction.

While a therapist can help a client become more motivated to change, ultimately, the onus is on the client to change. With that in mind, there are specific methods that therapists can use with clients to properly motivate them to make the needed changes in their lives.

One of the most widely used interventions for motivating clients is motivational interviewing. The goal of motivational interviewing is to help clients increase their intrinsic desire to change and achieve their goals in therapy. One of the techniques in motivational interviewing is bolstering the client's sense of self-efficacy by helping them recall examples of overcoming challenges in the past. This can allow the client to see that change is achievable and that the situation may not be as hopeless as they think. Developing discrepancies is another technique in motivational interviewing.

This involves a therapist helping the client voice their thoughts, feelings, and conflicts to call attention to the discrepancy between how the client is behaving and how they would like to behave. Motivational interviewing is a great way to help clients recognize their inner strengths and develop the desire to change.

There are many reasons why a client may resist taking the proper action discussed in therapy. One is fear of failure. Some clients, particularly those who are clinically depressed, do not have much faith in themselves or their ability to succeed. Even the slightest real or perceived setback can cause them to catastrophize or engage in negative self-talk such as I am so stupid or I am a failure who can never do anything right. With such a mindset, it is no wonder many clients are unwilling to attempt the steps required for positive change, even if they may truly desire to change. This is one reason why strengthening a client's self-efficacy is crucial.

Another cause of a client's resistance to change is a lack of clear goals. Some clients may struggle to articulate a vision of what desired change looks like, even if they sense that something has gone wrong. Helping the client develop a clear and realistic plan for change can give them additional motivation for following through with the often difficult and confusing work of pursuing meaningful changes in their lives.

Sarah F. O'Brien, LCSW, LLC

Thrive & Shine Counseling

https://www.sarahobrienlcsw.com

Without fail, as a therapist I will point out the discrepancy-mentioning to them how consistent they are with attending sessions, yet how inconsistent they are with completing homework. This usually sparks conversation and processing about why this may be happening for the client.

As a Clinical Social Worker, we are trained to assess a person fully within the context of their life circumstances, something we call BioPsychoSocialSpiritual assessment. With this, I may ask and find extenuating at-home circumstances that prevent clients from being able to complete homework i.e. too busy, not setting enough boundaries at work, ignoring self-care, over-committing to things that aren't beneficial to client's mental health.

What interventions have you found to be *helpful with motivating clients?

To increase client commitment to the change process, I use interventions such as:

*Psychoeducation* (explaining to them, with psychotherapy, most of 'the work' occurs outside of session to achieve desired change).

*Motivational Interviewing techniques* (to prompt and explore client reasons for lack of homework follow through and their awareness, if any, about this).

*Creative homework assignments* based on client's interests or talents (outside the box stuff that doesn't include worksheets or even writing anything down i.e. going for a walk and looking for different types of flowers or trees--this is a mindfulness practice. Or art/expressive assignments i.e. creating a playlist, making a collage or vision board, designing a room or space in their mind-- this is emotional processing, gaining new perspective, finding a safe 'place' to decompress).

*Encourage and suggest clients develop a reward system* for themselves for completing homework assignments (small gifts or tokens for completing that week's assignment, i.e. getting special coffee, taking an hour off work early, favorite dessert they rarely have etc. And larger tokens for consistent completion--every week for a month, for example, or tracking progress or having a breakthrough from the homework-- i.e. taking a weekend trip, taking a whole day off for self, purchasing non-practical or coveted item for self).

Although people willingly engage in therapy, the change process is often arduous and longer than we anticipate (or desire!). People lose motivation, it happens. Enjoyable assignments and rewards for completion are the external factors that motivate us until some positive change starts to occur. When noticeable, positive differences emerge from 'doing the work' outside of sessions, internal motivation often kicks in for clients and they WANT to keep doing homework BECAUSE it's producing the change they want to see in themselves.

Candace Kotkin-De Carvalho, LSW, LCADC, CCS, CCTP

Absolute Awakenings | Morris Plains, New Jersey

https://absoluteawakenings.com/

Therapy isn't a magic pill; clients need to work on their issues as part of the process. One strategy that may help is setting up firm boundaries. This can include scheduling regular appointments and requiring homework assignments between sessions. If a client repeatedly misses appointments or doesn't complete required tasks, it is helpful to schedule a check-in session to discuss this issue and help the client stay on track.

There may also be times when it's necessary to end therapy with a client who refuses to work on their issues. It can be challenging to make this decision, but it is important to do what's best for both the client and therapist to maintain a healthy professional relationship. If you are struggling with these issues, it may be helpful to seek out support from other mental health professionals or find a trusted mentor who can provide guidance.

Reflective listening and active listening can help clients feel heard and understood, which can ultimately motivate them to do the work. Reflective listening involves paraphrasing back to the client what you have heard them say. This way, empathy, and understanding are communicated, and the client feels more motivated to continue working on their issues. Active listening involves listening through nonverbal cues, such as eye contact, nodding, and facial expressions. This approach also encourages a client to articulate their own thoughts and feelings.

When it comes to doing their part in therapy, some clients may need additional support and guidance. This can include breaking down tasks into smaller parts, setting up time-bound goals, or providing positive reinforcement for progress made. If you give them homework assignments, check in with them at their next appointment to see how they are progressing and provide feedback or encouragement as needed.

For example, it may be overwhelming for some clients to make a major life change in one sitting, so you can help them develop a gradual plan to work toward their goals. Meanwhile, other clients may feel frustrated and unmotivated if they aren't making enough progress or meeting their goals quickly enough. In these cases, it can be helpful to provide positive reinforcement when they

make progress, such as offering verbal praise or tangible rewards.

Our behaviors are heavily affected by our thoughts, emotions, and environment. For clients who have been struggling with mental health issues for a long time, their thought patterns and coping mechanisms may be ingrained in their psyche. As a therapist, it is important to acknowledge that these behaviors may take time to change.

Often, this involves helping the client identify and understand unhealthy thought patterns and behaviors. This may involve identifying negative self-talk, challenging unhelpful beliefs, or learning coping strategies to better manage stress and anxiety. Accordingly, help the client focus on their strengths and build positive relationships with others. Acknowledging that they are working through a difficult time can provide support and motivation for them to keep going.

In addition, be mindful of your own thoughts and emotions as a therapist. For example, it is helpful to have regular supervision or check-ins with other mental health professionals so you can discuss any challenging client interactions. This will help ensure that your professional boundaries are maintained and that you provide the best support for your client.

Lauren Cook-McKay

Licensed Marriage, and Family Therapist and VP of Marketing at Divorce Answers

https://divorceanswers.com/

Although therapy is a two-way street in order to be successful, it's also a safe space for clients to be a mess. Dealing with incomplete homework usually involved capitalizing the inaction as a window to the realization of the issues they're dealing with in their lives.

Paradigm shifts were emphasized as a necessity, but the inaction itself is conceptualized as evidence of a barrier to wellness so it's leveraged for strategizing on better methods for management that are more suited to the client's capacities. We also make sure to leave room for these strategies to be adjusted until clients are ready to fully overcome their hindrances.

The most effective intervention that improves clients' motivations is the involvement of their support systems. Typically, the barriers they're facing and the reasons behind them being unpacked during the session bring forth the need to have sit-down talks with their loved ones. *Practicing that suggestion, they're able to verbally communicate the impact of the reactions and behaviors of the people around them which they've been repressing. *This frees them from their old self-concept and ultimately minimizes their hindrances.

After defining the specifics around the sequence of events that lead to the inaction of an assignment, analyses generally reveal that *clients feel unable due to complete them mostly due to the overwhelming pressure from expectations of accomplishing the assignment and/or apprehension of the mental labor being demanded by the task, as well as the potential impacts of the self-reflections that the task aims to bring to light. These reasons stop them from their tracks and/or deplete their mental energy to commit to the whole treatment.

Lawrence Barnier

Mental Health Officer

Women's Resources e-Information

https://www.wrei.org/

There are a few different ways to approach this situation. One way is to try to understand why the client is not doing the work. It could be that they do not understand what is expected of them, or they may feel overwhelmed and unsure of how to get started.

In these cases, it may be helpful to provide some guidance and support to help the client get started.

Another reason why a client may not be doing the work could be that they are not interested in changing their behavior. In these cases, the therapist may need to reassess the goals of therapy and decide if it is still appropriate to continue working with that client.

There are a number of interventions that can be helpful in motivating clients. One strategy is to set goals with the client and track their progress. This can help to provide feedback and encouragement and can help to show the client that they are making progress.

Another strategy is to provide positive reinforcement when the client demonstrates good behavior. This can help to encourage the client and can help to build a positive relationship with the therapist.

Finally, it is important to be understanding and supportive when the client does not meet their goals. This can help to provide motivation and can show the client that the therapist is there to help them.

Claudia Luiz

Psychoanalyst

http://www.claudialuiz.com

When clients “resist” in therapy, that resistance can yield more information than what the client can tell you consciously. If you focus on the resistances - why the homework isn’t getting done, why the client is stuck, why they can’t break negative patterns and integrate what they are learning - you are really getting into the zones that the client hasn’t been invited yet to explore.

We now know from neuroscience, the three areas of the brain that can hijack conscious effort. Fear, rage, and grief. When people are afraid of feeling things, they get stuck.

Neuroscience gives us a model for what the patient may be resisting. The other emotional zones, seeking, play, and love can be engaged in this exploration. The framework gives us a way of thinking of the clients' “stuckness” in a productive and creative way.

Joining the client in their “stuckness” with compassion and curiosity, while shifting the framework of what you are ultimately working on, avoids power struggles, or potentially shaming the client. It lets them know compassionately that we understand about resistances, and that talking more about feelings can hold the key to unlocking the mystery of what is standing in the way of progress.

Elisa Tidswell

Certified Coach and Therapist, Committed to Empowering Women, Breaking

Negative Generational Cycles, and Creating Economic Justice

https://elisatidswell.com

It's vital that therapists understand how to keep their clients accountable to their growth. Accountability is where therapists help their clients take action that will help them grow - and action is the only place where transformation takes place. Transformation is what clients pay their therapists for.

