Form 3.

Thought record and survey form

Event Place-time	Emotions/physiological reactionsIntensity (0-100)	Triggered thoughts Level of Convincing (0--100)	Behavior that is wanted/performed	Rationality test	Appropriateness test	Functionality test	Alternative thought & behavior	Outcome
What exactly is the internal or external event that happened? What would be perceived by an eye or camera seeing this event for the first time, and what would a device measure? E.g., my heart is beating fast and loudly (internal event) My friend said he/she can’t go out with me tonight (external event)	Are there bodily sensations/senses you are feeling? How can you describe this most objectively? For instance, tremors, shaking, sweating, muscle contractions in the stomach, fatigue. How are you feeling emotionally? Sad, joyful, excited, uncomfortable, anxious, fearful, enthusiastic, etc. Give a score for both groups, rating “0” for the lowest intensity of this emotion or feeling and “100” for the highest intensity.	What do these situations and these feelings mean? What does this situation mean for you? What does it indicate about the future? What kind of person does it show you? What kind of situation does it show you? How convincing does this thought sound to you right now? “0” is not convincing at all. “100” is strongly convincing.	If you haven’t done anything about this situation yet, what do you want to do? What would you usually do in such a situation? What did you do regarding this situation?	Among the thoughts in the second column, which one is the most influential on your feelings and behavior? 1.Why does this thought seem convincing to you (write down all the ideas that come to mind) 2. Is there any objective evidence that this thought to be true? For example, can this data be used as an evidence in a court of law? 3. Is there any data that suggests that your opinion may not be accurate? What would someone you trust present as an evidence against this situation? (No matter how convincing this data is to you, focus on how objective it is).	Does this thought (in the third column) adequately account for the current situation? If you were an inspector and you were asked to prepare an objective report on this situation, what would you write in the report? Keep in mind that there may not be a single truth to explain this situation. Again, if there were a council made up of people you trust in such a situation, what kind of a statement would they make if they made a joint statement to explain this situation?	What kind of a situation does this thought drive you to? What kind of behavior does it bring along? What could be the function and consequence of this thought as it is? Would you advise someone you are responsible for to think this way? How much influence do you think this thought has in your behavior or do you want to behave this way (fourth column)? What are the short and long-term effects of this behavior? What would you recommend to the person whose care and protection you are responsible for doing?	What could be realistic alternatives for this situation? How can one behave as an alternative? How do you behave to test the rationality, appropriateness, and functionality of this idea?	How are you feeling emotionally right now? What would be the outcome if you have behaved differently? What did you infer from these outcomes?

This document was prepared by Dr. Kadir Özdel It can only be used after being cited.