10 practical cognitive therapy activities

I’m sharing 10 practical cognitive therapy activities that I’ve done with my patients recently, with suggested SMART goals. Details have been changed to protect privacy.

Free DIRECT download: 17 SMART cognitive goals (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)

Outline:

Scheduling appointments

One patient I worked with was having trouble scheduling appointments.

  • Disorganized
  • Not taking notes during the phone call.
  • Waiting too long before adding the information to her calendar.
  • Using a monthly calendar with small boxes.
  • Messy and hard to read.

I recommended that she get a planner, which her daughter picked up. I taught the strategies:

  • Have planner open to avoid double-booking.
  • Take notes during the phone call.
  • Read back the information to confirm details.
  • Write in planner immediately.

When I went in for the next couple of sessions, I looked at her planner to see if I could understand it. Then I asked her questions about it. And finally, I had her call and make a new appointment. I could have asked her to confirm an appointment if she didn’t need to make a new one.

I listened to her side of the conversation to make sure she was gathering the correct information and confirming it, then watched as she wrote the information in the book.

That was all she needed. She was independently making and keeping track of her own appointments accurately when I discharged her.

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Sample goals

Patient will demonstrate:

  • Ability to add new appointments to personal planner with 90% accuracy independently to improve ability to manage own schedule by 12.31.19.
  • Understanding of personal schedule by answering comprehension questions with 100% accuracy independently to improve ability to participate in desired activities by 12.31.19.

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Organizing information

Another patient complained that calling doctors and the home health agency was a hassle. He had the phone numbers written down in various places, so it was an effort to find the information to make the calls.

He’d been using a smart phone for awhile, but his daughter had only entered family contacts. He was open to learning how to enter new contacts into his cell phone. So I spent about ten minutes during one session teaching that skill and guiding him to practice by adding a few home health and MD numbers.

At the next session, he told me that he tried adding another one on his own but got stuck. So I retaught that part and had him write down a reminder note about how to do that step.

At the following session, he had added more of his doctors and even included the addresses. He said that it made making phone calls really easy, and he wasn’t procrastinating anymore.

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Sample goals

Patient will demonstrate ability to:

  • Add at least 5 new contacts to electronic contact book with 100% accuracy independently to improve organization of information for daily tasks by 12.31.19.
  • Make at least 3 phone calls using electronic contact book with 100% accuracy independently to improve ability to communicate with medical professionals in a timely manner by 12.31.19.

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Daily writing to improve attention and memory

Another patient I worked with recently had pretty significant impairment of attention, memory, and executive function skills. She reported various problems which were frustrating to her:

  • Difficulty remembering strategies from PT and OT.
  • Trouble remembering recent conversations.
  • Not oriented to the day of week or the date.
  • No longer able to read for pleasure
  • Couldn’t sign her name (or write functionally).

One activity I started her on was to write in a notebook every day. In the beginning, she started off by copying the day of the week and the date with the help of her husband. And she signed her name over and over (the OT started that) as homework.

We built up to her writing the day of week and the date, copying her daily therapy schedule down, and then adding one of the strategies she was working on for each therapy.

On days when she didn’t have therapy, I had her write down a brief note about something that she did that day.

By the time I discharged her to outpatient therapy, she:

  • Could remember key recommendations from PT, OT, and ST.
  • Was oriented to time from memory.
  • Could sign her name.
  • Was remembering recent events without referring to her notes.
  • Could write short sentences (with errors).

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Sample goals

Patient will:

  • be oriented to day of week, date, and time using visual supports as needed with 100% accuracy independently to improve daily function and reduce frustration by 12.31.19.
  • recall at least 3 recommendations from any therapy with 100% accuracy independently using visual supports as needed to improve safety and independence by 12.31.19.

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Word finding

Another patient was having mild difficulty with word finding, which was very frustrating for her. I taught her Semantic Feature Analysis (SFA), which she learned how to do very quickly. I also taught her word finding strategies.

In therapy, we did a variety of word retrieval exercises for two reasons. First, to give her the opportunity to use the word finding strategies when she failed to retrieve a word. And second, to identify challenging exercises to assign for homework.

I also asked her to complete at least one SFA each day, ideally using a word that she really had trouble retrieving in her normal conversation.

