Reproducible Materials: Cognitive Processing Therapy for PTSD: A Comprehensive Manual

Cognitive Processing

Therapy:

CPT PATIENT WORKBOOK

Patricia A. Resick, Ph.D., Candice M. Monson, Ph.D.

Duke University

Ryerson University

Kathleen M. Chard, Ph.D.

Cincinnati VA Medical Center and University of Cincinnati

December 2016

Session 1: Overview of PTSD and CPT

Practice Assignment:

Please write at least a one-page statement on why you think your

most distressing traumatic event occurred. You are not being

asked to write specific details about this event. Write about what

you have been thinking about the cause of this event.

Also, consider the effects this traumatic event has had on your

beliefs about yourself, others, and the world in the following

areas: safety, trust, power/control, esteem, and intimacy.

Bring this statement with you to the next session. Also, please

read over the two handouts I have given you on PTSD symptoms

and Stuck Points (Handouts 5.1 and 5.2), so that you understand

the ideas we are talking about.

Session 1 Handouts:

5.1: Recovery or Nonrecovery from PTSD Symptoms Following

Traumatic Events

5.2: What Are Stuck Points?

HANDOUT 5.1

Recovery or Nonrecovery from PTSD Symptoms

Following Traumatic Events

In normal recovery, intrusions and emotions decrease over time and no longer trigger each other.

When intrusions occur, natural emotions and arousal run their course and thoughts have a

chance to be examined and corrected. It is an active “approach” process of dealing with the

event.

However, in those who don’t recover, strong negative emotions lead to escape and avoidance.

The avoidance prevents the processing of the trauma that is needed for recovery, and it works

only temporarily.

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

Intrusions

Arousal

Autobiographical

memory

Intrusions

Arousal

Autobiographical

memory

Intrusions

Arousal

Autobiographical

memory

Aggression

Self-harm behaviors

Substance abuse

Bingeing

Cognitive avoidance

Behavioral avoidance

Dissociation

Emotional suppression

Social withdrawal

Behavioral inhibition

Somatic complaints

Avoidance of

external reminders

HANDOUT 5.2

What Are Stuck Points?

Stuck Points are:

Black-and-white

Thoughts, not

feelings

All-or- nothing

Thoughts behind

moral statements

or the Golden

Rule

“If–then”

statements

Not always “I”

statements

Concise

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

Session 2: Examining the Impact of Trauma

Practice Assignment:

Please complete the A-B-C Worksheets (Handout 6.3) to become

aware of the connection among events, your thoughts, feelings,

and behavior. Complete at least one worksheet each day.

Remember to fill out the form as soon after an event as possible

and if you identify any new stuck points add them to your log

(Handout 6.1). Complete at least one worksheet about the

traumatic event that is causing you the most PTSD symptoms.

Also, please use the Identifying Emotions Handout (Handout 6.2)

to help you determine what emotions you are feeling.

Session 2 Handouts:

6.1: Stuck Point Log

6.2: Identifying Emotions

6.3: A-B-C Worksheet (six copies included)

6.3 (A-C): Examples of completed A-B-C Worksheets

6.4: Stuck Point Help Sheet

HANDOUT 6.1

Stuck Point Log

Date: Client:

We will be using this Stuck Point Log throughout therapy, and you will always leave it in the front

of your therapy binder or workbook. You will add to this log as you recognize Stuck Points after

writing your Impact Statement. Throughout therapy, we will add to it or cross off thoughts that

you no longer believe.

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.2

Identifying Emotions Handout

Date: Client:

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HAPPYSAD NEUTRAL

GUILTDISGUSTED

PRIDEASHAMED

HAPPYSAD

SCARED

ANGRY

Amused

Ecstatic

In despair

A little down

Enraged Slightly irritated

Terrified Uneasy

Regretful

Remorseful

Horrified A little turned off

Pleased Conceited

Mortified Slightly embarrassed

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3A

Sample ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Shooting a Vietnamese woman while in

combat

“I am a bad person because I killed a

helpless civilian.”

Guilt and anger at myself

Are my thoughts above in column B realistic or helpful? No. One mistake does not make me a bad person. People make mistakes,

and high- stress situations, like combat zones, increase the probability of such mistakes.

What can I tell myself on such occasions in the future? “I may have made mistakes in my life, but that does not make me a bad

person. I may have done things that I regret, but I have also done good things in my life.”

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3B

Sample ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

My uncle raped me “I let it happen and didn’t tell anyone.” Guilt and shame

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3C

Sample ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

I build a porch and the railing comes

loose.

“I can never do anything right.” Anger at myself and sadness

Are my thoughts above in column B realistic or helpful? No. It wouldn’t hold up in a court of law, because I do some things right.

What can I tell myself on such occasions in the future? “There are some things that I do all right. It is not true that I ‘never do

anything right.’ ”

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.4

Stuck Point Help Sheet

Date: Client:

What is a Stuck Point?

Stuck Points are thoughts that you have that keep you stuck from recovering.

• These thoughts may not be 100% accurate.

• Stuck Points may be:

• Thoughts about your understanding of why the traumatic event happened.

• Thoughts about yourself, others, and the world that have changed dramatically as a result

of the traumatic event.

• Stuck Points are concise statements (but they must be longer than one word—for example,

“trust” is not a Stuck Point).

• Stuck Points can often be formatted in an “If–then” structure. Here is an example: “If I let oth-

ers get close, then I will get hurt.”

• Stuck Points often use extreme language, such as “never,” “always,” or “everyone.”

What is not a Stuck Point?

• Behaviors. For example, “I ﬁght with my daughter all the time” is not a Stuck Point, because it

is describing a behavior. Instead, consider what thoughts you have when you are ﬁghting with

your daughter.

• Feelings. For example, “I am nervous whenever I go on a date” is not a Stuck Point, because

it is describing an emotion and a fact. Instead, consider what you are telling yourself that is

making you feel nervous.

• Facts. For example, “I witnessed people die” is not a Stuck Point, because this is something

that actually happened. Instead, consider what thoughts you had as this happened and what

you think about it now.

• Questions. For example, “What will happen to me?” is not a Stuck Point, because it is a ques-

tion. Instead, consider what answer to your question is at the back of your mind, such as “I will

not have a future.”

• Moral statements. For example, “The criminal justice system should always work” is not a

Stuck Point, because it reﬂects an ideal standard of behavior. Instead, consider how this state-

ment pertains to you speciﬁcally, such as “The justice system failed me,” or “I can’t trust the

government.”

Examples of Stuck Points

1. If I had done my job better, then other people would have survived.

2. Because I did not tell anyone, I am to blame for the abuse.

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.4 (p. 2 of 2)

3. Because I did not ﬁght against my attacker, the abuse is my fault.

4. I should have known he would hurt me.

5. It is my fault the accident happened.

6. If I had been paying attention, no one would have died.

7. If I hadn’t been drinking, it would not have happened.

8. I don’t deserve to live when other people lost their lives.

9. If I let other people get close to me, I’ll get hurt again.

10. Expressing any emotion means I will lose control of myself.

11. I must be on guard at all times.

12. I should be able to protect others.

13. I must control everything that happens to me.

14. Mistakes are intolerable and cause serious harm or death.

15. No civilians can understand me.

16. If I let myself think about what has happened, I will never get it out of my mind.

17. I must respond to all threats with force.

18. I can never really be a good, moral person again because of the things that I have done.

19. Other people should not be trusted.

20. Other people should not trust me.

21. If I have a happy life, I will be dishonoring my friends.

22. I have no control over my future.

23. The government cannot be trusted.

24. People in authority always abuse their power.

25. I am damaged forever because of the rape.

26. I am unlovable because of [the trauma].

27. I am worthless because I couldn’t control what happened.

28. I deserve to have bad things happen to me.

29. I am dirty.

30. I deserved to have been abused.

31. Only people who were there can understand.

Session 3: Working with Events, Thoughts,

and Feelings

Practice Assignment:

Please continue to self-monitor events, thoughts, and feelings

with the ABC Worksheets (Handout 6.3) on a daily basis, to

increase your mastery of this skill. You should complete one

worksheet each day on the trauma causing you the most distress,

or other traumas, but you can do additional worksheet items on

day-to-day events. Please put any newly noticed Stuck Points on

your Stuck Point Log (Handout 6.1) as you use the ABC

Worksheets.

Session 3 Handouts:

6.3: A-B-C Worksheet (six copies included)

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 6.3

ABC Worksheet

Date: Client:

Activating Event Belief/Stuck Point Consequence

ABC

“Something happens” “I tell myself something” “I feel something”

Are my thoughts above in column B realistic or helpful?

What can I tell myself on such occasions in the future?