It's also really important that therapists get really good at accountability, otherwise, they can actually wind up demoralizing their clients. After all, if clients don't do their homework consistently they are likely to internalize it, believing that there is something wrong with them or that they are failing. This is the polar opposite of what therapists want for their clients.

So how can therapists help their clients do their homework? By cultivating an environment of curiosity and learning. Accountability is not about judgment or being 'told off', however, sadly this is exactly what many people believe it to be: they learned about accountability from their parents and school environments where not doing homework or handing in sub-par homework was met with shame. It's really important for therapists to dispel this mindset and ensure their clients know that accountability is about learning.

The best approach I have found after coaching hundreds of clients to stay accountable is to include three main parts to the accountability conversation. The first is for the client to share a win: something positive that's happened since they last met with their therapist. This could be an insight, a decision, a process (such as 'I felt my feelings!'), or something extrinsic, such as a pay rise. Sharing a win is important to put the client in a state of abundance and is commonly used by positive psychologists in their practice.

The second part is to consider a goal or homework that the client did do, and break it down to see why they did it. For example, what were they thinking, how were they feeling about it, how did the goal tie in with their values, what was their motivation to get it done, did they tell others about it, had they put it in their diary, and so on. The therapist and the client want to learn about what works for them so that they can double down on it.

The third part is to consider a goal or homework that the client didn't do and then see what they can learn from why they didn't do it. Was the goal too big and overwhelming, and actually needed to be broken down into smaller steps? Were they clear on how to get started with the homework or was their understanding fuzzy? Was the homework tied in with their vision or values? Had they put it in their diary? Did they have support from others? Was a limiting belief getting in the way? Once the therapist and client have learned more about why they didn't do it, they can create a new goal to support them in achieving the original one.

The best action a therapist can take in supporting their clients with their homework is to let go of judgement and to a growth mindset. They have to see accountability itself as a learning exercise where they can explore

what's going on for the client, and understand what works for them.

Trish Glynn, LMHC, CRC

Licensed mental health counselor

Owner and therapist at The Carey Center

https://careycenter.squarespace.com/

Therapy is all about meeting the client where they’re at. Of

course, therapy will work best when the client is actively engaged both in and outside the therapy room. Results tend to be better and come faster. But not everyone is doing the work when they leave the appointment. There can be many reasons as well as many ways to address this. As a therapist, you want to try to figure out the “why” as that will help you determine next best steps.

For example, maybe you’re assigning work that is “too much” or isn’t a good fit for them. Are you asking a client to journal every week when sitting down to write is a mismatch for them?

Part of therapy is figuring out why the client is stuck. That takes time and talking about it in order to understand what the individual reason and best response may be.

In some cases, we just need more details, and so we keep talking and exploring to figure it out.

The client has a reason for what they do or don’t do – and therapy is about finding that out. Progress can come from discussing things the client has maybe never talked about with anyone before.

Also, it can be helpful to seek out some emotionally compelling reasons for change. If you can come up with some really meaningful “why” that speaks to the client, that can create a shift. Logic is often useless. We often know why we should do things. Yet, we don’t. But emotion can get us moving. What interventions have you found to be helpful in motivating clients?

A lot depends on client preference. As a therapist, it’s important to build rapport and get to know who is in front of you. That’s the ideal way to figure out what will work best for them. Because something can be incredibly effective, but if it’s not a good fit for a particular person, it won’t matter. Often, an eclectic approach is best. We are all so very different. One of the most important elements in therapy is the relationship. That matters more than any particular intervention. That’s why people go to therapy to talk to someone – a self-help book, for example, can list out some

interventions, but nothing compares to the human relationship, the rapport, the empathy, and the positive regard, which occurs in the therapy room. You can’t buy that off a shelf. Elaborate on any details you find helpful for explaining the mindset of the client and how it changes.

Therapy involves understanding the current mindset of the client. We want to understand if it’s fixed, or more growth-oriented, for example. We want to consider how their mindset both helps and hinders them. It’s usually a fixed mindset that gets us into trouble. We think we can’t change and our circumstances, too, can’t change. We will give up more easily and ignore helpful feedback. With a growth mindset, we know we are a work in progress. We are more open to accepting challenges. We are more able to seek them out.

Changing from fixed to growth involves challenging current thoughts. For instance, you can get stuck making a lot of false assumptions. You can begin to question your thoughts. Is that true? How do I know? What else might be happening here? Am I being too black and white, and missing the grey areas?

We have to notice where our mindset is now. Then we begin questioning it. We begin really getting deliberate about looking at our thoughts. For most of us, we don’t really spend much time if any thinking about our thoughts. It can help to start pausing to consider what thoughts are in your mind. And then we can start examining them and challenging them. And that’s when we can begin to create a shift. We can’t change what we don’t look at and understand.

Janelle Marshall, LPC

Marshall Gray Counseling Services

https://www.marshallgraycounselling.com

How do you navigate clients who faithfully come to therapy, but don't do the work?

I check in with the client and help process any challenges that are interfering with their ability to do the work. Sometimes the perception of the client not “doing the work” is an indicator of emotional trauma or blockage that needs to be processed.

Journaling is one of my favorite interventions to share with clients. I find it helpful for clients to visualize their therapeutic goals and their thoughts behind how their lives will reflect the efforts attempted. Habit tracking is a tool that helps take motivation a step further with clients that are committed to the therapeutic process. I have a collection of reflective habit tracker journals that serve as a guide to help the user align their actions with their desired goals.

As a solution-focused therapist, I help prepare my clients to embrace the evolution of their mindset throughout our journey together. It’s also understood that the client’s anticipated mindset change is contingent upon their willingness to commit to the work assigned in and out of the session.

Miriam Manela

The Thrive Group

https://childrenbloom.com/

The best motivation for clients is first and foremost for the therapist to let go of having a NEED to change their client, to let go of convincing their client to change and to simply allow the client to do what they have been doing and nothing different.

I usually tell clients, without any judgment, but just to give them an awareness that typically when the follow-up program is kept then results are significantly faster. If there is no follow-up done, that is okay, I just like them to be aware that therapy can take quite a bit longer then.

The third technique I use in therapy to motivate clients to change from within themselves is to create intentions. Rather than giving the client something they need to do, I would make an intention with them, which they could say once a day to give themselves the awareness of their challenge. Or if not, they may only use their intention once a week when they come to me for a session.

An intention would sound something like, I noticed that when someone questions my authority, I get very agitated. or I noticed that when my child comes home from school, or my boss walks into my office I feel flustered, overwhelmed, frustrated or anxious, etc. So without needing to tell the client to do any specific exercise at home, we've instead created together an intention to repeat every day to give themselves awareness. I may have them create a reminder on their phone with it or post a sticky note in their bedroom or bathroom.

Just remembering their awareness helps them remember what to do to calm down, on their own.

Danielle Bagus, MSW, LSW

Relief Mental Health

https://www.reliefmh.com

When a client seeks out therapy, faithfully attends without fail but once in session we are going over the same issues over and over again and I have found they are not doing the work on themselves outside of the therapy sessions, I attempt to look for a support system that may help them.

This might be a significant other, a parent, sibling, friend, etc. I ask who is in their close circle who they trust to help hold them accountable. I will also hold them accountable but sometimes encouragement coming from a loved one or someone they don't want to let down will mean more.

I also have found that the homework might not necessarily match up with their skill set or what they are willing to put in at that time. Therefore, as their therapist, it's my responsibility to find a new method or way to connect with the client and help them be successful.

One size does not fit all when it comes to therapy. Therapists need to have lots of tools in their toolkit to meet the needs of the client and ultimately to meet the client where they are in the process of therapy.

I think this can really depend on the client and what they need out of therapy. I find that Cognitive Behavioral Therapy (CBT) works the best to motivate my clients to continue to do the work outside of therapy. CBT helps people with such a wide range of mental health issues and ultimately helps with really digging deep to find new ways of thinking, coping and behaving in certain situations.

Clients seek therapy for many different reasons. Some want to change their mindset, some wish to seek outside advice or help on a specific situation or topic (divorce, relationship, school based issues, family issues, etc.), some come because they have been diagnosed with a mental illness (bipolar, depression, schizophrenia, eating disorder, OCD) and need help maintaining a healthy mindset, some clients want an outside person to just listen, the list goes on. As a therapist, you are there to be an impartial, nonjudgmental resource for the client. You are there to help them realize different ways of doing things and different ways of thinking.

The client takes the first step in seeking out therapy but also needs to be the one doing the work and willing to change what they have always done with the guidance of their therapist. It's important for the therapist to always ask what the client wants out of therapy or a specific session. Sometimes the client doesn't know but I think our clients are more self-aware than they realize. If you can ask the right questions, they ultimately will tell you what they need, want or expect to get out of therapy in general or even a specific session.

Kellie Brown, LMHC, NCC, MCAP, (she, her)

Licensed Mental Health Counselor (LMHC)

Owner of Quiet Water Counseling in Florida

https://www.QuietWaterCounseling.com

Oftentimes when a client comes regularly to therapy but does not want to do work outside of sessions it comes down to the client being afraid of making changes in their lives. People get so use to doing things one way it is very hard to change directions and try something new.

So instead of setting clients up for failure by giving them a huge homework assignment that is very likely overwhelming and they probably won't do, I give them very small tasks to accomplish.

So instead of giving a client the homework assignment of going to an Alcoholics Anonymous meeting or joining a gym, I ask clients to research AA meetings, or research local gyms. The next week I might ask them to just drive to the location of the meeting, or drive to the gym location, but tell them they don't have to go in, I just want them to physically see where it is located.

Giving smaller homework assignments tends to help break down a huge change into something more manageable.

