Cause and Effect Tracing Worksheet 2 of 4

1. Identify one adversarial (abuse, aggression, antagonism, bullying, hostility, humiliation, imminent danger, name-calling, shaming, threatening, unfriendly, violence, etc… ) or other dysfunctional behavior that was frequently expressed in your home and elsewhere during the first 20 years of your life.

If you are feeling emotional about your answer, do the following to help regulate your emotions. Take 2-3 deep breaths  Close your eyes and think about one person, place, or thing you are truly grateful for in your life. If you are still unable to continue with your answer, pause for a few minutes and choose another.

2. Who in your home or elsewhere expressed this adversarial and/or dysfunctional behavior? Select all that apply to this behavior.

3. Do you currently express and or experience this behavior with yourself or others on a daily, weekly, or monthly basis?

4. Do you have children or live with others who express this behavior more than once a day?

5. Which forms of media and entertainment exposed you to this adversarial dysfunctional behavior?

6. When and where do you notice yourself expressing this behavior?

Emotional Level

7. Enter a value from 0 to 100 on how the previous 6 questions make you feel now: 0 = no emotions   100 = Very emotional

8. If your answer to the previous scaling question is above 30, please write the corresponding question numbers and the words in this section that triggered emotional responses. (Example: Question 2, in the home, father, Question 3, behavior, daily, etc…) 

9. What insightful thoughts and discoveries would you like to add? Please use the space below or write and date additional information on separate paper, or in journal or notebook.

1. Identify one adversarial (abuse, aggression, antagonism, bullying, hostility, humiliation, imminent danger, name-calling, shaming, threatening, unfriendly, violence, etc… ) or other dysfunctional behavior that was frequently expressed in your home and elsewhere during the first 20 years of your life.

If you are feeling emotional about your answer, do the following to help regulate your emotions. Take 2-3 deep breaths  Close your eyes and think about one person, place, or thing you are truly grateful for in your life. If you are still unable to continue with your answer, pause for a few minutes and choose another.

2. Who in your home or elsewhere expressed some of this dysfunctional behavior? Select all that apply to this behavior.

3. Do you currently express and or experience this behavior from yourself or others on a daily, weekly, or monthly basis?

4. Do you have children or live with others who express this behavior more than once a day?

5. Which forms of media and entertainment exposed you to this adversarial dysfunctional behavior?

6. When and where do you notice yourself expressing this behavior?

Emotional Level

7. Enter a value from 0 to 100 on how the previous 6 questions make you feel now: 0 = no emotions   100 = Very emotional

8. If your answer to the previous scaling question is above 30, please write the corresponding question numbers and the words in this section that triggered emotional responses. (Example: Question 2, in the home, father, Question 3, behavior, daily, etc…)

9. If you have any insightful thoughts you would like to add, please use the space below or write and date them in a separate journal or notebook.

1. Identify one adversarial (abuse, aggression, antagonism, bullying, hostility, humiliation, imminent danger, name-calling, shaming, threatening, unfriendly, violence, etc… ) or other dysfunctional behavior that was frequently expressed in your home and elsewhere during the first 20 years of your life.

If you are feeling emotional about your answer, do the following to help regulate your emotions. Take 2-3 deep breaths  Close your eyes and think about one person, place, or thing you are truly grateful for in your life. If you are still unable to continue with your answer, pause for a few minutes and choose another.

2. Who in your home or elsewhere expressed some of this dysfunctional behavior?

3. Do you currently express and or experience this behavior from yourself or others on a daily, weekly, or monthly basis?

4. Do you have children or live with others who express this behavior more than once a day?

5. Which forms of media and entertainment exposed you to this adversarial dysfunctional behavior?

6. When and where do you notice yourself expressing this behavior?

Emotional Level

7. Enter a value from 0 to 100 on how the previous 6 questions make you feel now: 0 = no emotions   100 = Very emotional

8. If your answer to the previous scaling question is above 30, please write the corresponding question numbers and the words in this section that triggered emotional responses. (Example: Question 2, in the home, father, Question 3, behavior, daily, etc…)

9. If you have any insightful thoughts you would like to add, please use the space below or write and date them in a separate journal or notebook.

