Name
*
First Name
Last Name
Date
*
-
Year
-
Month
Day
Date
Unpleasant emotions
Rows
Check if Felt
Rate Intensity (0-100)
Afraid
Angry
Annoyed
Anxious
Ashamed
Bored
Burnt out
Confused
Demoralized
Depressed
Disappointed
Embarassed
Empty
Exhausted
Frustrated
Furious
Guilty
Insecure
Irritated
Jealous
Jittery
Lethargic
Lonely
Nervous
Numb
Resentful
Sad
Self-Conscious
Stressed
Tired
Worried
Check off any core beliefs that you think were involved in your automatic thoughts. Core beliefs sometimes sound odd when we say them out loud, but in the moments that we feel the worst they seem very true to us.
I am bad.
I am unlovable.
I am worthless, inadequate, or not good enough.
The world is a dangerous place.
People are bad, untrustworthy, selfish, or dangerous.
Life is bad or unfair.
Other
Pleasant Emotions
Rows
Check if Felt
Rate Intensity (0-100)
Bold
Calm
Confident
Content
Eager
Ecstatic
Energized
Engaged
Enthusiastic
Excited
Grateful
Happy
Humorous
Inspired
Joyful
Lively
Loving
Motivated
Optimistic
Passionate
Peaceful
Playful
Proud
Reassured
Refreshed
Relaxed
Relieved
Satisfied
Secure
Surprised
Thrilled
Wonderful
Should be Empty: