Event/ Situation

Emotion/ Feeling

Automatic Thought

Skewed Cognitions

Rational or Adaptive Response

New feeling

What were you doing at the time and where were you (brief factual description)

What did you feel? How intense was the feeling (1-10)?

What were your immediate thoughts? How much did you believe them?

What type of distortion or thought warp did they represent?

What would your rational response be to those automatic thoughts? How much do you accept them (1-100%)?

What is your feeling now? How intense is the feeling (1-10)?