1 – No
2 – Yes : Not at all distressing
3 – Yes : Somewhat distressing
4 – Yes : Moderately distressing
5 – Yes : Highly distressing
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1
2
3
4
5
1
Do you hold this belief? How distressing is this belief?
I believe I am a failure.
2
I believe I am unlovable.
3
I believe others will hurt, humiliate, or manipulate me.
4
I believe I do not deserve to be happy.
5
I believe loving someone means that I need to admire and idealize them.
6
I believe I deserve to be mistreated.
7
I believe others' needs are far more important than my own.
8
I believe disagreeing with others will result in rejection or angry reactions toward me.
9
I believe I should be just like parents or loved ones in order to avoid hurting them.
10
I believe pursuing my own interests and goals means I am selfish or uncaring.
11
I believe my desire for emotional support and nurturance will not be met by others.
12
I believe I deserve to be punished.
13
I believe I cannot rely on others to maintain a stable, strong attachment.
14
I believe others will be attentive or affectionate only when I am suffering.
15
I believe I am responsible for the feelings or behaviors of others.
16
I believe others are emotionally unreliable and rejecting.
17
I believe I overwhelm others with my feelings, needs, and/or behaviors.
18
I believe I should never challenge others or assert my own point of view.
19
I believe I am a deeply flawed or damaged person.
20
I believe I am unworthy and deserve very little in life.
21
I believe I need to be cautious in expressing loving feelings or being close to others.