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

Session 4: Examining the Index Event

Practice Assignment:

Please choose one Stuck Point each day, and then answer the

questions on the Challenging Questions Worksheet (Handout 7.2)

with regard to this Stuck Point. Please work on Stuck Points

related directly to the trauma first (e.g., “It is my fault,” “I could

have prevented it,” or “If I had done X, it would not have

happened”). Your therapist will give you extra copies of the

Challenging Questions Worksheets, so you can work on multiple

Stuck Points. Completed examples of this worksheet are provided

as Handouts 7.2a and 7.2b, and a Guide to the Challenging

Questions Worksheet (Handout 7.3) is also available.

Session 4 Handouts:

7.1: Levels of Responsibility Handout

7.2: Challenging Questions Worksheet (six copies included)

7.2(A-B): Examples of completed Challenging Questions

Worksheets

7.3: Guide for the Challenging Questions Worksheet

HANDOUT 7.1

Levels of Responsibility Handout

Date: Client:

Your role in the traumatic event: What are the facts?

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

The unforeseeable

Responsibility

Fault/

blameworthiness

No way to

predict it would

happen

Played a role in

the event, but

didn’t intend

outcome

Intended harm;

intended the

outcome

Grief/sadness

Regret

Guilt

HANDOUT 7.2

Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

1. What is the evidence for and against this Stuck Point?

For:

Against:

2. Is your Stuck Point a habit or based on facts?

3. In what ways is your Stuck Point not including all of the information?

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details). .

HANDOUT 7.2 (p. 2 of 2)

4. Does your Stuck Point include all-or-none terms?

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

6. In what way is your Stuck Point focused on just one piece of the story?

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

8. How is your Stuck Point confusing something that is possible with something that is likely?

9. In what ways is your Stuck Point based on feelings rather than facts?

10. In what ways is this Stuck Point focused on unrelated parts of the story?

HANDOUT 7.2

Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

1. What is the evidence for and against this Stuck Point?

For:

Against:

2. Is your Stuck Point a habit or based on facts?

3. In what ways is your Stuck Point not including all of the information?

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details). .

HANDOUT 7.2 (p. 2 of 2)

4. Does your Stuck Point include all-or-none terms?

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

6. In what way is your Stuck Point focused on just one piece of the story?

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

8. How is your Stuck Point confusing something that is possible with something that is likely?

9. In what ways is your Stuck Point based on feelings rather than facts?

10. In what ways is this Stuck Point focused on unrelated parts of the story?

HANDOUT 7.2

Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

1. What is the evidence for and against this Stuck Point?

For:

Against:

2. Is your Stuck Point a habit or based on facts?

3. In what ways is your Stuck Point not including all of the information?

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details). .

HANDOUT 7.2 (p. 2 of 2)

4. Does your Stuck Point include all-or-none terms?

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

6. In what way is your Stuck Point focused on just one piece of the story?

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

8. How is your Stuck Point confusing something that is possible with something that is likely?

9. In what ways is your Stuck Point based on feelings rather than facts?

10. In what ways is this Stuck Point focused on unrelated parts of the story?

HANDOUT 7.2

Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

1. What is the evidence for and against this Stuck Point?

For:

Against:

2. Is your Stuck Point a habit or based on facts?

3. In what ways is your Stuck Point not including all of the information?

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details). .

HANDOUT 7.2 (p. 2 of 2)

4. Does your Stuck Point include all-or-none terms?

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

6. In what way is your Stuck Point focused on just one piece of the story?

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

8. How is your Stuck Point confusing something that is possible with something that is likely?

9. In what ways is your Stuck Point based on feelings rather than facts?

10. In what ways is this Stuck Point focused on unrelated parts of the story?

HANDOUT 7.2

Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

1. What is the evidence for and against this Stuck Point?

For:

Against:

2. Is your Stuck Point a habit or based on facts?

3. In what ways is your Stuck Point not including all of the information?

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details). .

HANDOUT 7.2 (p. 2 of 2)

4. Does your Stuck Point include all-or-none terms?

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

6. In what way is your Stuck Point focused on just one piece of the story?

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

8. How is your Stuck Point confusing something that is possible with something that is likely?

9. In what ways is your Stuck Point based on feelings rather than facts?

10. In what ways is this Stuck Point focused on unrelated parts of the story?

HANDOUT 7.2A

Sample Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

It is my fault that my uncle had sex with me. [Therapist asked whether the Stuck Point had

a hidden word, “all.”]

1. What is the evidence for and against this Stuck Point?

For:

I must have done something that made him think it was OK. [After more questions

by therapist about fault and intent:] There is no evidence for its being my fault.

Against:

I didn’t want to do it, and I told him so. He threatened to hurt my little sister. He

said no one would believe me. He was an adult, and I was a child. He was bigger

and stronger than me.

2. Is your Stuck Point a habit or based on facts?

Habit. I have been saying this to myself for 25 years.

3. In what ways is your Stuck Point not including all of the information?

How could it be my fault? I didn’t even know what sex was when he started. You

don’t do that to kids. Just because he read me stories and babysat me didn’t give

him the right to do that.

4. Does your Stuck Point include all-or-none terms?

Well, we talked about the hidden word “all.” I thought it was all my fault and didn’t

even think about really blaming him. I was too scared of him, and my mother loved

him.

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

“All my fault.”

6. In what way is your Stuck Point focused on just one piece of the story?

Because he did it to me, I assumed it was about me. I didn’t think about the fact

that I was a child or that what he did was a crime. I told him “No,” and he threat-

ened my family.

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.2A (p. 2 of 2)

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

Mostly from me, but I think he said things that made it seem like it was my fault.

I was so pretty, that he couldn’t keep his hands off of me, I was special, etc.

8. How is your Stuck Point confusing something that is possible with something that is likely?

N/A.

9. In what ways is your Stuck Point based on feelings rather than facts?

Because I felt guilty and shameful, I thought it must be my fault.

10. In what ways is this Stuck Point focused on unrelated parts of the story?

I must have thought that I had more control over the situation than I did.

HANDOUT 7.2B

Sample Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief:

It is my fault that my brother was killed in the car accident, because I should have done

things differently.

1. What is the evidence for and against this Stuck Point?

For:

I should have made him wear his seat belt. He refused, and I thought it was only a

few blocks so it didn’t really matter. We were laughing and talking.

Against:

I didn’t cause the crash. The other person was texting and ran the red light. The



would have been killed anyway.

2. Is your Stuck Point a habit or based on facts?

Habit. I have been blaming myself for 2 years. I guess it was wishful thinking.

3. In what ways is your Stuck Point not including all of the information?

When the light turned green, I did look both ways before I entered the intersection.

He was coming so fast that there was nowhere for me to go.

4. Does your Stuck Point include all-or-none terms?

I thought it was all my fault because my brother died, and I didn’t even think about

the driver of the other car. I kept saying I should have done something different to

avoid the crash.

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

“All my fault.” “Should have done things differently.”

6. In what way is your Stuck Point focused on just one piece of the story?

I was focused on the fact that my brother refused to put on his seat belt, and

               

wouldn’t have made a difference. I was also focused on the fact that we were talk-

ing and laughing, but I overlooked the fact that I did look both ways.

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.2B (p. 2 of 2)

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

-

tion was that it was my fault, and that I shouldn’t have started the car until he put

his seat belt on. Later they were more supportive, but I think they were so upset

at the time that they took it out on me.

8. How is your Stuck Point confusing something that is possible with something that is likely?

I kept thinking that I could have done something different to avoid the crash.

Maybe there was something I could have done, but it isn’t likely.

9. In what ways is your Stuck Point based on feelings rather than facts?

Because I felt guilty, I thought it must be my fault.

10. In what ways is this Stuck Point focused on unrelated parts of the story?

I was focused completely on the seat belt. I didn’t kill my brother. The other driver

did. He shouldn’t have been texting and driving too fast. Focusing on the fact that

we were laughing was irrelevant. I was paying attention and following the rules.

HANDOUT 7.3

Guide for the Challenging Questions Worksheet

Date: Client:

Below is a list of questions to be used in helping you challenge your Stuck Points or problematic

beliefs. Not all questions will be appropriate for the belief you choose to challenge. Answer as

many questions as you can for the belief you have chosen to challenge below.

Belief: Put a Stuck Point here. You can use your Stuck Point Log to ﬁnd one.

The belief should not be a feeling or behavior, and should not be too vague. Use “If–then” statements if

possible.

1. What is the evidence for and against this Stuck Point?

Evidence consists of the type of facts that will hold up in court. We are not challenging that the

event happened. We are looking for evidence that supports and does not support the Stuck Point

you have given above.

For: Do not use another Stuck Point! Make sure you are identifying facts.

Against: Only one exception is needed to make a belief not a fact. A fact is 100% and absolute.

If you can identify one exception to your Stuck Point, then it is not a fact, and therefore would not

hold up in court.

