Cognitive Therapy of Anxiety Disorders

554

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 12.1

Trauma Intrusion Self-Monitoring Form

Name:

Date:

from

to:

Instructions:

Please use this form to record any intrusive thoughts, images, o

r memories related to the trauma and its consequences that you

experienced in the past week. Try to complete the form around the sam

e time that you reexperienced symptoms related to the trauma in order to

increase the accuracy of your remarks.Date, Time, and Duration of Intrusion

Situations or Cues That Triggered the Intrusion

Briefly Describe the Intrusive Thought, Image, or Memory

1

Label and

Rate Severity of a

ssociated

Emotions (0–100)

Personal Significance

of the Intrusion

2

Coping Responses and

Effectiveness

3

1 Indicate by marking an asterisk (*) beside each intrusion t

hat occurred as a “flashback” (i.e., a momentarily reliving o

f some aspect of the trauma).

2 In a few words indicate what was so distressing about t

his particular intrusive thought or memory of the trauma for yo

u. What was so personally significant about the intrusive

experience?^3 What did you do to get rid of the intrusive thought, imag

e, or memory? How effective was it?