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Category 1
Category 2
Category 3
100

I can “Find the Trap Door” by giving myself a time out by

  • a.  Running away
  • b.  Sitting in the corner
  • c.  Leaving the situation and finding a quiet place to calm down
  • d.  Cutting a hole in the wall

C

100
  • When I need to “Find Someone to Talk to”, I would like that person to be
  • Mom/Dad/Grandparent/Aunt/Uncle/Cousin/Brother/Sister
  • Friend/Classmate/Neighbor/Church Member
  • Ms. Sullivan/Guidance Counselor/Teacher/Principal
  • Pet/Diary/Crisis Hotline
100
  • I can “Practice Healthy Habits” by
  • Eating right
  • Sleeping Right
  • ExercisingAll of the Above
200
  • I will “Express my Emotions” by          
  • Singing
  • Dancing
  • Drawing
  • Journaling
  • Your Choice
200
  • I will “Do Something Pleasurable” such as
  • Cutting the grass
  • Cleaning my room
  • Playing my game
  • Doing homework
  • Your Choice
200
  • Things that help me “Visualize and Pray” are
  • Practicing Mindfulness
  • Listening to calming music
  • Being in a quiet room 
  • Guided Imagery
  • Your Choice
300
  • I will “Do Something that Requires Concentration” so that I can take my mind off of the ________.
  • a.  Problem 
  • b.  Solution
  • c.  Prize
  • d.  Goal

A

300
  • “Practicing More Helpful Thinking” will help me manage
  • a.  Other people
  • b.  My thoughts, feelings, and behaviors
  • c.  The world
  • d.  Nothing

B

300
  • “Deep Breathing and Muscle Relaxation” will not help slow my body and mind down.
  • True
  • False

False

400
  • I can “Find Solutions” and have more positive _________if I manage my  ___________ to different _________.
  • a.  Events, Outcomes, Responses
  • b.  Outcomes, Responses, Events
  • c.  Responses, Events, Outcomes
  • d.  None of the Above

B

400
  • I will “Engage in Simple Repetitive Activities” such as _________ and __________ so that I give my ________ a break.
  • a.  Folding sheets, washing clothes, heart
  • b.  Folding towels, washing dishes, mind
  • c.  Folding paper, washing my feet, brain
  • d.  A, B, and C

D

400
  • It is important that I “Stay in the Present” so that I
  • a.  Get stuck in the past
  • b.  Get too stressed about the future
  • c.  Forget to focus and end up responding in a negative way
  • d. None of the Above

D