2. Is your Stuck Point a habit or based on facts?

Have you been telling yourself this belief for so long that it feels like a fact? It’s like advertising:

After a while, you start to believe it. Is this belief something that you have been in the habit of tell-

ing yourself for a long time?

3. In what ways is your Stuck Point not including all of the information?

Is it possible that your Stuck Point is unrealistic or not completely accurate or not completely true?

Does your belief reﬂect all the facts of the situation? Remember the context of the trauma.

4. Does your Stuck Point include all-or-none terms?

Does your Stuck Point reﬂect all-or-none, black-and-white categories? Are things all good or all

bad? Are you missing the gray areas in between? Example: If your performance falls short of per-

fect, you see yourself as a failure.

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as

“always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?

These words or phrases may be hidden. Example: “Men can’t be trusted” is actually “All men can’t

be trusted.”

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.3 (p. 2 of 2)

6. In what way is your Stuck Point focused on just one piece of the story?

This question is about deciding that one piece of information from the event caused the event to

happen. Then, you use this one aspect to create your Stuck Point. Example: “If I had been stronger,

then this wouldn’t have happened.” Now think about drawing a pie chart and showing one small

slice of that pie as the one aspect you are focusing on. You are probably assigning 100% of the

“blame” or “cause” to this “slice” and discounting all the remaining factors (other slices) in the rest

of the pie. Other slices might include that you were outnumbered, the perpetrator had a weapon,

you were taken by surprise, there were no other options at the time, or similar factors. Why are

these other factors/slices not considered here as contributory? Are you discounting them and only

focusing on the one factor/slice?

7. Where did this Stuck Point come from? Is this a dependable source of information on this

Stuck Point?

Think about the time period when the event happened. Who were you at the time (a scared 20-year-

old in combat, a child victimized by an adult, etc.)? Your Stuck Point may be based on a thought that

you developed when you were scared or very young. You have retained that Stuck Point all these

years, based on how you thought at the time. Or think about the enemy/perpetrator/other sources:

Are these people reliable? Can they be trusted to make judgments about the event (or you)? Your

Stuck Point might be a statement told to you by a perpetrator. Is a perpetrator to be trusted (reli-

able) to make this statement? Would we expect that a perpetrator is truthful? Consider your source.

8. How is your Stuck Point confusing something that is possible with something that is likely?

This question is best for a Stuck Point that is focused on the present or the future. It asks you, “What

is the likelihood or percentage/chance that the Stuck Point will happen again?” An example of a

present or future- oriented Stuck Point would be “If I trust others, then I’ll get hurt.” It may actually

be a low probability, but you are living your life as if it is a certainty. Yes, it could happen, but are

you living as if it will happen? Of course, in a dangerous environment, you may have to consider

everything as a high probability, because the consequences (death or injury) are great. But are you

taking into consideration that you don’t need to hold this same degree of probability in all environ-

ments? In other words, are you applying the Stuck Point as if it has a high probability (a certainty)

of happening again in all situations now? For example, think about driving. We all know that many

people die every year in car accidents, yet we still drive. We do this because although we are aware

that we could die in a car accident, we don’t live as if it will happen.

9. In what ways is your Stuck Point based on feelings rather than facts?

This question represents the idea that if you feel something is true, then it must be. For example,

think about hypervigilance: Because you feel uncomfortable or under threat in a crowd, you assume

(or develop the belief) that it is dangerous. This becomes “I don’t like crowds,” which translates into

the Stuck Point “I am never safe in a crowd,” or “If I am in a crowd, then I will be harmed.” Another

example is that if you feel guilty, then you assume you must be at fault.

10. In what ways is this Stuck Point focused on unrelated parts of the story?

This question is about focusing the cause or blame on something that had nothing to do with the

event’s happening. For example, “I wore a red dress; therefore, I was assaulted.” This is different

from question 6 because it is about something that was irrelevant, whereas in question 6 the fac-

tor may have contributed to the event but is not wholly to blame. However, even in question 6, the

piece may be incorrect rather than factual.

Session 5: Using the Challenging Questions

Worksheet

Practice Assignment:

Your practice assignment is to consider your Stuck Points, as well

as some examples of your everyday thinking, and to find ones

that fit into each relevant thinking pattern on the Patterns of

Problematic Thinking Worksheet (Handout 7.5). Each day, list a

Stuck Point or example of everyday thinking under each pattern,

and think about ways in which your reactions to the traumatic

event may be affected by these habitual patterns. A completed

example of this worksheet is provided as Handout 7.5a.

Session 5 Handouts:

7.5: Patterns of Problematic Thinking Worksheet (6 copies

included)

7.5A: Example of a completed Patterns of Problematic Thinking

Worksheet

HANDOUT 7.5

Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

3. Ignoring important parts of a situation.

4. Oversimplifying things as “good–bad” or “right–wrong.”

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

6. Mind reading (assuming that people are thinking negatively of you when there is no deﬁ-

nite evidence for this).

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.5

Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

3. Ignoring important parts of a situation.

4. Oversimplifying things as “good–bad” or “right–wrong.”

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

6. Mind reading (assuming that people are thinking negatively of you when there is no deﬁ-

nite evidence for this).

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.5

Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

3. Ignoring important parts of a situation.

4. Oversimplifying things as “good–bad” or “right–wrong.”

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

6. Mind reading (assuming that people are thinking negatively of you when there is no deﬁ-

nite evidence for this).

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.5

Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

3. Ignoring important parts of a situation.

4. Oversimplifying things as “good–bad” or “right–wrong.”

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

6. Mind reading (assuming that people are thinking negatively of you when there is no deﬁ-

nite evidence for this).

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.5

Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

3. Ignoring important parts of a situation.

4. Oversimplifying things as “good–bad” or “right–wrong.”

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

6. Mind reading (assuming that people are thinking negatively of you when there is no deﬁ-

nite evidence for this).

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.5

Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

3. Ignoring important parts of a situation.

4. Oversimplifying things as “good–bad” or “right–wrong.”

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

6. Mind reading (assuming that people are thinking negatively of you when there is no deﬁ-

nite evidence for this).

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 7.5A

Sample Patterns of Problematic Thinking Worksheet

Date: Client:

Listed below are several different patterns of problematic thinking that people use in different

life situations. These patterns often become automatic, habitual thoughts that cause people to

engage in self- defeating behavior. Considering your own Stuck Points, or samples from your

everyday thinking, ﬁnd examples for each of these patterns. Write in the Stuck Point or typical

thought under the appropriate pattern, and describe how it ﬁts that pattern. Think about how that

pattern affects you.

1. Jumping to conclusions or predicting the future.

[Victim of childhood sexual abuse:] If a man is alone with a child, then the man will

hurt the child. But I know my husband will not hurt my kids so this belief is caus-

ing problems in my marriage

2. Exaggerating or minimizing a situation (blowing things way out of proportion or shrink-

ing their importance inappropriately).

[Traveler:] I saw a dead body and riots, but I didn’t get hurt and others saw worse,

so my reaction to the situation was wrong. I was weak.

3. Ignoring important parts of a situation.

[Robbery victim:] I keep forgetting the fact that the perpetrator had a gun, which

is important information about how much control I had.

4. Oversimplifying things as “good–bad” or “right–wrong.”

[Police ofﬁcer:] Not everyone is all good or all bad. I may have done some things in

my life that were not that good, but that does not make me a bad person.

5. Overgeneralizing from a single incident (e.g., a negative event is seen as a never- ending

pattern).

[Adult rape victim:] I was raped by a man, so all men are dangerous. Maybe I am

using this belief to stay away from men?

6. Mind reading (in particular, assuming that people are thinking negatively of you when

there is no deﬁnite evidence for this).

[Victim of childhood physical abuse:] My dad yells now, so I assume he must be

angry. But it’s not true a lot of the times, because he yells sometimes because he

is deaf in one ear and going deaf in another. He yells because he doesn’t know he

is yelling.

7. Emotional reasoning (using your emotions as proof—e.g., “I feel fear, so I must be in

danger”).

[Survivor of a traumatic bereavement:] I feel guilt over my friend’s death, so I must

have done something wrong.

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

Session 6: Patterns of Problematic Thinking

Worksheet and Introduction to Challenging

Beliefs Worksheet

Practice Assignment:

Use the Challenging Beliefs Worksheets (Handout 8.1) to analyze

and confront at least one of your Stuck Points each day. You can

also use the Challenging Beliefs Worksheets to challenge any

negative or problematic thoughts and related emotions you may

have about day-to-day events.

Session 6 Handouts:

8.1: Challenging Beliefs Worksheet (6 copies included)

8.1(A-E): Examples of completed Challenging Beliefs Worksheets

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1A

Sample Challenging Beliefs Worksheet

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section

A. Rate your belief in this

thought/Stuck Point from 0

to 100%. (How much do you

believe this thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider whether

the thought is balanced and factual, or extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide

whether this is one of your

problematic patterns of

thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

I have to ride

on a plane.