Elizabeth Mateer, MS, MA, LMHCA *(she/her/they)

Director, Divergent Wellbeing https://www.divergentwellbeing.com

Lead with curiosity. Asking why didn't you do X this week like we talked about automatically leads to defensiveness and shuts down motivation to discuss what happened. Something like After our conversation last week, you seemed excited to work on using that coping skill. I'm curious about what the barrier was when you thought about applying it this week. This framing allows the client to explore the *process* of doing the work, rather than the content of I didn't do it.

Don't let it go. As therapists, we tend to feel compassion and understanding toward our client's challenges. While this is an important skill in many aspects of therapy, it can sometimes be tempting to let it go when our clients are consistently not doing the work outside of therapy. This is not only avoidant ourselves, but it doesn't serve our clients by teaching them to take accountability for their well-being. We can still be compassionate while being direct.

Meet them where they are at. Clients know when they aren't doing what they said they would, and yet, they are still showing up. That says a lot about the relationship and trust you've already built with them. Highlighting any progress you see, regardless of how small, is an effective way to motivate clients to continue moving forward. Sometimes these clients just move at a slower pace than others we see coming into therapy ready to take action, and that's OK.

Self-reflect on what we are asking from them and if it is too much. Sometimes as therapists we see the potential a client has and give homework assignments that are beyond what is realistic in the present moment, especially if we have seen our clients for a long time and have an idea of what they are capable of. Is there a way to break down the work into smaller, more achievable pieces? For some clients, if a task seems too aspirational or unrealistic, they won't attempt it at all. Smaller steps towards progress are better than no progress at all.

Steve Carleton, LCSW, CACIII

Gallus Detox

https://www.gallusdetox.com/

Navigating clients who come to therapy but don't complete their homework can be difficult and often requires a tailored approach.

The first step is to create an honest dialogue with the client about why they are not completing the assigned tasks.It could be that the tasks are too challenging or time-consuming, or that they don't understand what is expected of them. It is important to understand the underlying reasons behind the lack of motivation, and build a plan together that works for both parties.

The next step is to offer alternative homework assignments that are tailored to each individual client's needs. This could include reading an article or book related to the problem being discussed in therapy, journaling about their thoughts and feelings, writing a letter to their future self, or attending a workshop or class related to the topic. It might even be more helpful to ask your client what they would like to work on or what they would find most helpful. This will help to make the homework assignments more meaningful and will give them a sense of ownership over their progress.

The last step is for the therapist to provide ongoing support and accountability for their client's progress. Check-ins at the end of each session are a great way to ensure that homework is being completed, and providing regular feedback can help the client stay motivated. Above all else, try to create an environment of understanding and acceptance that encourages your client to be open and honest about their progress. With patience and dedication, you can help your clients reach their goals.

Nirmala Bijraj, LMHC, NCC, She/Her/Hers*

Aligned Self, LLC

https://alignedself.co

I explore with them why they don't do the homework, what about getting it done, and doing it, makes it difficult.

I usually start with the least possibly intrusive change. We explore the change they want to make, identify the first step and then explore how to incorporate that change with the least amount of barriers and effort possible to start to build a new habit.

I've found if we start with something that feels like the least amount of effort, takes the least amount of time, and is the least intrusive on their life and schedule, then the client is most likely to do it.

For example: A client wants to work out in the mornings: *(this is a real scenario that I've worked with clients on with these steps). We start with building the habit of getting into gym clothes first thing in the morning when they wake up, the goal is to start the habit, we don't focus on how many times they work out or if they work out at all, just starting the first part of the process.

Then a week or two later or more depending on the client, we would add a 10-20 minute workout, something that they can actually make the time to do, 5 minutes if that's all the time they have to start with, again the least amount of effort that will help them start building the habit. And then continue to build on that habit until they're where they want to be with that goal.

Lindsey Ferris, MS, LMFTA

Individual & Couples Psychotherapist

https://www.talkhealthrive.com

If I notice that clients are coming regularly and sticking with therapy, but I'm not seeing progress or an effort to do out-of-session homework. I will bring this up directly to the client to ask them what they are seeing and how they are experiencing therapy. If they are seeing the changes and growth, they want to see, then I'll have them elaborate on this so I can understand from their perspective what growth and change looks like.

Oftentimes it takes checking in with my client to learn that they in fact are feeling the benefits and see growth in themselves in different ways than what I may be looking for, and it is a good idea to level set vs. assume that 'work' isn't being done or growth isn't happening.

If I find that clients are resistant to homework, or not making progress towards their therapeutic goals, I will address this directly and ask them what is getting in the way of doing homework and impacting their ability to engage fully in their therapy process. This can often lead to areas that need to be addressed first, before other priorities, so that any

therapy-interfering behavior can be resolved and progress can continue.

I find that oftentimes addressing directly with clients what I am observing in therapy interfering behavior or lack of compliance to homework can lead to thought-provoking insight and dialogue and instigate a change in how the client sees the way they show up for therapy. Once it is out on the table as a barrier to therapy compliance, the client and I can have an open dialogue about when either of us see it coming up in the room to work towards behaviors and changes that they want to see. When a client has insight into patterns that may be blocking them from growth, it can be a true aha moment that changes the engagement and adherence to therapeutic homework and growth.

William Schroeder

Licensed Counselor and Owner of Just Mind LLC

https://justmind.org/

Every therapist has clients like this and it's a helpful thing to not beat around the bush about. If you notice someone is saying they are motivated and then not doing the work, the meat of the therapy is digging into what's getting in the way.

Motivational interviewing could be one way to approach this. On a scale of 1-10, how motivated are you to see X change. If it's low, then that's helpful to know and you might need a new target. If it's high and there isn't follow through, then you need to see what ideas they have that might help them have success and assess their perception of those as well.

Sometimes trauma can get in the way and it can help to make sure this is properly assessed. There are a number of trauma screens but trauma can be a big barrier to change if it's not dealt with. Things like EMDR can be helpful in treating PTSD, for instance. 100% of single-trauma incidents and 77% of multiple-trauma survivors no longer met the diagnostic criteria for PTSD after 6 fifty-minute EMDR sessions.

It also can be helpful to assess ADHD to see if that's possibly a complicating factor. The World Health Organization has a simple test clinicians or clients can use to see if they might meet criteria.”

Alexandra Alex Cromer, LPC

Thrive Works

https://thriveworks.com/richmond-therapy/

A great tactic to navigate this is to have an honest conversation on their progress and introduce them to your theoretical framework/how you judge and measure client success.

The Transtheoretical Model of Change is my personal favorite, and it takes into account client motivation and any barriers that might be keeping them from making continued progress.

Another tactic is to discuss one of the main goals of therapy with a client; making the client more effective in their daily lives. Through this lens, we can invite the client into a bidirectional conversation in which we discuss progress and change as well as ways in which they believe your time together in therapy is effective.

I tend to favor a lot of motivational interviewing techniques as well as cognitive challenging skills to help motivate clients. If a client is faithfully attending session but is not doing the work, we could ask them a cognitive challenging question to get them to explore and identify their current patterns and routines and the efficacy of these.

Motivational interviewing techniques are similar in this way, in that they require work and active reflection on the part of the client in order to answer the questions. The most effective techniques to motivate clients are the ones which require the clients to do active work and are not closed-ended questions. The more you can allow a client to engage in self-reflection, research shows client motivation and propensity to change increases.

One of the biggest frustrations that therapists experience is a client who is seemingly not putting in the work or reportedly making progress and change. It's very common for a therapist to assume that a client is unwilling to change and is purposefully resistant to the process. Often, this is not the case and the client's stagnation can be better explained through a theoretical lens. For example, using the Transtheoretical Model of Change, we can identify that client barriers to progress come in the form of fear of failure, anxiety, and perceived low self-esteem, rather than willful ignorance.

Honest, direct conversations with clients allow them to see themselves through your perspective, and vice versa. Typically, research shows that clients who have a high sense of self-efficacy have a higher propensity to engage in change making behaviors. Therapists can increase client self-efficacy by continuing to engage clients in

Self-reflection.

Wrapping up…

The bottom line is that when clients do their homework things progress quicker, but when clients DON’T do their homework, we get new insights to resistances and what is actually going on inside. Thank you to all the fantastic therapists that contributed to this article! With great insight comes improved well-being.

You can find the original article published here: https://www.psychreg.org/therapists-weigh-how-motivate-clients-who-dont-do-their-therapy-homework/

Feel free to download the interactive PDF but don't forget to share the link to our page!!

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When I found myself on a therapist’s couch in 2017, I kept waiting for the real work to begin. I had started therapy because I wanted to “fix” my life — my anxiety, my relationships — and wanted someone who was wiser than me to tell me how to do that. My natural orientation toward uncomfortable feelings is to take action, because that’s easier than wading through them. I feared I’d drown in all those tough emotions if I fully stepped into their swirling waters.

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My therapist would kindly tap the brakes every time I had that pleading “What should I do?” look in my eyes. I wanted things to change, and immediately. Thankfully, this therapist was more interested in guiding me toward my own thoughts and patterns and understanding where they came from.

These early therapy days came to mind when a reader, who asked to remain anonymous, asked this question: “Is a therapist just a safe space to talk about your problems, or can you expect to make goals and be given ‘homework’ or guidance on how to achieve better mental health? I am wondering if a life coach is a more appropriate option than a therapist for affecting change in my life.”

At the end of the day, that’s why 99% of us go to therapy: to affect change in our lives. But how can that change be set in motion with the help of a professional?

My dog ate my therapy homework

I’m going to tackle the question of homework first.

The short answer is yes — homework is totally a thing in therapy. In fact, most therapists invite clients to complete certain tasks between therapy sessions, said Jesse Owen, a counseling psychology professor at the University of Denver who studies the process and outcomes of psychotherapy.

“The real work of therapy, other than the courage to be vulnerable in sessions, is to do something to change your life outside of the 50 minutes we spend together each week,” Owen told me.

And it can have real payoffs: Research suggests that incorporating homework into psychotherapy enhances its effectiveness, and that clients who consistently follow through with assignments tend to have better mental health outcomes.

