First Five Systems Form

First Form: Five Systems Approach

Your therapist could well use the 5 systems approach to help you understand what is affecting your moods and thoughts and behaviour. By keeping records between sessions, you will allow yourself a better understanding of how the 5 systems fit together. The following is a completed form as an example, and is followed by a blank form for you to fill in. Don’t worry if you get mixed up or aren’t sure whether you are right – you are just looking to make a start.

Trigger or Event	What was your mood or feelings?	What were your thoughts	How did you feel physically	What did you do or didn’t do
Television programme talking about depression	Depressed	If I watch this I will feel more depressed.	Physically sick	Turned the programme off and started drinking to feel better
Talking with a friend on the phone and she was saying that she was seeing a new boyfriend	Jealous, angry and depressed	She has her life sorted and how I will never meet anybody because I’m so depressed	Tired – its all wearing me down	Kept the conversation brief and made an excuse to come off the phone
Had to go shopping when there were a lot of couples out shopping	Depressed and jealous	Everyone seems to be in a relationship but me because no one wants a loser like me	Weary, its taking everything out of me	Cut short my shopping decided to do my shopping on line in future

First Form: Five Systems Approach

Trigger or Event

What was your mood or feelings?

What were your thoughts

How did you feel physically

What did you do or didn’t do