Air travel is

dangerous.—75%

Evidence for? People have been killed.

Evidence against? Airport security has been

increased.

Habit or fact? It is a habit.

Not including all information? The fact that planes



All-or-none? Yes, I am making a statement that



Extreme or exaggerated? Yes. I am exaggerating

the risk.

Focused on just one piece? I notice in the

news when there is a crash, but I don’t pay



every day.

Source dependable? No, I misinterpreted

turbulence.

Confusing possible with likely? Yes, I have been

saying that it is likely that the plane will

crash.

Based on feelings or facts? I am letting myself

believe this because I feel scared and not

because it is realistic.

Focused on unrelated parts? Many people I know



Jumping to conclusions: Yes,



plane will crash.

Exaggerating or minimizing:

I am exaggerating the

possibility.

Ignoring important parts: All

the thousands of planes



don’t crash.

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning: Just

because I am anxious on





The chances are very small

that I will be killed or hurt



Even if the plane blew up,

I could not do anything

about it.—80%

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck

Point in section B, from 0 to

100%.

15%

C. Emotion(s)

Specify your emotion(s)

(sad, angry, etc.), and rate

how strongly you feel each

emotion from 0 to 100%.

Afraid—100%

Helpless—75%

Anxious—75%

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

Afraid—40%

Helpless—5%

Anxious—10%

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1B

Sample Challenging Beliefs Worksheet

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section

A. Rate your belief in this

thought/Stuck Point from 0

to 100%. (How much do you

believe this thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider whether

the thought is balanced and factual, or extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide

whether this is one of your

problematic patterns of

thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

I led my

company

into an

ambush, and

many of my

men were

killed.

I should have prevented

it.—100%

Evidence for? People were killed.

Evidence against? There was no way to know

that there was going to be an ambush—that’s

the nature of an ambush. To think I should

have known it was coming is to ignore the fact

that it was an ambush.

Habit or fact? A habit. I have been saying this

for years.

Not including all information? It was an ambush.

We had no intel that there were insurgents in

that area.

All-or-none? No one else would have led their

company into an ambush.

Extreme or exaggerated? Extreme to say I

should have prevented it when I didn’t know.

Focused on just one piece? That I am

responsible for my men.

Source dependable? I am the source of the self-

blame. No one else blamed me.

Confusing possible with likely?

Based on feelings or facts? Feelings.

Focused on unrelated parts? That I was their

leader. I couldn’t predict the future.

Jumping to conclusions:

That I could have

prevented it.

Exaggerating or minimizing:

Exaggerating my control

in the situation.

Ignoring important parts:

I haven’t been paying

attention to the fact that

it was an ambush. There

was no way I could have

known.

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

Because I feel guilty, I am

guilty.

There was no way to see it

coming at the time.—85%

I did the best I could, given



G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck

Point in section B, from 0 to

100%.

10%

C. Emotion(s)

Specify your emotion(s)

(sad, angry, etc.), and rate

how strongly you feel each

emotion from 0 to 100%.

Guilty—100%

Helpless—100%

Anxious—75%

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

Guilty—40%

Helpless—80%

Anxious—40%

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1C

Sample Challenging Beliefs Worksheet

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section

A. Rate your belief in this

thought/Stuck Point from 0

to 100%. (How much do you

believe this thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider whether

the thought is balanced and factual, or extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide

whether this is one of your

problematic patterns of

thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

I am putting

off doing

my therapy

practice

assignment.

If I let myself feel angry,

I’ll be out of control.—50%

Evidence for? I have acted aggressively in the

past when I felt angry.

Evidence against? I have never been really

destructive when I was angry. It is my choice

how I act when I feel angry. I can always take

a break or leave the situation.

Habit or fact? Habit.

Not including all information? That I am not

totally out of control. I am still making choices

on how to behave.

All-or-none? Yes, no control.

Extreme or exaggerated? It is exaggerated to

say that I would be out of control, I have some

control.

Focused on just one piece? That if I do my out-

of- session therapy assignment, I will be angry

and out of control.

Source dependable? No, my assumption.

Confusing possible with likely? Not likely I will



Based on feelings or facts? Feelings.

Focused on unrelated parts? It’s just a

worksheet, not the trauma.

Jumping to conclusions:

I am jumping to

conclusions to assume

that I will have no control

if I feel my feelings.

Exaggerating or minimizing:

I am equating anger with

rage instead of what it

is— unpleasant.

Ignoring important parts: I

am disregarding the times

I have felt angry and

maintained control.

Oversimplifying: Yes, feeling

angry is bad.

Overgeneralizing: Just

because I have been

aggressive in the past

doesn’t mean I will do it

with a worksheet.

Mind reading:

Emotional reasoning: Anger

always leads to aggression.

Anger can be expressed

without aggression.—60%

Anger is an emotion

like sadness. I can let

myself feel that and still

maintain control over my

behaviors.—60%

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck

Point in section B, from 0 to

100%.

20%

C. Emotion(s)

Specify your emotion(s)

(sad, angry, etc.), and rate

how strongly you feel each

emotion from 0 to 100%.

Angry—50%



H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

Angry—30%

Afraid—35%

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1D

Sample Challenging Beliefs Worksheet

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section

A. Rate your belief in this

thought/Stuck Point from 0

to 100%. (How much do you

believe this thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

A friend

wants to set

me up for

a date with

someone she

knows.

I can’t get involved with

anyone and let anyone

close enough to see how

restricted my life has

become.—75%

Evidence for? One person I told about the

assault while we were dating was very

supportive at the time, but became more and



calling altogether.

Evidence against? My friends and family have

been supportive.

Habit or fact? Habit.

Not including all information? My friend wouldn’t

set me up with a mean person.

All-or-none? Most healthy people would not run

from a relationship.

Extreme or exaggerated? I am making

assumptions about how other people will

react.

Focused on just one piece? That he will judge

me.

Source dependable? Coming from past negative

experience and from an unhealthy person.

Confusing possible with likely? It is possible that

he won’t like me, but it is possible I won’t like

him either.

Based on feelings or facts? Feelings.

Focused on unrelated parts? Just because I was a

victim before doesn’t mean that everyone will

judge me. Maybe they would judge the rapist.

Jumping to conclusions: Yes,

assuming that it will go

badly.

Exaggerating or minimizing:

Because one date may have

had problems, this doesn’t

mean that others will.

Ignoring important parts: That

person was not healthy or

secure.

Oversimplifying: If I tell

someone who can’t deal

with it, it is not necessarily



out something important

about the relationship.

Overgeneralizing: Same as

above. One bad experience

doesn’t mean that

everyone is the same. I

don’t have to talk about

my restricted life.

Mind reading: Yes, I am

assuming what he thinks,

and I haven’t even met him

yet.

Emotional reasoning: Because

I am scared, I assume that

it will go badly.

A date could tell me they

don’t want anything to

do with me because I am

dealing with having been

assaulted.—60

Some people have been

very supportive.—70%

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck

Point in section B, from 0 to

100%.

50%

C. Emotion(s)

Specify your emotion(s)

(sad, angry, etc.), and rate

how strongly you feel each

emotion from 0 to 100%.

Fearful—50%

Sad—80%

Angry—50%

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

Fearful—25%

Sad—40%

Angry—10%

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1E

Sample Challenging Beliefs Worksheet

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section

A. Rate your belief in this

thought/Stuck Point from 0

to 100%. (How much do you

believe this thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider whether

the thought is balanced and factual, or extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide

whether this is one of your

problematic patterns of

thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

lieutenant

sent us down

a road that

he knew was



insurgents.

Four friends

were killed

because of

him.

He got them

killed.—100%

Evidence for? They are dead!

Evidence against? He was probably given an

order to send us there because they needed

the supplies.

Habit or fact? He didn’t actually kill them.

Not including all information? Insurgents killed

them.

All-or-none? Yes.

Extreme or exaggerated? I guess. The order

didn’t seem to make sense, though—why did

we have to go then? And there was a pretty

good chance we all could have made it.

Focused on just one piece? I guess I don’t know

if he had pressure (orders) to send us there

right then.

Source dependable? My assumption.

Confusing possible with likely?

Based on feelings or facts? Outrage at not

understanding why he made that call.

Focused on unrelated parts? That it was his

fault. He didn’t intend for them to get killed.

Jumping to conclusions: I

guess I don’t know what

he was thinking when he

ordered us there.

Exaggerating or minimizing:

Yes.

Ignoring important parts: I

don’t really know why he

made that call.

Oversimplifying: We had

made the run before

there, even though it was

really dangerous.

Overgeneralizing:

Mind reading: I am mind-

reading his intentions.

