Thought Record Sheet
Thought Record Sheet
Situation Trigger
What happened? Where? When? Who with? How?
0% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
Emotions / Moods
(rate 0 - 100%)
What emotion did I feel at that time? What else? How intense was it?
16% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
Physical Sensations
What did I notice in my body? Where did I feel it?
33% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
Unhelpful Thoughts and Images
What went through my mind? What disturbed me? What did those thoughts/images/memories mean to me, or say about me or the situation? What am I responding to?
What ‘button’ is this pressing for me? What would be the worst thing about that, or that could happen?
50% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
Alternative response / Healthier
more balanced perspective
STOPP! Take a breath…. Is this fact or opinion? What would someone else say about this situation? What’s the bigger picture? Is there another way of seeing it?
What advice would I give someone else? Is my reaction in proportion to the actual event? Is this really as important as it seems?
66% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
What I did / What I could do /
Defusion technique /
What’s the best response?
Re-rate Emotion 0-100%
What could I do differently? What would be more effective? Do what works! Act wisely. What will be most helpful for me or the situation? What will the consequences be?
84% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
To learn more about Relaxation and to get in touch with one of iTherapy's counselors visit our Education and Resources Page for Relaxation.
| Situation | Emotions / Moods |
Physical Sensations |
Unhelpful Thoughts and Images | Alternative Response/ Healthier More balanced perspective |
What I did / What I could do / Defusion technique / What’s the best response? |
|---|---|---|---|---|---|
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
| Situation |
|---|
Answer Question to Complete Worksheet |
| Emotions / Moods |
Answer Question to Complete Worksheet |
| Physical Sensations |
Answer Question to Complete Worksheet |
| Unhelpful Thoughts and Images |
Answer Question to Complete Worksheet |
| Alternative Response/ Healthier More balanced perspective |
Answer Question to Complete Worksheet |
| What I did / What I could do / Defusion technique / What’s the best response? |
Answer Question to Complete Worksheet |
© Carol Vivyan 2009, permission to use for therapy purposes.
100% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Relaxation to learn more about Relaxation and to get in touch with one of iTherapy's counselors.
Thanks to www.getselfhelp.co.uk for this template.