The homework you receive will depend on your therapist’s approach. For example, clinicians who use Cognitive Behavioral Therapy (CBT) — which focuses on changing the way you think — may ask you to keep track of your thoughts, feelings and behaviors that arise in situations that are stressful or upsetting. Then, in the therapy room, you and the therapist can come up with more helpful ways to respond in those situations in the future. CBT is arguably the most homework-heavy kind of therapy, Owen said.

Others might suggest workbooks that you can do together, always with the gentle caveat that it’s up to you to complete the work.

Ann Kelley, a psychologist in Austin, Texas, and the co-host of Therapist Uncensored , a podcast (that I love!) about attachment and relational science, said her homework is all about broadening her clients’ awareness of themselves and those around them.

Let’s say that you’re someone who is afraid of conflict and has a hard time voicing your opinions and needs in intimate relationships. Kelley might ask you to try to speak more directly with your partner that week. Later, you and Kelley could discuss what you noticed in those moments (like: “I was scared to death to do that!” or “It actually felt really good to tell my partner how I really felt”).

With certain couples, Kelley might ask them to go home, look each other in the eyes, hold their gaze and ask each other important questions. Often, people are shocked that they can’t make sustained eye contact with their partner without getting really anxious. If your therapist has a more psychodynamic approach, you would probably explore why you have that reaction. (Quick note: For some neurodivergent folks, we know this exercise might not be helpful and appreciate your readership.)

“It’s all about getting new information about yourself,” Kelley said, “about being in a place of deep curiosity instead of knowing.”

People can (often unintentionally) approach therapy in a passive way, Kelley said. They show up for an hour each week after not thinking about or applying what they discussed with their therapist the week prior. Homework is one way to ensure you’re getting the most out of therapy because it shifts what you learned from an intellectual understanding to lived experience.

If your therapist hasn’t given you homework and that’s something you’d like, Kelley recommends asking your therapist for ways you can deepen what you learned in between sessions.

A different kind of conversation

Our reader also asked whether they can expect “guidance” in therapy, which I interpreted as “advice.”

Usually when we’re really opening up, it’s to a best friend who, with permission (hopefully), can offer some advice. Therapy is a much different dynamic.

The job of a psychotherapist is to guide people toward self-awareness, but most are trained to avoid advice-giving, Owen said. There are a few reasons for this. People are more likely to metabolize insights they themselves discovered in the caverns of their unconscious, though a therapist may have been holding the flashlight. “Generally, advice doesn’t do as much as [asking] open-ended questions and exploring the deeper meaning of things,” Owen said. Therapists also don’t want to give bad advice, or dictate what a client should do because of power differentials in the therapy relationship.

If a client asks for advice, a therapist might share more general thoughts or encourage a client to think about what patterns are contributing to the problem.

“As much as we would like people to take advice — eat healthy, sleep, drink less — people don’t listen unless they’re really in touch with their own motivations for mental health,” Kelley said. “Our job is to help people want to make important shifts, not tell them how to do it.”

As a future therapist myself, I’m reflecting on what kind of feedback I’ve found most helpful in therapy.

The therapists I’ve worked with have never explicitly told me what to do — like when I’ve asked whether I should leave a relationship or a career — but did reflect back to me insights I’d been forming with their help.

Once, after describing a series of distressing conflicts with an ex-partner, my therapist flat out said, “I don’t like this for you.” I didn’t like it either, but I wasn’t ready to fully admit that to myself. When my therapist acknowledged that how I was being treated (as I was describing it) wasn’t OK, it opened the door for me to do the same.

This worked for me only because I’d been seeing this therapist for a while and I trusted her. But it should also be noted that this comment really did influence the way I saw my relationship — one reason therapists tread with caution when offering such commentary.

Put me in, coach

Lastly, this reader would like to know whether working with a life coach might be a better option.

Both therapists and life coaches offer support and guidance, but there are notable differences:

• A life coach helps you improve certain skills, like problem-solving and organization, and holds you accountable for reaching future goals.
• Therapists are trained in more in-depth psychological exploration and can help you get to the root of patterns that are holding you back.
• Unlike therapists who are held accountable by a licensing board, life coaching is not regulated by the government, and there’s not much empirical research yet on its effectiveness, Owen said.

Still, there are many great life coaches out there. Kelley refers clients to coaches when they need help building skills in a specific area, like finding a particular job, or working on time management for people living with ADHD.

“If you’re self-aware and need a confidence boost or help with goal setting, a life coach can be a good fit,” wrote health journalist Kaitlin Vogel in this Psych Central piece I recommend if you’d like more information on life coaching.

See you next week,

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind , where we’ll continue this conversation.

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More perspectives on today’s topic & other resources

Psychoanalyst and psychologist Nancy McWilliams talks about what actually works in therapy in this episode of Therapist Uncensored.

Ready to start your therapy journey? The Times put together a comprehensive list of low-cost mental health resources in Los Angeles and Orange counties, including therapy, support groups and meditation classes.

How to help people in psychosis — from Times contributor Erica Crompton, who’s experienced it firsthand .

Other interesting stuff

“What if the cure for our current mental health crisis is not more mental health care?” asks UCLA professor Danielle Carr in this thought-provoking New York Times op-ed . She makes the point that the medicalization of the problem puts the focus on the individual at the expense of reforming systems and structures that created it in the first place.

Renowned addiction expert Gabor Maté talks about the effect that toxic culture has on our minds and bodies in this great interview on the Higher Practice podcast. Maté’s new book, “ The Myth of Normal, ” came out earlier this month.

Women are doing more paid work, but the bulk of household labor still falls to them — and research shows it takes a toll on psychological well-being .

Group Therapy is for informational purposes only and is not a substitute for professional mental health advice, diagnosis or treatment. We encourage you to seek the advice of a mental health professional or other qualified health provider with any questions or concerns you may have about your mental health.

Laura Newberry is a former reporter with the lifestyle section at the Los Angeles Times. She wrote Group Therapy, a weekly newsletter that answers readers’ questions about mental health. She previously worked on The Times’ education team and was a staff reporter at both the Reading Eagle in Eastern Pennsylvania and MassLive in Western Massachusetts. She graduated from UC Berkeley’s Graduate School of Journalism and also has a master’s degree in social work from the University of Central Florida.

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Have a question about something that happened in therapy? Want to know how your experience compares to other peoples? Wondering what the heck your therapist is talking about? Thinking about going into therapy but want to know what it's like from a patient's perspective? Share your psychotherapy stories and questions here. Clients and therapists are both welcome to exchange perspectives and ideas. Please be kind to each other.

My CBT therapist does not give any homework

I have seen a CBT therapist for 50 sessions and he does not assign homework or give our worksheets to fill. Session after session is just talking. There seems to be slight change in perspective and little bit of acceptance of uncertainty that I have developed but I believe that to be mostly down to my own reading of books, watching videos and general observations of how others go about life.

I’m not sure if it’s helping. Is it normal for CBT therapists to not assign worksheets to fill in?

The therapist is also BABCP accredited in the UK.

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Anxiety Therapy: Types, Techniques, and Worksheets

Such anticipatory anxiety makes enjoying each moment a difficult endeavor. Unfortunately, anxiety disorders represent a serious and prevalent problem for children and adults worldwide.

The lifetime prevalence rate for anxiety disorders is estimated at 33.7% of the population—an estimate that has remained quite stable over the years (Bandelow & Michaelis, 2015).

Overall, anxiety disorders represent the most common psychiatric disorders within the general population (Öst, 2008), and the number one mental disorder among women (Chambala, 2008).

While anxiety may serve a useful purpose (e.g., alerting us to dangers), too much anxiety impairs functioning and performance in certain activities (Yerkes & Dodson, 1908).

If you are depressed you are living in the past. If you are anxious you are living in the future. If you are at peace you are living in the present.

When anxiety reaches the clinical level, it interferes with the ability to live life to the fullest, often causing significant social and occupational impairment. Anxiety disorders cover a lot of territories:

• Generalized anxiety disorder
• Panic disorders
• Post-traumatic stress disorder (PTSD)
• Specific phobias
• Social anxiety disorder
• Obsessive-compulsive disorder

Anxiety disorders may be terrifying for their victims, causing physiological, cognitive, and emotional symptoms (Hart, 1999). Those experiencing panic attacks often end up in the emergency room, believing they are dying. It is also common for anxiety disorders to occur concomitantly with other disorders such as depression.

On the positive side, there are several effective therapeutic approaches for anxiety disorders, as well as a variety of techniques and worksheets individuals may apply themselves.

This article will describe these approaches while also addressing the specific issues of social and childhood anxiety disorders. By shedding light on anxiety disorders and their treatment, the goal is to provide useful suggestions, tools, and above all, hope for individuals negatively impacted by these conditions.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

Can anxiety be cured with therapy, 6+ popular anxiety therapy options, exposure treatment for anxiety, 14+ techniques for treating anxiety, 9 useful worksheets for your sessions, helpful exercises, a look at anxiety group therapy + ideas, a note on art therapy for anxiety, 17 creative art and music therapy ideas, treating child anxiety, a note on e-therapy for anxiety, a take-home message.

While anxiety covers a range of areas and may be debilitating, it is highly treatable.

Despite the enormous stressors of modern society, there are ways to respond without succumbing to serious anxiety problems. Anxiety has been described as “the absence of the happy messengers that keep us tranquil” (Hart, 1999, p. 5).

Rebuilding such tranquility is possible thanks to a number of psychological treatment approaches. This article will focus on the non-pharmaceutical approaches that have been found effective for reducing and even curing individuals of anxiety disorders and associated symptomatology.

Man is not worried by real problems so much as by his imagined anxieties about real problems.

Severe anxiety is generally more a reflection of worry about anxiety itself as opposed to the problem underneath.

For example, an individual with a public speaking phobia is typically terrified of looking like a fool in front of an audience because of their anxiety symptoms (e.g., hyperventilating, throwing up, passing out, sweating, stuttering, etc.).