Emotional reasoning: I was

angry and blamed him.

I hate that my friends

died, and although it

didn’t seem critical

to make that run, I

don’t know what the

lieutenant was thinking or



It was really risky, but we

had made it safely four



G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck

Point in section B, from 0 to

100%.

40%

C. Emotion(s)

Specify your emotion(s)

(sad, angry, etc.), and rate

how strongly you feel each

emotion from 0 to 100%.

Angry—100%

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

Relieved, not as angry—

60%

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

Session 7: Challenging Beliefs and

Introduction of Modules

Practice Assignment:

Use the Challenging Beliefs Worksheets (Handout 8.1) to analyze

and confront at least one of your Stuck Points each day. Also,

please read over the Safety Issues Module (Handout 8.3) and

think about how your prior beliefs were affected by your trauma. If

you have safety issues related to yourself or others, complete at

least one worksheet to confront those beliefs. Use the remaining

sheets for other Stuck Points on your Stuck Point Log (Handout

6.1) or for distressing events that have occurred recently.

Session 7 Handouts:

8.1: Challenging Beliefs Worksheet (6 copies included)

8.3: Safety Issues Module

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.3

Safety Issues Module

Safety Beliefs Related to SELF: The belief that you can protect yourself from harm and have

some control over events.

PRIOR EXPERIENCE

Negative Positive

If you repeatedly experienced dangerous

and uncontrollable life situations, you may

have developed negative beliefs about your

ability to protect yourself from harm. A new

traumatic event may seem to conﬁrm those

beliefs.

If you have had positive prior experiences,

you may develop the belief that you have

control over most events and can protect

yourself from harm. The traumatic event may

have shattered this belief.

Symptoms Associated with Negative Safety Beliefs about the Self

• Chronic and persistent anxiety

• Intrusive thoughts about themes of danger

• Irritability

• Startled responses or physical arousal

• Intense fears related to future victimization

Examples of Possible Stuck Points

“I can’t protect myself from danger.”

“If I go out, I will be hurt.”

“When I feel fear, that means I am in danger.”

POSSIBLE RESOLUTIONS

If you previously believed that . . .

A possible alternative thought may be . . .

“It can’t happen to me,” then you will need to

resolve the conﬂict between this belief and

the traumatic event.

“It is unlikely to happen again, but the

possibility exists. Even if it does, I have more

skills I can use to manage my reactions.”

“I can protect myself from any harm,” then

you will need to resolve the conﬂict between

your prior beliefs and the traumatic event.

“I do not have control over everything that

happens to me, but I can take precautions to

reduce the risk of future traumatic events.”

“I cannot protect myself,” then the new

traumatic event will seem to conﬁrm these

beliefs. New beliefs must be developed that

are more balanced regarding your ability to

keep yourself safe.

“I do have some ability to keep myself safe,

and I can take steps to protect myself from

harm.”

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.3 (p. 2 of 2)

Safety Beliefs Related to OTHERS: Beliefs about the dangerousness of other people and

expectancies about the intent of others to cause harm, injury, or loss.

PRIOR EXPERIENCE

Negative Positive

If you experienced people as dangerous in

early life, or if you believed violence to be

a normal way of relating, the new traumatic

event will seem to conﬁrm these beliefs.

If you experienced people as safe in early life,

you may expect others to keep you safe and

not cause harm, injury, or loss. The traumatic

event may have caused a disruption in this

belief.

Symptoms Associated with Negative Safety Beliefs about Others

• Avoidant or phobic responses

• Social withdrawal

Examples of Possible Stuck Points

“The world is very dangerous everywhere.”

“People will always try to harm me.”

“There is nowhere safe to be.”

POSSIBLE RESOLUTIONS

If you previously believed that . . .

Possible alternative thoughts may be . . .

“Others are out to harm me and most people

will hurt me if they can,” then you will need

to modify this belief, or it will be impossible

to have trusting, happy relationships with

others.

“There are some people out there who are

dangerous, but not everyone is out to harm

me in some way.”

“I will never be hurt by others,” then you will

need to resolve the conﬂict between this

belief and the victimization.

“There may be some people who will try to

harm me, but not everyone I meet will hurt

me. I can take precautions to reduce the

likelihood that others can hurt me.”

Session 8: Processing Safety and Introducing

Trust

Practice Assignment:

Use the Challenging Beliefs Worksheets (Handout 8.1) to analyze

and confront at least one of your Stuck Points each day. Also,

please read over the Trust Issues Module (Handout 9.1), and

think about how your prior beliefs about trust were affected by

your trauma. If you have trust issues, Stuck Points, related to

yourself or others, complete at least one worksheet to examine

those beliefs. Use the remaining sheets for other Stuck Points on

your Stuck Point Log (Handout 6.1) or for distressing events that

have occurred recently.

Session 8 Handouts:

8.1: Challenging Beliefs Worksheet (6 copies included)

9.1: Trust Issues Module

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 9.1

Trust Issues Module

Trust Beliefs Related to SELF: The belief that you can trust or rely on your own judgments

and decisions. Trusting yourself is an important building block for developing healthy, trusting

relationships with others

PRIOR EXPERIENCE

Negative Positive

If you had prior experiences where you

were blamed for negative events, you may

have developed negative beliefs about your

ability to make decisions or judgments about

situations or people. A new traumatic event

may seem to conﬁrm these beliefs.

If you had prior experiences that led you to

believe that you had great judgment, the

traumatic event may have undercut this

belief.

Symptoms Associated with Negative Trust Beliefs about the Self

• Feelings of self- betrayal

• Anxiety

• Confusion

• Excessive caution

• Inability to make decisions

• Self-doubt and excessive self- criticism

Examples of Possible Stuck Points

“I can’t make good decisions, so I let others make decisions for me.”

“Because I am a poor judge of character, I can’t tell who can be trusted.”

“If I make choices, then they never work out.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . A possible alternative thought may be . . .

“I cannot trust my judgment” or “I have bad

judgment,” the recent traumatic event may

have reinforced these beliefs. It is important

to understand that the traumatic event was

not your fault and that your decisions did not

cause the traumatic event.

“I can still trust my judgment even though it’s

not perfect.”

“Even if I misjudged this person or situation,

I realize that I cannot always realistically

predict what others will do or how a situation

may turn out.”

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

If you previously believed that . . . A possible alternative thought may be . . .

“I have perfect judgment, and I never make

bad decisions,” then the traumatic event may

have shattered this belief. New beliefs need

to reﬂect the possibilities that you can make

mistakes but still have good judgment, and

that mistakes in judgment cannot always be

blamed as the reason why traumatic events

occur.

“No one has perfect judgment. I did the best I

could in an unpredictable situation, and I can

still trust my ability to make decisions even

though it is not perfect.”

“My bad decision did not cause the event to

happen.”

Trust Beliefs Related to OTHERS: Beliefs that the promises of other people or groups can

be relied on with regard to future behavior. One of the earliest tasks of childhood development

involves trust versus mistrust: A person needs to learn a healthy balance of trust and mistrust,

and to learn when each is appropriate.

PRIOR EXPERIENCE

Negative Positive

If you were betrayed in early life, you

may have developed the generalized

belief that “No one can be trusted.” A new

traumatic event may serve to conﬁrm this

belief, especially if you were hurt by an

acquaintance.

If you had particularly good experiences

growing up, you may have developed the

belief that “All people can be trusted.” The

traumatic event may have shattered this

belief.

POSTTRAUMATIC EXPERIENCE

If the people you knew and trusted, or people in positions of authority, were blaming, distant, or

unsupportive after the traumatic event, your belief in their trustworthiness may have been shat-

tered.

Symptoms Associated with Negative Trust Beliefs about Others

• Pervasive sense of disillusionment and disappointment in others.

• Fear of betrayal or abandonment.

• Anger and rage at betrayers.

• After repeated betrayals, negative beliefs so rigid that even people

who are trustworthy may be viewed with suspicion.

• Fear of close relationships; particularly when trust is beginning to

develop, active anxiety and fear of being betrayed.

HANDOUT 9.1 (p. 2 of 3)

(continued)

Examples of Possible Stuck Points

“No one can be trusted.”

“People in authority will always take advantage of you.”

“If I trust someone, they will hurt me.”

“If I get close to someone, they will leave.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . Possible alternative thoughts may be . . .

“No one can be trusted,” which was

seemingly conﬁrmed by the traumatic event,

then you need to adopt new beliefs that will

allow you to enter into new relationships

from a neutral position that allows you to see

whether various kinds of trust can be built.

“Although I may ﬁnd some people to be

untrustworthy in some ways, I cannot assume

that everyone is always untrustworthy.”

“Trusting another involves some risk, but I

can protect myself by developing trust slowly

and including what I learn about that person

as I get to know him or her.”

