Automatic Thoughts Questionnaire (ATQ-B)

Abstract

The Automatic Thoughts Questionnaire (ATQ), and its believability-extended variant the Automatic Thoughts Questionnaire-Belief (ATQ-B), is one of the most widely used psychometric instruments in clinical psychology, cognitive neuroscience, and psychiatry for assessing the frequency and subjective believability of negative automatic thoughts associated with major depressive disorder. Developed by Steven D. Hollon and Philip C. Kendall in 1980, the instrument operationalizes core tenets of Aaron T. Beck’s cognitive theory of depression, specifically the manifestation of repetitive, involuntary, negative self-statements. The standard scale comprises 30 self-referential items rated along a 5-point Likert frequency dimension ranging from 1 (“not at all”) to 5 (“all the time”), yielding a global frequency score from 30 to 150. In the ATQ-B format, respondents simultaneously rate the degree of conviction or subjective belief in each statement when it occurs, from 1 (“not at all”) to 5 (“totally”), capturing cognitive fusion and conviction independently of temporal recurrence.

Extensive psychometric investigations have affirmed the scale’s robust statistical architecture. The original validation identified four primary factors: Personal Maladjustment and Desire for Change (PMDC), Negative Self-Concepts and Negative Expectations (NSNE), Low Self-Esteem (LSE), and Helplessness. The instrument demonstrates high internal consistency, with Cronbach’s alpha coefficients consistently reported between .95 and .97 across diverse clinical, non-clinical, and cross-cultural cohorts. Concurrent and construct validity are supported by strong positive correlations with standardized depression inventories, including the Beck Depression Inventory (BDI) and the Minnesota Multiphasic Personality Inventory (MMPI) Depression scale. Moreover, the ATQ possesses discriminant validity, effectively distinguishing clinically depressed individuals from both non-depressed samples and patients presenting with pure anxiety disorders, conforming to the cognitive content-specificity hypothesis. This article provides a comprehensive academic analysis of the ATQ and ATQ-B, delineating its historical origin, latent psychometric structure, theoretical foundations, clinical diagnostic utility, and research applications.

Keywords

Automatic Thoughts Questionnaire, ATQ, ATQ-B, Cognitive Therapy, Aaron T. Beck, Depression Assessment, Cognitive Triad, Negative Self-Statements, Cognitive Fusion, Psychometrics

Authors

The Automatic Thoughts Questionnaire was conceived, developed, and empirically validated by two clinical psychologists:

• Steven D. Hollon, Ph.D.: Gertrude Conaway Vanderbilt Professor of Psychology at Vanderbilt University, Nashville, Tennessee. Dr. Hollon is an authority on the etiology and cognitive-behavioral treatment of depression, renowned for landmark clinical trials examining the comparative and combined efficacy of cognitive therapy and pharmacotherapy, the prevention of depressive relapse, and the neurocognitive mechanisms underlying cognitive restructuring.
• Philip C. Kendall, Ph.D., ABPP: Distinguished University Professor and Laura H. Carnell Professor of Psychology at Temple University, Philadelphia, Pennsylvania. Dr. Kendall is a pioneer in clinical child and adolescent psychology, recognized for developing evidence-based cognitive-behavioral interventions (such as the Coping Cat program), cognitive assessment paradigms, and research on internalizing disorders.

Their seminal collaborative paper detailing the instrument’s initial construction, psychometric parameters, and exploratory factor structure was published in 1980 under the title “Cognitive self-statements in depression: Development of an Automatic Thoughts Questionnaire” in the peer-reviewed journal Cognitive Therapy and Research.

Purpose

The primary clinical and empirical purpose of the Automatic Thoughts Questionnaire is to quantify the occurrence of conscious, self-directed negative cognitions. Within cognitive-behavioral frameworks, clinical depression is characterized not merely by sustained affective dysphoria, psychomotor alterations, or vegetative dysregulation, but by systematic, negatively biased information processing. Prior to the development of the ATQ, empirical measurement of depressive cognition relied heavily on broad symptom checklists (such as the Beck Depression Inventory) or generalized personality inventories, which conflated cognitive manifestations with affective, somatic, and behavioral symptoms.

Hollon and Kendall recognized that to systematically evaluate cognitive models of psychopathology and the precise mechanisms of therapeutic change in cognitive therapy, clinicians and researchers required an instrument focused exclusively on self-statements. The ATQ measures the internal cognitive dialogue that streams beneath overt emotional reactions. In clinical settings, the purpose of the questionnaire is multifaceted:

• Diagnostic Screening and Severity Tracking: It assists in identifying cognitive markers of depressive syndromes and monitoring symptom severity across treatment sessions.
• Target Identification for Cognitive Restructuring: By revealing the exact frequency of specific self-derogatory ruminations (e.g., “I’m a failure,” “What’s wrong with me?”), the questionnaire helps therapists identify automatic thoughts for empirical testing, guided discovery, and collaborative socratic dialogue.
• Process and Outcome Research: In randomized controlled trials (RCTs), the ATQ serves as a primary mediator variable to determine whether cognitive therapy selectively reduces negative automatic thoughts compared to other modalities, such as selective serotonin reuptake inhibitors (SSRIs), interpersonal psychotherapy (IPT), or behavioral activation (BA).
• Differentiating Thought Frequency from Believability: The extended ATQ-B format introduces a dual-rating methodology. Whereas traditional cognitive therapy focuses on reducing the recurrence and restructuring the content of dysfunctional thoughts, contemporary contextual and third-wave frameworks (e.g., Acceptance and Commitment Therapy [ACT]) emphasize cognitive defusion—the degree to which an individual believes, identifies with, or buys into their thoughts. The ATQ-B allows investigators to disentangle the sheer frequency of a thought from the subjective cognitive conviction attached to it.

Psychological Construct

The core construct measured by the ATQ is the phenomenon of Negative Automatic Thoughts (NATs). Automatic thoughts are characterized as rapid, evaluative internal monologues or mental representations that appear involuntarily, without deliberate logical deduction. These cognitions are experienced as plausible self-truths by the patient, bypassing standard reality-testing mechanisms unless brought into conscious awareness through systematic self-monitoring.

Rather than reflecting a unitary construct, latent psychological modeling demonstrates that the ATQ taps into four distinct yet interrelated cognitive dimensions:

1. Personal Maladjustment and Desire for Change (PMDC)

This subscale (items 7, 10, 14, 20, 26) reflects the introspective distress associated with perceived personal deficiency, disorientation, and an acute recognition that one’s current psychological functioning is failing. Cognitions loading on this factor capture self-questioning, inner turmoil, and an urgent sense of needing to escape personal inadequacy. Typical thoughts include: “I wish I were a better person” (item 7), “I’m so disappointed in myself” (item 10), “What’s wrong with me?” (item 14), “What’s the matter with me?” (item 20), and “Something has to change” (item 26). This dimension captures the self-critical monitoring and meta-cognitive distress over one’s own deteriorating emotional state.

2. Negative Self-Concepts and Negative Expectations (NSNE)

Accounting for the largest proportion of common variance, the NSNE factor (items 2, 3, 9, 21, 23, 24, 28) taps directly into negative appraisals of personal competence and pessimistic prognostications about the future. It operationalizes two branches of Beck’s cognitive triad: the self and the future. Typical thoughts include direct pejorative labeling such as “I’m no good” (item 2), “I’m a loser” (item 21), and “I’m a failure” (item 23), combined with chronic expectations of defeat, such as “Why can’t I ever succeed?” (item 3), “My life’s not going the way I want it to” (item 9), “I’ll never make it” (item 24), and “There must be something wrong with me” (item 28). This construct embodies absolute, overgeneralized, categorical defeatism.

3. Low Self-Esteem (LSE)

Comprising items 17 and 18, this factor reflects self-worth devaluation and self-directed hostility. In the original factor analysis, these items clustered into an affective-evaluative construct capturing profound self-rejection. The items—“I’m worthless” (item 17) and “I wish I were somebody else” (item 18)—represent the extreme nadir of self-esteem, where the individual views the self not just as fallible, but as devoid of human value, leading to the desire to renounce one’s own identity.

4. Helplessness

The Helplessness factor (items 29 and 30) measures the perceived futility of personal agency, effort, and survival. Characterized by cognitive resignations such as “My future is grim” (item 29) and “It’s just not worth it” (item 30), this construct aligns closely with learned helplessness and hopelessness models of depression. It serves as a clinical bellwether for motivational paralysis, psychomotor anhedonia, and suicidal ideation, reflecting the belief that negative outcomes are inescapable and personal effort is futile.

The Construct of Believability (ATQ-B Extension)

The extended ATQ-B format incorporates the distinct construct of cognitive fusion or conviction. In cognitive science, thought occurrence (frequency) and literal endorsement (believability) are dissociable cognitive events. An individual might experience an automatic thought 20 times a day due to conditioned habit or neural priming, yet through cognitive therapy or mindfulness, recognize it as a mental event rather than literal reality. Conversely, an individual might experience a thought rarely, yet hold absolute conviction in it when it arises. The believability subscale captures this level of epistemic trust in depressogenic narratives.

Theoretical Framework

The conceptual framework underpinning the ATQ is rooted in Beck’s cognitive theory of depression (Beck, 1967, 1976). Beck posited that depression is maintained by systematic cognitive distortions resulting from the hyper-activation of latent, depressogenic schemas. Within this architecture, human cognition operates across three distinct levels of hierarchy:

1. Core Beliefs / Schemas: Deeply held, rigid, overgeneralized cognitive templates regarding the self, others, and the world (e.g., “I am inherently defective”). These schemas typically remain dormant until activated by congruent life stressors or affective states.
2. Intermediate Beliefs: Conditional assumptions, rules, and attitudes that serve as compensatory strategies (e.g., “If I do not achieve perfection in everything, I am totally worthless”).
3. Negative Automatic Thoughts (NATs): The immediate, preconscious, situation-specific operational output of activated schemas. NATs form the conscious manifestation of underlying vulnerability. They are the target assessed directly by the ATQ.

Central to Beck’s theory is the Cognitive Triad, which posits that depressive thinking centers on three themes:

• Negative View of the Self: Perceiving oneself as defective, inadequate, diseased, or lacking the qualities necessary to achieve happiness (exemplified in the ATQ by items like “I’m so weak” and “I’m worthless”).
• Negative View of the World (Personal Environment): Interpreting current experiences as imposing insurmountable demands, systemic injustice, or continuous obstacles (exemplified by items like “I feel like I’m up against the world” and “No one understands me”).
• Negative View of the Future: Anticipating that current suffering, deficits, and failure will persist indefinitely, generating pervasive hopelessness (exemplified by items like “My future is bleak” and “Why can’t I ever succeed?”).

Furthermore, the ATQ operates under the Content-Specificity Hypothesis (Beck, Brown, & Steer, 1989). This hypothesis asserts that distinct psychopathological syndromes are defined by unique cognitive profiles. Whereas anxiety disorders are characterized by automatic thoughts involving physical harm, social threat, vulnerability, and unpredictability, depressive disorders are characterized by thoughts centered on absolute loss, self-deprecation, personal failure, and abandonment. Hollon and Kendall explicitly designed the ATQ to capture this depressive cognitive profile, providing an empirical tool to test whether depressive states could be differentiated from other internalizing conditions based purely on cognitive content.

Validity

The Automatic Thoughts Questionnaire has undergone rigorous empirical validation across multiple decades, clinical settings, and cultural contexts, demonstrating high construct, convergent, discriminant, and predictive validity.

Convergent Validity

In their initial validation study, Hollon and Kendall (1980) administered the ATQ alongside established indices of depressive symptomatology to a combined sample of clinical psychiatric inpatients, outpatients, and non-clinical university students. The ATQ total frequency score demonstrated strong convergent correlations with the Beck Depression Inventory ($r = .78$ in university cohorts, $r = .70$ to $.82$ in psychiatric clinical samples) and the Depression Subscale of the Minnesota Multiphasic Personality Inventory (MMPI-D) ($r = .67$). Subsequent investigations using clinician-rated scales, such as the Hamilton Rating Scale for Depression (HRSD), confirmed that self-reported automatic thoughts strongly reflect objective, clinician-assessed depressive symptom severity ($r = .65$ to $.75$).

Discriminant Validity

A critical psychometric requirement of the ATQ was its ability to separate clinical depression from both normative distress and other psychopathological conditions. Hollon and Kendall (1980) verified that ATQ scores discriminated between depressed and non-depressed subjects: patients meeting clinical criteria for major depression exhibited significantly higher mean scores ($M = 81.3$, $SD = 25.1$) compared to nondepressed controls ($M = 39.6$, $SD = 10.4$), yielding substantial effect sizes ($d > 2.0$).

