PIE Notes for CBT: Template + Examples (2026)
Overview
This guide is part of our complete PIE notes hub — format structure, a full clinical example, and all 72 diagnosis-specific templates.
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Short answer: a PIE note for cognitive behavioral therapy (CBT) has three parts. Problem: the CBT target for this session in concrete terms: the situation, the automatic thought, the emotion and the behavior it drives, plus current measure scores and what you observed. Intervention: the CBT techniques you used, such as homework review, a thought record, cognitive restructuring, behavioral activation or an exposure, and how you applied them. Evaluation: how the client responded, with numbers where possible (belief and emotion ratings before and after, homework completed), progress toward treatment goals, risk, and the homework and next steps.
PIE has no separate Plan section, so write homework and next steps at the end of the Evaluation. Name the cognition or behavior you targeted and link each technique to a treatment-plan goal, so another clinician can see what you did and why.
What to document in a PIE note for CBT
| Section | What to document | Example wording |
|---|---|---|
| Problem | Session target: situation, automatic thought with belief rating, emotion, behavior; homework completion; measure scores; observations; suicide screen | “After a missed deadline, thought ‘I’m a failure, I’ll be fired’ (belief 90%), sadness 8/10, stayed in bed the next morning; 2 of 4 planned activities done; PHQ-9 14, item 9 scored 0.” |
| Intervention | CBT techniques used and how: homework review, thought record, cognitive restructuring, behavioral activation scheduling, problem solving | “Reviewed activity log for the mood and activity link; seven-column thought record on ‘I’m a failure’; scheduled 4 activities in small steps.” |
| Evaluation | Response with ratings, skills shown, progress toward goals, barriers, risk, homework and next session | “Belief fell from 90% to 50%, sadness from 8 to 5/10; goal 1 not yet met; acute risk judged low; homework: 4 scheduled activities and one thought record.” |
Safety. Ask about suicidal thoughts directly, and do not rely on a questionnaire alone: a PHQ-9 item 9 score of 0 is a useful check, but the client’s answer to a direct question belongs in the note too. If a client reports suicidal thoughts, assess and record current thoughts, plan, intent, preparatory behavior, past attempts, access to means (including firearms and medications), protective factors, your risk formulation and the safety plan. The 988 Suicide & Crisis Lifeline takes calls and texts at 988; for imminent danger, call 911 or go to the nearest emergency department.
How to Document PIE Notes for Cognitive Behavioral Therapy
Problem
Define presenting problem(s), relevant background, current severity, and clinical context
When documenting the Problem section in CBT, clearly identify the presenting cognitive, emotional, and behavioral issues that the client reports or that are observed. This section should focus on the specific dysfunctional thoughts, beliefs, and patterns contributing to the client’s distress.
- Describe the primary cognitive distortions or maladaptive beliefs reported by the client.
- Note any specific emotional difficulties linked to identified thought patterns.
- Identify behaviors that are maintaining or exacerbating the client’s problems.
- Document any recent changes or escalation in symptoms relevant to CBT targets.
- Record client’s stated goals or problems they wish to address through CBT.
Intervention
Document therapeutic interventions, techniques, and clinical actions implemented during session
The Intervention section should detail the specific CBT techniques and therapeutic strategies applied during the session. Include observations about client engagement and any modifications made to standard CBT protocols.
- Specify which cognitive restructuring or thought challenging techniques were used.
- Document any behavioral experiments or exposure exercises conducted.
- Note the use of homework assignments and client’s response to them.
- Describe therapist’s observations of client’s insight and participation during interventions.
- Record any adaptations made to interventions based on client’s unique needs or session dynamics.
Evaluation
Assess effectiveness of interventions, progress on problem resolution, and plan adjustments based on outcome
In the Evaluation section, summarize the client’s progress toward CBT goals by assessing changes in thoughts, emotions, and behaviors. This section should reflect the effectiveness of interventions and inform future treatment planning.
- Assess changes in frequency or intensity of maladaptive thoughts since last session.
- Evaluate client’s ability to apply CBT skills outside of sessions.
- Note improvements or setbacks in emotional regulation and coping strategies.
- Document client’s self-reported progress and satisfaction with therapy.
- Identify any barriers to progress and plan adjustments for upcoming sessions.
SOAP Notes for CBT
Alternative format for documenting cbt
DAP Notes for CBT
Alternative format for documenting cbt
BIRP Notes for CBT
Alternative format for documenting cbt
Progress Notes for CBT
Alternative format for documenting cbt
SIRP Notes for CBT
Alternative format for documenting cbt
GIRP Notes for CBT
Alternative format for documenting cbt
Tips for PIE Notes for Cognitive Behavioral Therapy
Name the target thought
Quote the automatic thought and give a belief rating, such as “I’m a failure” (90%), so change can be measured in later sessions.
Rate before and after
Record belief and emotion ratings before and after the technique, such as sadness 8/10 to 5/10, to show the effect of the session.
Count homework
Write homework completion as numbers, such as 2 of 4 activities or 3 thought records, rather than “partly completed.”
Name the technique
Write behavioral activation, thought record, exposure or problem solving, and how you used it, instead of “used CBT techniques.”
Put next steps in Evaluation
PIE has no Plan section, so end the Evaluation with the homework the client agreed to and what you will review next time.