“Everyone can be trusted,” then the traumatic

event will have shattered this belief. To avoid

becoming suspicious of the trustworthiness

of others, including those you used to trust,

you will need to understand that trust is not

an either–or matter.

“I may not be able to trust everyone in every

way, but that doesn’t mean I have to stop

trusting the people I used to trust.”

“I can trust my family and friends,” then the

traumatic event may have shattered your

beliefs about the trustworthiness of your

support system when these persons did not

act the way you wanted them to after they

learned about the traumatic event. Before

you assume that you cannot trust anyone

in your support system, it is important to

consider why these people may have reacted

the way they did. Many people do not know

how to respond when someone they care

about is traumatized, and they may have

been reacting out of ignorance. Some people

may have responded out of fear or denial,

because what has happened to you made

them feel vulnerable and may have affected

their own beliefs.

“Trust is not an all-or-none concept. Some

people may be more trustworthy than others.”

“It may help to tell others what I need from

them and then see if they do a better job of

meeting my needs. I can use this as a way to

assess their trustworthiness.”

If you ﬁnd that others continue to be

unsupportive about the trauma, but kind to

you in other ways, you may choose to adopt

a statement such as “There are some people

I cannot talk to about the traumatic event, but

there are other areas of my life where I can

trust them.”

If a person continues to be negative or make

blaming statements toward you, you might

want to tell yourself, “This person is not

trustworthy, and it is not healthy for me to

have the person in my life at this time.”

HANDOUT 9.1 (p. 3 of 3)

Session 9: Processing Trust and Introducing

Power/Control

Practice Assignment:

Use the Challenging Beliefs Worksheets (Handout 8.1) to analyze

and confront at least one of your Stuck Points each day. Also, if

not completed in session, complete the trust star example

(Handout 9.3). Please read over the Power/Control Issues Module

(Handout 9.4) and think about how your prior beliefs about

power/control were affected by your trauma. If you have

power/control Stuck Points related to yourself or others, complete

at least one work- sheet to examine those beliefs. Use the

remaining sheets for other Stuck Points on your Stuck Point Log

(Handout 6.1) or for distressing events that have occurred

recently.

Session 9 Handouts:

8.1: Challenging Beliefs Worksheet (6 copies included)

9.3: Trust Star Worksheet

9.3(A): Example of a completed Trust Star Worksheet

9.4: Power/Control Issues Module

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 9.3

Trust Star Worksheet

Date: Client:

There are many different types of trust (such as keeping secrets and being reliable). Below,

in the lines down the right side of the page, list all the different types of trust you can think

of. Then think about one particular person. Write in your relationship with this person

here: . If you cannot think of a family member or friend, then think

of someone in which you must place your trust, such as a doctor, mechanic, or bus driver. Put

a star by the most important types of trust for this person. Then ﬁll in the Trust Star graphic by

writing a type of trust on each line, and putting an × on the line to indicate how much you trust

this person with that type of trust. The plus sign at one end of each line means maximum trust;

the minus sign means no trust at all. If you don’t know how much you trust the person in this way,

put the × just inside the “No information” circle. Does this person need to be trustworthy in every

way? What about the most important ways? Would you trust this person to pull your tooth, cut

your hair, or ﬁx your car?

TYPES OF TRUST

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

–+

––

information

HANDOUT 9.3A

Sample Trust Star Worksheet

There are many different types of trust (such as keeping secrets and being reliable). Below,

in the lines down the right side of the page, list all the different types of trust you can think

of. Then think about one particular person. Write in your relationship with this person

here: friend . If you cannot think of a family member or friend, then think

of someone in which you must place your trust, such as a doctor, mechanic, or bus driver. Put

a star by the most important types of trust for this person. Then ﬁll in the Trust Star graphic by

writing a type of trust on each line, and putting an × on the line to indicate how much you trust

this person with that type of trust. The plus sign at one end of each line means maximum trust;

the minus sign means no trust at all. If you don’t know how much you trust the person in this way,

put the × just inside the “No information” circle. Does this person need to be trustworthy in every

way? What about the most important ways? Would you trust this person to pull your tooth, cut

your hair, or ﬁx your car?

TYPES OF TRUST

Keeps private information

Trust with my child*

Returns money*

Reliable

On time*

Supportive*

Protective

Competent

Faithful

Doesn’t gossip

Keeps me physically safe*

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

–+

––

information

Supportive

Returns money

On time

Trust with my child

Physically safe

HANDOUT 9.4

Power/Control Issues Module

Power and Control Beliefs Related to SELF: Beliefs that you can solve problems and meet

challenges that you may face.

PRIOR EXPERIENCE

Negative Positive

If you grew up experiencing repeated

negative events, you may have developed

the belief that you cannot control events or

solve problems even if they are controllable/

solvable. A new traumatic event may seem to

conﬁrm prior beliefs about helplessness.

If you grew up believing that you had control

over events and could solve problems, the

traumatic event may have disrupted those

beliefs.

Symptoms Associated with Negative Power/Control Beliefs about the Self

• Numbing of feelings

• Avoidance of emotions

• Chronic passivity

• Hopelessness and depression

• Self- destructive patterns

• Outrage when you are faced with events that are out of your

control, or with people who do not behave as you would like

Examples of Possible Stuck Points

“Because I can’t be completely in control, I might as well be out of control.”

“The traumatic event wouldn’t have happened if I had had better control over it.”

“I need to be perfect to be in control.”

“If I lose complete control over my emotions, something bad will happen.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . A possible alternative thought may be . . .

“I have control over everything that I do and

say, as well as over the actions of others,”

then it will be important to realize that none

of us can have complete control over our

emotions or behavior at all times. Although

you may be able to inﬂuence many external

events, it is impossible to control all events or

all behaviors of other people. Neither of these

“I do not have total control over my reactions,

other people, or events at all times. However,

I am able to have some control over my

reactions to events, and to inﬂuence some

behaviors of others or the outcomes of some

events.”

“Bad things do not always happen when I am

not in control.”

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

If you previously believed that . . . A possible alternative thought may be . . .

facts is a sign of weakness, but only an

understanding that you are human and can

admit that you are not in control of everything

that happens to you or your reactions.

“I am helpless or powerless to control myself

or others,” then you will need to work on

developing a sense of control to decrease the

symptoms of depression and low self- esteem

that often go along with believing you are

helpless. It may help to look at your actual

ability to control some events in your life.

“I cannot control all events outside myself, but

I do have some control over what happens to

me and my reactions to events.”

“I can try to notice all the little things I have

control over in my life, and I can practice

taking control over more things in my life that

are important to me.”

Power and Control Beliefs Related to OTHERS: Beliefs that you can control others or future

events related to others (including people in power).

PRIOR EXPERIENCE

Negative Positive

If you had prior experiences with others that

led you to believe that you had no control in

your relationships with others, or that you had

no power in relation to powerful others, the

traumatic event will seem to conﬁrm those

beliefs.

If you had prior positive experiences in your

relationships with others and in relation

to powerful others, you may have come

to believe that you could inﬂuence others.

The traumatic event may shatter this belief

because you were unable to exert enough

control, despite your best efforts, to prevent

the event.

Symptoms Associated with Negative Power/Control Beliefs about Others

• Passivity

• Submissiveness

• Lack of assertiveness that can generalize to all relationships

• Inability to maintain relationships, because you do not allow the other per-

sons to exert any control in the relationships (including becoming enraged

if the other persons try to exert even a minimal amount of control)

Examples of Possible Stuck Points

“People will always try to control you.”

“There is no point in even trying to ﬁght against authority.”

“This event just proves that people have too much power over me.”

HANDOUT 9.4 (p. 2 of 3)

(continued)

POSSIBLE RESOLUTIONS

If you previously believed that . . . Possible alternative thoughts may be . . .

“I am powerless and have no control in

relationships,” then you will need to learn

ways that it is safe and appropriate for you

to exert control over yourself, others, and

events.

“Even though I cannot always get everything

I want in a relationship, I do have the ability

to inﬂuence others by standing up assertively

for my rights and asking for what I want.”

“I have to control everything in the lives of

people I care about, or they will be hurt,”

then the traumatic event may have further

reinforced this belief. It will be important

for you to realize that healthy relationships

involve sharing power and control, and that

relationships in which one person has all the

power can be abusive (even if you are the

one with all the power). It may also be helpful

to realize that it can be relaxing to give up

some of the power, and freeing to let others

make decisions some of the time.

“Even though I may not get everything I want

or need out of a relationship, I can assert

myself and ask for it. A good relationship is

one in which power is balanced between both

people. If I am not allowed any control, I can

exert my control in this relationship by ending

it, if necessary.”

“I can learn to let others have some of the

power in a relationship, and even enjoy

having others take responsibility for some of

the things that need to be done.”

