Thought Record

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If you wish to automatically receive a copy of this form insert your email address here. 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

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TRIGGERING EVENTS, FEELINGS OR IMAGESWhat happended to trigger the problem?

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INITIAL REACTIONHow did you feel emotionally and physiclaly? Rate each feeling 0-100%

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UNHELPFUL THOUGHTS or IMAGESWhat went through your mind at the time? What are you thinking about others and what might they be thinking about you? What are you thinking about yourself and your future?

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COSTS AND BENEFITSWhat is helpful or unhelpful about thinking this way?

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SELF-COMPASSIONATE ALTERNATIVES TO UNHELPFUL THOUGHTS AND IMAGES

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ALTERED REACTIONHow would your feelings change? Would you do anything different if you thought this new way?