Executive Dysfunction

Cognitive Behavioural Therapy

Program
From the whole team at Cognito Health, we want to welcome you to
our 12 session Cognitive Behavioural Therapy (CBT) program; we are
happy to be working with you!

Throughout your sessions, your CBT Care Provider will always strive
to provide you with:
Evidence-based CBT tools that you can apply in your own life at a
pace that works for you
Emotional support and a listening ear
Motivation and accountability to keep you going throughout the
hard times and easier times

Over the course of the program, you will learn about a number of
different CBT techniques that will help you build up your own 'toolkit'
to manage challenges with executive functioning. To aid you in your
progress toward reaching your desired goals, your provider will
recommend integrating your new found CBT toolkit into daily life by
practicing the skills between sessions.

The objective of the program is:

To learn more about executive dysfunction

To impart effective behavioral skills about how to go
about regulating attention, planning, organizing, initiating
tasks, task completion, etc.
To spot unhelpful thoughts and reframe these into more
adaptive thoughts

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 PROGRAM
OVERVIEW

Section
Introduction to Executive
01 Functioning and CBT
Pages 3-15
Our first two sessions provide the
framework for our program, offering
education and validation regarding the
symptoms of executive dysfunction
and the impact on one’s life. We will
also look at the CBT model and
establish the goals you are hoping to
achieve.

Behavioural Techniques and

02 Environmental Engineering
Pages 16-59
The behavioural component is the biggest section of the
program, spanning 7 sessions. It involves learning
constructive behaviours to support your ability to
function well, such as using task lists and calendars. It
also involves learning tools that focus on engineering
your environment to be more conducive to concentration
and focus.

Cognitive Interventions and Emotion

03 Regulation
Pages 60-77
The next two sessions focus on the thinking-feeling
connection, exploring how to identify and modify “unhelpful
thinking styles” to align your thoughts with success and
confidence.

04 What next?
Pages 78-84
To finish up the program, we will recap the strategies we
have covered and identify ways to maintain these goals
moving forward.

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 Session 1
What is Executive
Dysfunction? And the Role of
CBT
Objectives

What is executive functioning

Common symptoms of executive dysfunction
How CBT can be helpful
Identifiying your CBT cycle

Section 01
Introduction
TABLE
to CBTOF
CONTENTS 3 of 84
 What is Executive
Functioning?
The challenges we explored in your intake appointment may relate to
your executive functioning. Executive functioning refers to a
collection of regulatory cognitive skills that help us (a) manage our
behaviour and emotions, (b) initiate and follow through on tasks, (c)
plan and organize information, (d) access working memory, and (e)
shift from one activity to another.
Think of executive functions as the CEO of your
brain; they control purposeful goal-directed
behaviors.

An effective CEO can organize themselves to

monitor and direct their different departments
to proceed as effectively and efficiently as
possible. This includes, but is not limited to,
organizing team members to remember
important information, managing their time,
monitoring task completion and motivating their
employees to achieve desired goals.

Realms of Executive Functioning

Executive function is often said to

encompass a number of different
skills. Task Initiation &
Completion
Se
Combined, these areas allow us y ns
or eo
to: em
fT
M

im
ng

e
rki

1. Think of what we have

Wo

to do,
Emo

2. Organize the things we

tional Regulation

need to do it,
Adaptability

3. Regulate our emotions

and behaviours
towards the task,
4. Initiate the task,
5. Work through the task
ing

Att

while monitoring
itiz

e
r

nt

progress (including the

io

io
Pr

na
time it takes), and & lC
ing on
6. Complete the task. nn tro
Pla Switc l
hing Tasks

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What Impacts Executive Functioning?
We all have strengths and challenges with our executive functioning.
However, certain factors can result in more challenging or frequent
difficulties, and this can be described as Executive Dysfunction,
which is when we notice difficulties in practising the skills we just
discussed on the previous page.
Executive dysfunction is often present with ADHD, and
whilst executive dysfunction and ADHD are often seen
together, they are not always mutually inclusive.
Executive dysfunction can also arise due to other
factors, such as anxiety, depression, lack of sleep, and
lack of nutrition.
Additionally, we know that our ability to think
clearly and put executive function into action
is directly related to what we feel and how
intensely we feel it. When our emotions
become very intense, our executive function
will not work at full capacity.

Imagine if the CEO we mentioned earlier became very anxious,

bereaved, or angry. Maybe they are beginning to think negatively
about their performance. Would they be able to efficiently manage
all the complex demands of running a business while they are
thinking negatively and their emotions are running so hot?

The Brain
To help us understand the impacts of emotionality, let’s take a
moment to look at the different parts of our brain that are
responsible for our emotions and executive functioning.

The Limbic The Cortex

System "Upstairs
'Downstairs Brain"
Brain" Our thinking brain
The limbic system is is where our
responsible for our executive
emotions & memories. functions are
Our amygdala acts as housed, allowing
a guard dog that us to plan, make
activates our decisions,
instinctive survival problem-solve, and
reactions. regulate emotions.
The Brain Stem
Our brain stem is responsible for important life functions,
like breathing, sleeping and your heart beating.

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 To see how these areas work together, Dr. Daniel Siegel suggests
pretending your hand is your brain, your wrist is your spinal cord and
your palm is your brain stem.
Place your thumb in
the middle of your Close your fingers
palm to make the on top of your palm
number 4.Your thumb and thumb, and this
represents the forms the cortex
amygdala and limbic (Our Upstairs
system (Our Brain).
Downstairs Brain).
Most of the time, these areas of our brain are in constant
communication with one another. We use our executive functioning
to help us regulate our thoughts, feelings and behaviours, before our
emotions escalate to the point where we can’t control them.
.
Flipping Our Lid
Sometimes when we experience strong emotions
or the alarm system goes off... we can flip our
lids. Now the connection between our upstairs
and downstairs brain is lost. Intense emotions
pull us away from our rational mind, where
executive functioning is housed, and pull us into
Lift your our emotional mind, where our emotions take
four fingers control. In this state, creating a plan, setting
up straight! goals, managing our time, and shifting between
tasks can be extremely challenging.

It is worth noting that we can “flip our lid” when

some of our needs have not been met, such as
if we are hungry, tired, sick, or stressed.

Tending to our needs and learning tools to regulate our emotions

helps to rebuild the connection between these areas of our brain,
mobilizing our executive functions.

Where does CBT come into play?

Cognitive Behavioural Therapy is founded in the understanding that
our thoughts, feelings and behaviors are all interconnected. For
example, unhelpful thinking patterns, dysfunctional behaviors and
habits can impact how we feel and perpetuate the effects of
executive dysfunction.
To illustrate this relationship, it is helpful to complete the CBT
cycle, which provides you with a visual representation of your own
experiences in these different areas.

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 The CBT Cycle
Now that we have covered what executive dysfunction looks like, it is
time to reflect on your own experience. This cycle represents the
relationship between these symptoms, specifically how we think, how
we feel, and how we behave.

Take some time to make a note of the thoughts, emotions, physical

symptoms and behaviours you currently experience, and the impact of
these.

My Thoughts

My Behaviours My Emotions

My Physical
Symptoms

The Impact

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CBT aims to improve our emotional well-being by empowering us with
practical tools and techniques to help us think and respond to
challenges more effectively. It is a goal-oriented and practical
approach, focusing on learning and applying a number of different
strategies to work towards your goals.

To help guide our program, we will be exploring techniques to help us

answer the following 4 questions:

What do I need to do?

When do I need to do
it?

How can I do it?

How can I overcome

internal obstacles?

For each of these questions, your CBT Care Provider will introduce
techniques that focus on externalizing your executive functions by
creating systems and structures in the world around you to help
manage any challenges around focus, self-motivation, emotional
regulation, impulse control and higher-level functioning such as
organizing, planning, and problem-solving. They will also introduce
ways to become more aware of unhelpful thinking patterns that may
be influencing your mood and motivation.

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 Session Recap

Today we have covered:

What is executive functioning
What is executive dysfunction
The impact of emotionality
The rationale for CBT
The CBT Cycle

Before next session:

To complete the CBT cycle

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 2
Goal Setting
Objectives

Reflecting on your experience

What are SMART goals and how are they helpful
How to create SMART goals

Section 01
Introduction
TABLE
to CBTOF
CONTENTS 10 of 84
 Goal Setting
Last session, we explored executive functioning and the role of CBT.