HANDOUT 9.4 (p. 3 of 3)

Session 10: Processing Power/Control and

Introducing Esteem

Practice Assignment:

Use the Challenging Beliefs Worksheets (Handout 8.1) to analyze

and confront at least one of your Stuck Points each day. Also,

please read over the Esteem Issues Module (Handout 9.7) and

think about how your prior beliefs about esteem were affected by

your trauma. If you have esteem Stuck Points related to yourself

or others, complete at least one worksheet to examine those

beliefs. Use the remaining sheets for other Stuck Points on your

Stuck Point Log (Handout 6.1) or for distressing events that have

occurred recently.

Also, each day before the next session, do one nice thing for

yourself “just because,” not because you achieved something.

Also, practice giving one compliment and receiving one

compliment each day. Write the nice things you did for yourself,

and the names of the persons whom you complimented and who

complimented you, on a piece of paper. It is better to compliment

people for something they did rather than how they look. If any of

these assignments result in Stuck Points, please complete a

Challenging Beliefs Worksheet on them.

Session 10 Handouts:

8.1: Challenging Beliefs Worksheet (6 copies included)

9.6: Ways of Giving and Taking Power Handout

9.7: Esteem Issues Module

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 9.6

Ways of Giving and Taking Power Handout

Giving Power Taking Power

Positive

• Being altruistic (helping others without

expecting anything in return)

• Helping others in need or crisis

• Sharing yourself with another person as

part of the give-and-take in relationships

Example: You are on your way to the store

when a friend asks for a ride to the doctor,

and you decide to help your friend.

• Being assertive

• Setting limits and boundaries with others

• Being honest with yourself and others

Example: You tell a friend you cannot help

him or her now, but you schedule a time to

meet later when it ﬁts into your schedule.

Negative

• Basing your actions or behaviors solely on

the reactions you expect from others

• Always placing the needs of others above

your own

• Allowing others easy access to your “hot

buttons,” to get you emotionally upset

Example: You have a strong negative

reaction to someone who is clearly

manipulating you to feel that way.

• Giving ultimatums

• Testing limits

• Intentionally upsetting others for personal

gain

• Behaving aggressively

Example: You tell your partner, “I will not

have sex with you until you do what I want.”

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 9.7

Esteem Issues Module

Esteem Beliefs Related to SELF: Beliefs in your own worth. Such beliefs are a basic human

need. Being understood, respected, and taken seriously is basic to the development of self-

esteem.

PRIOR EXPERIENCE

Negative Positive

If you had prior experiences that made you

doubt your own worth, a new traumatic event

will seem to conﬁrm these negative beliefs

about your self-worth. Some life experiences

that can lead to negative beliefs about the

self include these:

• Believing other people’s negative state-

ments about you

• Receiving little caring or support from oth-

ers

• Being criticized or blamed by others, even

when things were not your fault

If you had prior experiences that were

positive and built up your beliefs in your

own worth, the traumatic event may have

disrupted those beliefs and lowered your

self- esteem. Your self- conﬁdence in making

decisions and your faith in your opinions may

be decreased.

Symptoms Associated with Negative Esteem Beliefs about the Self

• Depression

• Guilt

• Shame

• Possible self- destructive behavior

Examples of Possible Stuck Points

“I am bad, destructive, or evil.”

“I am responsible for bad, destructive, or evil acts.”

“I am basically damaged or ﬂawed.”

“Because I am worthless, I deserve unhappiness and suffering.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . A possible alternative thought may be . . .

“I am worthless” (or any of the beliefs listed

above) because of prior experiences, then

the traumatic event may seem to conﬁrm this

“Sometimes bad things happen to good

people. Just because someone says

something bad about me, that does not make

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

If you previously believed that . . . A possible alternative thought may be . . .

belief. If you received poor social support

after the event, this may also conﬁrm

negatives beliefs about yourself. To improve

your self- esteem, it may help to reevaluate

your beliefs about your self-worth and replace

maladaptive beliefs with more realistic,

positive ones.

it true. No one deserves this, and that

includes me. Even if I have made mistakes

in the past, that does not make me a bad

person deserving of unhappiness or suffering

(including the traumatic event).”

“Bad things will not happen to me because I

am a good person,” then the event may have

disrupted such beliefs, and you may wonder

what you did to deserve the event (e.g.,

“Maybe I was being punished for something

I had done, or because I am actually a

bad person”). To regain your prior positive

beliefs about your self-worth, you will need

to look carefully at the situation, so that your

sense of worth is not disrupted every time

something unexpected and bad happens to

you. When you can accept that bad things

might happen to you (as they happen to

everybody from time to time), you will let go

of blaming yourself for events that you did not

cause.

“Sometimes bad things happen to good

people. If something bad happens to me, it is

not necessarily because I did something to

cause it or because I deserved it. Sometimes

there is not a good explanation for why

bad things happen. I might have been the

occasion, but not the cause of the event.”

Esteem Beliefs Related to OTHERS: Beliefs about how much you value other people. Realistic

views of others are important to psychological health. In less psychologically healthy people,

these beliefs are stereotyped, rigid, and relatively unchanged by new information.

PRIOR EXPERIENCE

Negative Positive

If you had many bad experiences with

people in the past, you may have concluded

that other people are not good or not to

be trusted. You may have developed this

belief about everyone (even those who are

basically good and have your best interests

at heart). The traumatic event may seem

to conﬁrm these beliefs about people. In

addition, negative experiences may make

it difﬁcult to respect people in authority,

especially if your trauma involved someone in

a position of power.

If your prior experiences with people were

positive, and if negative events in the world

did not seem to have an impact on you,

the traumatic event was probably belief-

shattering. Prior beliefs in the basic goodness

of other people may have been particularly

disrupted if people who were assumed to be

supportive were not there for you after the

event.

HANDOUT 9.7 (p. 2 of 4)

(continued)

Symptoms Associated with Negative Esteem Beliefs about Others

• Chronic anger

• Contempt

• Bitterness

• Cynicism

• Disbelief when treated with genuine caring compassion (“What do they really want?”)

• Isolation or withdrawal from others

• Antisocial behavior, justiﬁed by the belief that people are only out for themselves

Examples of Possible Stuck Points

“People are basically uncaring, indifferent, and only out for themselves.”

“People are bad, evil, or malicious.”

“Large parts of the human race [e.g., all men, all government ofﬁcials]

are bad, evil, or malicious.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . Possible self- statements may be . . .

“All people are no good,” then it will be

important for you to reconsider the automatic

conclusion that all people (or at least all

people from a particular group) are no good,

and consider how that belief has affected

your behavior and social life in general.

When you ﬁrst meet someone, it is important

that you do not make decisions based on

stereotypes, which are not generally true

for the majority of people you will meet. It is

better and more accurate to adopt a “wait-

and-see” attitude, which will allow you time to

develop your beliefs about the other person

without automatically judging the person you

are trying to get to know.

“While some [members of a particular group]

do bad things, not all [members of this group]

are out to hurt me.”

“While some people in power will abuse their

power, not all people in power are out to hurt

others.”

“I need to put up with other people’s behavior,

even if it makes me uncomfortable,” you need

to keep in mind that if over time a person

makes you uncomfortable, or does things

that may hurt you, you are free to stop trying

to develop the relationship. It is important

to remember, however, that all people make

mistakes, and you need to consider your

ground rules for friendships or intimate

relationships ahead of time. If you confront

the person with a request to stop doing

“Although there are people I do not respect

and do not wish to know, I cannot assume

this about every new person I meet. I may

come to this conclusion later, but it will be

after I have learned more about this person.”

HANDOUT 9.7 (p. 3 of 4)

(continued)

If you previously believed that . . . Possible self- statements may be . . .

something that makes you uncomfortable,

you can use that person’s reaction to your

request to help you decide if the person is

going to be good for you to have in your life.

That is, if the person is apologetic and makes

a genuine effort to avoid making the same

mistake, then you might want to continue

getting to know this person. If the person is

insensitive to your request or belittles you in

some way, then you may want to get out of

this relationship. The important point about

esteem of others is like the point about trust

of others: You need time to get to know

people and form an opinion of them. It is

important that you adopt a view of others that

is balanced and allows for changes.

“People I expect to support me will always

let me down,” it will be important not to drop

relationships immediately, even if those you

expected support from let you down. Talk

to them about how you feel and what you

want from them. Use their reactions to your

request as a way of evaluating where you

want these relationships to go.

“People sometimes make mistakes. I will try

to ﬁnd out whether they understand it was

a mistake or whether it reﬂects a negative

pattern that will continue from that person.

At that point, I can end the relationship if it is

something I cannot accept.”

