CBT session note: template, structure and example

A CBT session note is the document in which a cognitive behavioural therapist records how a session went, the situations worked on, the exercises carried out and the tasks agreed for the following week. It follows the logic of CBT, with an agenda, structured work and a review of the exercises done between sessions.

It is designed for psychologists and psychotherapists trained in CBT, in private practice or in institutions. It helps track the treatment plan session by session, keep a precise record of functional analysis and exposure work, and adjust goals with the patient. Below you will find the template, a completed example and the mistakes to avoid.

What a CBT session note is for

CBT is a structured therapy. Each session follows an agenda, exercises are chosen according to the disorder and progress is reviewed regularly to decide what comes next. Without a precise note, this tracking quickly becomes vague. Which exposure step had been reached? Which thought kept coming back? Was the task done?

The note answers these questions in a few lines. It also lets you show the patient how far they have come, which supports motivation, and prepare the review points where you decide together to continue, adjust or end therapy.

When to use it

For every CBT follow-up session, individual or group. The first sessions, devoted to assessment and the initial functional analysis, need a broader template. The session note takes over afterwards. It adapts to the different techniques (exposure, cognitive restructuring, behavioural activation, assertiveness training) without changing structure.

The rules

In France, the code of ethics for psychologists (2021 version) applies whatever the approach. Psychologists are bound by professional secrecy (article 7) and archive their notes in a way that protects privacy (article 23). Article 9 requires them to seek the person's free and informed consent and to explain clearly the goals, methods and limits of their work. In CBT this applies in particular to exposure, especially when it takes place outside the consulting room. Note in the file that the principle of exposure was explained and accepted.

Patients may have access to what is in their file. In a French healthcare facility, access is governed by article L1111-7 of the Public Health Code. In private practice, the GDPR provides a right of access to personal data, with a reply within one month. In Belgium, patients can consult their entire file, personal notes included, since 4 March 2024. In Switzerland, the FSP code also gives them this right.

Worksheets completed by the patient (observation diary, thought records, exposure hierarchy) are part of the therapy. If you keep them, file them with the record and protect them in the same way.

The template, section by section

Header

Date, session number, length, format, and a one-line reminder of the current treatment goal.

Review of the week and tasks

What the patient did with the agreed task, what was easy or hard, and what they noticed. If the task was not done, note why without judgement. This is often useful clinical information, pointing to avoidance or a poorly calibrated task.

Measures

The numbers that track change, such as questionnaire scores, how often a behaviour occurs, or anxiety before and after an exercise. Always state the scale (0 to 10, 0 to 100) so numbers stay comparable from one session to the next.

Agenda

The two or three items set with the patient at the start of the session. This line helps check that the session covered what was planned.

Functional analysis of the situation worked on

For each key situation, describe the situation, the emotion and its intensity, the automatic thoughts, the behaviour and its consequences. A grid often used in France is Cottraux's SECCA grid (Situation, Emotion, Cognition, Behaviour, Anticipation). This breakdown shows how thoughts, emotions and behaviours keep each other going, and it guides the choice of techniques.

Interventions and exercises

What was done in session, for example cognitive restructuring, role play or exposure. For exposure, note the situation, the duration, the anxiety level at the start, at its peak and at the end, and any safety behaviours observed.

Clinician's assessment

Your reading of the session, with progress towards goals, obstacles, hypotheses to test and the risk assessment if one was carried out.

Agreed task and next steps

This week's task, stated precisely (what, when, how often, how to record the result), and what will be picked up next session.

Completed example

Fictional patient. Mr D., 28, technician, is seeking help for panic attacks and growing avoidance of public transport. Treatment plan set in session 3, main goal taking the metro to work again.

Header. 9 October, session 7, 45 minutes, in person. Current goal, graded exposure to public transport.

Review of tasks. Planned task, take the bus for three stops on four occasions. Done three times out of four. Anxiety rated 60 out of 100 at the start the first time, then 40 the third time. He kept his phone in his hand throughout, "just in case". Fourth trip cancelled on a tired day.

Measures. One panic attack this week, compared with three the week before, according to his diary.

Agenda. Review of bus trips, work on holding the phone, preparing the first metro trip.

Functional analysis. Situation, crowded bus on Tuesday at 8 am. Emotion, fear at 70 out of 100. Thought, "if I feel faint, nobody will help me". Behaviour, he stands by the door with his phone ready to call. Consequence, quick relief, but the belief that the phone protects him grows stronger.

Interventions. Explanation of how safety behaviours bring short-term relief but keep fear going. Review of the evidence for and against the thought "nobody will help me". Building the next two steps of the hierarchy, one metro stop outside rush hour, then three stops.

Clinician's assessment. Good progress, with anxiety falling over the trips and fewer attacks. Holding the phone probably limits the benefit of exposure. Mr D. agrees to keep it in his pocket. No cause for concern regarding risk.

Task and next steps. Three bus trips with the phone in his pocket, and one metro trip of one stop on a Saturday morning. Rate anxiety at the start, at its peak and at the end. Next session on 16 October, review of the first metro trip.

Common mistakes

• Skipping the task review. Without it, you no longer know whether the strategy is working.
• Numbers without a scale. "Anxiety at 7" means nothing if nobody knows out of what.
• A vague task. "Expose yourself more" does not help. State the situation, the frequency and what to record.
• Ignoring safety behaviours. They often explain why exposure is making little progress.
• Recording a failure rather than information. A task not done is described, not judged.
• Losing sight of the treatment plan. Restate the current goal so each note links to the overall strategy.

Save time with Delta

Delta is the clinical assistant for mental health and allied health professionals. During the session, Delta transcribes what is said. You can also dictate your observations after the session and add written notes. Delta then generates the session report (short summary, detailed summary, topics for the next session) taking your approach into account, CBT included, and updates the patient record with a summary of the therapy and the goals being tracked. Data is hosted in France by an HDS-certified provider, the patient's name and identifying details are pseudonymised before reaching the AI, no audio file is kept and data is never used to train a model. Learn more about Delta.

Further reading

• DAP note template and example
• EMDR session note template and example
• Psychodynamic session note template
• Choosing note-taking software for psychologists
• All our clinical document templates

Sources

• French Code of Ethics for Psychologists, 2021 revision
• Psycom, brochure on cognitive and behavioural therapies (in French)
• CNIL, how to answer a subject access request (in French)
• Belgian Commission of Psychologists, ethics newsletter on the patient file, April 2025 (in French)