CBT Handouts [Portrait]

7/28/2019 CBT Handouts [Portrait]

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Client’s Name _______________________________________ Date _______________

BASIC-ID Worksheet

Read the statement by each category and circle the appropriate rating in the shaded areain the column on the right. (6 = highest and 0 = lowest)

Behavior How active are you? How much of a doer are you? Do

you like to keep busy?

6 5 4 3 2 1 0

Affect How emotional are you? How deeply do you feel things? 6 5 4 3 2 1 0

Sensation How much do you focus on the pleasures and painsderived from your senses? How tuned in are you to your

bodily sensations – to sex, food, music, art?

6 5 4 3 2 1 0

Imagery Do you have a vivid imagination? Do you engage infantasy and daydreaming? Do you think in pictures? 6 5 4 3 2 1 0

Cognition How much of a thinker are you? Do you like to analyze

things or reason things out?

6 5 4 3 2 1 0

Interpersonal How social are you? How important are other people toyou? Do you gravitate to people? Do you desire intimacy

with others?

6 5 4 3 2 1 0

Drugs &

Biology

Are you healthy and health conscious? Do you take good

care of your body and physical health? Do you overeat?Do you avoid abusing drugs and alcohol?

6 5 4 3 2 1 0




Disentangling Thoughts, Feelings, and Situations

This exercise will help you better distinguish your thoughts, feelings, and situations.

Circle your answer in the right column to indicate if the item in the left column is athought, feeling, or situation.

Depressed Thought Feeling Situation

At the bar Thought Feeling SituationI’m crazy Thought Feeling Situation

Angry Thought Feeling Situation

Irritated Thought Feeling Situation

At work Thought Feeling Situation

It’s awlful. Thought Feeling Situation

At home Thought Feeling Situation

I’m good at this Thought Feeling Situation

Driving a car Thought Feeling Situation

Something terrible happened Thought Feeling Situation

Nothing ever goes right Thought Feeling Situation

In the garage Thought Feeling Situation

Discouraged Thought Feeling Situation

I can’t stand this Thought Feeling Situation

Sitting alone Thought Feeling Situation

Furious Thought Feeling Situation

I’m a failure Thought Feeling Situation

Talking on the phone Thought Feeling Situation

Panic Thought Feeling Situation

She is being inconsiderate Thought Feeling Situation

I’m a loser Thought Feeling Situation

Guilty Thought Feeling SituationDrinking and driving Thought Feeling Situation

At a friend’s house Thought Feeling Situation

I’m having a heart attack Thought Feeling Situation

He took advantage of me Thought Feeling Situation

Anxious Thought Feeling Situation

In bed trying to get to sleep Thought Feeling Situation

I’m going to loose everthing Thought Feeling Situation

I’m in trouble Thought Feeling Situation

Thrilled Thought Feeling Situation

I hate my life Thought Feeling Situation

I have to get sober Thought Feeling SituationSad Thought Feeling Situation

Sitting in an AA meeting Thought Feeling Situation

I always work hard Thought Feeling Situation

I’m lazy Thought Feeling Situation

Panic Thought Feeling Situation

In the office Thought Feeling Situation




Goals Worksheet

Reviewing your goals can strengthen your motivation.

The changes I want to make during the next ________ weeks are:

The most important reasons why I want to make those changes are:

The steps I plan to take in changing are:

The ways other people can help me are:

Some things that might interfere with my plan are:




The CBT Model of Addiction

We think ten times faster than we talk. On the average we talk about 150 words a minute

but we think about 1500 words a minute. This inner dialogue is continuous (you are

doing it right now). We process information through words, images and memories.

There are five components: thoughts, feelings, behavior, physiological reactions, and

environment (situation). Each of the five components affects and interacts with the

others. Small changes in any one area can lead to changes in the other areas.

Environment

Addiction

Thought

s

Feelings

Behavio

r

Physical Reaction





Conceptualizing the Client Who Is Seeking Treatment

Environment Several family members and friends abuse alcohol and drugs. Legal

trouble. Financial trouble. Divorce and parent-child problems.Problems at work.

Thoughts I’m a failure. I am worthless. My life is hopeless. I am rejected. Iwill never get sober. I may as well be dead.

Feelings Depressed, Anxious.

Physical Reaction Great deal of time spent in using alcohol and drugs, or recovering

from hangovers. Sweating, rapid pulse, insomnia, nausea or vomiting, physical agitation

Behavior Great deal of time spent thinking about, acquiring and using alcohol

and drugs. Difficulty working; isolating self, crying, anger outburst,suicide attempts

Environment

Addiction

Thought

s

Feelings

Physical

Reaction

Behavio

r





Understanding My ProblemsDescribe the five areas listed below.

