CBT can help children recognise emotions, notice the thoughts connected to difficult moments and practise helpful ways of responding. For younger clients, these concepts are usually easier to understand when they are taught through play, pictures, stories and movement.
The following CBT activities can be adjusted for the child’s age, language, attention span and developmental needs. Use simple examples first, offer choices and avoid pressuring children to disclose personal experiences before they feel safe.
1. Draw the CBT Triangle
Draw three large circles for thoughts, feelings and actions. Use a child-friendly example, such as not being chosen first for a game. Fill in each circle together and draw arrows to show how each part can affect the others.
2. Thought-Bubble Detective
Show a picture of a character in an uncertain situation. Ask the child what might be inside the character’s thought bubble. Generate several possibilities and discuss how each thought might create a different feeling.
3. Feelings Charades
Take turns acting out emotions using facial expressions, posture and movement. After guessing, identify situations that might lead to that feeling and body clues that can help the child recognise it.
4. Thought, Feeling or Action Sort
Prepare simple cards such as “My stomach feels fluttery,” “I might get it wrong,” “worried” and “hide behind Dad.” Sort them into thoughts, feelings, body clues and actions.
5. Flip that Thought Card Game
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6. Helpful and Unhelpful Thought Race
Read a situation and offer two possible thoughts. The child moves a counter toward the response that is more balanced and useful. Clarify that a helpful thought is believable—it does not need to pretend everything is wonderful.
7. Put the Worry on Trial
Use toy figures as the worry, the evidence detective and the fair judge. Let each figure speak before the judge creates a balanced conclusion. Externalising the worry can make thought examination feel safer.
8. Coping-Skills Toolbox
Decorate a box and fill it with pictures or reminders of strategies such as slow breathing, drawing, movement, sensory objects, asking for help and positive self-talk. Discuss which tools suit different situations.
9. Balloon Breathing
Ask the child to imagine gently inflating a balloon in their belly as they breathe in and slowly letting the air out as they breathe out. Practise when calm so the skill is easier to access during stress.
10. Body-Clue Map
Use a body outline and add colours or symbols showing where the child notices worry, anger, sadness or excitement. Connect early body clues with a coping action the child can try.
11. Brave-Steps Ladder
Choose a fear or avoided task and draw steps from easiest to hardest. Help the child select a manageable practice step. When this is used as exposure, caregivers and clinicians should agree on a supportive plan that avoids overwhelming the child.
12. Problem-Solving Superhero
Create a superhero who stops, names the problem, thinks of choices, predicts what may happen and tries one safe solution. Practise with fictional problems before applying the steps to the child’s life.
13. Puppet Perspective Swap
Use two puppets to interpret the same event differently. One assumes the worst; the other asks questions and considers alternatives. Invite the child to give each puppet advice.
14. Catch the Win
At the end of the session, record one brave action, one helpful thought or one coping skill the child used. Put the wins in a jar or add them to a growing paper chain.
15. Make a Coping Comic
Draw a short comic containing a trigger, the character’s first thought, the emotion, a coping choice and what happens next. Comics allow the child to rehearse a new response without needing long written answers.
Tips for Using CBT With Children
Keep explanations short and alternate conversation with action. Children often need repeated practice across different examples before a concept becomes familiar. Caregivers can support generalisation by using the same simple language at home, while respecting the child’s privacy and the boundaries of therapy.
Most importantly, CBT should validate the child’s emotional experience. The aim is not to label feelings as problems or insist on happy thoughts. It is to help children understand what is happening inside them and build a wider range of safe, flexible responses.