First Cbt Appointment - Prompt (Page 4 of 4) in pdf

First Cbt Appointment - Prompt Page 4

CBT Assessment

Name......................................ID........................

Prompt Sheet

Use if preferred as simple checklist / prompt sheet

Describe the main problems

Can you think of a recent example when you felt…….?

Describe what happened.

Thoughts & Images, Emotions, Behaviours, Physical sensations (use 5 Aspects prompt form?)

Is this situation typical of what happens? Where is it most likely to happen? When does it happen?

Who are you most likely to be with? How does it happen?

How often does this happen?

How distressing? How long does it go on for when it happens? How does it usually start?

What helps?

What makes things better?

E.g. avoidance, substances, safety behaviours

Impact - How does this problem affect your daily life?

work, home, family/friends, study

Coping resources. What helps you cope generally?

Enjoyment, achievement, relationships, spirituality

What brings you to therapy now? At this time?

What do you hope to achieve in therapy? What will be different?

What medication do you take?

Do you use alcohol, drugs, tobacco, other substances? How much?

General mental state

Mood, concentration, memory, sleep, weight changes etc.

Risk – self-harm: thoughts, plans, likelihood to act etc.

Other risks?

What have you tried before? What helped? What didn’t help?

Previous therapy / treatment

Problem summary

Initial formulation

Give brief explanation of CBT

Homework?

Check out understanding, any questions etc

Arrange next appointment

First Cbt Appointment - Prompt Page 4