Further testing the content-specificity hypothesis, later studies (e.g., Ingram, Kendall, & Chen, 1991; Clark & Beck, 1999) compared patients with unipolar depression against patients with generalized anxiety disorder (GAD) and panic disorder. While anxious patients scored moderately on the ATQ due to non-specific negative affect, their depressive automatic thought scores were significantly lower than those of clinically depressed patients, whereas their scores on anxiety-specific cognitions (such as the Cognition Checklist – Anxiety subscale) were markedly elevated. This confirmed the instrument’s capacity to isolate depressive cognitive content.

Sensitivity to Clinical Change and Predictive Validity

The ATQ has proven sensitive to therapeutic interventions. In clinical trials evaluating cognitive therapy, pharmacotherapy, and placebo control conditions (e.g., DeRubeis et al., 1990; Hollon et al., 1992), reductions in ATQ total scores closely tracked symptomatic remission. Notably, patients receiving cognitive therapy showed accelerated declines in ATQ scores compared to those receiving pharmacotherapy alone, supporting the hypothesis that cognitive interventions directly modify negative automatic thoughts. Furthermore, residual elevations in ATQ scores following acute treatment termination consistently predicted clinical relapse during 1- and 2-year longitudinal follow-up evaluations.

Reliability

The reliability of the ATQ has been verified across clinical, university, and community populations, with empirical metrics consistently exceeding standard psychometric thresholds.

Internal Consistency

In the original normative sample of Hollon and Kendall (1980), the instrument achieved an overall internal consistency coefficient (Cronbach’s alpha) of $\alpha = .97$. Subsequent replications across clinical and community samples have confirmed this high level of homogeneity, generally reporting alphas between $.95$ and $.98$. Individual subscale alpha values are similarly solid:

• Personal Maladjustment and Desire for Change (PMDC): $\alpha = .85 – .89$
• Negative Self-Concepts and Negative Expectations (NSNE): $\alpha = .88 – .93$
• Low Self-Esteem (LSE): $\alpha = .75 – .82$
• Helplessness: $\alpha = .72 – .80$

The believability dimension (ATQ-B) exhibits comparable internal consistency, with total believability alpha coefficients typically exceeding $.95$. Item-total correlations across the 30 items regularly range between $.50$ and $.82$, indicating that each individual item contributes meaningfully to the measured construct without redundancy.

Test-Retest Reliability and Stability

Because negative automatic thoughts are conceptually conceptualized as cognitive *states* that fluctuate in tandem with acute mood changes, test-retest reliability varies according to the stability of the underlying depressive episode. In untreated, stable depressed outpatients over a 1-week interval, test-retest correlations are high ($r = .85$ to $.90$). Over longer intervals (e.g., 6 to 12 weeks), the stability of the ATQ in general student cohorts remains moderate to high ($r = .65$ to $.78$). However, when clinical intervention occurs, test-retest coefficients drop significantly, reflecting the scale’s sensitivity to state-dependent cognitive shifts.

Split-Half Reliability

Split-half reliability evaluations utilizing the Spearman-Brown prophecy formula yielded an initial correlation of $.97$ in the Hollon and Kendall validation study, confirming parallel item-domain sampling across the upper and lower halves of the instrument.

Factor Analysis

The latent structure of the ATQ has been analyzed using both exploratory (EFA) and confirmatory factor analysis (CFA).

Original Exploratory Factor Analysis (Hollon & Kendall, 1980)

Hollon and Kendall conducted an exploratory principal components analysis with varimax orthogonal rotation on the responses of 312 undergraduate students and clinical patients. Eigenvalue extraction (criteria $> 1.0$) combined with scree plot inspection revealed four stable, interpretable factors that accounted for the majority of the total variance:

Factor	Factor Name	Items Assigned	Sample Item
Factor I	Personal Maladjustment and Desire for Change (PMDC)	7, 10, 14, 20, 26	Item 10: “I’m so disappointed in myself.”
Factor II	Negative Self-Concepts and Negative Expectations (NSNE)	2, 3, 9, 21, 23, 24, 28	Item 23: “I’m a failure.”
Factor III	Low Self-Esteem (LSE)	17, 18	Item 17: “I’m worthless.”
Factor IV	Helplessness	29, 30	Item 30: “It’s just not worth it.”

While these four factors isolated specific thematic components of depressive thoughts, the first factor accounted for a high percentage of the variance. Many items demonstrated secondary cross-loadings across dimensions, pointing toward a hierarchical or unidimensional structure.

