Chronic Pain Thought Record

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					                                                                          Chronic Pain Thought Record

    Trigger Situation                  Emotion(s)                     Intensity of Pain                     Negative                           Alternative                           Result
                                        (0 - 10)                           (0 - 10)                      Thoughts/Images                       Perspective

                                                                                                                                                                                 Re-rate your
                                                                                                                                                                                  emotion(s)
                                                                                                                                                                                   (0 - 10)
Describe what was going on,    Describe what you felt at that    Rate intensity of pain from 0 (no   Describe what you were thinking Consider another perspective. Is     What could say, imagine, or do
where were you, when did it    time                              pain at all) to 10 (intense pain)   or what bothered you.           this another perspective a fact or   differently to cope?
happen, who you were with?                                                                                                           opinion?
                               How intense was the emotion?                                          Describe what those thoughts                                         Describe what helped or would
                                                                                                     mean to you and what they say   What would someone else say          have helped?
                                                                                                     about you or the situation.     about this situation? What
                                                                                                                                     advice would you give to
                                                                                                     What is the worst that can      someone else in this situation?
                                                                                                     happen?




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

				
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posted:10/30/2012
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