Health Anxiety Change Record
The purpose of this exercise is to identify and alter the negative thinking and behavioural patterns that maintain distress, interfere with key relationships and place limits on daily tasks and longer-term goals. Complete all sections of the exercise before submitting your results. You can respond anonymously, and no data will be retained from this assessment. If you choose to include your initials and an email address, your results will be automatically sent to the email address provided. Please check that the email address has been entered correctly before submitting this form. All client information is managed on a strictly confidential basis. Please Note: Whilst every effort is made to ensure that our system is securely encrypted, email is not a completely secure means of communication. Think CBT does not accept liability for loss or theft of personal data where any individual chooses to transmit or receive information via email.
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1. Trigger: What was the situation, image, feeling or intrusive thought that triggered the health worry?
2. Initial Reaction: What feelings and reactions did you notice?
3. Intensity of Reaction: How strong was the initial reaction?





4. Health Worry: What obsessional thoughts and worries went through your mind?
5. Which of the following health anxiety patterns are maintaining the problem?





6. Checking / Reassurance Seeking Behaviours: What did you do to deal with the health worry?
7. Effectiveness of Response: How effective is the checking / reassurance seeking behaviour?




8. Alternative Response: What helpful, workable and sustainable action can you take in response to the health worry? E.g. Mindfulness, Rationalising, Acceptance / Willingness, Defusion, Competing Response, Slow Motion Focus, Committed Action.
9. Making Room: What uncomfortable thoughts and feelings will you need to make room for to take the alternative response?
10. Values and Goals: How will this move you closer to your values and goals?