[form] Name: [text,name,40] Email: [text,email,30] Depression profile for this past week Dates from: [text,datefrom,20] To: [text,dateto,20]

SITUATIONAL Experiences I am facing loss (with implications for the future) [possessions, job, loved one etc.] [list,depress01] [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 feeling failure [list,depress02] [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 had depressing thoughts about SELF [list,depress03] [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 person(s) [list,depress04] [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 in general [list,depress05] [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 PROCESS I only see negative aspects of the loss of failure [list,depress06] [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 think of other losses and failures that I have experienced [list,depress07] [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 think I am unable to help myself (a sense of helplessness) [list,depress08] [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 only see pain and blackness in the future (a sense of hopelessness) [list,depress09] [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 had negative views of the future and its prospects [list,depress10] [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 withdraw from postive reinforcements (e.g. activity that will alter my state) [list,depress11] [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 into myself [list,depress12] [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 create an environment consistent with my feelings [list,depress13] [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 attempted to terminate feelings of depression in these self-destructive ways: Excesses in medication [list,depress14] [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] Inflicting pain on myself [list,depress15] [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] Damaging property [list,depress16] [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] Suicide attempts or planning to do so [list,depress17] [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

Alternative THINKING PROCESS I see both negative and positive aspects of the loss of failure [list,depress18] [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 less likely to think of other losses and failures than when depressed [list,depress19] [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 able to help myself (a sense of being able to cope) [list,depress20] [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 able to look to the future with hope [list,depress21] [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] Alternative Thinking Score: [text,thinkANscore,10] Add up the scores for your thinking

Alternative BEHAVIOUR EXPRESSION I am able to express feelings about the loss or failure and talk about these to significant others [list,depress22] [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 able to seek out reinforcements after a period of mourning [list,depress23] [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 create an environment consistent with my feelings [list,depress24] [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 do not seek inappropriate or unhelpful ways to console my sadness [list,depress25] [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] Alternative Behavioural Score: [text,behaveANscore,10] Add up the scores for your alternative behaviour this week