1. Situation Who? What? When? Where?

2. Moods What did you feel? Rate each mood (0100%)

3. Automatic Thoughts (Images) What was going through your mind just before you started to feel this way? Circle hot thought.

4 Evidence That Supports the Hot Thought

5. Evidence That Does Not Support the Hot Thought

6. Alternative / Balanced Thoughts Write an alternative or balanced thought. Rate how much you believe the alernative or balanced thought (0-100%)

7. Rate Moods Now Re-rate moods listedin column 2 as well as any new moods (0-100%)


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