Depression Self-Assessment Worksheet

Use this worksheet to reflect on how often you’ve experienced common symptoms of depression over the past two weeks. For each statement, circle the number that best describes your experience:

Reflection Questions

1. Which symptom did you rate highest (most often)? Why do you think this area stood out for you?
   
   
   
   
   
   

2. Did any of your ratings surprise you? Describe what felt unexpected and why.
   
   
   
   
   
   

3. How have these symptoms affected your daily routines (work, sleep, relationships, self-care)?
   
   
   
   
   
   
   
   

4. Looking at your responses, what pattern or trigger do you notice that might contribute to these feelings?
   
   
   
   
   
   
   
   
   
   

5. What is one small step you could take this week to address one of these symptoms? Be specific.
   
   
   
   
   
   

Mindfulness Exercise Guide

Use this guide to lead a brief, focused breathing exercise. The goal is to anchor your attention in the present moment, calm your mind, and reduce stress.

Duration

• Approximately 5 minutes

Preparation

• Find a quiet, comfortable space.
• Sit upright in a chair or on the floor with your back straight but relaxed.
• Place your hands gently on your lap or knees.

Guided Breathing Steps

1. Begin with Grounding
   • Close or soften your eyes.
   • Take two slow, gentle breaths to settle in.

2. Anchor Your Attention
   • Inhale slowly through your nose for a count of four (1–2–3–4).
   • Notice the cool air entering your nostrils and filling your lungs.
   • Exhale slowly through your mouth for a count of four (1–2–3–4).
   • Feel the release of tension as you breathe out.

3. Continue the Cycle
   • Repeat the inhale–exhale cycle for 8–10 breaths.
   • If your mind wanders, gently guide your focus back to the sensation of your breath.

4. Body Scan (Optional)
   • After a few breaths, shift attention to your body:
   – Notice any areas of tightness or discomfort.
   – With each exhale, imagine sending breath to those areas and releasing tension.

5. Closing the Exercise
   • Take two final, deep breaths—inhale freshness, exhale stress.
   • Slowly open your eyes and take a moment to notice how you feel.

Reflection Questions

1. What sensations did you notice in your body as you breathed?
   
   
   
   
   
   

2. How did your mind respond when thoughts or distractions arose?
   
   
   
   
   
   

3. After completing the exercise, what changes do you observe in your mood or tension levels?
   
   
   
   
   
   

4. When might you use this breathing exercise in your daily routine? Be specific.
   
   
   
   
   
   

Cognitive Restructuring Worksheet

Use this worksheet to identify a negative automatic thought, examine the evidence, and create a more balanced alternative thought.

1. Describe a Recent Situation

What happened? (Where, when, who was involved?)

2. Automatic Thought

What immediate thought went through your mind in that situation?

3. Belief Rating for Automatic Thought

How much did you believe this thought at the time?
0 = Not at all 100 = Completely believed it

Belief: _______%

4. Evidence That Supports the Automatic Thought

List facts or observations that seem to confirm this thought:

5. Evidence That Does Not Support the Automatic Thought

List facts or observations that challenge or contradict this thought:

6. Balanced Alternative Thought

Based on the evidence above, write a more balanced or realistic thought:

7. Belief Rating for Balanced Thought

How much do you now believe this new thought?
0 = Not at all 100 = Completely believe it

Belief: _______%

8. Impact of the Balanced Thought

How might adopting this balanced thought influence your feelings or actions next time?

You can repeat these steps for another challenging thought to continue building your cognitive restructuring skills.

Self-Care Planning Template

Use this template to develop SMART self-care goals and map out supports, barriers, and action steps.

1. Areas of Focus

Identify three self-care domains you want to work on (e.g., physical health, emotional well-being, social connection).

1. Area 1: ________________________________
   
   
   
2. Area 2: ________________________________
   
   
   
3. Area 3: ________________________________
   
   
   
   

2. SMART Goal 1

• Specific (What exactly will you do?): ________________________________
  
  
• Measurable (How will you know you’ve succeeded?): _____________________
  
  
• Achievable (Is this realistic for you?): ______________________________
  
  
• Relevant (Why is this important to your well-being?): ________________
  
  
• Time-Bound (By when will you complete this?): ________________________
  
  
  

3. SMART Goal 2 (Optional)

• Specific: ________________________________
  
  
• Measurable: ______________________________
  
  
• Achievable: ______________________________
  
  
• Relevant: ________________________________
  
  
• Time-Bound: ______________________________
  
  
  

4. Support & Resources

List people, tools, or materials you can use to help reach your goals.

• Resource 1: _____________________________
  
  
  
• Resource 2: _____________________________
  
  
  
• Resource 3: _____________________________
  
  
  

5. Potential Barriers & Solutions

Identify obstacles and plan how to address them.

Barrier 1: ________________________________

Solution: __________________________________

Barrier 2: ________________________________

Solution: __________________________________

6. Action Steps & Timeline

Break your main goal into smaller steps.

Step 1: __________________ by _____________


Step 2: __________________ by _____________


Step 3: __________________ by _____________

7. Tracking & Reflection

How will you monitor progress? What will you do if you need to adjust?

______________________________________________________

Facilitator Script: Finding Light Session

Total Time: 30 minutes
Materials: Depression Self-Assessment Worksheet, Mindfulness Exercise Guide, Cognitive Restructuring Worksheet, Self-Care Planning Template, Timer or Clock

1. Introduction & Self-Assessment (5 minutes)

Facilitator: "Hello and welcome. Today, our goal is to explore practical strategies you can use to manage feelings of depression and build resilience. Over the next 30 minutes, we’ll complete a self-assessment, try a couple of coping techniques, and create a personalized self-care plan."

Facilitator: "To begin, please complete the Depression Self-Assessment Worksheet. This helps us pinpoint which symptoms are most prominent for you right now."

Facilitator: "You have five minutes—be as honest as possible. There are rating items and reflection questions at the bottom."

Start timer. At 2½ minutes: “You have about two and a half minutes left.”
At 1 minute: “One minute remaining.”
Stop at 5 minutes.

2. Discuss Assessment Results (5 minutes)

Facilitator: "Thank you for finishing. Let’s review your responses together. Which symptom did you rate highest?"

Pause for response.

Facilitator: "What do you think made that area stand out for you?"

Pause.
Follow-up if needed: "Can you describe how that shows up in your daily life?"

Facilitator: "Did any of your other ratings surprise you? What felt unexpected?"

Pause.

Facilitator: "It’s completely normal to discover patterns we didn’t anticipate. Thank you for sharing your reflections."

3. Practice Coping Strategies (10 minutes)

3.1 Mindfulness Exercise (5 minutes)

Facilitator: "Next, let’s try a brief mindfulness exercise from the Mindfulness Exercise Guide. This will help ground you in the present moment."

Facilitator: "Please sit comfortably with your back upright and feet flat on the floor. Rest your hands gently in your lap."

Facilitator: "Close your eyes or soften your gaze. Take two slow, gentle breaths to settle in."

Facilitator: "Now inhale through your nose for a count of four—one, two, three, four. Feel your lungs expand. Exhale through your mouth for a count of four—one, two, three, four."

Facilitator: "Continue this cycle for eight more breaths. If your mind wanders, simply guide your attention back to your breath."

After eight breaths:
Facilitator: "Now take two final deep breaths—inhale freshness, exhale tension. When you’re ready, slowly open your eyes."

Facilitator: "What sensations did you notice in your body?"

Pause.
Facilitator: "How did you handle any distractions that arose?"

Pause.

3.2 Cognitive Restructuring (5 minutes)

Facilitator: "Our second strategy is cognitive restructuring. Please open the Cognitive Restructuring Worksheet."

Facilitator: "First, describe a recent situation that felt stressful or upsetting. Where and when did it happen, and who was involved?"

Pause.

Facilitator: "Next, write down the immediate thought that popped into your mind—your automatic thought."

Pause.

Facilitator: "On a scale from 0 to 100, how strongly did you believe that thought at the time?"

Pause.

Facilitator: "Now list the evidence that supports this thought."

Pause.

Facilitator: "Then list evidence that does not support it."

Pause.

Facilitator: "Based on the evidence, write a more balanced alternative thought."

Pause.

Facilitator: "On a scale from 0 to 100, how much do you now believe this new thought?"

Pause.

Facilitator: "How might adopting this balanced thought influence your feelings or actions next time?"

Pause.

4. Develop Personal Self-Care Plan (10 minutes)

Facilitator: "Finally, let’s create a self-care plan using the Self-Care Planning Template."

Facilitator: "First, identify three areas of focus—this might be physical health, emotional well-being, or social connection. Which three feel most important right now?"

Pause.

Facilitator: "Great. Now let’s set a SMART goal for your first area: What exactly will you do? How will you measure success? Is it realistic and relevant? By when will you complete it?"

Pause.

Facilitator: "Would you like to set a second SMART goal?"

Pause.

Facilitator: "Next, list the people or resources you can tap for support."

Pause.

Facilitator: "What barriers might come up, and how could you address them?"

Pause.

Facilitator: "Finally, break your main goal into smaller action steps with timelines."

Pause.

Facilitator: "Excellent work. You now have a personalized plan to support your well-being."

5. Conclusion (1–2 minutes)

Facilitator: "Thank you for your openness and effort today. You’ve completed a self-assessment, practiced two coping techniques, and developed a tailored self-care plan."

Facilitator: "Before we finish, do you have any questions or anything else you’d like to discuss?"

Pause.

Facilitator: "I encourage you to use these strategies regularly and revisit your plan often. You’ve taken key steps toward managing your mood and strengthening your resilience. Take care, and remember—you have these tools whenever you need them."
End of session.