11. CBRT PRACTITIONER GROUP ONE - Session TWO - Participant TWO
The CBRT Relaxation Support Session should last for approximately 40 minutes.

You are not required to complete the CBRT Initial Response sheets when working in a group setting.

Please ask your participant to answer as many questions as they wish. (Some of the questions are marked as being optional.)

Their feedback as a case study is very valuable and much appreciated. It will support you in becoming a fully licensed CBRT Practitioner.

Practitioner FULL NAME *
Your answer
Date of Training *
Your answer
Place of Training *
Your answer
Participants’ name or initials *
Your answer
Session Two feedback - Please complete before 2nd CBRT session
Has the Participant experienced any changes since the first CBRT Relaxation Support Session? *
Required
If YES, please write a brief description here
Your answer
Health Statements - Please complete before 2nd CBRT Session
Please tick the appropriate box for your response.
Your Physical Health : *
Your Mental Health: *
Your Enjoyment of Life: *
Feeling Statements - Please complete before 2nd CBRT Session
Please tick the appropriate box for your response.
I've been feeling optimistic about the future. *
I've been feeling useful. *
I've been feeling relaxed. *
I've been dealing with problems well. *
I've been thinking clearly. *
I've been feeling close to other people. *
I've been able to make up my own mind about things. *
GAD - 7 Questionnaire - Please complete before 2nd CBRT Session
Over the last 2 weeks, how often have you been bothered by the following problems?
1.Feeling nervous, anxious or on edge *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
2. Not being able to stop or control worrying *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
3. Worrying too much about different things *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
4. Trouble relaxing *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
5. Being so restless that it is hard to sit still *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
6. Becoming easily annoyed or irritable *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
7. Feeling afraid as if something awful might happen *
0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.
Not at all
Nearly every day
User feedback - Please complete after 2nd CBRT Session
Please complete the following statements after the CBRT Relaxation Support Session.
The participant felt at ease with the CBRT Practitioner. *
Required
The CBRT Practitioner clearly explained the CBRT technique and what was going to happen. *
Required
The CBRT Practitioner completed the Initial Response Sheets. *
Required
The participant felt able to relax during the CBRT Relaxation Support Session *
Required
The participant became more aware of their breathing pattern. *
Required
The participant became more aware of their physical body. *
Required
The participant enjoyed using the Colour Breathing Disks as a focus. *
Required
The participant enjoyed using the Colour Breathing Affirmation Cards as a focus. *
Required
The participant enjoyed using the following Colour Breathing Disks the most: *
Required
The participant enjoyed using the following Colour Breathing Disks the least: *
Required
The participant feels more relaxed because of the CBRT Relaxation Support Session. *
Required
The participant would like to continue receiving CBRT Relaxation Support Sessions - as an individual. *
Required
The participant would like to continue receiving CBRT Relaxation Support Sessions - in a group setting. *
Required
The participant would like to be able to use their own CBRT kit at home. *
Required
The following three questions are for Practitioner use only:
These questions are for you to reflect on your performance during this case study.
As a Practitioner, did you encounter any problems? *
Based on the above feedback from the participant is there anything you would have changed or will do in your next session?
Your answer
Were any conditions helped by CBRT? Please describe briefly here: *
Based on the above feedback from the participant is there anything you would have changed or will do in your next session?
Your answer
Any additional feedback? *
Please describe briefly here:
Your answer
This CBRT Practitioner Case Study template is for use by CBRT Practitioners Use Only. ©Alison Bourne CBRT Healthcare Innovation Systems Ltd. All rights reserved 2018.
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