Name:_________________________________ Date:________________________
What incident during your mission abroad would you like to work on today in the IRRT session? ___________________________________________________________________________
How much time has passed since this incident? ____________________________________
What emotion(s) do you associate with this incident when you think about it today?
Anger
0 not at all	1	2	3	4	5 very strong
Helplessness
0 not at all	1	2	3	4	5 very strong
Sadness
0 not at all	1	2	3	4	5 very strong
Emotional numbing
0 not at all	1	2	3	4	5 very strong
Guilt
0 not at all	1	2	3	4	5 very strong
Shame
0 not at all	1	2	3	4	5 very strong
Fear
0 not at all	1	2	3	4	5 very strong
Disgust
0 not at all	1	2	3	4	5 very strong
Horror
0 not at all	1	2	3	4	5 very strong
Sense of unreality
0 not at all	1	2	3	4	5 very strong