Form: Cognition Checklist, CCL

1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Always
¹
1
2
3
4
5
1
I am a social failure.
2
I will never be good as other people are.
3
People don't respect me anymore.
4
No one cares whether I live or die.
5
I'm worse off than they are.
6
I don't deserve to be loved.
7
I've lost the only friends I've had.
8
I'm not worthy of people's attention or affection.
9
There's no one left to help me.
10
What if I get sick and become an invalid?
11
Something might be happening that will ruin my appearance.
12
I am going to be injured.
13
What if no one reaches me in time to help?
14
I'm going to have an accident.
15
I might be trapped.
16
I am not a healthy person.
17
There's something very wrong with me.
18
Life isn't worth living.
19
I'm worthless.
20
I have become physically unattractive.
21
I will never overcome my problems.
22
Something awful is going to happen.
23
I'm going to have a heart attack.
24
I'm losing my mind.
25
Something will happen to someone I care about.
26
Nothing ever works out for me anymore.

The presented answer sheet is not an original form and is not intended for printing or use as a handout.

The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.