It is not fear of public speaking per se that is the real problem, but rather, the anticipation of associated anxiety that causes distress. It is by confronting such anxiety that individuals often experience relief.

Although the nature of intervention needs to be individualized based on the particular type of anxiety disorder, the following anxiety treatments can be effective for many people.

1. Cognitive therapy

Cognitive therapy is the most common psychological treatment for anxiety disorders.

This approach involves working with therapists to identify the feelings, thoughts, and beliefs that impact an individual’s ability to modify behaviors. For example, a person with a phobia of dogs would work to uncover the irrational beliefs that surround this phobia, such as the inherent danger in approaching all dogs.

Cognitive therapy is typically combined with behavior therapy to address beliefs and cognitions in conjunction with working toward ways of changing behaviors.

For example, the patient with the dog phobia might try approaching docile dogs while also working with a therapist on their irrational fears. This is an approach known as exposure therapy.

2. Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) is widely used for anxiety disorders because it encompasses each of the underlying tenets that are related to clinical anxiety.

CBT is grounded in the following ideas:

• Mental health disorders involve key learning and information processing mechanisms (e.g., irrational beliefs about perceived dangers).
• Behaviors are better understood by exposing their true functions (e.g., examining the belief that sweating and heart palpitations will result in death).
• New adaptive learning experiences can be used to substitute prior nonadaptive learning processes (e.g., developing new beliefs about a feared object after increasing exposure).
• Clinicians take on a scientific approach to therapy by creating hypotheses about patients’ cognitive and behavioral patterns, intervening and observing outcomes, and reframing original hypotheses as needed (Hazlett-Stevens & Craske, 2004).

In this way, the CBT approach is tailored to the individual needs of the client and modified based on their progress (Hazlett-Stevens & Craske, 2004). CBT is grounded in the assumption that “emotional [i.e., anxiety] disorders are maintained by cognitive factors, and that psychological treatment leads to changes in these factors through cognitive and behavioral techniques” (Hofmann & Smits, 2008, p. 621).

CBT contains a variety of potential components:

• Social skills training
• Cognitive restructuring
• Problem-solving training
• Self-monitoring or journaling of symptoms
• Relaxation training

Also, it may be implemented via brief therapy or over a longer duration depending upon the client and their presenting problems.

Meta-analyses have determined that CBT is an effective approach for the treatment of anxiety disorders (Butler, Chapman, Forman, & Beck, 2006; Deacon & Abramowitz, 2004; Hofmann & Smits, 2008; Stewart & Chambless, 2009).

In addition, CBT implemented by primary physicians with minimal mental health training (i.e., ‘The Calm Program’) has been reported as an acceptable and encouraging way for primary doctors to help anxious patients who might otherwise remain untreated (Craske et al., 2009).

3. Attention bias modification

Attention bias modification is a newly emerging approach that involves the use of computer-based attention training with patients with anxiety to affect hyper-attention to perceived threats in the environment (Bar-Haim, 2010).

In this way, problematic attentional biases can be modified to reduce anxiety.

Attention bias modification is similar to CBT because it involves exposure to feared objects or situations, but it is also unique because of its focus on specific attentional bias targets (Hakamata et al., 2010).

Although studies investigating this approach are minimal, attention bias modification represents a promising new approach for the treatment of anxiety disorders (Hakamata et al., 2010).

4. Hypnosis

Hypnosis has also been found to benefit individuals dealing with anxiety.

Hypnosis is “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion” (Elkins, Barabasz, Council, & Spiegel, 2014, p. 6).

Hypnosis is like meditation, but with added objectives based on the needs of the individual. It may involve varying states of consciousness during which attention is focused and distractions are tuned out (McNeal, 2019).

Importantly, hypnosis is not an out-of-control experience, as the patient has power over and awareness of what’s going on. Additionally, its goals are achievable within a minimal time commitment (Straub & Bowman, 2016).

Hypnosis (including self-hypnosis) has been widely used within the mental health field (Valentine, Milling, Clark, & Moriarty, 2019). It has also been reported as a useful tool for patients dealing with the following:

• Dental anxiety (Potter, 2013)
• Surgical anxiety (Capafons & Mendoza, 2009)
• Anxiety related to sports competitions (Mendoza, 2010)
• Social phobia (Capafons & Mendoza, 2013)
• Anxiety disorders in general (Hammond, 2010)

5. Psychodynamic therapy

Psychodynamic therapy as a therapeutic approach often conjures up antiquated images of psychiatrist couches and patients reliving early childhood experiences. Psychodynamic therapy, which is rooted in Freudian theory, involves building strong therapist–patient alliances in which patients may develop the psychological tools needed to deal with fears and anxieties.

Although treatment may be lengthy, short-term psychodynamic therapy also has been reported as an effective approach for anxiety.

For example, one study reported that a 30-session psychodynamic treatment was helpful for the treatment of generalized anxiety – although this approach was less successful than CBT (Leichsenring et al., 2009).

Additionally, in a study examining long-term follow-up after psychodynamic therapy, significant reductions were reported for anxiety symptoms, with short-term approaches producing quicker improvements and long-term approaches providing longer lasting improvements (Knekt et al., 2008).

Finally, in a study comparing psychodynamic therapy with CBT, both approaches produced significant positive effects for social anxiety (Bögels, Wijts, Oort, & Sallaerts, 2014).

In contrast, a comparison of CBT and short-term psychodynamic therapy for patients with excessive health-related anxiety indicated significant improvements only for those who received CBT (Sørensen, Birket-Smith, Wattar, Buemann, & Salkovskis, 2010).

6. Vagus nerve stimulation

In this unique treatment approach, an anticonvulsant device sends electrical stimulation to the vagus nerve. The vagus nerve is targeted because of its ability to modulate anxiety.

Although this approach is typically used for epilepsy and treatment-resistant depression, studies have also demonstrated its effectiveness for treatment-resistant anxiety disorders (George et al., 2008).

Additionally, studies in which vagus nerve stimulation was used to treat epilepsy or depression have reported significant reductions in anxiety symptoms (Chavel, Westerveld, & Spencer, 2003; Rush et al., 2000).

Importantly, vagus nerve stimulation is an invasive approach that is used as an add-on treatment for patients who have not achieved success with CBT and other forms of therapy.

With exposure therapy, the patient is exposed to their feared object or situation, such as flying.

Such exposure is typically gradual, with the exposure beginning with less threatening stimuli and gradually working its way toward increasingly feared stimuli (Wolpe, 1958).

This graduated exposure therapy is grounded in behavioral psychology, with the goal of desensitizing the patient to their feared trigger.

An example of graduated exposure therapy is that of an individual with arachnophobia. In this case, the patient might work with a therapist as follows:

• The patient first watches a film with giant spiders.
• The patient then views a large but harmless spider in a glass case across the room.
• The patient approaches and looks directly into the glass case.
• The patient works toward actually handling the spider.

Of course, the nature and duration of the arachnophobia exposure therapy will depend upon the patient’s individual symptoms and needs.

If systematic desensitization is used, gradual exposure will also involve relaxation techniques as a way of pairing the feared stimulus with a state that is not compatible with anxiety. Therefore, the patient might experience relaxation training while viewing spider images.

Like CBT, there are different ways in which exposure therapy may be implemented depending upon the client and diagnosis. For example, exposure therapy may be in vivo, as is the case with the live spider. Simulated exposure is a similar technique in which the patient experiences a proxy of the feared stimuli. For example, viewing a film of spiders is a simulated exposure.

Recent technology has provided therapists with the tools to implement more realistic simulations via virtual reality exposure therapy .

In such cases, patients wear headsets in which they experience a highly realistic virtual space. This technique is useful for several anxiety disorders and phobias; for example, military patients with PTSD can use virtual reality to simulate battlefield experiences.

Research studies have shown support for virtual reality exposure therapy in the treatment of anxiety disorders. For example, in a comprehensive meta-analysis, researchers found significant positive effects for virtual reality exposure therapy across outcomes (Powers & Emmelkamp, 2008).

Another type of exposure therapy is flooding. ’ With this technique, patients confront their fears via simulated or in vivo exposure that is not gradual. Instead, patients are rapidly exposed to fear-provoking stimuli until they feel less anxious. For example, a patient with a bridge phobia is taken to a bridge and asked to stand on it until their anxiety wanes.

Flooding is based on the idea that without engaging in avoidance, the patient’s fear will become extinguished (Abramowitz, Deacon, & Whiteside, 2019). Therapists generally prefer gradual exposure over flooding because the latter is intense and may have negative repercussions for patients not prepared for such direct and immediate exposure to feared stimuli.

Other forms of exposure therapy include prolonged exposure , which was designed for the treatment of PTSD. With prolonged exposure, both repeated in vivo and imaginal exposure are combined to enable the patient to experience trauma without the feared outcomes.

This technique has been widely used for the treatment of PTSD and is considered by many clinicians as the best option for this disorder (Van Minnen, Harned, Zoellner, & Mills, 2012).

In a meta-analysis examining prolonged exposure among PTSD patients, individuals in the prolonged exposure group experienced better results than 86% of those in control condition (Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010).

Acceptance-based therapy is another CBT approach sometimes used together with in vivo or simulated exposure therapy. The goal of this relatively new approach is to help patients increase their willingness to experience anxiety as part of their exposure to feared situations (England et al., 2012).

For example, in a study examining the use of acceptance-based exposure therapy for individuals with public speaking phobias, participants received group-based therapy in which they experienced public speaking exposure combined with acceptance-based treatment aimed at promoting acceptance of distressing emotions and sensations associated with public speaking (England et al., 2012).

Participants who received acceptance-based exposure therapy, which seeks to promote ‘psychological flexibility,’ experienced significant improvements in public speaking confidence, skills, and associated emotions (England et al., 2012).

If you want to conquer the anxiety of life, live in the moment, live in the breath.

