EMDR Negative and Positive Cognitions: PDF Worksheet, Tools and Exercises

Asking a patient to identify their negative cognition verbally, mid-session, often stalls the work before bilateral stimulation even begins. Patients offer facts, descriptions of the perpetrator, or emotions rather than a self-referential belief in the present tense, and correcting them repeatedly erodes the alliance. This PDF worksheet provides a structured visual support to make the NC/PC distinction clear and precise before you ever pick up the tappers.

Why NC and PC Identification Breaks Down Without a Visual Support

The conceptual gap is not ignorance; it is domain confusion. Patients spontaneously generate event-level statements ("he was cruel"), emotion labels ("I felt terrified"), or past-tense descriptions ("I was helpless back then") when asked what the memory says about them now. Explaining the difference verbally is slow and tends to generate defensiveness or blank compliance.

The same difficulty appears with positive cognitions: patients either overshoot into grandiosity ("I am invincible") or negate rather than affirm ("I am not weak"), neither of which carries the adaptive loading the PC needs to do. For clinicians new to the protocol, or working with patients whose core beliefs are heavily entrenched, having every criterion visible on the page shortens that corrective loop considerably.

There is also a subtler problem: patients conflate the NC with a core belief that spans all domains, rather than identifying the specific self-belief glued to this memory. The fiche's domain structure addresses exactly that.

What the Fiche Contains: A Structured Visual Map of Beliefs

The fiche PDF organises the NC/PC framework across six clearly numbered panels, working from definition to application to troubleshooting.

• Panel 1 states the principle in a single sentence: "A hard memory carries a sentence about you... Naming that sentence is what lets it shift." This anchors the entire session in Shapiro's core rationale without requiring the clinician to re-explain the model from scratch.
• Panel 2 presents the NC-to-PC shift side by side, with paired examples ("I am in danger" → "I am safe now"), making the transformation visible rather than abstract.
• Panel 3 organises four belief domains (Responsibility, Safety, Control, Self-worth) with prototypical NC and PC examples for each, so patients can scan for a somatic click rather than construct a belief from nothing.
• Panel 4 specifies the formal criteria for a well-formed NC (self-referential, present tense, generalised, belief not fact) and a well-formed PC (same domain, positively phrased, believable, growth-oriented), criteria that are straightforward to apply when they appear on the page rather than recited aloud.
• Panel 5 offers worked NC/PC pairings domain by domain, useful when a patient's belief is partially formed and needs calibration.
• Panel 6 names four common traps: the opposite extreme, negation, attribution to the other person, and fact dressed as belief. Pointing to these during session normalises the error without pathologising the patient's attempt.

A final "To discuss in session" block prompts disclosure of three specific situations: when no cognition surfaces, when the same NC recurs across many memories, and when the PC rates very low on the 1-7 Validity of Cognition scale. This panel functions as a debriefing guide embedded in the resource itself.

> Key takeaway: The fiche is a visual psychoeducation support to be used with the patient in session, not a self-administered questionnaire. It allows you to point, compare, and anchor shared clinical vocabulary without interrupting the session's momentum.

When and How to Introduce This Worksheet

The optimal moment is during EMDR preparation phase (Phase 2), once the patient has a working understanding of the model but before processing begins. For patients with complex PTSD or high alexithymia, introducing it a session earlier, alongside a psychoeducation on common trauma reactions, reduces cognitive load when the target memory is accessed.

A low-pressure introduction: "Before we start working with the memory itself, I'd like to show you a short reference sheet. It maps out the kinds of beliefs that tend to get attached to difficult memories, we'll use it together to find the one that fits yours."

During the belief-identification phase, direct the patient to the domain grid (Panel 3) rather than asking an open question. Many patients immediately recognise the NC domain somatically, the fiche describes this accurately: "a sigh, a tightness, a quiet 'yes, that one'." That body signal is clinically significant and worth naming explicitly.

For debriefing: revisit the PC after processing to check whether the patient's felt sense has shifted toward the chosen belief. If the PC now rates higher on the VoC, the fiche becomes a concrete marker of change the patient can take home. If it does not, the domain analysis often reveals a mismatch worth exploring, and resources like the downward arrow technique or a guided core belief clarification exercise can support the next step.

For patients who require further belief-level work between EMDR sessions, pairing the fiche with structured exercises on tracing the origins of a negative belief or consolidating a positive alternative extends the session work without overloading the therapeutic frame. The Ehlers and Clark PTSD model provides a useful parallel framework if you are also working within a TCC trauma protocol alongside EMDR. If automatic thoughts rather than trauma-level beliefs are the primary target, the cognitive distortions worksheet or restructuring a negative core belief may be better suited.

The fiche does not replace clinical judgment in belief selection; it reduces the verbal overhead so that judgment can be applied where it matters.

Sources

• Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
• Morgan, S. (2021). Inclusive Negative and Positive Cognitions and Emotions List. EMDR International Association (EMDRIA).
• Leeds, A. M. (2016). A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants (2nd ed.). Springer Publishing Company.