She worked diligently, and when I discharged after six sessions she was independently using the strategies and was experiencing far fewer word retrieval failures (less than once a day).

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Sample goals

Patient will demonstrate:

  • ability to use at least 3 word finding strategies during moments of word finding failure on 4 of 5 opportunities to improve communication and reduce frustration by 12.31.19.
  • no more than one un-repaired word-finding failure during 30 minutes of conversation independently to demonstrate improved word-finding skills for conversation by 12.31.19.

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Using YouTube for attention and memory

Another patient I worked with recently had left neglect, with general attention and memory deficits. His wife really wanted him to be able to focus on television and then be able to discuss what they watched. He was happy to work on anything that would help him.

I found a seven-minute TED talk, divided into three parts, that I knew he would enjoy.

The first time he watched it, he was very excited and talked during the video. After it was over, he said how much he liked the video but his comments were only tangentially-related. He couldn’t recall any specific details independently.

So I taught the strategies of paying attention and noticing the details. We then watched the time lapse section from 0:50 to 1:58 and I asked him to tell me what he could remember. He could not remember the four specific examples: the mushroom, the creeping vine, the air traffic, and the ship traffic.

We worked on remembering those four examples using WRAP: writing, repetition, association, and picturing it (visualization). By the end of the session, he was able to watch that part of the exciting video and then state the four examples. He worked on studying the video for homework, and we continued in this way.

By the end of therapy, he was able to recall at least eight specific details independently and several more when given a question prompt. Ideally, I would have had him watch a new video to see if his performance was improved, but we ran out of time with the reassessment and discharge.

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Sample goal

Patient will:

  • demonstrate ability to recall at least 5 specific details from information recently heard or seen with 100 percent accuracy independently to improve ability to engage in leisure activities by 12.31.19.

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Remembering spouse’s name after brain surgery

I treated a young man recently after brain surgery who was persistently calling his wife by his ex-wife’s name. As you can imagine, this was embarrassing for him even though his wife didn’t seem overly bothered by it.

In addition to treating general word-finding and memory deficits, we focused on her name. I taught the WRAP strategies of writing, repetition, association, and picturing (visualization).

Then I had him write her name 10 times which imagining her face and saying her name each time he wrote it. I suggested doing that every day until he wasn’t mixing the names up anymore. Finally, I helped him to find an association that would help trigger the word when he was in conversation with her.

This is a fictional example to preserve privacy, but the idea is the same. His wife’s name was Marla, and he created a little phrase “I’m married to Marla” that he would think when he saw her. This way, he was sure of her name and it reduced the anxiety of possibly mixing the names up in conversation.

We spent perhaps 10 minutes total in therapy on this issue. When I returned the following week, he reported that he was no longer mixing up the names and was no longer feeling stress about it.

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Sample goals:

Patient will:

  • independently use recommended strategies to recall wife’s name in 9 of 10 opportunities by report or observation to reduce stress and embarrassment by 12.31.19.
  • demonstrate the use of at least 3 memory strategies for recalling preferred information with 100% accuracy independently to improve recall of important information by 12.31.19.

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Basic executive function skills

I recently worked with a patient who was impaired in all areas of cognitive-communication. It seemed that working memory and executive function skills were impacting her the most.

Her specific complaints included:

  • Difficulty remembering and following directions.
  • Unable to complete basic reading and writing tasks.
  • Trouble maintaining the topic in conversation.
  • Difficulty remembering recent information.

We started off with functional activities: activities that she would do in the course of her normal day. Such as using the TV remote, maintaining a conversation, and sequencing the steps to get up from the wheelchair. I modified in various ways: simplifying, visual supports, written instructions, discussing and then doing (even down to the single step level), and modeling for imitation. I even tried spaced retrieval with errorless learning. However, I wasn’t seeing as much improvement as I’d have liked.

So we switched from these real-life activities to apps on her iPad. After trying some different things, we ended up using the iBrainHD app and Tactus Therapy’s Visual Attention and Writing apps.

We focused on learning and using strategies to slow down and improve accuracy, error detection, and error correction. For instance, I taught her to point to and/or verbalize each element, compare to the target, and double check her work.

