George Samuels, MA, MSW, BCD
   

OFTEN USED FORMS AND WORKSHEETS
These forms and worksheets are intended only for the use of current clients to help in the
completion of thoroughly explained, understood and agreed upon homework.
                                                                                  

OCD LOG

DATE & TIME              

SITUATION/TRIGGER                            

THOUGHT                                                                          


BEHAVIOR                                                                                    


OCD SUD



EXPOSURE RESPONSE PREVENTION LOG

DATE & TIME

ERP CONDITIONS



START SUD
END SUD

COMMENTS



PROBLEM WORKSHEET


Problem definition


Desired outcome


Options (brain storm)



Evaluate options (achieve desired out, doable, other implications, etc.)


Choose and test

Repeat/reward






EXPOSURE HOMEWORK



Date:

Situation:


What is the worst thing that could happen in this situation?


What is the likelihood that this could happen?


What is the evidence for or against the likelihood of this happening?



EXPOSURE:

        Time                    SUD

Before    _______                _______


After        _______                _______


Comments:




BEHAVIOR RECORD


SITUATION 
Describe actual event leading to problem behavior:


BEHAVIOR
Describe what you actually did:


CONSEQUENCES
Describe the actual consequences:


ALTERNATIVE BEHAVIOR
Describe a more desirable behavior:                   


CONSEQUENCES
Describe the expected consequences of the alternative behavior:











 










 
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