Thought Record

1

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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2

Your email address

example@example.com

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3

Please put your client ID. It should begin with 'WU'

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4

Date

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5

SITUATION or TRIGGER

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6

FEELINGS (Rate 0-100% for each feeling)

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7

UNHELPFUL THOUGHTS or IMAGES

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8

Facts that support the unhelpful thought

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9

Facts that provide evidence against the unhelpful thought

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10

Alternative, more realistic and balanced perspective

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11

Outcome (re-rate the emotion)

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