Supporting clients to develop a range of coping skills is a common focus in therapy.
Having effective coping tools helps to manage difficult emotions, overcome challenging situations, build strengths, and work toward personal goals.
However, a big challenge of therapy is translating helpful ideas and strategies from sessions into real-world situations. It is therefore important for therapists to have a range of creative and practical therapeutic tools to help facilitate change and maximize benefits from therapy into day-to-day life.
Coping skills cards are a great example of this and a must-have in your toolbox as a therapist. Coping cards are used widely across different therapeutic modalities and have been effective in helping a range of clients successfully implement coping strategies.
Below, we will introduce coping cards, a rationale for using them in therapy, as well as examples and templates to try.
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What Are Coping Skills Cards?
Coping skills cards are helpful therapeutic tools that can be used with clients of any age. These cards are also known as coping index cards, coping strategy cards, or simply coping cards. They are simple small cards with brief prompts on them to facilitate use of a specific coping strategy or idea from therapy.
Coping skills cards are often used in conjunction with therapy sessions. Coping tools are usually generated and rehearsed in therapy sessions, and then clients use the coping cards to carry out these ideas in real-life situations (Wright, 2006).
There are several benefits of coping cards, including being easier to access day-to-day than larger documents or workbooks.
Coping cards are also usually created collaboratively with the client to ensure they are tailored to the client’s specific needs and difficulties. Cards may include words or pictures, depending on client preferences, age, and literacy level.
8 Examples of Coping Cards
There are no set rules regarding how to use coping cards, as they should be created in a flexible and client-centered way in order to maximize therapy gains.
However, there are some common ways coping cards are used in therapy.
Here are eight examples:
- Anxiety management tools
Cards are used for practical coping strategies that help to regulate anxiety, for example, breathing exercises and progressive muscle relaxation (Wright, 2006). A coping card may include a list of different strategies, or different cards may detail different tools, with more detailed steps on how to do the strategy.
- Behavioral experiments
Coping cards can be helpful reminders for behavioral goals, including steps on a graded exposure plan (Wright, 2006). For example, for someone who is anxious about asking their lecturer for help, a coping card may include reminder prompts of what they want to say (Beck, 2011).
- Behavioral activation
Cards may be used to remind clients about scheduled daily activities arranged in therapy, which contribute to improving low mood (Wenzel et al., 2011). A card may also prompt the client to remember the vicious cycles of low mood and how beneficial these activities can be.
- Cognitive tools
Cards may include cognitive strategies learned in therapy, for example, cognitive reframing of an anxious situation. Beck (2011) gives the example of a client using a coping card to remind themselves of alternative thoughts to the anxious appraisal of ‘I am not capable of applying for a job.’
- Grounding techniques
Coping cards are commonplace in trauma work and recommended as reminders of grounding strategies (Peckham, 2021), for example, the “54321 skill.”
Cards may also include grounding statements, such as, “I am safe now.” In the context of trauma work, coping cards can be particularly helpful for clients who experience flashbacks and dissociation as a tool to help them ground back into the here and now.
- Positive/strength-based statements
The positive psychology approach of fostering strengths can also be applied to coping cards, with clients using cards detailing their own identified strengths or positive affirmations. These can bolster self-esteem and have been linked to a reduction in anxiety (Rahayu & Rizki, 2020).
- Safety planning
Coping cards are often integrated within safety plans for clients who are at risk of suicide or self-harm. Cards can be reminders of warning signs such as behaviors or cognitions, as well as include helpful coping statements to counteract these. Cards can also detail who to speak to, including crisis numbers (Henriques et al., 2003).
- Relapse prevention
At therapy termination, coping cards can be used to foster a client’s confidence and independence by detailing an agreed plan for what to do if there is a setback or relapse after therapy has ended, for example, looking at therapy notes or calling a family member (Beck, 2011).
Do Coping Cards Work? 14 Findings
Coping cards have a good evidence base to support their use in therapy, including the following 14 key references, manuals, and papers.
There is evidence in CBT that coping cards are an effective strategy. Beck (2011) provides a range of examples of cognitive coping cards, and Wright (2006) highlights coping cards as key to helping clients use behavioral skills.
Hunt and Fenton’s (2007) case study also provides support for using coping cards for clients with phobias, as cards helped to increase self-efficacy and challenge catastrophic beliefs.
There is further evidence that coping cards have been effective in third-wave approaches, such as in Dialectical Behavior Therapy (Goldstein et al., 2007).
Wenzel et al.’s (2011) manual reports that coping cards are effective in CBT for veteran populations and documents the following explanation of why coping cards work:
- Simple to create, either in therapy sessions or as a homework task
- Good for clients who prefer more simple and visual approaches
- Clients are more likely to recall instructions or tools if they are readily available in an easy-to-use format.
There is also evidence that coping cards work effectively with the following client presentations and populations:
- Trauma interventions for adults (Peckham, 2021) and children (Treisman, 2018).
- Clients at risk of suicide (Anderson et al., 2016) and self-harm (Ougrin et al., 2012). Henriques et al. (2003) further advocate that coping cards help suicidal clients identify dysfunctional cognitions and identify more adaptive responses, with Pauwels et al. (2017) reporting evidence of using electronic coping cards with this client group.
- Physical health settings, including children undergoing surgery (Kain et al., 2000) and individuals coping with a cancer diagnosis (Santana & Lopes, 2016).
- Refugee populations (Tay et al., 2020), where coping cards helped aid comprehensibility of therapy content.
How to Use Coping Cards in Therapy
Top tips for using coping cards
Tip 1: Take a practical approach
Spend time in therapy sessions to consider practical aspects, for example, where cards are kept and the specific circumstances in which they will be used.
Cards should be easy to access in times of need (Wenzel et al., 2011), so encourage clients to have them readily available, such as in their purses/wallets.
Tip 2: Get creative
Clients are more likely to use cards if they are colorful or laminated (Wenzel et al., 2011). Clients may feel more empowered to use the cards if they have created them themselves, so therapists can prepare for this by providing craft supplies (Anderson et al., 2016).
Tip 3: Short and sweet
Cards are intended to be short prompts that are easy to digest in times of high distress. It is therefore beneficial to encourage clients to keep coping cards brief and written in their own words (Pauwels et al., 2017).
Tip 4: Adapt for the individual
Cards should be appropriate for the age, developmental stage, and language needs of the client. For example, Tay et al. (2020) found that using culturally sensitive and pictorial cards was most effective when supporting refugee populations.
Furthermore, when working with children, using engaging fun images, such as cartoon characters, is likely to increase the chance they will use the cards (Anderson et al., 2016).
Tip 5: Use multimedia
Being flexible with the format of coping cards is key to maximizing benefits, for example, possibly creating them on a computer or having pictures on a phone.
There are also smartphone applications for creating coping cards (Pauwels et al., 2017).
Using coping cards for anxiety and panic attacks
Anxiety is the activation of the body’s fight, flight, or freeze response, which is often experienced as bodily sensations, such as heart palpitations and shortness of breath (Clark & Beck, 2011).
Panic attacks are acute and extreme anxiety responses, where the individual feels overwhelmed and out of control. When anxious, our rational thinking is reduced, and it’s hard to recall and implement helpful strategies (Kennerley, 2014).
Coping cards are therefore particularly helpful for anxiety difficulties, as they can act as clear digestible reminders of the steps to take in times of high distress.
Here are examples of common anxiety/panic strategies (Kennerley, 2014) that could be included on coping cards:
- Breathing strategies
- Progressive muscle relaxation
- Calming imagery
- Distraction techniques
- Cognitive strategies, such as cognitive restructuring or coping statements (Hurley, 2007)
- Behavioral strategies, such as graded exposure
- Psychoeducation, for example, “When I feel my heart beating fast, this is just the fight, flight, or freeze response. It is not dangerous. I can use my strategies to calm this.”
This video provides helpful visual ideas for creating coping cards for panic attacks.
A Look at Coping Strategy Cards in CBT
The flexible nature of coping cards means they can be applied to various CBT components. This article has already touched on behavioral strategies, including anxiety body tools, behavioral activation, and behavioral experiments. The following is a look at applying coping cards to the more cognitive elements of CBT.
1. Negative automatic thoughts
A core part of CBT is identifying negative automatic thoughts and generating alternative, more balanced thoughts.
Coping cards can include the client’s common negative automatic thoughts to help increase self-awareness, as well as give reminders of alternative, more balanced thoughts.
This thought-challenging approach has often been done in therapy, with coping cards used to help a client “over-learn” these adaptive responses, increasing the likelihood that they will be used in stressful situations (Wenzel et al., 2011).
2. Core beliefs
Core beliefs represent how we fundamentally perceive ourselves, others, and the world.
They develop through past experiences and are often the focus of more intensive CBT interventions. Examples of core beliefs include, “I’m a failure” or “The world is dangerous.”
Coping cards can be used to challenge negative beliefs and reinforce new adaptive beliefs discussed in therapy. For example, the card may include the old core belief at the top, followed by the new adaptive belief, with a list of evidence for the new belief (Wenzel et al., 2011).
Coping cards can also be used in conjunction with problem-solving in therapy (Wenzel et al., 2011).
This may remind clients of the process of problem-solving or list agreed steps on how to manage a specific problem, for example, asking someone for help. A card may also involve the pros and cons of possible ways to manage specific problems.
5 Templates for Helping Adults and Children
1. Anxiety strategy cards
This worksheet gives a range of coping cards that can be printed and cut out for use in therapy. All the cards start with, “When I feel anxious, I could try…”
On the first page, the cards already include example strategies, including controlled breathing, muscle relaxation, and distraction. The second page is a template of blank cards for people to fill in their own chosen strategies or add pictures.
2. Negative automatic thoughts cards
This worksheet can assist thought challenging as part of CBT to target ‘inner critic’ negative thinking and create more balanced or positive thoughts. The worksheet includes squares that must be cut out. In each square, the client captures a negative thought. After shuffling the pack and picking a card, the client thoroughly disputes the negative thought.
3. Core Beliefs Cards
This Core Beliefs Cards worksheet is informed by Wenzel et al.’s (2011) coping card approach.
It includes one example card and one blank template card that clients can use. It is helpful to use one card for each core belief. On one side, you write the negative core belief that must change, such as “I’m a failure.” Under this, you write the new core belief you want to introduce, such as, “I am successful.”
On the other side of the card, it states “Reasons why…” where you write the new belief again and then add bullet points of the evidence or reasons this new belief is true.
Use double-sided printing to align the front and back of the cards.
4. Strengths cards (adults)
This printable worksheet includes cards representing different personal strengths. Strengths cards have a variety of applications, including as coping skills cards, where they can assist clients in coping with negative thinking and distress.
It is helpful for the client to have time to look at the strengths cards and pick the ones they identify with the most. These can then act as positive affirmations and positive strengths-based challenges to negative thinking about their personal abilities.
Use double-sided printing to align the front and back of the cards.
5. Strength cards (children)
These are child-friendly versions of the strengths cards above.
Valuable Resources From PositivePsychology.com
If people are new to coping cards, it can help to have examples of coping skills to add to cards.
This Coping Skills Inventory worksheet provides ideas for different types of coping skills that may be helpful for adults.
In terms of skills for children, the following three worksheets detail helpful tools that young people may wish to add to coping cards:
If you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.
A Take-Home Message
Making positive changes through therapy is all about putting coping theory into practice. The therapy room is a space for learning about difficulties and strengths and finding helpful strategies to manage challenges.
Clients can know the theory of why they feel a certain way and what things help, but a range of barriers can impede implementing these in the real world.
Coping cards are great tools to facilitate the application of what was discussed in therapy into someone’s day-to-day life. Cards are often used in CBT, and there is a broad evidence base supporting their use for different presentations and in different settings.
These cards are particularly effective, as they provide a tangible tool for clients to keep with them and use as prompts of therapy strategies in moments of high distress. When supporting clients to make coping cards, it is important to be creative and ensure they are tailored to the person’s needs.
When executed well, coping cards can be an invaluable therapy tool, empowering clients to feel confident in overcoming life’s challenges and helping them to live the life they choose.
We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.
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- Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: A 1-year open trial. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7), 820–830.
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- Hunt, M., & Fenton, M. (2007). Imagery rescripting versus in vivo exposure in the treatment of snake fear. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 329–344.
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- Kennerley, H. (2014). Overcoming childhood trauma: A self-help guide using cognitive behavioral techniques. Hachette.
- Pauwels, K., Aerts, S., Muijzers, E., De Jaegere, E., Van Heeringen, K., & Portzky, G. (2017). BackUp: Development and evaluation of a smart-phone application for coping with suicidal crises. PLoS One, 12(6).
- Peckham, M. (2021). Self-care and grounding. In A. Hershler, L. Hughes, P. Nguyen, & S. Wall (Eds.), Looking at trauma: A tool kit for clinicians (vol. 23, pp. 13–20). Penn State University Press.
- Ougrin, D., Tranah, T., Leigh, E., Taylor, L., & Asarnow, J. R. (2012). Practitioner review: Self-harm in adolescents. Journal of Child Psychology and Psychiatry, 53(4), 337–350.
- Rahayu, E. P., & Rizki, L. K. (2020). Effect of affirmation flashcards on level of anxiety in second stage of labor at midwifery clinic. The 7th International Conference on Public Health Solo, Indonesia.
- Santana, V. S., & Lopes, R. F. F. (2016). Coping cards with cancer patients: using a psychoeducational instrument. Revista Brasileira de Terapias Cognitivas, 12(1), 12–19.
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- Treisman, K. (2018). Therapeutic treasure deck of grounding, soothing, coping and regulating cards. Jessica Kingsley.
- Wenzel, A., Brown, G. K., & Karlin, B. E. (2011). Cognitive behavioral therapy for depression in veterans and military service members: Therapist manual. U.S. Department of Veterans Affairs.
- Wright, J. H. (2006). Cognitive behavior therapy: Basic principles and recent advances. Focus, 4(2), 173–178.