Before we get started on learning more about CBT, it is important to

take a moment to reflect on your feelings going into this program.
Maybe this is a new venture for you? Or maybe you are already
familiar with different techniques? Reflecting on our own experiences
and challenges helps to shine a light on the areas we may wish to
focus on and change.

What are the challenges that bother you the most?

How do these challenges make you feel?

What changes would you like to see?

What positive qualities and resources do you already have in place?

Creating Your Goals

To help guide our program, it’s essential to think about your goals
when it comes to working on the executive functioning challenges
that you experience.

Goals can serve as a reminder of what we are

working towards, helping us stay on track. They
also help us monitor our progress, resulting in
further motivation and the opportunity to
troubleshoot difficulties.

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 SMART Goals
When setting goals, it is important to follow the SMART structure.
This framework helps to ensure the goal is clearly defined and
attainable within a certain timeframe.

Specific - What do I want to

accomplish?
Our goals need to be clear and specific, so we
S know exactly what we are working towards.
“I will clean the dishes every evening before
bed”

Measurable - How will I know

when it is accomplished?

M Quantifying our goals makes it easier to track

progress and know when we've reached the finish
line.
“I will spend 15 minutes at 9pm every evening”

Achievable - Is this something I

can reasonably accomplish?
A Goals should be realistic, not high pedestals that
we are unlikely to be able to reach.
“Yes - I could listen to my favourite podcast
whilst doing it to help my motivation.”

Relevant - Does this seem

worthwhile?

R Our goals need to matter to us and align with our

values. It is hard to motivate ourselves to do
something that doesn't match our values.
“Waking up to a tidy kitchen will help my mood
& set me up for the day”
Time bound - When can I
accomplish this goal?
T Having a timeframe in mind helps to keep us on
track and ensure we are taking the necessary
steps.
“I will start tomorrow and review in 2 weeks
time”
Introducing SMART goals at the beginning of our program doesn’t
mean we have to set a long-term goal; it can also encourage us to
think about smaller stepping stones that could support us through
this process. Towards the end of the program, we will revisit SMART
goals and explore if there are any new goals you would like to set
once you have established your toolkit.

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 SMART Goals Worksheet
Starting Goal

Specific
What do I want to accomplish? What are the steps involved?

Measurable
How will I know when it is accomplished? How often? How many?

Achievable
How can I accomplish this goal? How realistic is this goal, based on
other factors, like time, cost, resources, skills? Are there any resources
I need before I can achieve this goal?

Relevant
Why do I want to do this? Is this goal worthwhile? Does it match my
values?

Time limited
When will I have achieved this goal? Are there any smaller milestones
along the way?

SMART Goal

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 Tips to Remember

Be Specific
We may be tempted to set general goals, such as “To be more
productive” or “To have better focus”. However, it can be difficult
to know when we have achieved this goal. Instead, it can be more
helpful to think about how we would know if we were
“functioning better”. What would this look like?
For example, “I would be meeting deadlines on time”
or “I would be responding to emails every day.”

Frame Positively
Goals should focus on moving towards something rather than away
from something. Making something off limits can actually have the
opposite effect, leading to resentment and rebelliousness. Placing
more emphasis upon things we want to achieve can make
reaching these goals easier.
Using positive words allows us to focus on what we
really want, creating positive energy and momentum.
They also make it easier to recover after a slip up.

Within Control
Choose goals that are within our control.
For example, “get a promotion at work”
requires others to act. However,
“take courses to improve my professional skills”
is in our control.

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 Session Recap

Today we have covered:

Reflecting on your experience
What is goal setting
How to make a SMART goal

Before next session:

Set at least one SMART Goal

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 3
What do I need to do?
Part One
Objectives

The importance of a master to do list

Exploring different recommendations on building it
into a habit

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 16 of 84
 The Foundations of Planning
At the beginning of the program, we explored executive functioning,
the “CEO” of our brain. Throughout our program, we will be exploring
tools to enhance our executive functions, and session 3 begins with
enhancing skills related to the question; “what do I need to do?”.
When focusing on the question “What do I
need to do”, people with executive
dysfunction may experience the following
challenges:

Difficulty mentally organizing the different tasks and activities

running through their mind.
Experiencing overwhelm and ‘analysis paralysis’ or decision
fatigue when trying to decide where to start.

Picture balls of yarn and thread thrown into a

basket; we may have an idea of what is in
there, but it can become so tangled that it can
feel seemingly impossible to separate or
distinguish from one another.

The “what do I need to do” section involves skills of defining,

selecting, and prioritizing what needs to be done in our lives. We are
working to untangle the ball of yarn to get a clearer picture of what
we would like to work on each day. With a clearer picture, we can
then move into organizing and prioritizing our time.

Introducing the “Master To-Do List”

Before we can introduce techniques to organize and prioritize tasks,
we first need to gain clarity on exactly what is on our plate. This is
where a master to-do list comes into play. We want to start with a
comprehensive list that represents a list of all conceivable relevant
tasks, from recurring tasks to longer-range tasks that are not
imminent.

You can picture this as dumping the

basket of yarn and thread onto the
floor to determine what’s in it to
begin with.

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How does it work?

Pick one system that works for you

There are many different options for to-do lists. We

can keep them on paper, smartphone applications,
planners, etc. Rather than looking for a perfect
system, it is essential to ask yourself, “What is the
best system for me?”. It is recommended to trial
different systems to see what works best for you.

Use one place only

We recommend writing down everything you need to do

in one place. The fewer places we have to keep eyes on
the better. We ideally want to have only one master list
that we are consistently adding to.

Keep it visible and visual

Can you relate to the saying, “out of sight, out of

mind”? - If your to-do list is written somewhere that
isn’t easily visible, there is a significant likelihood
that you will forget about it and become distracted
by other things. In order to prevent this, it could be
helpful to ensure you can carry around your to-do list
at all times. For example, use a notebook that you
can fit in your pocket.

Continuously add to it

Whilst it is helpful to do a master list once a day, you

may find your mind is constantly spewing out
additional tasks and activities you need or want to
complete. We want to capture each and every one of
these, no matter how big or small. So no matter what
you are doing, if you think of something else that
needs doing, start by adding it to your master list (of
course providing it is safe to do so).

To get started using a master to-do list, it can be helpful to focus on

a specific timeframe, such as tasks for the upcoming week. This
helps to keep tasks and activities more streamlined and reduce
overwhelm. As you become more comfortable with this tool, you can
expand this timeframe. In the upcoming sessions, we will explore
various tools to reduce feelings of overwhelm and make it easier to
stay organized and on track with your goals.

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 Why is a master to-do list helpful?

It gets to-do items out of your head and onto a list, which
1 relieves pressure on your working memory to try to hold all
this information in your mind.

It provides satisfaction when you are able to tick things

2 off.

3 It helps you be more intentional.

4 It is a constant visual reminder.

On the next page, you will find a Master To Do List worksheet. This is
here as an example. As we touched on, it is important to find the
right system for you. We encourage you to experiment with different
formats to find which works for you.

In our next session, we will be building on these foundational

practices by introducing a prioritizing system to help organize our
master to do list.

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 Master To Do List
This is a comprehensive list that represents a record of all relevant
tasks, from recurring tasks to longer-range tasks that are not
imminent.

Remember to keep adding to it throughout the day!

NOTES :

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 Session Recap

Today we have covered:

Foundations to planning and organization
The importance of keeping a master to do list
Tips to integrate this into your daily life

Before next session:

Start ONE master to do list - This can be written down or
digital

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 4
What do I need to do?
Part Two
Objectives

Breaking down our master list to decrease

overwhelm
Prioritizing with the ABCD system

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 22 of 84
 Organizing our To-Do List
Last session, we discussed the importance of keeping a master task
list and how that can support our executive functioning.

You may have found that your master list can get quite lengthy. When
we have a long list of tasks that we need or want to complete, it can
feel overwhelming, and it can be difficult to determine where to
start. Often, there is simply not enough time to complete everything
on our task list.

With this in mind, we want to build upon the habit and explore
separating our list into a “Master List” and a “Daily List.”

Master List
A record of all tasks that need to be
completed, e.g. all the yarn and thread
that is in our basket.

Daily List
A record of tasks that you are hoping to
accomplish on a particular day, e.g. only
the yarn we want and need to use today

How do you decide what goes on your daily

list?

To separate our list, we need to introduce prioritizing. Prioritizing

ensures that we are focusing our attention in the right places.
Sometimes, prioritizing can be easier said than done, especially with
executive dysfunction.

This could be for several different reasons:

Unless the deadline is imminent, it can be difficult to get started

on tasks because there is no external consequence looming over
us
We focus on the bigger picture and that leaves us feeling unclear
on the steps involved to get us to the finish line
We are drawn to novelty; we are drawn to tasks that are new and
different, regardless of their importance or significance
We are drawn by interest; it is easier to get started on tasks that
we are interested in, again regardless of their importance or
significance

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 It is worth noting that prioritizing can feel stressful, especially if we
already have a long to-do list to work through. Whilst it may not
always feel like it, spending time prioritizing our tasks allows us to let
go of the stress and anxiety related to deciding what to do and when
to do it. It can actually help to buy us time.

ABCD Prioritization System

Let’s take a look at one structured approach to prioritizing; the ABCD
system. We touched on how we may be drawn to easier, more
interesting or novel tasks, and whilst we may feel we are being
productive, we may find we aren’t making progress on the more
important tasks.

This approach involves assessing the importance of each task and

identifying the associated consequences of not completing them. It
will help us assign a category to each task, which will then guide our
focus.

Step 1: Assign a Category

Looking at your master to do list, assign each task to one of the

below categories.
A = Absolutely Essential
Your most important tasks; the ones with an
impending deadline or consequence if you don't
complete them

Think: An uncontained fire that if not dealt with

leads to bigger problems

B = Better Done Today

Your less urgent tasks; tasks you do need to
complete but are not as important as your A's

Think: A contained fire that doesn't have the

immediate consequences, but would still be a
benefit to put out
C = Can Wait
Tasks which would be nice to get to but don't
lead to any consequences if you don't get to
them today

Think: A flameless or electric candle

flickering on a table - not putting it out won’t
cause problems if left alone

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D = Delegate or Don't Do
Tasks which would be nice to get to but don't
lead to any consequences if you don't get to
them today, or they could be completed by
someone else.

Think: Asking someone else to get the fire

extinguisher to help relieve you from the
responsibility of putting out the fire on your
own

Tip: Utilize colour coding here as this can make things pop and keep
things interesting for the brain!

Step 2: Add to Daily List

Once labeled, add your A’s to your daily list, giving you a focused list
for the day. We begin with our A’s! If we complete these and find we
have time left, we can return to our master to-do list and move on to
our B's or C's—but we only do this when our A's are complete!

It is not uncommon for our priorities to change

throughout the day; Problems can arise, plans
can change or new tasks can come up.
Sometimes sudden changes can yield
unpleasant feelings for those with executive
dysfunction! We will explore tools to soothe
unpleasant emotions later in the program.

For now, to ensure you are focusing on your A’s, it is important to

regularly check in with your daily list throughout the day and update
it as needed. Sometimes this may require moving something from the
A category to the B category if something more pressing arises and
you don’t have enough time to do both.

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 Master To Do List
This is a comprehensive list that represents a “dump list” of all
conceivable relevant tasks, from recurring tasks to longer-range
tasks that are not imminent.

Remember to keep adding to it throughout the day!

ABCD Prioritization Category Key

A = Absolutely Essential C = Can Wait
B = Better Done Today D = Delegate or Don’t Do

NOTES :

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 Daily To Do List
A condensed list of the top priorities for the day. Only once our
absolutely essential tasks are complete do we move to other tasks.

Absolutely Essential

Better Done Today

NOTES :

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 Session Recap

Today we have covered:

How to break down our master list into a daily list
How to prioritize tasks using the ABCD system

Before next session:

Continue keeping a master list
Use the ABCD prioritizing system to create a daily list

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 5
When do I do it?
Part One
Objectives

The importance of having access to timepieces

Learning ways to reduce time blindness
Building the ability to accurately estimate time

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 29 of 84
 Sense of Time
In the last 2 sessions, we have focused on the question, “What do I
need to do?”. Hopefully, the techniques we have covered thus far
have clarified this question. Now, it is time to move on to the next
question, “When do I need to do it?”.

Time can be a challenge with executive dysfunction. At times, it can

feel like there is not enough of it, other times we have too much of it,
or maybe we aren’t aware of the time at all.

What challenges do you have with time

management?

Improving Our Awareness of Time

Time management tools start with having a good awareness of time.
In today’s session, we look at how to improve our awareness and
estimation of time.
In Session Exercise
Let’s practice a 1 minute mindfulness practice
to orient ourselves to how long one minute
feels vs. how long it actually is.

Step 1
How often do you find yourself thinking, “Where did the
time go?”

Perception of time or estimation of time is our ability to understand

the passing of time. It also involves assessing the amount of time
needed to complete a specific task. To improve our perception of
time, we first need to have access to time. It can be challenging to
accurately estimate how long something takes without consulting a
clock in the process.

Try this without looking at a clock:

What time did you sit down to read this over? How much time has
passed since sitting down?

Once you’ve guessed, check the clock to see how accurate you
were. Any surprises?

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 To start, we want to become joined to the hip with a clock.
This could be a watch, a clock on your desk, or your phone.
This is a skill that requires a lot of practice. It may feel
laborious, but when we are able to better estimate how
much time has elapsed, we are better set to manage our
time.

Step 2
Once we have access to a timepiece, it is important to be
mindful of potential distractions.

If you opt to use your phone or a smart watch,

it is important to find a way to reduce
distractions, look into using a simple clock app
which allows your phone to display the time in
large font. This way you have access to
another time piece, but reduce the potential
distraction of having your phone nearby.
Another way to reduce distractions is to use
voice assist functions on your phone to find the
time.

Step 3
How often do you find yourself thinking a task will take 15
minutes but find it actually takes much shorter or longer
than initially thought?

The next step is to increase our awareness of how long tasks actually
take. This is important because it is hard for us to manage our time if
we don’t know where the time goes. This is to make sure that we do
not overload ourselves and create unnecessary stress!

Using the worksheet in today’s materials or by

keeping a running log in your existing to-do list,
document the estimated time to complete a task
and then add the actual time it took to complete
once you have finished the task.

You can track the time it actually takes by setting a timer or by

writing down the time when you start and again when you finish.

Having an accurate understanding of how long it takes to complete

certain tasks can be helpful when organizing your schedule
effectively. It can also be helpful in motivating us to complete tasks
when we determine that sometimes things take less time than we
thought! At our next session, we will look into creating a schedule.

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 Time Logging Worksheet
To learn more about your awareness of time, log how long you estimate an activity will take and then
add how long it actually took afterwards. Add any reflections into the notes column.

Activity Estimated Actual Notes

Duration Duration

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 Session Recap

Today we have covered:

The importance of having access to timepieces
How to build awareness of your ability to estimate time
Time logging

Before next session:

Increase your access to timepieces
Practice time-logging

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 6
When do I do it?
Part Two
Objectives

The role of scheduling and using a planner

Considering which system would work best for you
Learning how to integrate your to do list and your
planner

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 34 of 84
 Using a Planner
So far, we have increased our awareness of what we need to do and
how long these tasks take; the next step is to introduce a planner to
plan out our time to complete such tasks. Alongside having a task
list, utilizing a planner forms the foundation of organization.

A planner or calendar acts as our key to scheduling appointments,

activities, and tasks effectively, providing us with scaffolding to build
upon to better organize our time. Having a system to keep track of
our schedule helps us answer the question; “when do I do these
tasks?”, which supports our executive functioning.

How many times have you said “Oh I can’t do this task right now, I’ll
do it later!” or “I will wait till I feel more motivated”?

But then, when later finally comes around, you realize you forgot
about other commitments and don’t have time to do the task then
either.

Step 1: Choose a Planner or Calendar

Similar to when we discussed to-do lists, the

planners or calendars that work for others
may not work for you. It is important to focus
on using a calendar that is within your
comfort zone and will be the best fit for you.
This could be electronic or paper.

Step 2: Populate with all known

commitments and appointments

On a recurring basis, dedicate time and go through each week,

adding important dates, commitments or appointments.

These commitments may be related to many

different realms of life; social, work, family, and
personal. Rest and personal time should also
count as a weekly commitment and be added
into your calendar.

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 As you begin utilizing a planner, it is important to identify and
account for buffer and transition time within your schedule. Adopting
a strategic approach to scheduling by accounting for time to
transition between tasks helps to avoid frazzled moments that come
with feeling rushed as you move between commitments. Not only
does this allow for more effective time management, but it also
supports mood management.

Example 2:
Example 1:
If your lunch break at work
If going to the gym regularly is
starts at 12pm, it could be
added to your planner, it could
helpful to buffer 5 minutes in at
be helpful to account for the
11:55am to “wrap up” loose
time it takes to travel to and
ends of what you were
from the gym and incorporate
previously working on to make
that into “gym time.”
it easier to pick up again later.

Step 3: Introduce “A tasks” from your

prioritized daily list into the remaining spots

Go through your prioritized daily to-do list and find

openings in your day to dedicate time to completing
these tasks. We recommend dedicating 10 minutes at
the beginning of each day to selecting the tasks you
will work on that day. Remember to be realistic about
the tasks for the week; you don’t have to think about
filling up the calendar with tasks. Start with a small
number of tasks, as this will be more approachable.

TIP: Be sure to consider what you learned

from the last session regarding how long
tasks really take.

If you are still working on time estimation, a helpful formula is to

estimate how long you think a task will take and then double or
triple it. For example, if you think it will take 15 minutes to complete
a certain task, you can multiply this by 2 or 3, which would equal a
new time estimate of 30-45 minutes. Remember, giving yourself
more time than you think you need to complete tasks is usually best.

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 Step 4: Regularly check and update your
calendar throughout the day

To keep us on track, it is important to

regularly check our planner throughout the
day. It allows us to see if we are on top of the
tasks for the day, ticking off what we have
achieved and checking out what to expect for
the rest of the day. When checking later in the
day, it provides a helpful moment to reflect
on how the day went and what to prepare and
plan for the next day. Creating a recurring
alarm on our phone can be a helpful prompt
to ensure we regularly check in with our
planner.

Things change! If unexpected tasks

or activities arise throughout the
day, review your schedule to see if
adjustments are required.

Keep in mind to reflect on the urgency of the unexpected task or

activity–is it really urgent enough to replace the tasks scheduled for
the day? If so, your planner is not set in stone, and life often requires
some level of flexibility in our agendas. More flexibility can often
support better follow through & less blame and shame.

Benefits of Planning
We want to look at scheduling as a way of giving us more time.
Taking time to plan might seem like a tedious task in the moment, but
as you continue to build this habit you will find it actually helps you
save time in the long run. Chances are there might be some tasks you
have been avoiding which realistically might only take a few minutes
to complete. Once you schedule these tasks in your planner, you will
realize you have more time than you originally thought.
To get the most out of using a planner, it is important
to make a commitment to regularly using it. Using it
on a regular basis, ensures that it always remains
the central repository for our commitments,
appointments and planning of tasks.

There is a saying, “If it is not in the calendar, it doesn't exist.” Think

of this phrase anytime there is a task that you want or need to
complete and remind yourself of the importance of scheduling it.

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 Session Recap

Today we have covered:

The role of a planner in supporting executive functioning
Steps to follow when using a planner
Benefits of planning

Before next session:

Try using a planner; either digital or written

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 7
How can I do it?
Part One
Objectives

Exploring problem solving skills to support

approaching our to do list
Utilizing the pomodoro technique to get started
and stay focused

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 39 of 84
 Approaching our To-Do List
Even when we have identified what we need to do and planned out
when we are going to do it, it can still be difficult to get started and
complete the tasks. The next few sessions focus on the question,
“how can I do it?” - We will explore different ways to approach our
tasks and commitments.

For when we don’t know where to

start; Problem Solving
Sometimes the steps needed to complete a task are unclear or they
become very jumbled in our minds, making it difficult to know where
to start. Just like using a planner to organize all the tasks we need to
complete, we also need a strategy to help break down bigger tasks
to be better equipped and motivated to tackle them.

Problem solving is a structured approach that

guides us through generating solutions to "stuck"
situations in life and tapping into our ability to
work towards carrying out one of these solutions.
It involves clearly naming the problem and then
working towards trying to find a way to manage it.

This structured approach to problem solving focuses on looking at

possible solutions without judgment, which can help us see things
from a different perspective and prevents us from discarding
solutions prematurely.

Steps to follow:

Define the problem.

1 Before jumping straight to solutions, figure out exactly
what the difficulty is.

Generate solutions without judgement.

2 Think of as many potential solutions as possible, it does

not matter how outlandish or unworkable they may be.

Evaluate the advantages and disadvantages of each

3 solution.

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 Pick the most feasible solution
There is no such thing as a "perfect" solution.
4 Remember that “even not-making-a-choice is a form of
choice”.

Plan it out
Once selected, create a plan to try it out. It is important

5 to break the task into smaller chunks and add these

chunks into your planner.

Do it
As the time comes, eliminate distractions and prep any
materials and supplies needed and consider whether any
6 physical preparation is necessary.

Review and evaluate the solution.

Once we have followed the plan, it is important to review
whether we have solved the problem. If we have, taking
7 time to reflect can help us understand what worked well,
what didn't, and what improvements can be made. If we
haven’t solved the problem, this is a cue to return to step
4 and pick a different solution to plan out. Reflecting on
the process during and after problem-solving allows us to
evaluate, learn, and adjust for future situations.

It is essential to write down your problem solving

rather than just doing it in your head! If you
identify a problem that needs solving during the
night, you can write down the problem and make
a plan to problem solve the next day.

When planning, it's important to consider

potential obstacles that could hinder task
completion or meeting deadlines. This
allows for better task management from
start to finish.

Setting reminders or alarms to remind you to complete the

problem solving worksheet and the chosen solution can be
helpful. It helps to have an external resource so you don’t have to
stress about remembering to do it.

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 Problem Solving Worksheet
Follow these steps to work through solving your practical problems.

1. Define the problem

2. Possible solutions
List all possible solutions - Be creative, it doesn't matter if they
seem unreasonable

3. Evaluate each of the solutions

Solution Advantages Disadvantages

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 Problem Solving Worksheet
4. Pick a solution
Based on your evaluation, pick a solution to help resolve your
problem.

5. Plan
List, in small steps, how you intend to implement the solution

Steps Details

What will
you do?

How will you

do it?

When will
you do it?

Who else
will you
involve?

Any
obstacles to
overcome?

6. Review
Review how well the solution was carried out. Revise your plans if
necessary. Continue until you have resolved your stress or achieved
your goal.

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 Chunking

Once you have identified a solution, we can sometimes still have

difficulty getting started, and that may be because the plan is too
big. When this happens, try breaking it down into
smaller chunks. The reality is that we can only do
one thing at a time.

Typically the hardest part is getting started.

Chunking can feel more manageable and help

overcome procrastination, by:
Focusing on one task at a time
Breaking it down by task or by time

Chunking by task: Chunking by time:

When tackling tasks, it can be

When you need to "clean the useful to chunk a specific
house," you can use task amount of time, such as
chunking to tackle it one room "cleaning the bathroom" from
at a time. You can even chunk it 9:00 am to 9:30 am. If this seems
down further, including tasks overwhelming, you can break it
like “picking up items from the down into smaller chunks, like
living room floor,” “vacuuming "clearing vanity in the bathroom
the living room floor,” and for 5 minutes" and "wiping
“wiping surfaces.” mirrors in the bathroom for 5
minutes."

For when we are having difficulty

maintaining focus; The Pomodoro
Technique
Developed by Francesco Cirillo, the Pomodoro Technique involves
breaking down our time into efficient time blocks, called pomodoros.
A pomodoro represents 25 minutes of focused work. Each pomodoro
should be followed by a 5 minute break.

The notion behind this technique is that by

dividing your work into smaller, more time-
manageable chunks, you can improve your
focus and productivity while avoiding burnout.

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 1 Get your to-do list, planner and a timer.

Determine how long your task will take to complete and

budget how many pomodoros you will need. For example, if
2 you foresee doing the laundry will take an hour, you would
budget 2 pomodoros.

Set your timer for 25 minutes (we suggest using a real

physical timer for this), and focus on the chosen task until
3 the timer rings.

When the pomodoro ends, tick off the tasks or make a note

4 of where you are at on your to-do list and then enjoy a five-
minute break.

Small tasks go together.

Any tasks that will take less than one Pomodoro
should be combined with other simple tasks. For
example, "write rent check," "set vet
appointment," and "read Pomodoro article" could
go together in one session.

Break down complex projects.

If a task requires more than four pomodoros, it needs to be divided
into smaller, actionable steps. It could be helpful to create a focus
plan. Sticking to this rule will help ensure you make clear progress on
your projects.

Take a longer break.

After four pomodoros, take a longer, more
restorative 15-30 minute break. Make the
most of your breaks. Use your breaks to sip
on water, nibble on a snack, stretch your
limbs, do a quick meditation, or take a short
walk. These activities can help you feel
refreshed so that you’re ready to return to
work after the break.

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Plan your day.
Estimate how many pomodoros
you need for each task, and
record this on your daily to do list Reply to 10 work emails

or as add blocks in your planner. Book hotel for birthday trip

Read 3 chapters for school

Iterate the ratio.

If 25 minutes is not feasible, build a ratio
based on your maximum focus time, e.g. 10
minutes of focus and 3 minutes of break.

Once a pomodoro is set, it must ring.

The pomodoro is an indivisible unit of time
and cannot be broken, especially not to
check incoming emails, team chats, or text
messages. Any ideas, tasks, or requests
that come up should be noted to return to
later.

Consideration

If your work or home life involves frequent interruptions or abrupt

changes in priorities, the Pomodoro Technique’s rigid structure may
not be the best fit. Similarly, if you work in a fast-paced
environment where you need to switch between tasks quickly, the
Pomodoro Technique may not provide the necessary flexibility.

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 Session Recap

Today we have covered:

Using structured problem solving to help us decide where to
start
Using “chunking” to break down tasks
Using the Pomodoro technique to keep us focused

Before next session:

Practice structured problem solving, chunking and/or the
pomodoro technique

NOTES, REFLECTIONS AND AGREED ACTIONS

47 of 84
 Session 8
How can I do it?
Part Two
Objectives

Engineering your environment to reduce potential

distractions
Building organized “homes” to compensate for
challenges with focus and memory
Automating tasks to support with task completion

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 48 of 84
Executive Functioning Friendly
Environments
Another way to approach our tasks is to consider the role our
environment may be playing. What is happening in the space around
us plays an important role in our mood and productivity, particularly
for those dealing with executive dysfunction. With this in mind, we
want to find helpful and creative ways to create an ‘executive
functioning friendly’ environment to promote productive behaviors.

Engineering our environment to

reduce distractions
Distractions can pull our attention away from the task at hand. We
may notice switching between tasks and struggling to return back to
what we were doing or forgetting it altogether.
The first step to creating an ‘executive functioning
friendly’ environment is identifying some of your main
distractions.

Take a few minutes to think about what some of

your main distractions are; maybe it’s your phone,
your TV, looking out your window, your pets, etc.

It is important to consider ways to reduce your

susceptibility to each of these distractions. Here are
some suggestions to get you started:

Utilize do not disturb function to

Close all other web browsers
mute notifications

Declutter your desk or

Leave phone in another room
workspace

Wear earplugs or noise-

Move apps off your homescreen
canceling headphones

Play white noise or background Turn your desk away from the
music window

Communicate with others that Close the door to the room so

you are working pets can’t get in

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Whilst adjustments can involve removal of distractions, we can also
reduce distractibility with additional sensory considerations. That
can include ensuring the right temperature in the room, sensory-
friendly lighting (e.g., lamps or string lights if overhead lights are
bothersome), and noise-filtering ear plugs (rather than just noise-
canceling).

Utilize this table to identify your distractions

and how you can reduce them:

Distraction Strategy to reduce distractibility

Engineering our environment to

support our memory
Alongside reducing distractions, we can also consider other
modifications to our environment to support task completion,
specifically creating organized “homes” and automating processes.
These are important factors to consider because they can make
finding things easier by reducing the time needed to locate an item.
They also allow for efficiency by removing our need to utilize our
working memory toward certain tasks and direct it to others. Both of
these strategies help reduce mental distractions as they arise.
Create a “home” for important items

One challenge to getting started on a task is

accessing what we need, when we need it.
Executive dysfunction can result in forgetfulness
and losing track of things. Creating a ‘home’ for
items can help with this - Having specific places
where the important items belong increases the
likelihood that you will be able to locate the items
when you need them, supporting your ability to
start tasks when you plan to.

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It can be helpful to ask yourself, “Can I move or adjust anything in my
environment to make a task easier to initiate?”

Steps to follow:

1 Decide which ‘homes’ you need to set up

2 Decide on where you will set these up in your home

Buy any materials that you need. For example, folders,

3 baskets, labels etc.

Plan time in your calendar to set up the system. Remember

4 you can use the chunking exercise to break this down over
time if needed

Create a reminder to check to see if your system is regularly

5 working and whenever you see one of these items out of
place, you must return it to the specified spot.

If it is not convenient to put it away at that moment, you could try

creating a "launch pad" in your home. Things that we often set down
(and then forget where we put them) go to the launch pad for the
time being. Then, when we have time/capacity to organize things,
we can take them from the launch pad and place them in their
homes.

Once you’ve established ‘homes’ for your items, the

“Don’t put it phrase “don’t put it down, put it away” should be a
down, put it recurring mantra that you use daily. Not only does
away” this reduce the likelihood of losing things, but it also
helps to keep environments tidy (which helps reduce
distractions)!

Automate Processes & Reminders

Remember earlier in session 3 when we discussed
‘analysis paralysis’ and decision fatigue?
Automating processes and reminders is a great
way to reduce it! Not only can automatic
processes reduce decision fatigue, but they can
also prevent us from missing important deadlines
and help us save time in general.

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 Think about tasks you struggle with throughout the week and ask
yourself, “How could this task be easier?” or “Can I cut out any
unnecessary steps or prep ahead of time?”.
It is important to consider ways to automate processes. Here are a
few tips and examples:
Automating bill payments to come
directly out of your account a day
or two after pay periods
Purchasing a robot vacuum cleaner
(some brands have become
inexpensive!)
Creating a running online meal
plan/grocery list and clicking
‘reorder’ to pick up later in the week

Meal prepping
Prepping outfits and lunches the night before
(this is especially helpful if you have difficulty
getting out of bed in the mornings)
Using the washing machine as a laundry
basket and starting it when it’s full

Take some time to identify processes or tasks that you could

automate or create a reminder to do.

I could automate/create reminder by...

Final Note

If you live with someone, it is important to ensure any modifications

you make are mutually agreeable.

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 Session Recap

Today we have covered:

What does it mean to create an executive functioning
friendly environment
Engineering our environment to reduce distractions
Engineering our environment to support working memory

Before next session:

Try one of the tools discussed today

NOTES, REFLECTIONS AND AGREED ACTIONS

53 of 84
 Session 9
How can I do it?
Part Three
Objectives

Learn motivation strategies to practice before

starting a task
Learn ways to support motivation whilst
completing a task
Learn tools to set up for after completing a task to
support motivation

Section 02
Behavioural
TABLE OF
Strategies
CONTENTS 54 of 84
 Supporting Your Motivation
Our final session on looking at ways to approach tasks is focused on
motivation, especially when it comes to less interesting or
stimulating tasks.
Dopamine is a neurotransmitter that facilitates
the modulation of reward, memory, attention,
motivation and mood. Pleasurable or stimulating
activities can raise levels of dopamine, making
you more likely to do those things again. If
certain tasks do not provide as much dopamine,
we are likely to avoid or procrastinate getting
started on it.

