Cognitive Behavioral Therapy Worksheet for Stefan

Patient Summary

• Name: Stefan
• Age: 55-64
• Current Status: Divorced; remarried for 10 years
• Main Issue: Threats from ex-wife against current wife; fear of violence
• Therapy Experience: Brief (1-5 sessions)
• Current Medication: None
• Behavioral Change Goal: No specific behavioral changes noted

Session Focus

The purpose of this worksheet is to help Stefan address his feelings of fear and anxiety related to the threats posed by his ex-wife and develop coping strategies.

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Section 1: Identifying Thoughts and Feelings

1.1 Current Thoughts

Please write down the thoughts you have regarding the situation with your ex-wife:

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1.2 Current Feelings

How does each thought make you feel? Use the feelings list below to assist you:

• Anxious
• Scared
• Angry
• Hopeless
• Victimized

Feelings associated with your thoughts:

1. Thought: ___

   • Feeling: ___

2. Thought: ___

   • Feeling: ___

3. Thought: ___

   • Feeling: ___

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Section 2: Cognitive Distortions

Assess whether you might be experiencing any cognitive distortions. Write "Yes" or "No" next to each distortion based on your current thoughts.

Common Cognitive Distortions

• All-or-Nothing Thinking: Do you see things in black-and-white terms? __
• Catastrophizing: Are you imagining the worst possible outcome? __
• Overgeneralization: Are you applying one situation to everything? __
• Personalization: Do you take responsibility for things that are not your fault? __

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Section 3: Challenging Negative Thoughts

3.1 Evidence For and Against

Choose one of your thoughts from Section 1.1 and examine the evidence for and against it.

Thought Selected: _____

Evidence For:

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2. ---

3. ---

Evidence Against:

1. ---

2. ---

3. ---

3.2 Alternative, Balanced Thought

Based on your evidence, develop a more balanced and realistic thought regarding the situation.

• Alternative Thought: ___

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Section 4: Emotional Regulation Strategies

4.1 Coping Strategies

List below some coping strategies that you can use when you start feeling anxious or scared.

1. Breathing Exercises: Take slow, deep breaths to calm down.
2. Grounding Techniques: Focus on your surroundings by naming 5 things you can see.
3. Talk to Someone You Trust: Share your feelings with a friend or family member.
4. Mindfulness Practice: Engage in a moment of mindfulness, focusing on the present.
5. Physical Activity: Go for a walk or do some exercise to release built-up tension.

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Section 5: Safety Planning

Given the threats to your wife, it's essential to have a safety plan. List steps you can take to ensure both your and your wife’s safety:

1. Contact Authorities: Keep communication open with the police.
2. Emergency Contacts: List people to call in case of an emergency.

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3. Safe Spaces: Identify places where you could go if you feel threatened.

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Section 6: Review and Reflection

At the end of each week, take a few moments to reflect on the following questions:

1. What coping strategies did you use? How effective were they?

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2. Did you encounter any thoughts that caused you distress? How did you address them?

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3. What are your goals for the upcoming week?

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Conclusion

Continue to use this worksheet as a tool for navigating your thoughts and feelings surrounding your current situation. Remember, it’s crucial to seek support from trusted individuals and continue communication with law enforcement regarding your ex-wife's threats. Focus on your well-being and the safety of your wife, and consider discussing further therapeutic approaches in your next session.