Environment

Thoughts

Feelings

Physical Reaction

Behavior

Environment

_________

Thought

s

Feelings

Physical Reaction

Behavio

r




Identifying and Rating Moods

Emotion can be difficult to identify. Below is a list of moods. Although the list is not

comprehensive it may help you describe your feelings in more exact terms. Check theselists for the exact nuance to describe your moods and intensity of feelings.

Intensity of Feelings

HAPPY SAD ANGRY CONFUSED

High ElatedExcitedOverjoyedThrilledExuberant EcstaticFired upDelighted

DepressedDisappointed AloneHurt Left out DejectedHopelessSorrowful

Crushed

FuriousEnragedOutraged AggravatedIrateSeething

BewilderedTrappedTroubledDesperateLost

Medium CheerfulUpGoodRelievedSatisfiedContented

HeartbrokenDownUpset DistressedRegret

Upset Mad AnnoyedFrustrated AgitatedHot Disgusted

DisorganizedFoggy MisplacedDisorientedMixed up

Mild GladContent SatisfiedPleasant FineMellowPleased

Unhappy Moody BlueSorry Lost BadDissatisfied

PerturbedUptight DismayedPut out IrritatedTouchy

UnsurePuzzledBotheredUncomfortableUndecidedBaffledPerplexed

Intensity of Feelings

AFRAID WEAK STRONG GUILTY

High TerrifiedHorrifiedScared stiff PetrifiedFearfulPanicky

HelplessHopelessBeat OverwhelmedImpotent SmallExhaustedDrained

Powerful AggressiveGung hoPotent Super ForcefulProudDetermined

SorrowfulRemorseful AshamedUnworthy Worthless

Medium ScaredFrightenedThreatenedInsecureUneasy Shocked

Dependent IncapableLifelessTiredRundownLazy InsecureShy

EnergeticCapableConfident PersuasiveSure

Sorry LowdownSneaky

Mild ApprehensiveNervousWorriedTimidUnsure

UnsatisfiedUnder par Shaky UnsureSoft

SecureDurable Adequate AbleCapable

Embarrassed




Anxious LethargicInadequate

Rating Moods

In addition to identifying moods, it is important to learn to rate the intensity of the

moods we experience.

♦ Rating the intensity of your moods allows you to observe how your moods

fluctuate.

♦ Rating the intensity of your moods helps alert you to which situations or thoughts

are associated with changes in our moods.

♦ You can also use changes in emotional intensity to evaluate the effectiveness of

strategies your learn in CBT.

Rating Your Mood

What was the situation?

Situation: ________________________________________________________

What did you feel?

Mood: ________________________________________

To what degree would you rate the intensity of this feeling?

_______________________________________________________________

0 10 20 30 40 50 60 70 80 90 100

Things to Remember

♦ Moods can usually be described in a word.

♦ Rating your moods allows you to evaluate their strength and track the fluctuations of

your emotional reactions.

♦ Identifying specific moods can help you set and track goals.

♦ Strong feelings or moods signal that something important is going on in your life.

♦ Rating your moods can enable you to choose interventions designed to alleviate

particular moods or reduce their intensity.

♦ It is important to separate situations, thoughts and moods.




Rating Your Mood


Situation: ________________________________________________________

What did you feel?

Mood: ________________________________________


_______________________________________________________________

0 10 20 30 40 50 60 70 80 90 100

Rating Your Mood


Situation: ________________________________________________________

What did you feel?

Mood: ________________________________________


_______________________________________________________________

0 10 20 30 40 50 60 70 80 90 100




Daily Mood Log

Situation Mood




Functional Analysis

What is your pattern of use (weekends only, every day, binge use)? ________________

_________________________________________________________________

What were the triggers? ___________________________________________________

_________________________________________________________________

Were alone or with other people? If so, who were you with? _______________________

_________________________________________________________________

Where did you buy drugs or alcohol? _________________________________________

_________________________________________________________________

Where do you use? _______________________________________________________

_________________________________________________________________

Where and how did you acquire the money to buy drugs or alcohol? ________________

_________________________________________________________________

What has happened to (or within) you before the most recent episodes of abuse? _______

_________________________________________________________________

What circumstances were at play when abuse began or became problematic? _________

_________________________________________________________________

How would you describe its effects on you during and after? ______________________

_________________________________________________________________




Managing Availability

List sources of alcohol and drugs here and what you'll do to reduce availability (for

example, people who might offer you alcohol or other drugs, places you might get it).

Source Steps I'll take to reduce availability




Refusal Skills

Tips for responding to offers of alcohol or other drugs:

• Say no first.

