Schema Therapy Worksheet for CPTSD (Scoreable Clinical Tool)

This schema therapy worksheet is designed to help clinicians and clients identify early maladaptive schemas that contribute to emotional dysregulation, relationship instability, and identity disturbance commonly seen in Borderline Personality Disorder. By linking current symptoms to underlying beliefs, attachment wounds, and coping patterns, this tool supports deeper clinical formulation and targeted treatment planning. It is especially useful for addressing core themes such as abandonment, defectiveness, emotional deprivation, and shame while guiding structured interventions and long-term change.

​This worksheet is part of a comprehensive Borderline Personality Disorder treatment hub that includes assessment tools, symptom trackers, and DBT-based interventions.

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C-PTSD Schema Therapy Worksheet

Section 1: Schema Identification

Schema	Description	Intensity (0-10)
Abandonment	Fear others will leave	0510
Mistrust	Expectation of harm	0510
Defectiveness	Feeling fundamentally flawed	0510
Emotional Deprivation	Needs won’t be met	0510

Calculate

Section 2: Schema Activation

Trigger situation: Emotions experienced: Behavioral response:

Section 3: CBT Reframe

Schema Thought	Balanced Thought

Section 4: Healthier Response Plan

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Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ASDCS, NATC, CCTP,  CCTP II, ADHD-CCSP,  C-DBT, C-PD
Double Board Certified Licensed Clinical Psychotherapist