Coping Cards in CBT: A Reminder for the Moment You Need It

When a hard thought arrives, the work you did in calmer moments is often out of reach. A coping card is a small, personal note, written when you are calm, to be read when you are not. It is one of the standard tools of cognitive behavioral therapy (CBT), and in CopingCard it lives in Coping Cards.

What a coping card is

Traditional coping cards are index cards. One side holds the thing that bothers you: a thought, a situation or a task. The other side holds the response you have worked out. In CopingCard the same two sides appear on your phone: the front holds the automatic thought or situation, and the back holds your realistic thoughts.

Where the content of a card comes from

A card is not magic text. Its power comes from the work behind it. The best cards carry something you learned: the balanced thought from a thought record, the result of a behavior experiment, a coping plan you made with your therapist. A card written without that work behind it is still useful as a reminder, but it is only a reminder, and in a strong moment it may not feel believable.

In CopingCard this link is built in. When you finish a Dysfunctional Thoughts Test, the app creates a coping card automatically from it: the automatic thought on one side, the realistic thought on the other. You can also create a card on its own.

How a card works

The mechanism is practice at recall. An old thought has been rehearsed for years, so it comes quickly. A new, more balanced response has to compete with it. Reading the card at the right time, again and again, gives the new response a better chance to come to mind first. In the language of memory research, therapy does not erase the old response; it changes which response wins the competition to come to mind (Brewin, 2006), and a response is strengthened by being retrieved in the situations where it will be needed. Spacing the readings out over days, rather than reading the card many times in one sitting, also helps learning last. This is why coping cards pair so well with reminders, and why practice between sessions is linked to better results in CBT.

What the app adds to a paper card

A paper card works only if you remember to take it out, and the moment you need it is the moment the old thought is loudest. CopingCard brings the card to you.

• Reminders by time. Each card has its own schedule: daily, on chosen weekdays, monthly or once. You can skip the next one, or switch a reminder off and back on without setting it up again. Readings spread out over days, rather than many in one sitting, are what memory research favors for lasting learning (Cepeda and colleagues, 2006).
• Reminders by place. A card can arrive as you approach a saved place or as you leave it. Many automatic thoughts belong to a place: the office before a meeting, a parent's home, the shop where panic once started. Research on extinction shows that the newer response is the one most tied to the context where it was learned, while the old one comes back easily elsewhere (Bouton, 2002). A card that arrives as you walk into the place helps the realistic thought be practiced where the old one usually wins.
• Cards from your thought tests. When you finish a Dysfunctional Thoughts Test, the app turns its automatic and realistic thoughts into a card, so the work and the card stay together.
• Work on it with your therapist. If you share your data with a therapist in CopingCard and allow editing, you can work on your cards together, and they can adjust the cards' reminders by time, so practice between sessions becomes part of the plan.

The case for place reminders comes from memory research, not from trials of the app. Context effects on recall are reliable but modest (Smith and Vela, 2001), so a card that arrives in the right place helps, without working by itself.

An example: Linda and one mistake

Linda finds a wrong figure in a report she has already sent, and the thought arrives at once: "I always mess things up." In that moment she cannot remember anything she worked out in calmer times.

Weeks earlier, after a thought test about another slip, she wrote this card:

The back does not claim she never gets things wrong. It holds what her earlier thought test found, in words that fit the next slip as well as the last one, because a card is written before the moment it is read. And it is short enough to read in a few seconds. One automatic thought on the front, one realistic thought on the back: that is the whole card.

Three types of coping card

Cards for unhelpful thoughts. One side holds the automatic thought, the other the adaptive answer. Example: a friend is late. "Something bad happened to them" on one side; "They are often late, and I can text them" on the other.

Cards for hard situations. One side names a situation that reliably brings difficult emotions, such as public speaking. The other side lists strategies: remind yourself of past speeches that went fine; make a plan; keep short notes.

Cards for motivation. One side names a task that is hard to begin. The other side lists why it matters to you, linked to your goals and values. For example: "Study English" on one side; "It opens the door to the course in the UK, and I want to read these books in the original" on the other.

Cards can also hold other things the CBT family uses: a values statement ("what matters to me here"), a phrase that helps you step back from a thought ("I'm having the thought that..."), or a skills plan like those used in dialectical behavior therapy (DBT).

How to write a good card

• Use your own words. If it sounds like a poster, you will not believe it.
• Keep it short and precise. One line on each side. You may read it on a bad day, with little attention.
• Make it believable. If you would not say it to a friend, change it. Aim for balanced, not cheerful.
• Ground it in fact. A realistic thought rests on what your thought test found, such as a fact from your own life. That carries more weight than reassurance.
• Make the thought specific. One card for one recurring thought works better than a general one.

The reassurance limit

Cards have one important limit. In anxiety, health worries and obsessive-compulsive disorder (OCD), rereading a card to feel calm or to feel certain can become a safety behavior or reassurance ritual. The relief is brief, and the urge comes back stronger. A useful question to ask: am I reading this card to act on it, or to make a feeling stop? If it is the second, or you find yourself reading a card again and again, bring it to your therapist. The card may need to change, or another method, such as exposure with response prevention, may fit better.

Where coping cards fit in the CBT family

Coping cards come from Beck's cognitive therapy, where they are a way to carry in-session learning into daily life. They are paired with thought records and behavior experiments, which create the learning. Third-wave approaches adapt the format, for example with defusion phrases (ACT) or skills plans (DBT). They are a support, not a method on their own: they work best when the work behind them is solid.

How to use Coping Cards in CopingCard

1. Create a card. Finish a Dysfunctional Thoughts Test and the app creates one for you. Or open Coping Cards and write one: the thought or situation on the front, your response on the back.
2. Read it through once, calmly, to check it sounds like you.
3. Set reminders. On the card, tap the bell. A reminder by time can be daily, on chosen weekdays, monthly or once: start frequent, for example three times a day, and spread them out as the new response starts to feel natural. A reminder by place ties the card to a saved place, such as the office, and arrives as you approach it or as you leave it.
4. Use it in the situation. When the thought or situation arrives, open the card, read it once, and go on with what you were doing.
5. Review and revise. If a card stops sounding true, or you have learned something new, edit it. Cards are living notes.

The full step-by-step technique behind most cards is in Dysfunctional Thought Testing.

When to get more help

Coping cards support everyday difficulties. If your low mood, anxiety or worry is making daily life hard, if you have severe symptoms, or if you have thoughts of harming yourself, please work with a therapist or doctor. If you are in crisis, open the Crisis tab in the app or contact your local emergency number. You do not have to deal with it alone.

Sources

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• Greenberger, D., & Padesky, C. A. (2015). Mind Over Mood (2nd ed.). Guilford Press.
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• Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755-772.
• Cepeda, N. J., Pashler, H., Vul, E., Wixted, J. T., & Rohrer, D. (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132(3), 354-380.
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• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and Commitment Therapy (2nd ed.). Guilford Press.
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