This approach seemed to work better. When I discharge her to out-patient therapy, she had improved from a “severe” to a “mild” cognitive communication impairment per the CLQT+. She was maintaining the topic of conversation at least 80% of the time, and she improved to only needing min assist with standing up from the wheelchair.

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Sample goals:

Patient will:

  • demonstrate understanding of at least two cognitive strategies by independently using them during functional activities in 4 of 5 opportunities to improve participation in daily tasks by 12.31.19.
  • maintain the topic of conversation for 3 turns in 4 of 5 opportunities to improve functional communication and reduce frustration by 12.31.19.
  • verbalize and demonstrate the correct sequence for safely standing up from the wheelchair with 100% accuracy across three trials to improve safety by 12.31.19.

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Massed practice for visual neglect

Another person I worked with had left visual neglect. His main complaint was difficulty reading because he was missing information on the left. Although he was fully aware of his deficit and with the slightest cue would correct himself, he was not consistently using the strategy independently.

Neither a bright-colored guideline or a written reminder worked for him. He continued to require a verbal cue to use the strategies to detect information on the left.

One activity that we did that was helpful was to have him page through a catalog and report what was in the top left corner on each page. After several correct answers in a row, then I would introduce a distractor question and then have him turn the page. When this was easy, I made it harder by asking him to name the third thing down on the left side of each page.

In this way, he had multiple opportunities to practice his skills in a short period of time.

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Sample goal:

Patient will:

  • locate the top left corner of reading material (e.g., paper, calendar, cell phone) using recommended strategy independently within 10 seconds in 9 of 10 opportunities across 3 sessions to improve functional reading by 12.31.19.

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Remembering to use the call bell

A gentleman I’m working with in an assistive living facility has recently started wearing a bracelet with a call button. He’s supposed to use it to obtain assistance for the bathroom, but he’s been forgetting. In talking with him, I don’t get the sense that he is deliberately avoiding using it.

We’re using spaced retrieval with errorless learning to train the use of the call button.

  • Prompt question: “What should you do when you need to use the bathroom?”
  • Response: “Press the button and wait” and demonstrate.

We just started this past week, and I’d guess it would take another week or so to take effect (if it will help). While spaced retrieval with errorless learning doesn’t work for everyone, I’ve had many good successes with it.

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Sample goal:

Patient will:

  • independently verbalize and demonstrate the recommendation to press the call button when he wants to use the bathroom with 100% accuracy across 3 sessions to improve safety by 12.31.19.

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Using supports to be oriented to time

Sometimes, just making sure the tools are in the right place is all that is needed: clock, calendar, or a digital combination.

One recent patient had a digital calendar* that was recommended by a physical therapist, but she wasn’t using it. It was just another bit of decoration on the shelf that she wasn’t paying attention to.

I used spaced retrieval with errorless learning to train her to use it in two session (and confirmed it in each subsequent visit).

  • Prompt question: “What should you do when you want to know the time or the date?”
  • Response: “Look at the clock” and then read off the time and the date.

Not only was she using the digital calendar independently when I returned the following week, but she was also independently oriented to the day of the week and the month (i.e. from memory).

*This is an Amazon affiliate link. As an Amazon associate, I may earn a small commission on qualifying purchases. There is no extra charge to you, and it will help keep Eat, Speak, & Think sustainable.

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Sample goal:

Patient will:

  • verbalize and demonstrate the independent use of the electronic calendar to determine the current day of week, date, and time with 100% accuracy across 3 consecutive sessions to improve ability to participate in desired activities by 12.31.19.

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Your cognitive therapy activities

What are some of your recent cognitive therapy activities? Leave a comment below!

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Free DIRECT download: 17 SMART cognitive goals (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)

Featured image by kang_hojun from pixabay.

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Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.

She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.

Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.

She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.

5 Comments

  1. Mireya said:

    Loving your blog. Thanks for sharing!

  2. Kristin Z said:

    I’m a graduate student treating a person with aphasia in therapy this semester. This is the first website I’ve found that has been truly helpful for my adult client, Thank you so much!

    • Thanks so much for sharing your feedback, Kristin! I’m happy to hear you’re finding something helpful on my site. Good luck with your client and your program!

      Lisa

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