1. Identify one adversarial (abuse, aggression, antagonism, bullying, hostility, humiliation, imminent danger, name-calling, shaming, threatening, unfriendly, violence, etc… ) or other dysfunctional behavior that was frequently expressed in your home and elsewhere during the first 20 years of your life.

If you are feeling emotional about your answer, do the following to help regulate your emotions. Take 2-3 deep breaths  Close your eyes and think about one person, place, or thing you are truly grateful for in your life. If you are still unable to continue with your answer, pause for a few minutes and choose another.

2. Who in your home or elsewhere expressed some of this dysfunctional behavior?

3. Do you currently express and or experience this behavior from yourself or others on a daily, weekly, or monthly basis?

4. Do you have children or live with others who express this behavior more than once a day?

5. Which forms of media and entertainment exposed you to additional forms of this type of adversarial dysfunctional behavior?

6. When and where do you notice yourself expressing this behavior?

Emotional Level

7. Enter a value from 0 to 100 on how the previous 6 questions make you feel now: 0 = no emotions   100 = Very emotional

8. If your answer to the previous scaling question is above 30, please write the corresponding question numbers and the words in this section that triggered emotional responses. (Example: Question 2, in the home, father, Question 3, behavior, daily, etc…)

9. If you have any insightful thoughts you would like to add, please use the space below or write and date them in a separate journal or notebook.

1. Identify one adversarial (abuse, aggression, antagonism, bullying, hostility, humiliation, imminent danger, name-calling, shaming, threatening, unfriendly, violence, etc… ) or other dysfunctional behavior that was frequently expressed in your home and elsewhere during the first 20 years of your life.

If you are feeling emotional about your answer, do the following to help regulate your emotions. Take 2-3 deep breaths  Close your eyes and think about one person, place, or thing you are truly grateful for in your life. If you are still unable to continue with your answer, pause for a few minutes and choose another.

2. Who in your home or elsewhere expressed some of this dysfunctional behavior?

3. Do you currently express and or experience this behavior from yourself or others on a daily, weekly, or monthly basis?

4. Do you have children or live with others who express this behavior more than once a day?

5. Which forms of media and entertainment exposed you to additional forms of this type of adversarial dysfunctional behavior?

6. When and where do you notice yourself expressing this behavior?

Emotional Level

7. Enter a value from 0 to 100 on how the previous 6 questions make you feel now: 0 = no emotions   100 = Very emotional

8. If your answer to the previous scaling question is above 30, please write the corresponding question numbers and the words in this section that triggered emotional responses. (Example: Question 2, in the home, father, Question 3, behavior, daily, etc…)

9. If you have any insightful thoughts you would like to add, please use the space below or write and date them in a separate journal or notebook.

1. Identify one adversarial (abuse, aggression, antagonism, bullying, hostility, humiliation, imminent danger, name-calling, shaming, threatening, unfriendly, violence, etc… ) or other dysfunctional behavior that was frequently expressed in your home and elsewhere during the first 20 years of your life.

If you are feeling emotional about your answer, do the following to help regulate your emotions. Take 2-3 deep breaths  Close your eyes and think about one person, place, or thing you are truly grateful for in your life. If you are still unable to continue with your answer, pause for a few minutes and choose another.

2. Who in your home or elsewhere expressed some of this dysfunctional behavior?

3. Do you currently express and or experience this behavior from yourself or others on a daily, weekly, or monthly basis?

4. Do you have children or live with others who express this behavior more than once a day?

5. Which forms of media and entertainment exposed you to additional forms of this type of adversarial dysfunctional behavior?

6. When and where do you notice yourself expressing this behavior?

Emotional Level

7. Enter a value from 0 to 100 on how the previous 6 questions make you feel now: 0 = no emotions   100 = Very emotional

8. If your answer to the previous scaling question is above 30, please write the corresponding question numbers and the words in this section that triggered emotional responses. (Example: Question 2, in the home, father, Question 3, behavior, daily, etc…)

9. If you have any insightful thoughts you would like to add, please use the space below or write and date them in a separate journal or notebook.