• Make direct eye contact.

• Ask the person to stop offering it.

• Don't be afraid to set limits.

• Don't leave the door open to future offers (e.g., not today).

People who might offer me

alcohol/drugsWhat I'll say to them

A friend I used to use with:

A coworker:

At a party:

Reminder Sheet For ProblemsolvingThese, in brief, are the steps of the problemsolving process.

• "Is there a problem?" Recognize that a problem exists. We get clues from our bodies,




our thoughts and feelings, our behavior, our reactions to other people, and the ways

that other people react to us.

• "What is the problem?" Identify the problem. Describe the problem as accurately as

you can. Break it down into manageable parts.

• "What can I do?" Consider various approaches to solving the problem. Brainstorm tothink of as many solutions as you can. Consider acting to change the situation and/or

changing the way you think about the situation.

• "What will happen if . . .?" Select the most promising approach. Consider all the

positive and negative aspects of each possible approach and select the one likely to

solve the problem.

• "How did it work?" Assess the effectiveness of the selected approach. After you have

given the approach a fair trial, does it seem to be working out? If not, consider what

you can do to beef up the plan, or give it up and try one of the other possible

approaches.

Select a problem that does not have an obvious solution. Describe it accurately.

Brainstorm a list of possible solutions. Evaluate the possibilities, and number them in theorder of your preference.

Identify the problem:

List brainstorming solutions:

Identifying Core Beliefs

Check the core beliefs that you identify with during times of distress. Indicate which core beliefs you are most vulnerable to when you are upset.




Helpless Core Belief

I am helpless I can’t get sober

I am trapped I can’t stay sober

I am a failure I can’t be successful

I am hopeless I can’t ask for helpI am inadequate I can’t work the program

I am ineffective I can’t improve my life

I am incompetent I can’t change

I am defective I can’t work the steps

I am useless I can’t trust

Unlovable Core Belief

I am unlovable I am not good enough

I am unlikable I am different

I am unattractive I am abandon

I am unwanted I am alone

I am rejected I am unnecessary

I am bad I am hated (by myself)

I am uncared for I am hated (by others)

I am unworthy I am evil

I am worthless I am insignificant

Understanding Core Beliefs

It is important to understand the following about core beliefs:

♦ That it is an idea, not necessarily the truth.

♦ That you can believe it strongly, even “feel” it to be true, and yet have it be

mostly or entirely untrue.

♦ That, as an idea, it can be tested.

♦ That it is usually rooted in past events; that it may or may not have been true at

the time you first believed it.

♦ That it continues to be maintained through the operation of your schemas, in

which you readily recognize data that support the core belief while ignoring or

discounting data to the contrary.

♦ That you and your counselor working together can use a variety of strategies over

time to change this idea so that you can view yourself in a more realistic way.

Core Belief Record




Record evidence that this Core Belief is not 100% true all the time.

Dysfunctional Core Belief __________________________________________________

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.




Modifying Core Beliefs

The purpose of this exercise is to modify dysfunctional core beliefs. Please follow the

instructions and complete the worksheet.

Old Core Belief ________________________________________________________

What’s the most that you’ve believed this? (0-100%) _________________

What’s the least that you’ve believed this? (0-100%) _________________

How much do you believe it right now? (0-100%) _________________

New Belief ____________________________________________________________

How much do you believe it right now? (0-100%) _________________

Evidence to Support the New Belief

List five or more reasons you believe it is true.

1.

2.

3.

4.

5.




Core Belief Record

Record evidence that supports an alternative Core Belief.

New Core Belief __________________________________________________

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.




Core Belief Record

Rate Confidence in new Core Belief over time.

New Core Belief __________________________________________________

Date

Date

Date

Date

Date

Date

Date

Date

Date

Date




Historical Test of New Core Belief

To strengthen your new Core Belief review your life history looking for evidence that supports it

New Core Belief __________________________________________________

Birth - 2

Age 3 - 5

Age 6 -12

Age 13 - 18

Age 19 - 25

Age 26 - 35

Age 36 - 50

Age 51 - 65

Age 66+

Summary ______________________________________________________________

______________________________________________________________________

______________________________________________________________________




Examples of Dysfunctional Thoughts

About self

• I am a total failure

• I should never be afraid

• I always mess up.

• I will not be able to stay sober.

• I am the worst example on earth.

• I never follow directions.

• I am so stupid.

• I can’t solve problems.

• I should be perfect.

• About others

•

• No one cares about anyone else.

• All men (or women) are dishonest and are never to be trusted.

• I can control other people.

• People are out to get whatever they can from you; you always end up being used.

