Kevin – Cognitive Restructuring Worksheet

CBT • DBT • Intrusive Memory Processing

Date:

Step 1: Trigger / Situation

Step 2: Intrusive Thoughts & Memories

Step 3: Emotions (Rate 1–10)

Fear / Anxiety 1-10
Shame / Embarrassment 1-10
Anger / Urge to Fight 1-10
Avoidance / Urge to Escape 1-10

Step 4: Cognitive Distortions

Step 5: Socratic Questioning

Step 6: Balanced Thought

Step 7: DBT Skill Application

Step 8: Behavior Choice

Self Scoring

Before Exercise (Distress 1–10): 1-10 After Exercise (Distress 1–10): 1-10

Change: 0

Calculate Change Print / Save PDF

Clinical Insight

Intrusive memories tied to bullying, rejection, and feeling different can create strong emotional reactions in the present. These reactions are not signs of weakness — they are learned responses from past experiences.

The goal is to reduce:

• Frequency of intrusive thoughts
• Severity of emotional response
• Avoidance behaviors

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