Feared Stimulus: __________________________________________________________ Date: ____________________________________________________________________ Time: ____________________________________________________________________ Anxiety Level (0-10): ________________________________________________________ Date: ______________________________________________________________________ Time: _____________________________________________________________________ Anxiety Level (0-10): _________________________________________________________ Date: _____________________________________________________________________ Time: _____________________________________________________________________ Anxiety Level (0-10): _________________________________________________________ Date: ____________________________________________________________________ Time: ___________________________________________________________________ Anxiety Level (0-10): ________________________________________________________ Date: ____________________________________________________________________ Time: ____________________________________________________________________ Anxiety Level (0-10): _________________________________________________________ Observations:_________________________________________________________________________________________________________________________________________ Challenges to Avoidance Behaviors:___________________________________________________________________________________________________________________________________________ Reflections:_____________________________________________________________________________________________________________________________________________________________________________________________________________________ |
Holdaway, C., & Connolly, N. (2004). Getting Through it with CBT: A Young Person's Guide to Cognitive Behavioural Therapy (CBT). Blue Stallion Publications.
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