Thought Record Form
Use this form to reflect on your thoughts, emotions, and reactions. Please answer each section to help track and process your thought patterns.
Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Situation or Trigger
*
Emotions Felt (select all that apply)
*
Anxious
Sad
Angry
Guilty
Ashamed
Embarrassed
Hopeful
Other
Emotion Intensity (0 = Not at all, 10 = Extremely intense)
*
0
0
1
2
3
4
5
6
7
8
9
10
10
0 is 0, 10 is 10
Automatic Thought(s)
*
Evidence That Supports the Thought
*
Evidence That Does Not Support the Thought
*
Alternative or Balanced Thought
*
Outcome: How do you feel now?
*
Outcome Rating (0 = Not at all improved, 10 = Greatly improved)
*
0
0
1
2
3
4
5
6
7
8
9
10
10
0 is 0, 10 is 10
Submit
Should be Empty: