"Anxiety Documentation Form"

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ANXIETY DOCUMENTATION FORM
NAME:
Date:
EVENT:
Time:
Emotion
Before
After
Emotion
Before
After
Anxious/Worried
Angry/Irritated
Sad/Depressed
Frustrated/Defeated
Embarrassed/Ashamed
Panicky/Scared
Inferior/Incompetent
Other:
Negative Thoughts
Before
After
Distortions
Positive Thoughts
Belief
DISTORTION KEY
1. Dichotomous Thinking
6. Arbitrary Inference
2. Overgeneralization
7. Catastrophizing
3. Personalization
8. Emotional Reasoning
4. Selective Abstraction
9. Blame
5. Labeling
10. Magnification or Minimization
Instructions: Use this form to log feelings related to your anxiety. Record the percentage strength of your
convictions in the before, after, and belief boxes. Categorize the distortions you are experiencing by
number using the distortions box. Share your results with your therapist to help outline further
improvement.
www.FreePrintableMedicalForms.com
ANXIETY DOCUMENTATION FORM
NAME:
Date:
EVENT:
Time:
Emotion
Before
After
Emotion
Before
After
Anxious/Worried
Angry/Irritated
Sad/Depressed
Frustrated/Defeated
Embarrassed/Ashamed
Panicky/Scared
Inferior/Incompetent
Other:
Negative Thoughts
Before
After
Distortions
Positive Thoughts
Belief
DISTORTION KEY
1. Dichotomous Thinking
6. Arbitrary Inference
2. Overgeneralization
7. Catastrophizing
3. Personalization
8. Emotional Reasoning
4. Selective Abstraction
9. Blame
5. Labeling
10. Magnification or Minimization
Instructions: Use this form to log feelings related to your anxiety. Record the percentage strength of your
convictions in the before, after, and belief boxes. Categorize the distortions you are experiencing by
number using the distortions box. Share your results with your therapist to help outline further
improvement.
www.FreePrintableMedicalForms.com