Along with CBT and other therapist-implemented approaches for anxiety, various additional techniques may help to ease symptoms. Here is a list of ideas:

Mindfulness approaches involve a type of awareness in which a person pays attention to their feelings and thoughts in the moment and without judgment. It is an open-minded and totally accepting way of responding to thoughts (Kabat-Zinn, 2005).

Mindfulness techniques may be beneficial to patients with anxiety by helping to increase relaxation while removing negative or stressful judgments. Mindfulness may be enhanced by using various approaches, such as meditation, yoga, or deep-breathing exercises.

While mindfulness activities are often add-ons with CBT and other forms of therapy, there is recent evidence supporting their unique benefit for the reduction of anxiety (Blanck et al., 2018).

Engaging in aerobic exercise also represents a useful way to reduce physiological stress responses and improve mood (Sharma, Madaan, & Petty, 2006). While it may be difficult for an anxious person to find the motivation to exercise, its potential benefits make it worth the effort.

Physical activity is linked to reduced anxiety symptomatology, as well as improved cognitive functioning, life satisfaction, and psychological wellbeing (Carek, Laibstain, & Carek, 2011).

Exercise is beneficial for anxiety disorders, including obsessive-compulsive disorder, generalized anxiety disorder, and social anxiety disorder (Baldwin et al., 2014).

Exercise has also been associated with reduced anxiety symptoms among sedentary patients with medical conditions (Baldwin et al., 2014).

Exercise is especially attractive because it’s cost-effective and may be performed in a variety of ways. While exercise may not reap the same benefits for patients with anxiety as CBT or other psychological approaches, it may enhance the impact of such treatment.

Along with mindfulness techniques and aerobic exercise, here are a variety of things that individuals can do to reduce anxiety:

• Get involved in a hobby you love (e.g., baking, gardening, reading, painting, etc.).
• Listen to your favorite music.
• Journal your feelings.
• Take a warm bath.
• Make sure to eat healthy, as junk food can have adverse effects on physical and psychological health.
• Get enough sleep.
• Go out in nature.
• Avoid emotional triggers (e.g., people and places that consistently increase your anxiety).
• Spend time with animals.
• Organize your home or workspace, as clutter may exacerbate anxiety.
• Watch caffeine and alcohol intake.
• Spend time with family and friends whom you enjoy.

Techniques for treating social anxiety

Social anxiety is a prevalent problem, with over 7% of Americans diagnosed with social anxiety disorder (Norton, 2012).

Social anxiety may take several forms, such as a fear of public speaking, social situations, or meeting new people.

Social anxiety stems from an individual’s fear of adverse judgments or scrutiny from others and the humiliation that follows. As such, social phobia may lead to significant problems within occupational, educational, and social domains, which often result in low self-esteem and loneliness.

The best treatment for social anxiety is CBT, with exposure therapy often recommended.

For example, an individual with public speaking anxiety might work on speaking in front of a few people and gradually work their way up to larger groups.

Socially anxious people may also benefit from social skills and relaxation training.

For example, in an in-depth meta-analysis, including 30 studies and 1,628 respondents, Acarturk, Cuijpers, van Straten, and de Graaf (2008) investigated various social anxiety treatments.

Therapy intervention methods included CBT, cognitive restructuring, exposure therapy, social skills training, and applied relaxation training.

The authors found the psychological treatments to be highly effective for social anxiety disorder, with no differences between treatment types (likely because so many studies used combined treatments). Lower effectiveness was noted for patients with more severe social anxiety disorder (Acarturk et al., 2008).

In another study, which was randomized with a one-year follow-up, Anderson et al. (2013) compared in vivo exposure with virtual reality exposure for the treatment of social anxiety.

Anderson et al. (2013) reported significant improvements at 12-month follow-up, with virtual reality therapy functioning equally well as in vivo exposure. Research also has indicated that attentional bias training for social anxiety is related to significant reductions in social anxiety symptoms (Schmidt, Richey, Buckner, & Timpano, 2009).

In sum, while social anxiety disorder often results in severe impairment, there are psychological treatments that have been found to diminish significantly associated symptomatology and enhance the quality of life for many individuals.

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There are numerous worksheets that may be useful for reducing anxiety. Here are several examples:

• The Anxiety Workbook : A 7-Week Plan to Overcome Anxiety, Stop Worrying, and End Panic (Cuncic, 2017)
• Jane’s Worry Elephant : A Self-Help Guide for Kids with Anxiety (Miller, 2019)
• The Worry Workbook for Kids : Helping Children to Overcome Anxiety and the Fear of Uncertainty (Khanna & Ledley, 2018)
• Conquer Anxiety Workbook for Teens : Find Peace From Worry, Panic, Fear, and Phobias (Chansard, 2019)
• The 5-Minute Anxiety Relief Journal : A Creative Way to Stop Freaking Out (Peterson, 2019)
• The Anxiety and Worry Workbook : The Cognitive Behavioral Solution (Clark & Beck, 2011)
• The Generalized Anxiety Disorder Workbook : A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear (Robichaud & Dugas, 2015)
• The Anxiety and Phobia Workbook (Bourne, 2015)
• Let That Sh*t Go : A Journal for Leaving Your Bullsh*t Behind and Creating a Happy Life (Sweeney, 2018)

Because such activities may be conducted as needed and for free, they represent highly feasible ways to deal with anxiety issues.

Many therapists will prescribe self-guided mindfulness and meditation exercises for clients to complete between in-person therapy sessions or as a tool to help during moments of intense anxiety.

With the rise in digital technologies, such as smartphones and blended care e-therapy platforms like Quenza (pictured here), the prescription of take-home interventions such as these is becoming increasingly more common and convenient.

While the potential value of self-guided exercise has face validity, standalone exercises performed outside of treatment intervention have rarely been researched.

However, in a meta-analysis of 18 studies, standalone exercises were found to be beneficial for the reduction of anxiety (Blanck et al., 2018).

The standalone mindfulness exercises included breathing meditation, sitting meditation, body scan (gradually attending to different parts of the body) and sound scan (mindfulness that adjusts responses to sounds so their aversive impact is reduced).

Blanck et al.’s (2018) study shows that there are positive ways for individuals to deal with their anxiety on their own, outside of a structured intervention.

If you are feeling anxious or stressed, you can search and apply various exercises based on your unique interests and needs. Here are some examples:

• Deep-breathing meditation
• Sitting meditation
• Body scan meditation
• Loving-kindness meditation
• Spiritual meditation
• Vipassana meditation
• Transcendental meditation
• Mantra meditation
• Walking meditation
• Buddhist meditation

Quick-start guide to anxiety treatment – Therapy in a Nutshell

Psychological treatment options for anxiety include both individual and group-based therapies.

Norton (2012) describes effective evidence-based approaches designed to help CBT therapists implement group-based interventions for patients with anxiety disorders.

Such group treatment approaches (e.g., exposure, cognitive restructuring, mindfulness, etc.) are useful for all anxiety disorders; there is no need to apply separate strategies for specific anxiety disorders (Norton, 2012).

For CBT group therapy to be effective, the group needs to be both cohesive and task focused. Other key group therapy factors include altruism, imitative behaviors, interpersonal learning, and installation of hope (Yalom, 1995).

While there is more research examining one-on-one CBT therapy for anxiety than for group therapy (Whitefield, 2010), the latter approach has some advantages:

• Cost-effectiveness
• The ability to reach more people
• May facilitate the normalization of behaviors (e.g., by seeing that others have the same problems)
• The acceptance of challenges that are elicited by peers versus the therapist
• Positive reinforcement by multiple people
• Exposure situations that are more easily recreated within a group setting
• The ability to exercise problem-solving skills by making suggestions to other group members (Whitefield, 2010)

While many individuals with anxiety disorders may benefit from group CBT, there are some people for whom group therapy is likely to be less effective, such as those with co-morbid psychological disorders, more severe and chronic presentation of problems, negative core beliefs, communication problems, interpersonal issues, active suicidal ideation, fear of group environments, extreme stress, or poor relationships (Moorey, 1996).

Additionally, individuals who lack the motivation to change or fail to comply with treatment are less likely to be a good match for group CBT (Moorey, 1996).

Group-based CBT as useful for the treatment of social anxiety disorders (Butler et al., 2018; Hedman et al., 2011).

In addition, preliminary research suggests that large-group CBT classes represent highly feasible and useful approaches for individuals with anxiety disorders (Palay et al., 2018).

In terms of key ingredients for group CBT as a treatment for social anxiety, researchers examined mechanisms for change for two group-based approaches: CBT, and mindfulness and acceptance-based therapy.

Results indicated that mindfulness and acceptance were fundamental mechanisms of change for both group approaches, whereas cognitive reappraisal was more important for CBT (Kocovski, Fleming, Hawley, Ho, & Antony, 2015).

Finally, a qualitative study examined perceptions among individuals with anxiety disorders who achieved benefits following group CBT (Abrahamsson, Nordling, & Michelsen et al., 2018).

Respondents described their anxiety as a lack of security and noted that creating a securing group environment involved the following themes:

• Sharing with others (e.g., getting to know others with similar problems)
• Knowledge given to participants (e.g., as related to the link between anxiety and thoughts, behaviors, health, and lifestyle)
• Structure (e.g., how instructors responded to participants’ needs and provided acceptable structures for group members to practice on their own; Abrahamsson et al., 2018)

Overall, if you are dealing with anxiety and feel that group therapy is a good fit for you, there is likely a group that will meet your needs. Once you do some research and find groups that interest you, it is also a good idea to try out several until you find the best fit.

There is a certain magic in the act of creating; young children expressing themselves through art appear not to have a care in the world.

Indeed, the therapeutic benefit in the creation of art transcends age and talent. There are two important reasons that art therapy is a viable approach for anxious individuals:

• It enables a type of self-expression that goes beyond words.
• Visual representations of anxiety aid in the application of certain types of therapy (Chambala, 2008).

Art therapy has also been described as creating a cathartic release of positive feelings (Curl, 2008). Research supports this idea, as art therapy has been found effective for the reduction of anxiety and other psychological symptoms across multiple populations.

