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PanicTRS

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					                                                              Panic Attack Thought Record Sheet

    Trigger Situation          Physical symptoms                   Emotion(s)                    Negative Thought               Response to Thought                      Outcome
                                                                    (0 - 10)                          Image


                                                                                                How much do you                                                       Re-rate your
                                                                                               believe that thought?                                                   emotion(s)
                                                                                                      (0 - 10)                                                          (0 - 10)
Describe what was going on,                               Describe your emotion in one        What is the worst thing that    Is this fact or opinion?         What consequences did you
where were you, when did it                               word e.g. panic, terror, anxiety,   could happen? What is the worst                                  consider?
happen, who you were with?                                fear, etc                           thing about that?               Was the problem really about
                                                                                                                              something terrible is going to   What will be the most helpful for
What were you doing?                                                                                                          happen or is it my belief that   me in this situation?
                                                                                                                              something terrible is going to
                                                                                                                              happen that was causing
                                                                                                                              physical symptoms of anxiety?




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

				
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posted:10/30/2012
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