HANDOUT 9.7 (p. 4 of 4)

Session 11: Review of Esteem and Introducing

Intimacy

Practice Assignment:

Read the Intimacy Issues Module (Handout 10.1), and use

Challenging Beliefs Worksheets (Handout 8.1) to confront Stuck

Points about intimacy related to yourself or others. Continue

completing worksheets on previous topics that are still

problematic, and/or any concerns you have about the ending of

treatment.

Continue to practice doing nice/worthwhile things for yourself, and

giving and receiving compliments.

Finally, please write at least one page on what you think now

about why your traumatic event(s) occurred. Also, consider what

you believe now about yourself, others, and the world in the

following areas: safety, trust, power/control, esteem, and intimacy.

Session 11 Handouts:

8.1: Challenging Beliefs Worksheet (6 copies included)

10.1: Intimacy Issues Module

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 8.1

Challenging Beliefs Worksheet

Date: Client:

A. Situation B. Thought/Stuck Point D. Challenging Thoughts E. Problematic Patterns F. Alternative Thought(s)

Describe the

event, thought,

or belief

leading to the

unpleasant

emotion(s).

Write thought/Stuck Point

related to situation in section A.

Rate your belief in this thought/

Stuck Point from 0 to 100%.

(How much do you believe this

thought?)

Use Challenging Questions to examine your

automatic thought from section B. Consider

whether the thought is balanced and factual, or

extreme.

Use the Patterns of

Problematic Thinking

Worksheet to decide whether

this is one of your problematic

patterns of thinking.

What else can I say instead of

the thought in section B? How

else can I interpret the event

instead of this thought? Rate

your belief in the alternative

thought(s) from 0 to 100%.

Evidence for?

Evidence against?

Habit or fact?

Not including all information?

All-or-none?

Extreme or exaggerated?

Focused on just one piece?

Source dependable?

Confusing possible with likely?

Based on feelings or facts?

Focused on unrelated parts?

Jumping to conclusions:

Exaggerating or minimizing:

Ignoring important parts:

Oversimplifying:

Overgeneralizing:

Mind reading:

Emotional reasoning:

G. Re-Rate Old Thought/

Stuck Point

Re-rate how much you now

believe the thought/Stuck Point

in section B, from 0 to 100%.

C. Emotion(s)

Specify your emotion(s) (sad,

angry, etc.), and rate how

strongly you feel each emotion

from 0 to 100%.

H. Emotion(s)

Now what do you feel? Rate it

from 0 to 100%.

photocopy this handout is granted to purchasers of this book for personal use or for use with individual clients (see copyright page for details).

HANDOUT 10.1

Intimacy Issues Module

Intimacy Beliefs Related to SELF: Beliefs that you can take care of your own emotional needs.

An important part of healthy living is the ability to soothe and calm oneself. Part of self- intimacy

is the ability to be alone without feeling lonely or empty.

PRIOR EXPERIENCE

Negative Positive

If you had prior experiences (or poor role

models) that led you to believe that you are

unable to cope with negative life events, you

may have reacted to the traumatic event with

negative thoughts suggesting that you were

unable to soothe, comfort, or nurture yourself.

If you previously had healthy, positive self-

intimacy, you may be able to cope with a

traumatic event because of the ability to use

internal coping strategies. However, some

traumatic events can create conﬂict; you may

begin to doubt your ability to take care of your

needs.

Symptoms Associated with Negative Intimacy Beliefs about the Self

• Inability to comfort and soothe the self

• Fear of being alone

• Experience of inner emptiness or deadness

• Periods of great anxiety or panic if reminded of trauma when alone

• Possibly looking to external sources of comfort— overeating, alcohol

or other substance use, spending money, self-harm behaviors, or sex

• Needy or demanding relationships

Examples of Possible Stuck Points

“If I get emotional, I will be out of control.”

“I can’t tolerate being alone.”

“I can’t handle my trauma symptoms by myself.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . A possible alternative thought may be . . .

“I can take care of myself, and other people’s

actions do not affect me,” the traumatic event

may have shaken this belief. It will be helpful

for you to remember the ways that you have

taken care of meeting your needs in the past,

“I will not suffer forever. I can soothe myself

and use the skills I have learned to cope with

these painful feelings. I may need help in

dealing with my reactions, but that is normal.”

“The skills and abilities I am developing now

(continued)

From Cognitive Processing Therapy for PTSD: A Comprehensive Manual by Patricia A. Resick, Candice M. Monson, and Kath-

book for personal use or for use with individual clients (see copyright page for details).

If you previously believed that . . . A possible alternative thought may be . . .

and how you were able not to make other

people’s crises your own. In addition,

understanding the typical reactions to trauma

may help you feel less panicky about what

you are experiencing. When some people

have a difﬁcult time making themselves feel

better, they may turn to unhealthy behaviors

(substance abuse, overeating, gambling,

etc.) that only mask the symptoms instead of

helping with recovery. The painful thoughts

and feelings do not go away, however, and

these persons then have to deal with the

consequences of the unhealthy behaviors,

which usually compound the problems.

will help me to cope better with other stressful

situations in the future.”

“I cannot take care of myself; I must have

other people to help me,” the traumatic event

may have reinforced this belief. You may

have become convinced that you do not have

any skills to help yourself or make yourself

feel better. It will help for you to begin to

identify the small ways that you take care

of yourself every day and to build on these

small wins. It is good to have others in your

life that you can rely on, but there are times

when others are not available.

“Although it may be hard at ﬁrst, I can

develop skills for taking care of myself,

including practicing self-care by doing things

that I enjoy doing.”

“It is healthy to ask others for help when

I need it, but people are not always free

immediately, and I can learn to take care of

myself until they are available.”

Intimacy Beliefs Related to OTHERS: Beliefs that you are capable of making different types

of emotional connections with others. The desire for closeness is one of the most basic human

needs. Intimate connections with others can be negatively affected by traumatic events or dam-

aged by insensitive, hurtful, or unempathic responses from others.

PRIOR EXPERIENCE

Negative Positive

Negative beliefs may have resulted from

traumatic loss of intimate connections. The

traumatic event may seem to conﬁrm your

belief in your inability to be close to another

person.

If you previously had satisfying intimate

relationships with others, you may ﬁnd that

the traumatic event (especially if it was an act

committed by someone you knew) left you

believing that you could never be close to

anyone again.

HANDOUT 10.1 (p. 2 of 4)

(continued)

Posttraumatic Experience

You may also have experienced a disruption in your belief about your ability to be intimate

with others if you were blamed or rejected by persons you thought would be supportive.

Symptoms Associated with Negative Esteem Beliefs about Others

• Pervasive loneliness

• Emptiness or isolation

• Failure to experience connectedness with others, even

in relationships that are genuinely loving and intimate

Examples of Possible Stuck Points

“If I get close to someone, I will get hurt.”

“All anyone ever wants is sex.”

“I will always be taken advantage of in relationships.”

POSSIBLE RESOLUTIONS

If you previously believed that . . . Possible self- statements may be . . .

“I can depend on others and feel close and

connected to them,” the traumatic event may

have had negative effects on your ability to

feel intimate with others. It will be important

for you to regain healthy beliefs about your

ability to become close to others. To have

intimate relationships with others again,

you may need to adopt new, more adaptive

beliefs about intimacy. Intimate relationships

take time to develop and effort from both

people. You are not solely responsible for

the failure of prior or future relationships. The

development of relationships involves risk

taking, and it is possible that you may be hurt

again. Staying away from relationships for

this reason alone, however, is likely to leave

you feeling empty and alone.

“Even though a past relationship did not

work out, it does not mean that I cannot have

satisfying intimate relationships in the future.

Not everyone will betray me. I will need to

take risks in developing relationships in the

future, but if I take it slowly, I will have a better

chance of telling whether this person can be

trusted.”

“I cannot be close to others, and everyone

will hurt me,” the trauma may have reinforced

this belief. It will be important for you to

begin slowly taking chances with some other

people, and to learn that you can not only

trust them but can also be intimate with them.

If there are people who let you down or hurt

you with their response after the event, you

can attempt to improve your relationships

with them by telling them what you need and

“I can still be close to people, but I may not

be able (or may not want) to be intimate with

everyone I meet. I may lose prior or future

intimate relationships with others who cannot

meet me halfway, but this is not my fault or

due to the fact that I did not try.”

HANDOUT 10.1 (p. 3 of 4)

(continued)

If you previously believed that . . . Possible self- statements may be . . .

letting them know how you feel about what

they said or did. If they are unable to adjust

to your requests and are unable to give you

what you need, you may decide that you

can no longer be close to those people. You

may ﬁnd, however, that they responded as

they did out of ignorance or fear. If you talk

to them about this, your relationships with

them may improve, and you may end up

feeling closer to them than you did before the

traumatic event.

Remember, many people need the support of

others to recover from a traumatic event.

HANDOUT 10.1 (p. 4 of 4)