| Date | Mood 1–10 | Anxiety 1–10 | Sleep Hours | 1 Good Thing That Happened | 1 Thing I’m Grateful For |
|---|---|---|---|---|---|
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| 30 |
| Prompt | Write here |
|---|---|
| Situation | |
| Automatic thought | |
| Emotion + intensity | |
| Evidence FOR the thought | |
| Evidence AGAINST the thought | |
| Balanced thought | |
| Outcome / new feeling |
| Prompt | Write here |
|---|---|
| Situation | |
| Automatic thought | |
| Emotion + intensity | |
| Evidence FOR the thought | |
| Evidence AGAINST the thought | |
| Balanced thought | |
| Outcome / new feeling |
| Prompt | Write here |
|---|---|
| Situation | |
| Automatic thought | |
| Emotion + intensity | |
| Evidence FOR the thought | |
| Evidence AGAINST the thought | |
| Balanced thought | |
| Outcome / new feeling |
| Prompt | Write here |
|---|---|
| Situation | |
| Automatic thought | |
| Emotion + intensity | |
| Evidence FOR the thought | |
| Evidence AGAINST the thought | |
| Balanced thought | |
| Outcome / new feeling |
| What I’m worried about | In my control? | Possible action | Scheduled time to address it |
|---|---|---|---|
Move slowly. Name concrete things. The goal is not to “win” against anxiety but to reconnect with the present moment.
| ☐ | Value | ☐ | Value |
|---|---|---|---|
| ☐ | Acceptance | ☐ | Honesty |
| ☐ | Adventure | ☐ | Humor |
| ☐ | Authenticity | ☐ | Independence |
| ☐ | Balance | ☐ | Integrity |
| ☐ | Belonging | ☐ | Joy |
| ☐ | Bravery | ☐ | Kindness |
| ☐ | Calm | ☐ | Leadership |
| ☐ | Compassion | ☐ | Learning |
| ☐ | Connection | ☐ | Love |
| ☐ | Contribution | ☐ | Mindfulness |
| ☐ | Courage | ☐ | Patience |
| ☐ | Creativity | ☐ | Peace |
| ☐ | Curiosity | ☐ | Play |
| ☐ | Dependability | ☐ | Presence |
| ☐ | Discipline | ☐ | Purpose |
| ☐ | Empathy | ☐ | Resilience |
| ☐ | Faith | ☐ | Respect |
| ☐ | Family | ☐ | Security |
| ☐ | Fitness | ☐ | Self-Respect |
| ☐ | Forgiveness | ☐ | Service |
| ☐ | Freedom | ☐ | Simplicity |
| ☐ | Friendship | ☐ | Spirituality |
| ☐ | Generosity | ☐ | Stability |
| ☐ | Growth | ☐ | Trust |
| ☐ | Health | ☐ | Wisdom |
| Top 10 Values | Top 3 Values | How this value guides my decisions |
|---|---|---|
| 1. | 1. | |
| 2. | 2. | |
| 3. | 3. | |
| 4. | ||
| 5. | ||
| 6. | ||
| 7. | ||
| 8. | ||
| 9. | ||
| 10. |
When panic rises: Inhale 4 • Hold 4 • Exhale 4 • Hold 4 — repeat 4 rounds.
Emergency contacts:
Hotlines / local help:
My top 3 coping strategies:
When panic rises: Inhale 4 • Hold 4 • Exhale 4 • Hold 4 — repeat 4 rounds.
Emergency contacts:
Hotlines / local help:
My top 3 coping strategies:
| Prompt | Notes |
|---|---|
| Where did I notice the most tension? | |
| What sensation did I feel first? | |
| Did my breathing slow down? | |
| What helped me feel safest? |