Here are some noteworthy examples:

• Engaging in art such as coloring mandalas, making collages, and modeling with clay is associated with reduced anxiety among college students (Sandmire, Gorham, Rankin, & Grimm, 2012).
• Creating art such as ‘healthy image posters,’ greeting cards, and silk wall hangings is related to reduced anxiety among family caregivers of cancer patients (Walsh, Martin, & Schmidt, 2004).
• Participation in group art therapy is related to the reduction of symptomatology among adult psychiatric outpatients primarily diagnosed with depressive, anxiety, and adjustment disorders (Chandraiah, Anand, & Avent, 2012).
• Engaging in art therapy is related to the reduction of overall state anxiety among adult cancer patients (Nainis et al., 2006).
• Creating art is related to reduced levels of perceived stress among Canadian college students (Abbott, Shanahan, & Neufeld, 2013).
• Making pottery is related to reduced anxiety among elderly nursing home residents (Doric-Henry, 1997).
• Engaging in art-therapy-based supervision among end-of-life care workers is associated with reduced anxiety and enhancement of emotional awareness and regulation (Potash, Ho, Chan, Wang, & Cheng, 2014).
• Art therapy incorporated into brief CBT among individuals with anxiety disorders is associated with reduced frequency of panic attacks (Morris, 2014).
• Simply being exposed to visual art has been shown to reduce anxiety symptoms among psychiatric inpatients (Nanda, Eisen, Zadeh, & Owen, 2010), a finding that attests to the powerful healing power of art.

The function of music is to liberate in the soul those feelings which normally we keep locked up in the heart.

Sebastian Faulks

Music does have a way of changing moods, whether this means sinking into the angst of the blues or experiencing the upbeat feelings of disco. Because of its ability to affect mood, music therapy has been used to help patients deal with a variety of psychological problems.

Music therapy basically consists of “the monitored use of music to promote clinical change” (Bulfone, Quattrin, Zanotti, Regattin, & Brusaferro, 2009, p. 238). Music therapy can be used in multiple ways, such as in combination with CBT or other types of therapy .

Performing music may also foster positive feelings that promote healing. The efficacy of music therapy for the reduction of anxiety is also supported by scientific literature.

For example, music has been found to reduce anxiety among cancer patients receiving chemotherapy (Bulfone et al., 2009; Karagozoglu, Tekyasar, & Yilmaz, 2012), physiological signs of anxiety among patients receiving mechanical ventilatory support (Korhan, Khorshid, & Uyar, 2011), and anxiety among patients with Alzheimer’s disease (Guétin et al., 2009).

Additionally, music therapy is associated with reduced anxiety among individuals with psychiatric disorders (de l’Etoile, 2002; Bibb, Castle, & Newton, 2015; Shiranibidabadi & Mehryar, 2015).

There are many ways we can enhance our moods with the use of music; here are some ideas:

• Pick music that fits your mood or activity, such as upbeat music for exercise and classical music for relaxation.
• Try meditative music before sleeping.
• Take dance lessons.
• If you are anxious or angry while driving, pick music that will calm your nerves.
• Do not expose yourself to others’ music if it causes stress.
• Use music while creating art as a way of adding inspiration.

Similarly, there are several ways you might engage in creative art as a way of promoting positive wellbeing.

Here are a few ideas:

• Collage making
• Painting or drawing
• Building with Legos or Lincoln Logs
• Making paper airplanes
• Scrapbooking
• Stained glass making
• Sewing or quilting

As with adults, childhood anxiety disorders cause significant impairment and are often unrecognized (Walkup et al., 2008).

Rapee et al. (2009) note that childhood anxiety has a negative impact on peer relationships, school functioning, and family processes. Childhood anxiety disorders also commonly occur in conjunction with other psychological diagnoses and have been linked to inhibited temperament (Rapee et al., 2009).

The most common childhood anxiety disorders include separation anxiety, phobias, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and PTSD.

As with adults, childhood anxiety disorders are often successfully treated using CBT or skill-focused treatment, both of which are sometimes combined with pharmacological treatment.

In a randomized, controlled study of 488 children with anxiety disorders, CBT, both alone and in combination with antidepressant therapy, was related to significant reductions in anxiety severity as compared to a no-treatment comparison group (Walkup et al., 2008).

Similarly, among children with anxiety disorders, responsiveness to CBT during childhood has been associated with reductions in anxiety during adulthood (Benjamin, Harrison, Settipani, Brodman, & Kendall, 2013).

In a study examining the long-term effects of CBT combined with parental anxiety management, children who received the combined treatment were significantly less likely to be diagnosed with an anxiety disorder three years later (Cobham, Dadds, Spence, & McDermott, 2010).

Interestingly, the combined therapy was significantly more effective than the CBT treatment alone, which makes sense given that psychological symptoms in parents are related to treatment outcomes among children with anxiety (Berman, Weems, Silverman, & Kurtines, 2000).

Along with parental influences, the quality of peer friendships has also been found to predict better CBT treatment responses among kids with anxiety disorders (Baker & Hudson, 2013).

While there is some evidence that children with particular anxiety disorders (e.g., obsessive-compulsive disorder) may benefit from pharmacological treatment (especially selective serotonin re-uptake inhibitors), quality studies examining the effects of psychotropic medication for the treatment of pediatric anxiety are scarce (Reinblatt & Riddle, 2007).

There is, however, evidence that CBT is an effective treatment for children with anxiety disorders, with long-term benefits often noted (Muris, Meesters, & van Melick, 2002). Moreover, CBT is particularly effective for treating childhood anxiety disorders when combined with family training (Muris et al., 2002).

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With the large numbers of individuals with anxiety disorders who remain undiagnosed and untreated, psychologists have attempted to find more effective ways to provide treatment.

This point is particularly salient concerning anxiety disorders, as the inability to engage in treatment outside the home is often inherent in the disorder itself.

Fortunately, technology has created an avenue in which individuals with anxiety disorders may be reached. By delivering therapist-guided CBT via the computer (

For example, in a study examining a 10-week dose of iCBT among participants with generalized anxiety, iCBT was associated with significant positive treatment effects comparable to those found for in-person treatment (Robinson et al., 2010). Similarly, CBT e-therapy has been reported as effective for the treatment of obsessive-compulsive disorder, PTSD, social anxiety, and generalized anxiety (Klein, Meyer, Austin, & Kyrios, 2011).

Finally, in a comprehensive review of 26 randomized controlled studies of internet therapy, 23 studies reported positive results for the treatment of depression or anxiety symptoms (Griffiths, Farrer, & Christensen, 2010). Preliminary findings for the efficacy of internet-based treatment provides promise for adults and children experiencing the often debilitating effects of anxiety disorders.

Anxiety symptoms and clinical anxiety disorders are highly prevalent and often debilitating.

Fortunately, these conditions are absolutely treatable. Effective treatment options include CBT, attention bias modification, hypnosis, psychodynamic therapy, and vagus nerve stimulation.

The psychological treatment approach with the most scientific support for anxiety disorders is CBT. Consequently, CBT is often the treatment of choice among therapists specializing in anxiety issues.

CBT may take many forms, with exposure therapy often reported as highly successful for the reduction of anxiety. Exposure therapy may be enhanced with other therapeutic approaches, such as relaxation training and acceptance-based therapy. There is also support for the efficacy of group CBT for the treatment of anxiety, especially when groups are both cohesive and task focused.

Anxiety disorders are common among children, with the most frequent diagnoses including separation anxiety, phobias, social anxiety, generalized anxiety, obsessive-compulsive disorder, and PTSD. Research similarly indicates that CBT has long-term benefits for kids, especially when combined with family therapy . Along with CBT, art and music therapy also represent research-based approaches found to soothe an anxious mind.

In addition, there are various things individuals can do on their own to relieve anxiety, such as deep breathing, aerobic exercise, meditation, yoga, enjoying a hobby, listening to music, etc.

Finally, anxiety treatment has been dramatically advanced by technology, with e-therapy (especially iCBT) reaching larger audiences than possible with face-to-face therapy. Overall, given the preponderance of evidence supporting anxiety-focused treatment, those with anxiety disorders or symptoms have much reason to be hopeful about the promise of a tomorrow without suffering.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

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Exploring the nuances of anxiety therapy in your blog was incredibly insightful. From outlining various types and techniques to providing practical worksheets, it’s a comprehensive guide for anyone seeking support. Your clarity and depth make navigating anxiety management feel less daunting. Thank you for this valuable resource!

Thanks for always sharing your insights, being selfless, and spreading kindness. I personally can’t thank you enough for all of the amazing content you share. You change lives! WE APPRECIATE YOU. Stay safe!

How do you find a good iCBT for children?

Hi Jill, Good question. While I’m not sure what the prevalence of iCBT services for children is (and it will depend somewhat on your country of residence), I’m aware that many face-to-face CBTs are switching to teletherapy as a result of COVID-19. So, a general suggestion I’d make is that if you have trouble finding online child CBT specialists, try doing a more general search for child CBTs and sending out some inquiries about whether they’ve moved online. Hope his helps! – Nicole | Community Manager

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Unleash Your Potential: Supercharge Your Therapy with a Homework App

The power of therapy homework.

Therapy homework plays a vital role in the progress and effectiveness of therapy sessions. It extends the therapeutic process beyond the confines of the therapy room, allowing individuals to actively engage with their mental health and well-being. By completing homework assignments, clients can reinforce what they learn during therapy, apply new skills in real-life situations, and make lasting changes.

The Importance of Homework in Therapy

Homework assignments serve as a bridge between therapy sessions, helping clients apply the concepts, techniques, and insights gained during therapy to their everyday lives. It provides an opportunity for individuals to practice new coping strategies, challenge negative thoughts, and develop healthier habits. Homework also empowers clients by giving them a sense of autonomy and control over their therapeutic journey.

