Body Dysmorphia - Thought Record Sheet

What’s the outcome?

Situation Emotion/s Initial thought, image, Alternative response What did I do?
& Trigger Rate 0 – 100% doub, feeling, worry What could I do or have
What would be a healthier How long for? done instead?
Physical Meaning of the initial more balanced perspective? Defusion technique?
Sensations? thought or image. How many times? What’s the best response?
Re-rate Emotion
What’s the worst thing?

What helped or would have been

STOPP! Take a breath…. helpful?

What’s the bigger picture? What could I do differently?

Is there another way of seeing it? What would be more effective?
What advice would I give Act wisely. Consider my
someone else? goals/values.
What went through my mind?
What emotion did What disturbed me? What importance am I giving this If I gave this issue less
What happened? I feel at that time? What’s the real issue here? issue? How important is it importance, what would I feel or
Where? When? What else? How What did it mean that I had REALLY? Is my reaction in do differently?
Who with? How? intense was it? that thought or image? proportion to the actual issue?
What am I responding to? If I didn’t give it such importance, What will be most helpful for me or
What did I notice? What did I feel in What’s the worst thing about how would that intrusive thought What did I feel like doing but didn’t? the situation?
What did I react to? my body? that? (about that issue) affect me? What did I do instead? What will the consequences be?

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