This form is for keeping a weekly track of therapy progress in working on strategies to reduce anger.
[form]
Name: [text,name,40]
Email: [text,email,30]
Anger Profile for this past week:
Dates
from: [text,datefrom,20]
To: [text,dateto,20]
SITUATIONAL Experiences
I have experienced frustration this week
[list,anger01]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I have broken some of my own personal rules or values this week
[list,anger02]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
Other(s) have broken my personal rules or values
[list,anger03]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
Life has delivered me blocks to my personal values or beliefs
[list,anger04]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
Memories of past events where my beliefs or values were broken by myself or others
[list,anger04a]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
Situational Score: [text,sitAgscore,10]
Add up the scores (your evaluative figures) for your situations
THINKING PROCESSES
My personal self-esteem is threatened
[list,anger05]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
My personal view of self is threatened
[list,anger06]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I overestimate the extent the other person acted deliberately
[list,anger07]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I see malicious intent in the motives of others
[list,anger08]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I see myself as definitely right; other(s) seen as definitely wrong
[list,anger09]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I am unable, blocked from seeing the other person's point of view
[list,anger10]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I plot to exact revenge of some kind
[list,anger11]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
Thinking Score: [text,thinkAgscore,10]
Add up the scores for your thinking
BEHAVIOUR EXPRESSION
I attack the other physically
[list,anger12]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I attack the other verbally
[list,anger13]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I attack the other passive-aggressively
[list,anger14]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I displace the attack onto another person, animal, or object
[list,anger15]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I withdraw aggressively
[list,anger16]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
I recruit (propaganda) allies against the other
[list,anger17]
[option,choose,Choose the frequency of occurence,selected]
[option,0,0 Not at all]
[option,1,1 Some occurences]
[option,2,2 Frequently]
[option,3,3 Most of the time]
[/list]
Behavioural Score: [text,behaveAgscore,10]
Add up the scores for your behaviour this week
[checkbox,send copy] Check here if you wish a copy of this emailed to you
[submit,SEND this Entry][reset,Start Over again]
[/form]
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