By engaging in homework, clients can deepen their understanding of themselves, their challenges, and their goals. It allows them to explore and experiment with new ways of thinking, feeling, and behaving. Homework assignments can range from reflective exercises and journaling to practicing relaxation techniques and implementing problem-solving skills. The specific assignments are tailored to each client’s unique needs, goals, and therapeutic approach.

Enhancing Therapy with a Homework App

In today’s digital age, technology has opened up new possibilities for enhancing therapy through the use of  homework apps . These apps provide a streamlined and convenient platform for clients and therapists to collaborate on assignments, track progress, and stay connected between sessions.

A therapy homework app offers several benefits that enhance the therapeutic experience. Firstly, it provides  convenience and accessibility , allowing clients to access their homework assignments anytime, anywhere, using their smartphones or other devices. This accessibility ensures that clients can engage with their therapy at their own pace and according to their own schedule.

Secondly, a homework app promotes  organization and accountability . It allows clients to keep all their assignments, resources, and progress in one place, preventing tasks from being forgotten or overlooked. Clients can also set reminders and receive notifications to stay on track with their homework.

Lastly, a therapy homework app facilitates  personalization and customization . It allows therapists to create tailored assignments that address the specific needs and goals of each client. These apps may offer a range of features, such as goal setting, progress tracking, resource libraries, and communication tools, to support the individualized nature of therapy.

By leveraging the power of technology, a therapy homework app can revolutionize the way clients engage with their therapeutic process. It empowers clients to take an active role in their own growth and provides therapists with valuable insights into their clients’ progress. With the right app, therapy homework becomes an integrated and seamless part of the therapeutic journey.

In the next section, we will delve deeper into the benefits of a therapy homework app, exploring the various features that can enhance the therapeutic experience. Stay tuned to learn more about how a homework app can supercharge your therapy.

Benefits of a Therapy Homework App

Utilizing a  therapy homework app  can bring numerous benefits to both therapists and clients. These apps offer a range of features designed to enhance the therapeutic process and promote progress. Let’s explore some key advantages of using a therapy homework app:  convenience and accessibility ,  organization and accountability , and  personalization and customization .

Convenience and Accessibility

One of the primary benefits of a therapy homework app is the convenience it offers. With a digital platform, clients can access their therapy assignments anytime, anywhere, using their mobile devices or computers. This eliminates the need for physical paperwork and allows for easy integration of therapy into their daily routines. By having their assignments readily available at their fingertips, clients can engage with their therapeutic exercises and resources at their own pace and in a comfortable environment.

Organization and Accountability

A therapy homework app provides a centralized platform for managing and organizing therapy assignments. Clients can keep track of their tasks, progress, and completed exercises all in one place. This helps to maintain a clear overview of their therapeutic journey and ensures that nothing gets overlooked. Additionally, the app can serve as a  therapy homework tracker , allowing both clients and therapists to monitor progress and identify areas that require further attention.

Furthermore, a homework app promotes accountability. Clients receive reminders and notifications for their upcoming assignments, helping them stay on track and committed to their therapeutic goals. This built-in accountability system can boost motivation and engagement, leading to more effective therapy outcomes.

Personalization and Customization

Every client’s therapeutic journey is unique, and a therapy homework app allows for personalized and customized assignments. Therapists can create tailored exercises and resources based on the specific needs and goals of each client. These  therapeutic homework templates  can be easily shared with clients through the app, providing them with targeted activities and tools to support their progress.

Moreover, a therapy homework app often includes a  resource library  with a wide range of content, such as  therapeutic homework worksheets ,  activities , and  journaling prompts . Clients can explore these resources, selecting the ones that resonate most with them and align with their therapeutic objectives. This level of personalization empowers clients to take an active role in their own therapy and promotes a sense of ownership and autonomy.

By embracing the benefits of a therapy homework app, therapists and clients can optimize their therapeutic experience. These apps provide convenience, organization, accountability, and personalization, ultimately supercharging the effectiveness and impact of therapy. When selecting a therapy homework app, it’s important to consider the specific needs and preferences of both therapists and clients, ensuring a seamless integration into the therapeutic process.

Features to Look for in a Therapy Homework App

When considering a  therapy homework app , it’s important to look for features that enhance the effectiveness and efficiency of your therapeutic journey. Here are three key features to consider:

Goal Setting and Tracking

A therapy homework app should allow you to set clear goals and objectives for your therapeutic progress. Look for an app that provides a  goal-setting feature , where you can define specific targets and milestones. This feature helps you stay focused and motivated throughout your therapy sessions.

In addition to goal setting, the app should offer a  tracking mechanism  to monitor your progress. This could include features such as progress charts, reminders, and notifications. By tracking your progress, you can see how far you’ve come and identify areas that require further attention or adjustment.

Resource Library and Content

A comprehensive therapy homework app should provide a  resource library  or a collection of therapeutic materials. Look for an app that offers a wide range of  content  such as worksheets, exercises, articles, or guided meditations. These resources can provide guidance, insights, and inspiration during your therapeutic journey.

The app should also allow you to upload your own  custom content , such as personal reflections or journal entries. This feature enables you to tailor your therapy experience to your individual needs and preferences.

Communication and Collaboration

Effective communication and collaboration with your therapist are crucial for successful therapy outcomes. Look for a therapy homework app that facilitates  communication and collaboration  between you and your therapist. This could include features such as secure messaging, video conferencing, or shared note-taking capabilities.

By having a direct line of communication with your therapist through the app, you can clarify doubts, seek guidance, and receive personalized feedback. This level of engagement and collaboration enhances the therapeutic process and strengthens the therapeutic relationship.

Consider these features when choosing a therapy homework app to ensure that it aligns with your specific needs and preferences. Remember to explore different options, read reviews, and make an informed decision. For more information on therapeutic homework and related resources, visit our article on  therapeutic homework portal .

How to Make the Most of a Therapy Homework App

To fully benefit from a  therapy homework app , it’s important to adopt effective strategies and practices. Here are three key aspects to consider when maximizing the potential of your therapy homework app:  setting clear goals and objectives ,  incorporating homework into your routine , and  tracking progress and reflecting .

Setting Clear Goals and Objectives

Before starting your therapy homework, take the time to set clear and specific goals and objectives. What do you hope to achieve through your homework assignments? Whether it’s managing anxiety, improving communication skills, or building self-esteem, clearly defining your goals will provide direction and focus. By aligning your homework tasks with your therapeutic objectives, you can ensure that your efforts are purposeful and meaningful.

When setting goals, make sure they are SMART:  specific ,  measurable ,  achievable ,  relevant , and  time-bound . For example, instead of setting a general goal like “improve self-esteem,” make it more specific such as “practice positive affirmations for 10 minutes each day for two weeks.” This specificity allows you to track your progress and measure the effectiveness of your efforts.

Incorporating Homework into Your Routine

Consistency is key when it comes to therapy homework. To make the most of your app, incorporate your homework into your daily or weekly routine. Treat it with the same importance as other tasks in your life. Set aside dedicated time for your homework, whether it’s in the morning, during lunch breaks, or before bed. By establishing a routine, you create a sense of structure and make your homework a regular part of your life.

Consider using reminders or notifications within the app to prompt you to complete your assignments. These gentle reminders can help you stay on track and ensure that you don’t forget to engage with your therapy homework. It’s also helpful to create a comfortable and distraction-free environment where you can focus on your assignments. Find a quiet space where you can concentrate and fully engage with the tasks at hand.

Tracking Progress and Reflecting

Regularly tracking your progress and reflecting on your experiences is essential for making the most of your therapy homework app. Take advantage of any tracking features offered by the app to monitor your completion of assignments and note your progress. This can help you stay motivated and provide a visual representation of your efforts.

In addition to tracking, take time to reflect on your experiences with each homework assignment. Consider what went well, what challenges you encountered, and what insights you gained. Reflecting on your experiences can deepen your self-awareness and enhance the therapeutic benefits of your homework. You may also want to discuss your reflections with your therapist during your therapy sessions to gain further insights and support.

By setting clear goals, incorporating your homework into your routine, and tracking your progress and reflecting, you can supercharge your therapy with the help of a homework app. Remember, a therapy homework app is a tool to support your therapeutic journey, and your active engagement and commitment are what will ultimately drive your growth and success.

Finding the Right Therapy Homework App for You

When it comes to selecting a  therapy homework app , it’s essential to consider your specific needs and preferences. With numerous options available, finding the right app can greatly enhance your therapy experience. Here are a few key considerations to keep in mind when making your selection.

Considerations for App Selection

• Compatibility : Ensure that the app is compatible with the device(s) you intend to use, whether it’s a smartphone, tablet, or computer. Compatibility will determine the ease of access and integration into your daily routine.
• User-Friendliness : Look for an app that offers a user-friendly interface and intuitive navigation. The app should be easy to navigate and understand, allowing you to focus on the therapeutic content rather than struggling with the technology.
• Security and Privacy : Prioritize an app that places a strong emphasis on security and privacy. Look for features such as encryption and data protection to ensure that your personal information and therapy-related content remain confidential.

Exploring Different Options

To find the best therapy homework app for you, take the time to explore different options. Many apps offer free trials or basic versions that allow you to test their features and functionality. Compare the features, user reviews, and overall reputation of each app to ensure it aligns with your specific therapy goals.

Making an Informed Decision

When making a final decision, consider the following factors:

• Features : Assess the features that are most important to you. Look for apps that offer  goal setting and tracking , as well as a  resource library  with relevant therapeutic content to support your homework assignments. Additionally, consider apps that facilitate  communication and collaboration  with your therapist or coach.
• Customization : Determine whether the app allows for personalization and customization of assignments. This flexibility can help tailor the therapy experience to your specific needs and preferences.
• Support and Updates : Check for the availability of customer support and regular updates. A responsive support team can address any technical issues or concerns that may arise, while regular updates ensure that the app remains up-to-date and compatible with evolving technology.

By considering these factors and exploring different options, you can make an informed decision when selecting a therapy homework app. Remember that the right app should enhance your therapy experience, providing convenience, organization, and personalization.

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