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									                                                                       Worry Thought Record Sheet

    Trigger Situation                   Emotion                 Automatic Thought,                Worry About Initial               Healthier and more                Diffusion technique?
                                        (0 – 10)                 Image, Doubt or                   Thought/Image                    balanced perspective
                                Physical Symptoms?
                                                                                                                                                                          Re-rate emotion
Describe What was going on,   Describe what you felt at the   Describe your initial thoughts.   What did it mean for you to have Consider another perspective.       What could you do differently?
where were you, when did it   time.                           What bothered you.                that thought or image?           What advice would you give to       What would be a more effective
happen, who you were with?                                                                                                       someone else in this situation?     actions?
                              How intense was the emotion?                                      What is the worst thing that
What did you notice?                                                                            could happen? What is the worst Consider the Worry Tree. Is this     Do what works! Act wisely and
                                                                                                thing about that?                situation within your control?      considering your goals and
What was your reaction?                                                                                                          Can you put this worry aside?       values.

                                                                                                                                   If there are things within your   Is it within your control to do
                                                                                                                                   control, can you make an action   about this situation?
                                                                                                                                                                     What can you do or think about
                                                                                                                                                                     in order to focus your attention
                                                                                                                                                                     on this situation?

                            © Dr. Virginia Chow, 2012 This document can be distributed freely        Montreal Anxiety Therapy

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