• People never listen to my point of view.

• I always get hurt in relationships so I should withdrawal from other people.

• All people are out for #1.

• I must be accepted by other people.

• I have to be on my guard because people always disappointment me.

About treatment

I don’t need help.• All counselors are untrustworthy.

• All those people who attend AA meetings gossip.

• I will never be able to work the steps.

• The people in treatment don’t really want to get sober.

• I can’t learn new coping skills.

•

It’s impossible for me to attend AA meetings.• Counselors are in for the money.

• I can’t help the way I feel.

I will never get sober.

I will never be able to maintain sobriety.

Counselors don’t like to work with me.

•




Ten Common Dysfunctional Beliefs

Read the ten common dysfunctional beliefs and identify which beliefs you are most

vulnerable to when you are upset by placing a check (√) in the shaded area.

I should be loved and approved by significant others and live up to their expectations.

I must be highly competent, adequate, intelligent and achieving before I can me

happy.

When people act unfairly I should blame them and view them as bad people.

It is a terrible catastrophe when I am rejected, treated unfairly, or when things aren’t

as I would like them.

Since my feelings are caused by external factors, I have little or no ability to control

or change them.

I should be greatly concerned about dangerous and fearful things and must center my

attention on them until the danger has past.

I can handle difficulties and responsibilities better by avoiding them than by facing

them.

People and things should turn out better than they do, and when they don’t I should

see them as awful, terrible, etc.

My past remains all-important, and must influence my feelings and behavior now

because it once did.

I can achieve happiness by being passive.




Thought Record

Situation

What happened

Thoughts

List five or more thoughts.Describe any images.

Feelings

Identify and rate theintensity of each feeling on

a scale of 0-100%.




Socratic Questioning

21 Questions to Ask Yourself Before You Get Upset

Thought to be Tested ____________________________________________________

1. Are my thoughts and/or images true and accurate?

2. Are my thoughts and/or images healthy? Are they helpful?

3. What evidence supports my ideas?4. What evidence does not support my ideas?

5. Are there other more central thoughts and images left unidentified or

unevaluated?

6. Have I correctly identified the problem or upsetting event?7. Do I completely understand the situation or upsetting event? What is known?

What remains unknown?

8. What is the worst possible thing that could happen?9. What is the best thing that could happen?

10. What is the most realistic outcome?

11. What was going through my mind before I started to feel this way?12. Are there other disturbing circumstances that contribute to my upset emotion?

13. What images or memories do I have about this situation?

14. If it is true, what does it mean about me? my life? my future?15. Is there an alternative explanation?

16. Am I going to be able to live through this?17. What is the effect of my believing this thought or imagining this scene?

18. What could be the effect of changing my thinking?19. What can I do about it? Are their certain aspects about it that are beyond my

control?

20. What would I tell a friend if he or she were in the same situation?21. Can I speak to myself in the same compassionate way I would talk to a friend?




Labeling Cognitive Distortions

Category Thoughts and Beliefs

Magnifying the negative

All or nothing thinking

Overgeneralizations

Mind reading

Catastrophic exaggerations

Blaming

Assuming

Shoulds (Musts/oughts)

The fairy tale fantasy

Mislabeling

Unfavorable comparisons

Personalizing

Fortune telling

Perfectionism

Making feelings facts

Entitlement




The ABCD Worksheet

Activating Event Beliefs Consequent Emotion

Dispute “B”

Is it true?

Is it helpful or healthy?




Coping Plan

If I run into a high-risk situation: 1. I will leave or change the situation.

Safe places I can go: ______________________________________________________

2. I will put off the decision to use for 15 minutes. I'll remember that my cravings usually

go away in ______ minutes and I've dealt with cravings successfully in the past.

3. I'll distract myself with something I like to do.

Good distracters: _________________________________________________________

4. I'll call my list of emergency numbers:

Name:________________________________ Phone #: __________________________

Name:________________________________ Phone #: __________________________

Name:________________________________ Phone #: __________________________

5. I'll remind myself of my successes to this point: ______________________________

_______________________________________________________________________

6. I'll challenge my thoughts and beliefs by: ____________________________________

_______________________________________________________________________




Symptoms Leading to Relapse

Not attending meetings.

Not having or working with a sponsor.

Not working the steps.

Not mediating.

Not praying.

Not reading AA material.

Not serving.

Exhaustion.

Dishonesty.

Impatience.

Anger

Conflict in relationships.

Depression.

Frustration.

Self-pity.

Cockiness.

Complacency.

Expecting too much from others.

Entitlement.

The use of mood-altering chemicals.

CBT Handouts [Portrait]

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