aidemia--modules-cbt_worksheet_request	Create a Cognitive Behavioral Therapy worksheet for a patient dealing with mentioned issue(s) and aiming for behavioral changes. Take into account the details listed further.
Full name	Rachelle Connors
Age	25-34
Patient condition details	Recent break up
Patient condition	Relationship Issues
Relevant challenges	Nothing in particular
Therapy experience	Brief (1-5 sessions)
Medication	Antidepressants
Needed behavioural change	No particular
How many pages	1
Emergency contact
Any other preferences

Cognitive Behavioral Therapy Worksheet for Rachelle Connors

Patient Information

• Name: Rachelle Connors
• Age: 25-34
• Therapy Experience: Brief (1-5 sessions)
• Current Medication: Antidepressants
• Main Condition: Relationship Issues
• Recent Challenge: Recent break-up

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Introduction

This worksheet is designed for Rachelle Connors to facilitate self-reflection and identify patterns in her thoughts and behaviors following her recent break-up. The goal is to promote awareness, challenge negative thoughts, and foster behavioral changes that contribute to emotional well-being.

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Section 1: Identifying Thoughts and Feelings

A. Current Emotional State

Please list your current feelings:

• [ ] Sad
• [ ] Angry
• [ ] Confused
• [ ] Relieved
• [ ] Lonely
• [ ] Hopeful

Other feelings: ___

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B. Automatic Thoughts

Identify the automatic thoughts you have when thinking about your recent break-up. Use the table below:

Situation	Automatic Thought	Emotion	Rate Intensity (1-10)
Thinking about the break-up	___	__	__
Seeing a couple together	___	__	__
Hearing a song that reminds you	___	__	__

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Section 2: Challenging Negative Thoughts

A. Cognitive Distortions

Identify any cognitive distortions in your automatic thoughts (e.g., catastrophizing, all-or-nothing thinking):

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B. Evidence Gathering

For each automatic thought, list evidence supporting and contradicting it.

Automatic Thought	Evidence Supporting	Evidence Contradicting
___	___	___
___	___	___

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Section 3: Behavior Activation

A. Setting Goals

Identify one small, attainable goal to work on in the coming week:

• ---

B. Action Steps

List the steps you will take to achieve this goal:

1. ---

2. ---

3. ---

4. ---

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Section 4: Coping Strategies

A. Healthy Coping Mechanisms

List healthy activities you can engage in when feeling down or stressed:

• Exercise (e.g., running, yoga)
• Socializing with friends
• Practicing mindfulness or meditation
• Engaging in a hobby (e.g., painting, reading)
• Journaling thoughts and feelings

B. Self-Care Plan

Create a self-care plan that includes daily or weekly activities to support your emotional well-being:

Activity	Frequency	Date & Time
____	___	___
____	___	___
____	___	___

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Section 5: Reflection and Next Steps

A. Reflecting on Progress

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

• What went well?

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• What challenges did you face?

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B. Next Therapy Session Preparation

What topics would you like to discuss in your next therapy session?

• ---

• ---

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Conclusion

Completing this worksheet is an essential step in understanding the impact of your thoughts and feelings regarding your recent break-up. By becoming aware of these patterns, you are on your way to implementing positive change and coping more effectively. Remember to bring this worksheet to your next therapy session for further discussion.