Vicious cycle, problem statement, setting targets & building motivation to change worksheet pack

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My vicious cycle In the circles on the diagram make a note of the your thoughts, physical feelings and altered behaviours (the things you are doing more of, or less of since feeling this way). These symptoms can have a knock on effect with each other and keep you in a vicious cycle that maintains how you are feeling. The good news is that breaking into one of these areas using an evidence based treatment designed to target it, will help to reverse the cycle and help to improve how you are feeling.

My altered physical symptoms

My altered behaviours

My altered thoughts

©2017-2021. 4th edition. M. Chellingsworth. The CBT Resource® www.thecbtresource.co.uk

My problem statement (how things are now)

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A problem statement is a short summary of how things are for you right now. It is a baseline to measure your progress against. It also helps you to set targets for what you want to work on during treatment. It has examples of the symptoms you are experiencing and their impact. Once your problem statement has been written it can be reviewed regularly to see if the symptoms you had at the start of treatment are improving or make any changes that may be needed if they are not.

What the main problem is (for example

feeling down, panicky, anxious or worried)

What triggers it (what

brings on your symptoms on a day to basis)

Examples of your physical symptoms, changes in what you are doing as a result and your thinking

What consequence the problem is having on your life (for example

relationships, social life, finances)

Example: My main problem is feeling depressed most of the day, every day.

I feel tired and am waking up early and struggle to get back to sleep. My appetite is poor and I struggle to concentrate. I have stopped seeing friends, reading, going to work or doing things around the home. I am spending more time in bed. I have negative thoughts that I am letting my family down and that I can’t be bothered to do anything. As a consequence I am isolated and being off sick means I have used up most of my savings so money is tight and I am missing payments.

Now write your own problem statement in the space below ensuring that you cover all the elements above:

My main problem is.....

©2017-2021. 4th edition. M. Chellingsworth. The CBT Resource® www.thecbtresource.co.uk

How would I know my symptoms have improved?

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The problem statement is a baseline. It is how things are now, not how they will always be. Imagine for a moment into the future. The symptoms in your problem statement and their impact on your life has all improved, the vicious cycle has been broken. What would life be like? Answer the questions below and think how things would be different for you and what you would be doing as a result. It can help to think of things you may be doing less (or more) of as a result of your symptoms, people you are not seeing or things you are avoiding that you would like to do again.

What would tell you that you are feeling better? What would you notice?

(E.g. I would be having fewer panic attacks, or I would be sleeping through the night)

Where would you be going during the week or at weekends then?

(E.g. I would be able to go to the supermarket by myself without safety behaviours or getting panicked, or I be able to focus on a task without ruminating)

What would you be doing or not doing then?

(E.g. I would be able to do the weekly shop for myself or I would be doing the housework every Saturday)

Who would you be spending your time with?

(E.g. I would be able to take the children to the cinema or be able to go on a flight for a family holiday at Christmas)

©2017-2021. 4th edition. M. Chellingsworth. The CBT Resource® www.thecbtresource.co.uk

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My targets for treatment If the things that you have identified by thinking about what you will be doing when your symptoms improve and what life will be like are targets you would like to work towards in treatment you can create goals from them below:

Target 1 Things I can do towards this goal in the next couple of weeks:

Things that I can do towards this goal in the next month:

Longer term things I can do to work towards this goal over the next six months or so:

Target 2 Things I can do towards this goal in the next couple of weeks:

Things that I can do towards this goal in the next month:

Longer term things I can do to work towards this goal over the next six months or so:

Target 3 Things I can do towards this goal in the next couple of weeks:

Things that I can do towards this goal in the next month:

Longer term things I can do to work towards this goal over the next six months or so:

©2017-2021. 4th edition. M. Chellingsworth. The CBT Resource® www.thecbtresource.co.uk

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Building motivation to change Thinking about the problem and beginning to work on the targets that you have set on a 0-100 scale rate:

How much impact does the problem have on my life currently?

0

50 100 not at all

affects everything

How important is it for me to reach my targets?

0

50 100 not at all

totally important

How willing am I to set aside some time each day to getting better?

0

50 100 not at all

totally willing How much of a priority is getting better for me at the moment?

0

50 100 not at all

complete priority

If you are struggling with your motivation because of how you are currently feeling; or because of what treatment may involve, some people find it helpful to complete the following activity of writing yourself two versions of a letter to you now from your future self: Letter 1: Write a letter to yourself. It’s five years into the future and you haven’t set aside the time to get better or improve your symptoms. You haven’t met the targets you wanted to reach. What would life be like? What would you be doing? Where would you be going? What would you want to say to your self now? Try and visualise what life is like and then write it down as a letter to you from your future self.

Letter 2: Next, write another short letter to yourself. It’s five years in the future and you have made the changes to break the vicious cycle and feel better. How pleased are you? What changes has it opened up in your life? What would you be doing? Where would you be going as a result?

What would that future version of yourself want to say to you now? Try and visualise what life is like and write it down as a letter to you from your alternative future self.

Which version of your future self is more appealing? Which letter do you want to receive more?

Once you have written the two letters and reflected, see if you feel more ready to focus on taking action to make the changes and reach your targets, if not, speak to your therapist or practitioner for more help with this. ©2017-2021. 4th edition. M. Chellingsworth. The CBT Resource® www.thecbtresource.co.uk