For use when the participant is in his/her 12th week of the plan.
Name __________________________________________
Date ___________
Name of Plan ___________________________________________
You are about 4 months into your brain change plan. You should be seeing some real differences in
your life by now. You are making behavioral changes while your brain is becoming more and more
efficient at helping you reach your brain change goal.
Do you sense any gains in efficiency (such as being able to think positive thoughts more quickly or with
less internal resistance)? ____Yes ____No ____I’m not sure.
Please give an example: _______________________________________________________
_____________________________________________________________________.
Have others noticed any changes in you yet related to your brain change goals?
____Yes ____No ____I think so but I’m not certain.
Please mention your brain change plan to one other person and ask if they’ve seen any changes in you.
Report the result here:
_______________________________________________________________________.