Capacity Building
In cases where we are struggling to get started on a task, we may
need to get creative with taking extra steps before, during or after a
task to help support our motivation. But regardless of the strategies
we may utilize, it is important to start with identifying our capacity
and engaging with capacity-builders before doing anything else.
Recognizing capacity is essential for task initiation because it allows
you to understand your limitations and abilities and plan and execute
tasks more effectively.
For example, if you had a poor night's sleep, you may be more
limited in focus, attention, and energy levels.
By recognizing your capacity in this way, you can avoid
overcommitting yourself and ensure you set realistic and achievable
goals. This can lead to better time management, improved
productivity, and reduced stress.

We can do this by checking in with

ourselves and asking “do we have capacity
to do this task and what can we do to
increase capacity?”
Do I need a short nap first?
Do I need to feed myself first?
Do I need to use the bathroom first?
Do I need to move my body?

Once we have determined our capacity, we can support our

motivation by engaging in tools before, during and after the activity.

Before During After

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 Things to Consider Before a Task
Create and externalize a deadline if you don’t
already have one
Do you notice a difference in motivation when you have
an external deadline? Sometimes we need to create our
own deadlines to keep us on track. When setting our
own deadlines, it is important to externalize these to
increase accountability and create a sense of urgency
that can support our motivation. Examples of
externalizing deadlines include;
Booking an appointment at the bank to motivate you
to prepare the necessary documents.
Inviting a friend for dinner to motivate you to tidy
the kitchen.

Involve an accountability partner

Organizing a planner and making use of timers and

reminders will be important for keeping yourself
accountable, but sometimes having an accountability
partner can be helpful when you need that extra
external motivation. Whether it's an accountability
partner in your home life, work life or a professional
accountability partner like a counselor or coach, find
ways to effectively keep yourself accountable for the
tasks you wish to complete in the week.

Exercise

Incorporating some level of physical activity before a

task can be beneficial as it helps to increase the
production of the “feel-good” chemical, endorphins. This
can influence motivation and focus. Movement can also
help regulate our emotions by helping us release any
built-up energy. There are also studies that show
physical exercise improves working memory as well.

Visualize the Outcome

Taking a moment to visualize having success at

completing a task can remind our mind how it feels to
complete a non-preferred activity and spur us on to
start the task. Whether it is the feeling of getting closer
to one of your goals or just checking that item off your
task list, focus on the positive feeling resulting from
that task being completed. The more detailed and
visceral we get, the better.

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 Things to Consider During a Task

Prime Time & Place

Consider the time and location that best supports your

focus on the specific task at hand. Plan to start your
more difficult or less stimulating tasks at the time of
the day when you are most productive or focused. If
there is a certain point in the day or a specific place
where you know your focus or energy is not strong, take
this into account when creating your schedule for your
tasks.

Body Doubling

Body doubling is when we do a task in the presence of

another person. Whether the other person is helping
with the task or just sitting on the sidelines, body
doubling can help with extra motivation and
stimulation.

Gamify the Task

Look for ways to make the task more enjoyable or

engaging. This can be done by incorporating rules,
challenges or rewards as a way of transforming the
task into a more game-like experience.

Make the environment more interesting

If the task itself cannot be made more interesting,

consider how you make your environment more
stimulating. Pairing a mundane task with a more
enjoyable activity can make it easier to engage with as
long as the enjoyable activity is something you can
simultaneously do that doesn’t require your full
attention.

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 Things to Consider After a Task

Pair your task with a reward for afterwards

Think of it as doing one “have to” task, followed

by one “want to” task. It can be helpful to create
a list of rewards that you could plan for.

Rest

Getting things done often requires more energy for

neurodiverse folks. If you are feeling low-capacity,
take time to rest after completing a task. Consider
doing small things to prepare for the next day
instead of trying to push through or find motivation
somewhere.

Today’s session has introduced a number of strategies to support

motivation, particularly for tasks that are less interesting or
stimulating. We recommend trialing these different tools to see
which approaches work best for you.
Bonus tip: If one strategy doesn’t help with a
specific task, try another! These strategies
aren’t always a one-fits-all solution and they
might just have to be tailored to specific tasks
and activities.

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 Session Recap

Today we have covered:

How to support our motivation
The importance of identifying our capacity
Strategies to try before, during and after a task

Before next session:

Practice one of the tools discussed today

NOTES, REFLECTIONS AND AGREED ACTIONS

59 of 84
 Session 10
How can I overcome internal
obstacles?
Part One
Objectives

Learn about the cognitive model and the

connection between our thoughts and our feelings
Learn about mindfulness and grounding techniques
to soothe difficult emotions
Build awareness of our own thoughts

Section 03
Cognitive
TABLE
StrategiesOF
CONTENTS 60 of 84
 Thinking Feeling Connection
In our first session, we discussed the CBT cycle and the relationship
between our thoughts, feelings, and behaviors. Throughout the
program thus far, we have focused on our behaviours, imparting skills
and strategies to enhance our ability to manage time, organize, and
plan in our daily lives.
Now it is time to look at our
thoughts. Living with executive
Thoughts
dysfunction comes with challenges
and you may have experienced
recurring frustration regarding
such challenges. This frustration
may have led to negative outlooks
and assumptions about your
abilities. Such thoughts can have a
knock on effect on how we feel
and the behaviours we engage in, Behaviours Feelings
further perpetuating a cycle of
executive dysfunction.
Today’s session explores the question, “‘How can I overcome internal
obstacles?”, which includes building awareness of the internal
assumptions and beliefs we hold about ourselves. We will explore a
number of grounding techniques to soothe difficult emotions that
may arise when attending to our beliefs.

The Power of our Thoughts

Our brains are meaning-making machines and have the ability to run
on “autopilot”, which is important as it frees up resources for other
tasks. The difficulty with this is that the accuracy of our automatic
thoughts isn’t always assessed. While some thoughts we have may
be factual, others may not. As a result, thoughts with inadequate
evidence may be accepted as fact.
Facts are verifiable statements, e.g. "the sky is blue
today"

Opinions are personal interpretations of facts,

which differ from person to person, e.g. "the
weather is beautiful today"
Even with knowing the difference between facts and opinions, our
brain does not always differentiate between the two. When this
happens, harmful opinions, such as “I’m useless,” are sometimes
treated as fact, which can contribute to negative thinking, stress,
and other problems.

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 Decide whether each statement is a fact or an opinion:
"I will never get this done" = FACT or OPINION
"I can’t do anything right" = FACT or OPINION
"I didn’t finish my to do list" = FACT or OPINION
"I will wait till later, I will feel motivated then" = FACT or
OPINION

Recognizing the difference between

facts and opinions can assist us in
challenging the dysfunctional
opinions we may hold about
ourselves and others.

Keeping a Thought Record

Before we can assess the accuracy of our thoughts, we first need to
know what thoughts we are experiencing. We need to increase our
awareness of our own automatic thoughts and how these influence
our emotions.

On the next page, you will find a thought monitoring record.

Whenever you notice your emotions or motivation significantly shift,
take a moment to complete this exercise of identifying the situation,
the related emotions, behaviours and thoughts. This can be difficult
to start, as we may not be used to asking ourselves this. You might
need to practice this step a few times.

Use shifts in emotion as a prompt to complete the record.

You can start at any point, maybe you can label the emotions
first or the behaviours first.

We know it is much easier to work with thoughts when they

are written down, especially with a busy mind.

It can be done on paper or electronic device, whatever is

most convenient for you.

Becoming more aware of our thoughts and opinions can provide us

with the opportunity to fact check thoughts that may be impacting
our confidence and interfering with the successful initiation and
completion of tasks.

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 Thought Monitoring Record

Situation Feelings Behaviours Thoughts

What were you doing? What did you feel physically What did you do? How did you What thoughts or images
Where were you? When did it and emotionally? respond? were going through your mind
happen? as your feelings started to
Tip: We can feel several change?
emotions at one time. For
each emotion, rate the
intensity out of 100.

