On your own or with a therapist
Many people use thought records on their own, and many are given them by a therapist as practice between sessions. Both are reasonable. They aren’t quite the same thing, and it helps to know what each offers.
Practice between sessions
Between-session practice, usually called homework, is a defining part of CBT, and it has its own research. Meta-analyses have found that therapy with homework produces better outcomes than the same therapy without it, and that people who do more of the practice tend to do better. A later review found that the quality of the practice mattered at least as much as the amount, though few studies measured quality. One study of people treated for depression found that those who became skilled at CBT techniques were less likely to relapse in the year after therapy ended.
The practice between sessions is part of the treatment, and doing it carefully appears to matter.
On your own
Self-guided CBT, through books and apps, can help, particularly for milder difficulties. A meta-analysis of smartphone interventions found small but real benefits for depression and anxiety, with larger effects when apps were built on CBT and came with some professional guidance and reminders. A large recent trial of a CBT skills app for adults with depressive symptoms below the level of a diagnosis found that cognitive restructuring, the skill a thought record practices, helped more than the control conditions.
Self-guided work tends to do better with some human support, though, especially when symptoms are more than mild, and it isn’t a substitute for treatment when problems are more serious or aren’t improving.
Bringing records to therapy
A few ways to make the most of it:
- Flag the ones to discuss. On the last step, or from a record’s menu, mark it for your next session.
- Share a summary. When you’ve flagged records, you can make a session summary PDF from the home screen, or from Settings. It opens with a short overview, flagged records first, then the rest from the period you pick, and then includes each of those records in full. You choose where it goes. Nothing is sent anywhere automatically.
- Bring the stuck ones. Records where nothing moved, or where the balanced thought stayed hard to believe, are often the most useful to talk through.
- Mention patterns. If the same hot thought or thinking style keeps coming up, say so.
If you don’t have a therapist
In the United States, your primary care doctor can refer you, and many insurance plans list in-network therapists. Look for someone who offers CBT. University training clinics and community mental health centers often offer lower-cost care. In England, NHS Talking Therapies accepts self-referrals.
References
- Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144–156. doi.org/10.1111/j.1468-2850.2010.01204.x
- Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755–772. doi.org/10.1016/j.beth.2016.05.002
- Strunk, D. R., DeRubeis, R. J., Chiu, A. W., & Alvarez, J. (2007). Patients’ competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression. Journal of Consulting and Clinical Psychology, 75(4), 523–530. doi.org/10.1037/0022-006X.75.4.523
- Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., & Fuller-Tyszkiewicz, M. (2019). The efficacy of app-supported smartphone interventions for mental health problems: A meta-analysis of randomized controlled trials. World Psychiatry, 18(3), 325–336. doi.org/10.1002/wps.20673
- Furukawa, T. A., Tajika, A., Toyomoto, R., Sakata, M., Luo, Y., Horikoshi, M., Akechi, T., Kawakami, N., Nakayama, T., Kondo, N., Fukuma, S., Kessler, R. C., Christensen, H., Whitton, A., Nahum-Shani, I., Lutz, W., Cuijpers, P., Wason, J. M. S., & Noma, H. (2025). Cognitive behavioral therapy skills via a smartphone app for subthreshold depression among adults in the community: The RESiLIENT randomized controlled trial. Nature Medicine, 31(6), 1830–1839. doi.org/10.1038/s41591-025-03639-1
- Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F. M. G., Furukawa, T. A., Cuijpers, P., & Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371. doi.org/10.1001/jamapsychiatry.2020.4364
Helpful links
- NIMH: Psychotherapies, including how to find a therapist
- NHS Talking Therapies, England
- 988 Suicide and Crisis Lifeline
Educational content, not medical advice or a substitute for professional care. Ready to try one? Fill in a thought record online, read how to do one step by step, or print one.