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Patient’s name: Date:
Diagnosis: Axis I Axis II
Situation 1
Automatic Thought
Meaning of the A.T.
Emotion
Behavior
Situation 1
Automatic Thought
Meaning of the A.T.
Emotion
Behavior
Situation 1
Automatic Thought
Meaning of the A.T.
Emotion
Behavior
What was the problematic situation?
What went through his/her mind?
What did the automatic thought mean to him/her?
What emotion was associated with the automatic thought?
What did the patient do then?
Relevant Childhood Data
Core Belief(s)
Conditional Assumptions/Beliefs/Rules
Compensatory/Coping Strategy(ies)
Which experiences contributed to the development and maintenance of the core belief(s)?
What are the patient’s most central beliefs about him/herself?
Which positive assumption help him/her cope with his/her core belief(s)? What is the negative counterpart of this assumption?
Which behaviors help him/her cope with the belief(s)?
FIGURE 13.1. Cognitive Conceptualization Diagram. Adapted from Cognitive behavior therapy worksheet packet. Copyright 2011 by Judith S. Beck. Bala Cynwyd, PA: Beck Insti-tute for Cognitive Behavior Therapy.
Reprinted by permission in Cognitive Behavior Therapy: Basics and Beyond, Second Edition, by Judith S. Beck (Guilford Press, 2011). Permission to photocopy this material is granted to purchasers of this book for personal use only (see copyright page for details).