STAFF USE ONLY — DO NOT DISTRIBUTE TO PATIENTS
Purpose
Introduce the thought-feeling-action loop and have each patient map one real, low-stakes moment of their own onto it. Patients leave able to see that a thought sits between a moment and a reaction — the foundation every later cognitive skill builds on.
The Message (keep consistent)
- Thoughts, feelings, and actions pull on each other in a loop. The same moment lands differently depending on the thought attached to it.
- Today is noticing, not fixing. Seeing one loop clearly is the whole win; questioning the thought comes in later groups.
- Low-stakes moments are plenty. Nobody needs to bring their hardest material to make this work.
Your Delivery — Pick One or Bring Your Own
- Teach from the worksheet (suggested default). Walk the quick picture in the orientation box, read Denise's example together, then give quiet time for steps 1–5 and invite two or three volunteers to share just their loop's shape.
- Map it live. Take one volunteer's low-stakes moment and draw the loop on a whiteboard — moment, thought, feeling, action — letting the group call out where each piece goes, then send everyone to the worksheet.
- Same moment, two thoughts. Offer one neutral moment (an unanswered knock, a canceled visit) and have the group generate two different thoughts and trace how each plays out, then work their own on the sheet.
These are options, not a script — teach it your way, as long as the message lands.
Framework Notes for the Facilitator
- This sheet draws on the CBT cognitive model (situation → thought → feeling → behavior). If you teach thought records, this is the front half of one — capture, not challenge.
- Keep interpretations invitational; a patient's label for their own thought or feeling is always accepted as offered. One topic-specific note: shame-flavored thoughts ("I've worn everyone out") often surface here — normalize without probing.
- This material supports — but does not replace — individualized assessment and treatment by the patient's care team.
Documentation — 4 Scenarios
Actively participated: "Patient participated in facilitator-led cognitive skills group. Patient mapped a personal situation onto the thought-feeling-action model and identified the connecting thought. Supports treatment goals of coping skills and self-awareness."
Participated minimally: "Patient attended facilitator-led cognitive skills group. Participated minimally; completed portions of the worksheet with prompting. Continued opportunities offered to support treatment goal of coping skills."
Present but disengaged: "Patient was present for facilitator-led cognitive skills group. Declined active participation but remained in group milieu. Staff encouraged engagement. Will continue to offer programming to support treatment goal of self-awareness."
Did not attend (alternative delivered): "Patient did not attend facilitator-led cognitive skills group. Alternative material hand-delivered with focus on noticing one thought-feeling-action loop. Patient [completed / partially completed / declined] independent reflection. Supports treatment goal of coping skills."
Hand-Delivery Note
Hand-deliver the alternative worksheet to anyone who missed group, with a brief check-in.