555
From
Cognitive Therapy of Anxiety Disorders: Scienc
e and Practice
by David A. Clark and Aaron T. Beck. Copy
right 2010 by The Guilford Press. Permission to photocopy
this appendix is granted to purchasers of this book fo
r personal use only (see copyright page for details).
aPPENDIX 12.2
Cognitive Restructuring Form for Trauma Intrusions
Name:
Date:
from
to:
Instructions:
Please use this form to work on challenging unhelpful thoughts a
nd beliefs about the personal significance of intrusive thoughts,
images, or memories related to the trauma and its consequences. Try to c
omplete the form around the same time that you re-experienced
symptoms related to the trauma in order to increase the effectivene
ss of therapy.
Date and Time
Briefly Describe the Intrusive Thought, Image, or Memory
Label
and Rate Severity of associated Emotions (0 –100)
Initial Evaluation of the
Intrusion
[What makes this thought/
memory threatening, upsetting
for you? What makes it personally significant or
important to you?]
Reevaluating Initial Thoughts and Beliefs about the Intrusion
[What’s the evidence, what are the consequences of this
evaluation, am I catastrophizing
the intrusion?]
alternative More Helpful Evaluation
[What’s a more helpful
way to think about these trauma-related
intrusions?]