Theme: Mood & Affect

Kid /Teen strategy of the week:

Feelings/Mood Chart: Supporting kids and teens in learning the connection between their feelings, moods, and motivation can help build resilience. This strategy focuses on how a feeling can contribute to mood, which can then influence choices and/or actions.

  • Start by making a feelings chart with a few emotions along the top of the page, such as happy, sad, angry, afraid, calm and so on (see source for example or print out)
  • Underneath these, join the client in describing the emotions (how do they experience in facial expression, body responses, behaviors, etc.). Take turns acting out what they look like or act like when they feel these emotions. Feel free to use a mirror or the screens on your computer to provide feedback.
    • Examples:
      • Therapist furrows their brow when worried.
      • Client stomps their feet and rolls their eyes when annoyed
      • Therapist twists their hair when nervous
      • Client makes a poker face/shuts down when sad
  • Then talk about how emotions influence motivation (e.g. “I will” or “I won’t” mood) and help the client add to their chart which emotion leads to an “I will/won’t” mood. Such as, I will play outside or with others (happy/calm) or I won’t (sad/angry)
  • Lastly, collaborate on coping strategies the client can use to transition from a I won’t to an I will mood and add those to the bottom of the chart!

Source: https://fit.sanfordhealth.org/units/u2-k2-helping-kids-manage-feelings-and-emotions/u2l2-k2-ways-that-feelings-affect-kids-moods

Sample Progress Note: The focus of the session was (tailor based on treatment plan). The therapist engaged the client in a feelings chart activity to build understanding on the connection between feelings, mood, and motivation. The client responded to the activity by (fill in the blank).

Adult strategy of the week:

CBT Triangle Psychoeducation: Spend time in session discussing and educating on the CBT Triangle; how our thoughts, behaviors, and emotions are connected and influence each other. Help the client sketch out their own CBT triangle and list where their symptoms appear.

  • For example:
    • Feelings: Depression, irritability, sadness
    • Thoughts: “I’m a failure,” “This will never end,” “My friends are sick of me feeling like this,” “I have nothing to look forward to.”
    • Behaviors: Staying in bed all day, avoiding social gatherings, forgetting to eat
  • Ask the client to draw out their CBT triangle a few times throughout the week (if able) or simply reflect on how their thoughts, behaviors, and emotions are affecting one another.

Source: https://depts.washington.edu/uwhatc/PDF/TF-%20CBT/pages/4%20Coping%20Skills/Thoughts/Cognitive%20Triangle_Worksheet_Coping_and_Processing.pdf

Sample Progress Note: The focus of this session was… The therapist provided psychoeducation about the CBT triangle and engaged the Ct in a reflection activity to assist them in identifying points of intervention in their thoughts, emotions, and behaviors, as well as building awareness of how these factors affect one another. The client reported that was (helpful/not helpful/painful/etc) to understand their mental health symptoms.

Depression strategy of the week:

DBT IMPROVE Skill: One helpful strategy for reducing depression symptoms is the learning ways to improve the moment through various DBT distress tolerance and emotional regulation skills. The IMPROVE DBT skill entails an acronym, in which each letter represents a strategy for increasing tolerance of stress and regulating emotions.

  • Imagery: Imagine a beautiful scene on the beach or in the mountains. Image a safe place in your home. Imagine how you would feel different physically if you were present in the scene.
  • Meaning: Find purpose or meaning in your daily activities or present circumstances. Tap into what is most important to you in life.
  • Prayer/Pause: Ask for strength from a source greater than yourself and/or pause for a moment to connect with your inner strength.
  • Relaxation: Breathe deeply, take a moment to stretch, engage in progressive muscle relaxation, listen to calming music.
  • One: Focus on one thing at a time. Focus all of your attention on this moment.
  • Vacation: Take a mini vacation/break and look at videos/photos or listen to music; do something that you haven’t done in a while that you enjoy.
  • Encouragement: Bring to the moment self-affirming statements, that are real, helpful, and empowering.

Source: https://dbt.tools/distress_tolerance/improve.php
Sample Progress Note: The focus of this session was… The therapist supported the client in learning and practicing the DBT IMPROVE skill. The client reported that it was (helpful/not helpful/etc) to learn this skill and was able to identify (one/a couple/several) ways to practice outside of session.

Mindfulness/Meditation of the week:

Meditation for Depression: Use this meditation to practice acceptance and self-compassion for where you are right now; even in the midst of depression.

Source: https://selffa.com/guided-meditation-for-depression/

Sample Progress Note: The focus of this session was… The therapist led Ct. in a mindfulness activity around self-acceptance and depression. Ct. (engaged/did not engage in the activity), and they reported that the meditation was (helpful/difficult/not helpful).


Practice this meditation while lying and bent flat on your back and tucked under the covers.
Once you’re ready, place your left hand over your heart and your right hand over your left hand and softly close your eyes. Let your breath be soft and natural. Make sure that if you’ve been holding your stomach in that you just let it be loose right now.
This helps your breath be natural and easy.
If you can, fully expand your stomach on every inhale and contract on every exhale.
In this moment, just allow yourself to focus inwards, being present with your heart’s energy center located directly in the middle of your chest and a couple of inches inwards. As you breathe softly, just stay present with this energy center.
In this moment, allow yourself to feel whatever small sense of appreciation you can feel. Feel this appreciation towards yourself for being here right now for showing up for this – Even when you are experiencing depression. This is no small feat and it is worthy of you feeling appreciation towards yourself for it.
Even if you can only feel the slightest bit thankful to yourself for this moment, let that be enough. Become open, willing and ready to experience a shift of some kind. The beauty of meditation is that it can bring you to a neutral state. The stage where you are not depressed and you are not happy. You just are. Let’s allow ourselves to enter into that state,
Letting go of judgment towards yourself, letting go of judgment about the world around you and just letting whatever is be and as you do this let your breath deepen.
In this moment, be open and willing and ready to accept how you feel as it is without trying to alter it or change it. Because when you accept it, it automatically shifts into a state of simply being. It’s no longer a bad thing or a good thing. It simply is
Keep focusing on your heart as you breathe softly and gently.
Anytime a thought passes, just let it go and return your awareness back to your heart, back to your breath.
This enables you to enter into the moment to be present with what is in this moment is truly where all peace exists and you are worthy of feeling that peace.
When you feel ready, allow your hands to come down to your sides, palms facing upwards and from this state of simply being just in this moment, even if only for a second, welcome in feelings of love. You don’t have to feel them. Just be welcoming and open to receiving them.
To do this, simply think or say out loud: “I’m willing to be open to feeling and receiving love.”
Stay with this willingness.
You don’t have to change anything and you don’t have to feel anything. Just be willing and relax into your breath.
Take a long, deep inhale, feeling your stomach expand completely and blow the air out through your mouth, stomach contracting completely. Notice your body feeling slightly more alive.
Deepening each inhale and blowing the air out through your mouth on each exhale. Perhaps feeling more grateful towards yourself for being than you were able to feel in the beginning.
Stay here as long as you need to, and when you’re ready, slowly open your eyes and bring your awareness back to the room around you.

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