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 Grounding Techniques
Attending to our thoughts and feelings can be difficult. As you begin
recording your thoughts, you may find it helpful to practice
grounding yourself using one of the following techniques:

Box Breathing Inhale

Box breathing is a powerful but simple

relaxation technique that aims to
return breathing to its normal rhythm 4
after a stressful experience. It may Hold Seconds Hold
help clear the mind, relax the body, Each
and improve focus.

Follow the outline of a box, holding

each step for 4 seconds. Exhale

54321
Calm our worries and emotions by reorienting to the present using
our five senses.
What are 5 things you can see?
Look for small details such as a pattern on the ceiling,
the way light reflects off a surface, or an object you
never noticed.

What are 4 things you can feel?

Notice the sensation of clothing on your body, the sun
on your skin, or the feeling of the chair you are sitting
in.

What are 3 things you can hear?

Pay attention to the sounds your mind has tuned out,
such as a ticking clock, distant traffic, or trees blowing
in the wind.

What are 2 things you can smell?

Notice smells in the air around you, like an air
freshener or freshly mowed grass.

What is 1 thing you can taste?

Carry gum, candy, or small snacks for this step. Pop
one in your mouth and focus your attention closely on
the flavors.

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 TIPP Skills
Sometimes emotion is so intense it takes away our ability to use
other coping skills - This is where TIPP Skills come in. The goal of TIPP
skills is to change our body chemistry to quickly reduce our intense
emotions and keep ourselves from acting in ways that may make the
situation worse.

TIP THE Hold your breath and put

your face in a bowl of cold
TEMPERATURE
T
water, or hold a cold pack
Calm down fast by on your eyes and cheeks.
slowing your heart rate Hold for 30 seconds.
down as you change the (Do not attempt this if you
temperature of your face have cardiac problems)

INTENSE Expend your body's stored

EXERCISE
I
up physical energy by
Emotion primes our for running, walking fast,
intense activity, exercise jumping, dancing etc., for
can release this energy approximately 20 minutes

PACED For at least 5 minutes,

BREATHING breathe out more slowly

P P

P
Slow your breathing down
to calm your emotion and
than you breathe in (for
example, 5 seconds in and
7 seconds out)
show your mind you are
safe

Tense your muscles as you

PAIRED breathe in, and relax them as
MUSCLE you breathe out. Notice the

P P RELAXATION
Recognize tension in our
difference between tension
and relaxation. Go through
each muscle group. Avoid
muscles, and work on
relaxing each muscle tensing any areas where you
might have an injury.

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 In our first session, we touched on how our execution function
cannot work at full capacity when our emotions become too intense.
This is crucial to consider because tasks can feel even more difficult
to accomplish, the more our emotions interfere. The benefit of being
aware of this allows us to practice these techniques when we are
experiencing intense emotions in order to get our executive
functioning back on track. In other words, these tools can help to
regulate our emotions and re-mobilize our executive functions.

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 Session Recap

Today we have covered:

The thinking feeling connection
Building awareness of our thoughts
Soothing our emotions with grounding techniques and TIPP
skills

Before next session:

Complete the thought monitoring record
Practice grounding techniques and TIPP skills

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 11
How can I overcome internal
obstacles?
Part Two
Objectives

Labelling cognitive distortions

Learn how to reframe our thoughts with cognitive
restructuring

Section 03
Cognitive
TABLE
StrategiesOF
CONTENTS 68 of 84
 Reframing Our Thoughts
Last session, we shifted focus to exploring the role of our thoughts.
We explored the importance of building awareness of our thoughts
and how grounding techniques can be used to soothe our emotions
when paying attention to our thoughts. In today's session, we are
going to build on this and explore ways to reframe our thinking.

Layers of Thoughts

Before we look at reframing our

thoughts, it is important to be aware
of the different layers of thoughts.
CBT outlines the existence of three Automatic Thoughts
layers of thoughts. Each layer is
interconnected and plays a significant
role in how we interpret and respond
to situations. Rules for
Living
At the deepest level of our thinking are “Core
Beliefs”. These beliefs may not have been Core
verbalized, but are treated as the ‘truths’ about Beliefs
ourselves, the world, or other people. We typically
arrive at these beliefs following experiences in our
childhood, the society we live in and the people we
are surrounded by.

Core Beliefs can be described as rigid or inflexible, and

often take the form of "I am../People are../The world
is..." statements. They typically go unquestioned and
are absolutely accepted by us as our normal ways of
thinking, feeling, and being.

To protect ourselves from our Core Beliefs, we may

have developed Rules and Assumptions for how we
should live our lives. “Rules for Living” make up the
second layer of our thoughts; these guide our
behaviours and aim to guard and defend us from the
truth of our negative core beliefs. Similarly to core
beliefs, they can easily pass by unconsciously.

Finally, we have “Automatic Thoughts”, quick and

spontaneous thoughts that we have in reaction to
particular events. As a more conscious layer of
thoughts, we tend to be more aware of them than
core beliefs or rules for living. They are also more
malleable than the rigid core beliefs and, as such, it
can be easier to challenge them.

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When working through thought monitoring records, we are capturing
our automatic thoughts. It is important to be aware that there are
different layers of thoughts, as the automatic thoughts that we have
are often determined by the core beliefs that we hold.

Automatic Thoughts
When tending to our automatic thoughts, we may notice some
patterns in how we think, and these are called Cognitive Distortions.

Cognitive distortions are irrational and inaccurate

thinking patterns that are not fully based in fact.
We all experience them, but left unchallenged,
these negative thoughts can shade our view of
ourselves and the world around us and can lead to
a cascade of self-criticism, emotional distress, and
avoidant behavior.

Let’s take a look at the common distortions on the next page. You
may notice that some of them sound similar to one another. They are
not meant to be distinct categories but to help you see if there is a
kind of pattern to your thoughts. Take some time to see which ones
you can relate to.

Practice Exercise: Name the Cognitive

Distortion

“I can never get started on

things ahead of time.”

“I am lazy because I can’t get

started on my task.”

“If I can’t complete this task,

I might as well quit this job.

“I can’t do this right now

because I dont feel like it, I
will try again later”

"I should never be late"

“I lost my keys. I can never

keep track of things.”

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 Cognitive Distortions
Cognitive distortions are irrational and inaccurate thinking patterns
that are not based in fact. We all experience them, but left
unchecked these unhelpful thinking styles can impact our mental
health.

Black & White/

Polarized Personalizing
Thinking Assuming responsibility
Seeing only one extreme for something even
or the other, ignoring the though what happened
grey areas - wasn't your fault.

Emotional
Reasoning Catastrophizing
Accepting one’s emotions Thinking of worst case
as fact - “I feel it, scenarios - “What if…?”
therefore it must be true.”

Mind Reading Fortune Telling

Believing we know what Predicting that bad
someone else is thinking, things are going to
or why they are doing happen, without the
something, without having evidence to support it.
enough information.

Magnifying &
Minimizing Overgeneralizing
Fears or imperfections are Using evidence to make
exaggerated. Strengths or sweeping negative
achievements are made to assumptions -
seem small and
unimportant.

Should Labelling
Statements Assigning judgments of
Putting unreasonable value to ourselves or to
demands and pressure on others based on one
ourselves and others - instance - "I am..."

Disqualifying the
Mental Filter Positives
"Tunnel Vision" - Focusing Acknowledging positive
on a single negative piece experiences but
of information and rejecting them instead of
excluding all the positive embracing them - "That
ones. was a one off" "That was
lucky"

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 Thought Monitoring Record Extended

Cognitive
Situation Feelings Behaviours Thoughts
Distortions
What were you doing? What did you feel What did you do? How What thoughts or Which cognitive
Where were you? When physically and did you respond? images were going distortions do your
did it happen? emotionally? through your mind as thoughts fall into?
your feelings started to
TIP: We can feel several change? TIP: It can be more than
emotions at one time. one of the thinking
For each emotion, rate styles.
the intensity out of 100.

