[form] CBT ACTIVITY Journal The purpose of this journal is to help you review your morning, afternoon, evening periods of the day as an activity log. The aim is to see what corelates in terms of people/time/place with your body/emotions/thoughts/image/memories AND how that works out in your relating to your self and others. Ask the Online Counsellor to help you if you feel stuck for any reason. Your full name:[text,r_name,50] Email address:[text,r_email,30] =================================================================== TIPS or CLUES BODY How did your body feel? Describe breathing, muscles tensing, heart rate, Chest tight, hands sweaty etc.] MOVEMENT How did you MOVE ACT or BEHAVE when you experienced the trigger? (behaviour) POSTURE What did you observe about your posture when this was happening? What about the posture of others? VOICE: Notice the loud or soft volume of your voice, how fast or slow you speak, the kinds of words you use RELATING: Notice how people around you are relating to you and you to them SENSES: which of your sense were strongest in your awareness or concerns? Visual - colours, images, shapes, Hearing - sounds, voices, music, Smelling - familiar or unfamiliar, Tasting - food, drink, water, Touch - skin, texture, fear of Examining the your thinking or self-talk Please explore what thoughts or images (memories of image or voice)you were (or are) aware of? =================================================================== MORNING - daybreak to Midday PATTERN: Activity - Feelings - Thought [textarea,morning,6,70,time location people... ] [text,8am,80,8:00am] [text,9am,80,9:00am] [text,10am,80,10:00am] [text,11am,80,11:00am] [text,12pm,80,12:00pm] Explanatory Notes [textarea,morningnotes,3,70] ================================================================== AFTERNOON - Midday to Evening [textarea,afternoon,6,70,time location people... ] [text,1pm,80,1:00pm] [text,2pm,80,2:00pm] [text,3pm,80,3:00pm] [text,4pm,80,4:00pm] [text,5pm,80,5:00pm] [text,6pm,80,6:00pm] Explanatory Notes [textarea,afternoonnotes,3,70] ================================================================== EVENING - evening to morning [textarea,evening,6,70,dreams sleep pattern evening activity ... ] [text,7pm,80,7:00pm] [text,8pm,80,8:00pm] [text,9pm,80,9:00pm] [text,10pm,80,10:00pm] [text,11pm,80,11:00pm] [text,12am,80,12:00am] Explanatory Notes [textarea,eveningnotes,3,70] ================================================================== ------------------------------------------------------------------- Have you gained any new thoughts or insights by journalling this situation or do you have any QUESTIONS about it? [textarea,Other comments or questions,3,70,My insights are... My Questions are...] [checkbox,send copy,checked]CHECK THIS BOX to receive a copy of your journal work to the email address you have at the top of this form. [submit,SEND this Entry][reset,Start Over again] [/form]