Repeat a measure
Repeat a scale such as the PHQ-9 or GAD-7 at set intervals and compare it with intake, so progress toward goals is clear.
Example PIE note for CBT (depression, behavioral activation and a thought record)
Fictional documentation example, not treatment guidance. Every detail is invented. Adapt it to the session you actually provided and your organization’s requirements.
Session details: Fictional client, 41, accountant. Major depressive disorder, recurrent, moderate (F33.1). Session 6 of a planned 16-session course of cognitive behavioral therapy (CBT), 53 minutes, in person (CPT 90837). No current psychiatric medication. Treatment-plan goals: (1) PHQ-9 below 10; (2) complete at least 4 planned activities a week; (3) identify and test self-critical thoughts with a thought record.
Problem: Client reports low mood most days this week and says, “I know I should do the things on the list, but I don’t see the point.” Completed 2 of 4 scheduled activities (a 20-minute walk on Tuesday, a phone call with his sister on Thursday); skipped the Saturday run. On Wednesday he missed a work deadline and thought, “I’m a failure, I’ll be fired” (belief 90%, sadness 8/10), then stayed in bed until 11 a.m. on Thursday. Sleeping about 6 hours a night; appetite reduced. Observed: casually dressed, slowed movements, constricted affect that brightened when he described the call with his sister; speech soft, thought process logical, no evidence of psychosis. PHQ-9 14 (19 at intake), item 9 scored 0. Asked directly: denies current or past thoughts of suicide or self-harm, plan, intent, preparatory behavior and past attempts; no firearms in the home.
Intervention: Reviewed the activity and mood log: mood was rated 3/10 on the two mornings spent in bed and 5 to 6/10 after the walk and the call; guided the client to describe the pattern in his own words. Completed a seven-column thought record on “I’m a failure, I’ll be fired”: evidence for (one missed deadline, a short email from his manager) and against (the email asked for a new date and contained no warning; he met 11 of 12 deadlines this quarter); labeled all-or-nothing thinking and fortune-telling; client wrote a balanced thought. Problem-solved the deadline: client drafted a brief email to his manager proposing a new date. Scheduled 4 activities for the coming week, each broken into a small first step (for example, running shoes by the door, 15-minute run on Saturday morning).
Evaluation: Client generated the balanced thought with prompting: “I missed one deadline in a hard month; I usually deliver, and I can ask for a realistic date.” Belief in the original thought fell from 90% to 50%; sadness from 8/10 to 5/10. He said, “When I do something, the day is less bad,” showing understanding of the activity and mood link. Progress: PHQ-9 down 5 points from intake; goal 1 not met; goal 2 partly met (2 of 4 activities); goal 3 met in session with prompting. Barrier: all-or-nothing predictions before planned activities (“If I can’t run 5 km, it doesn’t count”). Risk formulation: ongoing depression and work stress remain risk factors. The clinician judges acute suicide risk low today given the direct denial of current or past suicidal thoughts, plan, intent, preparatory behavior and attempts, reported absence of firearms at home, and engagement in treatment and agreed next steps. Continue outpatient CBT; reassess each session and sooner if symptoms or circumstances worsen. Homework (client agreed): the 4 scheduled activities, one thought record when mood drops by 2 points or more, and send the email to his manager by Tuesday. PHQ-9 at the next session; session 7 next week. Client knows to call or text 988 in a crisis and to call 911 or go to the nearest emergency department for imminent danger.
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Documentation Considerations for Cognitive Behavioral Therapy
Track distorted thoughts and behavioral avoidance patterns
CBT notes should show the connection between thoughts, feelings, and actions, not just symptom complaints. For anxiety or depression, document the exact automatic thoughts, the behaviors they trigger, and any avoidance patterns that maintain distress. Include measurable examples such as skipped tasks, number of exposures completed, or time spent ruminating so the note clearly reflects CBT case formulation and progress.
Tie interventions to session goals and homework
PIE notes for CBT work best when interventions are clearly linked to the client's stated goal. If the goal is reducing avoidance, document graded exposure, behavioral activation, or cognitive restructuring and note the specific homework assigned. Include whether the client accepted the task, any barriers discussed, and how homework will be reviewed next session to support medical-necessity and treatment continuity.
Use quantifiable response data whenever possible
CBT documentation is strongest when response includes numeric indicators such as SUDS ratings, PHQ-9/GAD-7 scores, adherence percentages, or confidence ratings before and after an exercise. These details help demonstrate measurable change, the client's skill acquisition, and the effect of an intervention during the session. Briefly compare current scores with prior scores to show trend data.
Reflect skill acquisition, not just emotional relief
The Evaluation section of a CBT PIE note should capture what the client learned or practiced, such as identifying distortions, generating balanced thoughts, or completing an exposure despite anxiety. Document observable behavior changes, like improved eye contact, reduced agitation, or better tolerance of discomfort, in addition to subjective relief. This shows the client is building skills that generalize outside the session.
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Further Reading
- APA Documentation Guidelines — Provides detailed guidance on clinical documentation practices relevant to mental health professionals using structured note formats like PIE Notes.
- SAMHSA — Offers resources on evidence-based behavioral health practices and documentation standards applicable to CBT and related therapies.
- APA Ethics Code — Outlines ethical requirements for documentation and confidentiality in psychological treatment, essential for proper CBT note-taking.