Penn State Worry Questionnaire
Please take a moment to complete this questionnaire.
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I prefer to respond anonymously:

1. Situation / Trigger – What triggered the problem; this could be an external event, a memory, image, feeling or sensation?
2. Initial Response - when this happens, how do I feel emotionally and physically; what do I do?
3. Intensity of Reaction

4. Negative Automatic Thoughts – What unhelpful thoughts, assumptions or beliefs go through my mind; rate the strength of each thought 0-100% and identify the “Hot Thought”.
5. Supporting Evidence / Benefits - What tangible facts / benefits support the hot thought?
6. Opposing Evidence / Costs - What tangible facts / benefits oppose the hot thought?
7. Cognitive Distortions – Which of the following thinking errors apply?

8. Alternative Response – How does changing my interpretation in this way, help to alter my initial response?
9. New Coping Strategies – What steps can I take to pre-empt the problem and improve the way I respond in future?
10. Having completed this exercise, how do I feel emotionally and physically; what will I do?
11. Re-rate reaction. How strong does the reaction feel now?