Thought Record

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If you wish to automatically receive a copy of this form insert your email address. You are advised to protect your privacy by creating a separate anonymous email account for this purpose which does not contain any identifying details. I suggest that my clients use their ID number as the email address, rather than their own name e.g. WU456YT@gmail.com

Although this form is completed over a secure link, please don't put your name or any identifying details. This is to protect your privacy
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Your email address
example@example.com
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Please put your client ID. It should begin with 'WU'
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Date
Date
Day
Month
Year
Date
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SITUATION or TRIGGER
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FEELINGS (Rate 0-100% for each feeling)
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UNHELPFUL THOUGHTS or IMAGES
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Facts that support the unhelpful thought
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Facts that provide evidence against the unhelpful thought
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Alternative, more realistic and balanced perspective
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Outcome (re-rate the emotion)
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Tags
[object Object]
Should be Empty: