Table 2.

Examples of Cognitive Support within a therapy session

Cognitive support	Cognitive Support Strategy
Can you think of any situations in the past week in which you tried to apply the concepts and skills from last session? Which ones did you apply? What was the situation? What helped you remember?	Practice Remembering; Application; Praising Recall
If not: ‘Thinking back now can you imagine applying the concepts and skills to something that happened last week?
Praise successful application.
‘How often did you think back to therapy, or remember a concept or skill in the context of your everyday life in this past week?’ ‘What could we do to try to help you think about what we cover in therapy between sessions?’ or ‘One thing that we could try is to do X whenever you see Y,’ in which X is the desired behavior and Y is the cue/reminder’.	Cue-Based Reminders
Incorporate props, activities, and media that require patient to use as many senses as possible. Videos, pictures, songs, poems, handouts, role-playing, games, food (e.g., raisin to explain mindfulness), colored markers, scented markers, pipe cleaners, wiki sticks, draw on the board together. If applicable, suggest that the patient brings home one of these ‘souvenirs’ to remind him/her of a therapy point.	Attention Recruitment; Cue-Based Reminders
Group/organize concepts/skills into themes (e.g., create a list of helpful/unhelpful ways of managing rumination). ‘Out of all these ways (e.g., to manage rumination), what are the ones you are most likely to use? Least likely?’ Praise when they recall therapy points while categorizing them.	Categorization; Practice Remembering; Praising Recall
Ask patient to describe a new perspective that a concept/skill provides, and compare it to a pre-existing or alternate perspective.	Evaluation
Ask the patient to teach you the skill/concept (e.g., ‘If you were the therapist how would you explain this to me?’). Encourage the patient to come up with examples of the newly learned therapy points in action. Praise for remembering concepts and/or applying the new therapy points after teaching.	Attention Recruitment; Practice Remembering; Application; Praising Recall
Visualize using new skills or learning in a real world situation (e.g., implementation intention). Include as many ‘real world’ cues as possible (e.g., induce a sad mood).	Application; Attention Recruitment
Implementation intentions. ‘When you encounter X situation, imagine yourself doing X to achieve your goal. Now, write down your commitment, and say it out loud a few times.’	Attention Recruitment, Evaluation, Application, Repetition, Practice Remembering, Praising Recall
Praise implementations.
End of session.	Practice Remembering; Evaluation; Application; Cue-Based Reminders; Praising Recall
‘Based on this session, what things might you do differently this coming week? What situations might you respond differently to?’, ‘How will you apply the skill(s) from today?’ ‘Why is this new way better?’; ‘What trigger will help you remember to do that?’
Praise for accurate recall and/or application of new skills/strategies.
Between session intervention.	Repetition; Attention Recruitment
Record the patient’s own voice reviewing the therapy skills for today. Link to learning in prior sessions. Email the audio to the client to replay each day.