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 Cognitive Restructuring
We know that our automatic thoughts can often be based on our
personal opinion or experiences, and thus are not necessarily
grounded in fact. With this in mind, it is important for us to take a
step back and consider the accuracy of our thoughts. To challenge
these thoughts, we focus on collecting factual evidence to see how
accurate the thoughts really are.
Think of it as taking your thought to court!
During Cognitive Restructuring, only verifiable facts
are admissible as evidence. Similar to a real court of
law, opinions, assumptions, and conjecture are not
taken as evidence.
Focusing on the hot thoughts, which cause the most emotional
distress, we assess how much truth there is to these thoughts by
gathering evidence that may support or contradict our thought.

What is a hot thought?

A hot thought is an automatic thought or image that
goes through our mind in response to a situation.
They are our initial thinking reactions that go on to
affect emotions and behaviours. Sometimes they
can go unnoticed and usually they go unquestioned.

Balanced Thoughts
Cognitive restructuring finishes with creating a new alternative
thought based on all the gathered evidence.
In order for the technique to be effective, we need to own the new
balanced thought, rather than just writing something we think we
'should' think.
It is important that we actually believe the new balanced thought at
least 70 out of 100. If needed, we sometimes need to tweak the
balanced thought slightly to make it more believable and reach the
70 out of 100 threshold. We can do this by using words like "maybe"/
"perhaps"/ "potentially".
The aim of this technique is not to just look at the
bigger picture, including the positive side of
things, but to look at thoughts in a more balanced
and accurate way. More balanced thoughts can
improve our mood and enable us to function
better, which will result in enjoying our life again.

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 Cogntive Restructuring Steps
Identify the hot thought and rate how you much you
believe it
1 Looking at your thought record pick the thought that has
the most charge; The one most strongly linked to your
mood. This is the defendant you are going to put on trial.

Identify Cognitive Distortions

2 Label any unhelpful thinking styles.

Gather Evidence For

3 Ask what is certain about this situation? What factual
proof supports my thought?

Gather Evidence Against

4 Ask if my friend was having this type of thought, what

would I say to them? If I wasn’t frustrated or upset, how
would I look at the situation?

Create a Balanced Thought Based on the Evidence

Come to a ‘verdict’/ balanced thought that reflects the
5 evidence for and against the hot thought. It is important
that you “own” your thought (believe it) in order for it to
have an impact.

Re-rate the Belief of Your Original Thought and Re-rate

the Intensity of Your Initial Emotions
6 Have you noticed a shift in how you feel? Does the shift
coincide with a reduction in the belief in the original
thought?
If you want, repeat this process with the next hottest thought. If you
notice other intense feelings that linger, it could be secondary to
another hot thought that has not yet been explored.

Important!
Sometimes our thoughts can be so hot that they are tough to shift
and can make cognitive restructuring even more challenging. This
may be because we have hit a core belief. As a starting point, we
recommend starting with less emotionally charged thoughts in order
to get good practice on how to complete the process of thought
challenging.

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 Cognitive Restructuring Record
Situation What happened? Feelings How did it make me feel?

Emotion Intensity = ___/100

Hot Thought What was I telling myself when the situation was happening? Unhelpful thinking
style

Belief in original thought = ___/100

Evidence for my thought Evidence against my thought

What facts show my thought is true? What facts show my thought might not be true?

Alternative Thoughts
Given all of the evidence, what do I think of the original thought now? What is a balanced and realistic way of
looking at the thought now?

Rate belief in new thought = ___/100

Re-rate belief in original thought = ___/100
Re-rate emotion intensity = ___/100

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 What do we do with “Core
Beliefs”?
Core beliefs are better tackled after we have
completed several thought records and are
comfortable with the process of cognitive
restructuring for less intense hot thoughts.

Each time we complete thought challenging for a hot thought, we are

actually chipping away at our core beliefs.

Identifying Strengths
When looking at situations in a more balanced way, we are
encouraged to highlight the evidence that contradicts our distorted
thinking. While doing this, we can also shine more light on our
strengths and traits rather than solely on the challenges we face.
When we remind ourselves of our strengths, we can not only
appreciate them more but also work to strengthen and integrate
them more into our lives.

To finish up today’s session, let’s take a moment to

identify the strengths and positive traits you possess.
To help guide this, think about the different areas of
your life. Having your strengths written down can
help you easily access them when you are working
through cognitive restructuring.

My Strengths

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 Session Recap

Today we have covered:

Layers of thoughts
Identifying automatic thoughts and cognitive distortions
Challenging our thoughts using cognitive restructuring
Creating new balanced thoughts supported by evidence
Identifying our strengths

Before next session:

Label cognitive distortions
Practice cognitive restructuring

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Session 12
Maintaining Gains
Objectives

Goal review
Recapping the tools covered so far
Creating a summary of strategies to utilize once
the program is complete

Section 04
What
TABLE
Next? OF
CONTENTS 78 of 84
 Goal Review
We have now covered all the content for this CBT program - We’re
glad you stayed on with us. As we work through our last session of
the program, we want to begin by revisiting the goals that you set at
the start. Regularly reviewing our goals is a great way to celebrate
our wins, no matter how big or small. It allows us to focus on the
progress we made rather than only focusing on where to go next.
Occasionally, we may find we have not made any progress, so
reviews give us a chance to make adjustments when needed.

Let's start by reminding ourselves of your original goals, and see

what progress you have made and the impact this may have had.

Progress Impact
Original Goal What progress have What has been the
What was your goal? you made towards impact of focusing on
reaching this goal? this goal?

Following this program, it is important to

continue working towards new and existing
goals, and regularly review how your progress
is going. At first, it is challenging to set goals
at the right level of difficulty, and only with
practice will we get better at it. We have
included another copy of the SMART goals
worksheet if you would like to create a new
goal to work on.

Moving forwards, the most important thing is to keep practicing

some of the strategies you have learned. The more you practice, the
more these skills will become automatic habits that are integrated
into your lifestyle.

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 SMART Goals Worksheet
Starting Goal

Specific
What do I want to accomplish? What are the steps involved?

Measurable
How will I know when it is accomplished? How often? How many?

Achievable
How can I accomplish this goal? How realistic is this goal, based on
other factors, like time, cost, resources, skills? Are there any resources
I need before I can achieve this goal?

Relevant
Why do I want to do this? Is this goal worthwhile? Does it match my
values?

Time limited
When will I have achieved this goal? Are there any smaller milestones
along the way?

SMART Goal

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 What Next?
The end of the structured program marks the beginning of your own
self-guided journey. Practicing these skills in your daily or weekly
schedule will help ensure that you continue to maintain or extend
the gains you have achieved.

1. Expect slip-ups
Progress can be a windy road and slip-ups can
happen at any time and are to be expected.
Although they are to be expected, slip-ups don't
mean we are ‘back to square one’. Don't forget that
‘down days’ or days where life feels harder to deal
with are part of being human! These days can also
be learning opportunities that help us avoid similar
problems in the future.

2. Utilize social support

Talking through what’s going on in your life, venting about difficulties
or sharing your goals can be helpful. Sometimes, talking helps to
take the edge off our difficulties, and open our mind to other
perspectives. It can also help keep us accountable.

3. Plan a regular check in

with yourself
Once our sessions end, it is helpful to make
a commitment to checking in with yourself
on a regular basis. This may be more
frequent to begin with. This can help you
identify early warning signs and put into
practice behaviours/skills if required.

“I will check in with myself every … over the

next … weeks.”

A common theme throughout our program is the benefit of

externalizing our executive functions. We have talked about
externalizing your to do list, your calendar, timelines, problem
solving and sources of motivation. To help guide you through the
next steps, we want to continue this thread and create an external
summary of what was most valuable to you throughout this
program.

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 Maintenance Plan
Take a moment to identify warning signs that suggest you need to revisit the program, followed by the
tools or techniques that you have found most helpful throughout our program. Highlight in what ways
they were helpful and how you may be able to maintain use of these tools moving forwards.

Warning Signs

How can I maintain

Tool or Technique How is it helpful?
use of this tool?

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 Session Recap

Today we have covered:

Goal review
Maintaining our mental health
Creating a maintenance plan

To complete:
Complete the maintenance plan

NOTES, REFLECTIONS AND AGREED ACTIONS

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 Course Complete!
We have reached the end of
the Cognito CBT Program.

Thank you for sticking with us throughout this CBT

Program. We hope these sessions have provided you
with a toolkit of techniques to support your mental
health.

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