Cognitive Behavioral Therapy (CBT) Worksheet

Patient Information:

• Age: Unknown
• Condition Summary:
  • F70 Mild Intellectual Disabilities
  • F43.25 Adjustment Disorder with Mixed Disturbance of Emotions and Conduct
• Main Condition: Grief/Loss
• Therapy Experience: Brief (1-5 sessions)
• Current Medication: None
• Needed Behavioral Change: No particular focus

---

Objectives of This Worksheet

• To help the patient understand their emotions related to grief and loss.
• To identify unhelpful thoughts and behaviors.
• To promote positive coping strategies.

Instructions

1. Reflect on your feelings and experiences related to grief and loss.
2. Identify specific thoughts, emotions, and behaviors you wish to change or understand better.
3. Apply coping strategies from this worksheet.

---

Section 1: Understanding Grief and Loss

Grief can manifest in various ways, such as:

• Sadness
• Anger
• Guilt
• Confusion

Reflection Questions:

1. What does grief feel like for you?

   • Write down emotions and physical sensations you experience.

   My emotions are: ___________
   My physical sensations include: ___________

2. Who or what have you lost?

   • Describe the person, pet, or situation that has led to your current feelings of grief.

   I have lost: ___________

---

Section 2: Identifying Thoughts and Behaviors

Common unhelpful thoughts associated with grief and loss include:

• "I should have done more."
• "I will never feel happy again."

Activity: Identify Your Thoughts

• Write down any negative or unhelpful thoughts you have related to your grief.

Thought 1: ___________________
Thought 2: ___________________
Thought 3: ___________________

Section 3: Challenging Unhelpful Thoughts

To challenge unhelpful thoughts:

• Ask yourself:
  • What evidence do I have that supports this thought?
  • What evidence do I have that contradicts this thought?
  • How would I advise a friend who had this thought?

Replace each unhelpful thought with a balanced thought:

• Example:
  • Unhelpful Thought: "I will never feel happy again."
  • Balanced Thought: "It's okay to feel sad; happiness can come back in time."

Balanced Thought 1: ___________________
Balanced Thought 2: ___________________
Balanced Thought 3: ___________________

---

Section 4: Coping Strategies

Positive Coping Strategies:

1. Talk to someone you trust about your feelings.
2. Engage in a hobby that brings you joy (drawing, crafting, etc.).
3. Practice mindfulness or relaxation techniques (deep breathing, meditation).

Choose a coping strategy to try this week:

I will try: ___________________ 

---

Section 5: Setting Goals for Behavioral Change

Create a small, achievable goal related to coping with your grief:

Goal 1: ___________________
Goal 2: ___________________

Plan how you will achieve these goals:

To achieve my goal(s), I will: ___________________

---

Section 6: Reflection

At the end of the week, reflect on your progress:

• How did you feel after trying your chosen coping strategy?

I felt: ___________________

• Did you accomplish your goals? Why or why not?

I accomplished my goal(s): Yes / No
Why: ___________________

---

Final Notes

• Grieving is a process and takes time. Allow yourself to feel your emotions.
• If you need additional support, consider reaching out to a therapist or counselor.

Keep this worksheet for future sessions and updates to track your progress.