| 1. The patient [I] understood that his/her [my] thoughts, feelings, and behaviors can contribute to his/her [my] depression. | 1 | 2 | 3 | 4 | 5 |
| 2. The patient [I] examined his/her [my] underlying assumptions (or schema) and how they contributed to his/her [my] depression. | 1 | 2 | 3 | 4 | 5 |
| 3. The patient [I] identified automatic negative thoughts and completed thought records. | 1 | 2 | 3 | 4 | 5 |
| 4. The patient [I] scheduled and participated in activities which improved his/her [my] mood. | 1 | 2 | 3 | 4 | 5 |
| 5. The patient [I] looked for alternative explanations when he/she [I] had negative thoughts. | 1 | 2 | 3 | 4 | 5 |
| 6. The patient [I] weighed the evidence for and against negative thoughts. | 1 | 2 | 3 | 4 | 5 |
| 7. The patient [I] tested negative automatic thoughts or beliefs by setting up experiments. | 1 | 2 | 3 | 4 | 5 |
| 8. The patient [I] stated his/her [my] thoughts in ways that could be tested. | 1 | 2 | 3 | 4 | 5 |