Subsequent Confirmatory Factor Analyses and Structural Models

Subsequent psychometric evaluations across larger clinical cohorts (e.g., Netemeyer et al., 2002; Burgess & Haaga, 1994) have tested competing latent structural models:

• Unidimensional General Factor Model: Because all 30 items correlate strongly with each other, a single-factor model accounts for approximately 50-60% of the variance. For clinical purposes, researchers commonly utilize the global total score rather than individual subscale scores.
• Four-Factor Correlated Model: Confirmatory structural equation modeling (SEM) supports the four-factor correlated model proposed by Hollon and Kendall, demonstrating acceptable goodness-of-fit indices (Comparative Fit Index [CFI] $ge .92$, Tucker-Lewis Index [TLI] $ge .91$, Root Mean Square Error of Approximation [RMSEA] $le .06$).
• Bifactor Model: Modern psychometric analyses suggest that a bifactor model—comprising one broad general ‘depressive negative cognition’ factor and four specific group factors (PMDC, NSNE, LSE, Helplessness)—provides optimal empirical fit. This structure justifies interpreting both the general composite score and specific domain-level variations.

Instrument / Measurement Tool

The Automatic Thoughts Questionnaire is structured as follows:

• Test Type: Standardized self-report rating scale (paper-and-pencil or digital administration).
• Item Count: 30 self-referential items.
• Target Population: Adults and adolescents aged 14 and older. (A specialized child version, the Children’s Automatic Thoughts Questionnaire [CATQ], exists for younger cohorts).
• Administration Duration: Approximately 5 to 10 minutes.
• Assessment Dimensions:
  • Frequency Scale (ATQ): Evaluates how often specific thoughts occurred over the preceding week, rated on a 5-point Likert scale: 1 = “not at all”, 2 = “sometimes”, 3 = “moderately often”, 4 = “often”, 5 = “all the time”.
  • Degree of Belief Scale (ATQ-B Extension): Evaluates the degree of conviction in each thought when it occurs, rated on a 5-point Likert scale: 1 = “not at all”, 2 = “somewhat”, 3 = “moderately”, 4 = “very much”, 5 = “totally”.
• Scoring Architecture:
  • Total Frequency Score: Sum of all 30 items, with scores ranging from 30 to 150.
  • Total Believability Score (if ATQ-B is administered): Sum of belief ratings across all 30 items, ranging from 30 to 150.
  • Subscale Factor Scoring (Frequency):
    • Personal Maladjustment and Desire for Change (PMDC): Sum of items 7, 10, 14, 20, 26 (Score range: 5 to 25).
    • Negative Self-Concepts and Negative Expectations (NSNE): Sum of items 2, 3, 9, 21, 23, 24, 28 (Score range: 7 to 35).
    • Low Self-Esteem (LSE): Sum of items 17, 18 (Score range: 2 to 10).
    • Helplessness: Sum of items 29, 30 (Score range: 2 to 10).
• Clinical Interpretive Norms (Frequency Score):
  • 30 – 50: Normal, non-depressed range; typical frequency of negative thoughts in healthy populations.
  • 51 – 70: Mild depressive cognition; indicative of subthreshold distress or mild unipolar depression.
  • 71 – 90: Moderate depressive cognition; consistent with acute clinical unipolar depressive episodes.
  • 91 – 150: Severe depressive cognition; reflects severe cognitive entrenchment, often associated with major depressive episodes with melancholic or suicidal features.

Permissions & Fee and Test Year

The Automatic Thoughts Questionnaire was originally published in 1980 by Steven D. Hollon and Philip C. Kendall in the journal Cognitive Therapy and Research (Volume 4, Issue 4, pp. 383–395), copyrighted by Plenum Publishing Corporation (now part of Springer Nature). The extended belief modification (ATQ-B) emerged in clinical research environments during the late 1980s and early 1990s as cognitive therapy protocols expanded.

The ATQ is broadly accessible for non-commercial academic research, empirical study, and clinical practice without licensing fees, provided proper academic citation is given to the original 1980 publication. Commercial reproduction, inclusion within fee-generating digital assessment platforms, or integration into proprietary electronic medical records often requires formal copyright clearance from Springer Nature or the authors.

References

• Beck, A. T. (1967). Depression: Causes and treatment. University of Pennsylvania Press.
• Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
• Beck, A. T., Brown, G., & Steer, R. A. (1989). Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness. Journal of Consulting and Clinical Psychology, 57(2), 309–310. https://doi.org/10.1037/0022-006X.57.2.309
• Burgess, E., & Haaga, D. A. (1994). The construct of believability in cognitive therapy: Assessment and validation. Cognitive Therapy and Research, 18(1), 31–47. https://doi.org/10.1007/BF02359395
• Clark, D. A., & Beck, A. T. (1999). Scientific foundations of cognitive practice and therapy of depression. John Wiley & Sons.
• DeRubeis, R. J., Evans, M. D., Hollon, S. D., Garvey, M. J., Grove, W. M., & Tuason, V. B. (1990). How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology, 58(6), 862–869. https://doi.org/10.1037/0022-006X.58.6.862
• Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an Automatic Thoughts Questionnaire. Cognitive Therapy and Research, 4(4), 383–395. https://doi.org/10.1007/BF01173648
• Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garvey, M. J., Grove, W. M., & Tuason, V. B. (1992). Cognitive therapy and pharmacotherapy for depression: Singly and in combination. Archives of General Psychiatry, 49(10), 774–781. https://doi.org/10.1001/archpsyc.1992.01820100018004
• Ingram, R. E., Kendall, P. C., & Chen, A. H. (1991). Cognitive specificity of emotional states: A comparative study of thoughts in depression and anxiety. Cognitive Therapy and Research, 15(4), 289–302. https://doi.org/10.1007/BF01173177
• Netemeyer, R. G., Williamson, D. A., Burton, S., Biswas, D., Jindal, S., Linda, S., & Bentz, B. C. (2002). Psychometric evaluation of the Automatic Thoughts Questionnaire: Factor structure and measurement invariance. Journal of Psychopathology and Behavioral Assessment, 24(1), 1–10. https://doi.org/10.1023/A:1014022416131

13. Items of the Scale (Questionnaire)

Below are the authentic scale items in their original language as published in the standard psychometric validation studies, without modification or translation to preserve instrument validity and reliability:
Instructions / Directions: Listed below are a variety of thoughts that pop into people's heads. Please read each thought and indicate how frequently, if at all, the thought occurred to you over the last week.
Response Scale: Listed below are a variety of thoughts that pop into people’s heads. Please read each thought and indicate how frequently, if at all, the thought occurred to you over the last week. Please read each item carefully and circle the appropriate answers on the answer sheet in the following fashion (1 = “not at all”, 2 = “sometimes”, 3 = “moderately often”, 4 = “often”, and 5 = “all the time”).
Scoring / Reverse Items: Items are summed to produce a total score ranging from 30 to 150. Higher scores indicate higher frequency of automatic negative thoughts. Four factors: Personal Maladjustment and Desire for Change (PMDC: items 7, 10, 14, 20, 26); Negative Self-Concepts and Negative Expectations (NSNE: items 2, 3, 9, 21, 23, 24, 28); Low Self-Esteem (LSE: items 17, 18); Helplessness (items 29, 30).
Scoring Formula: Scoring: Items are rated on the frequency of occurrence from “not at all” to “all the time”. Total scores are the sum of all 30 items. Items on each factor are: PMDC: 7, 10, 14, 20, 26; NSNE: 2, 3, 9, 21, 23, 24, 28; LSE: 17, 18; Helplessness: 29, 30. A high total score indicates a high level of automatic negative self-statements.
1
I feel like I'm up against the world.
2
I'm no good.
3
Why can't I ever succeed?
4
No one understands me.
5
I've let people down.
6
I don't think I can go on.
7
I wish I were a better person.
8
I'm so weak.
9
My life's not going the way I want it to.
10
I'm so disappointed in myself.
11
Nothing feels good anymore.
12
I can't stand this anymore.
13
I can't get started.
14
What's wrong with me?
15
I wish I were somewhere else.
16
I can't finish anything.
17
I'm worthless.
18
I wish I were somebody else.
19
I just can't get it together.
20
I hate myself.
21
What's the matter with me?
22
I'm a loser.
23
My future is bleak.
24
It's just not worth it.
25
I can't finish anything.
26
I feel so helpless.
27
Something has to change.
28
There must be something wrong with me.
29
My future is grim.
30
It's just not worth it.
★
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