Daily Self-Monitoring Sheet

Use the following scale to indicate your stress level:

      
Not at all stressed As stressed as you can be

Daily Stress Level

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Time : Rating: Rating: Rating: Rating: Rating: Rating: Rating:
1 1 1 1 1 1 1

Time : Rating: Rating: Rating: Rating: Rating: Rating: Rating:

1 1 1 1 1 1 1

Time : Rating: Rating: Rating: Rating: Rating: Rating: Rating:

1 1 1 1 1 1 1

Time : Rating: Rating: Rating: Rating: Rating: Rating: Rating:

1 1 1 1 1 1 1

Day Overall Rating: Rating: Rating: Rating: Rating: Rating: Rating:

1 1 1 1 1 1 1

Relaxation Practice

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Exercise: Before: Before: Before: Before: Before: Before: Before:
1 1 1 1 1 1 1
After: After: After: After: After: After: After:
1 1 1 1 1 1 1

Exercise: Before: Before: Before: Before: Before: Before: Before:

1 1 1 1 1 1 1
After: After: After: After: After: After: After:
1 1 1 1 1 1 1

Exercise: Before: Before: Before: Before: Before: Before: Before:

1 1 1 1 1 1 1
After: After: After: After: After: After: After:
1 1 1 1 1 1 1

Exercise: Before: Before: Before: Before: Before: Before: Before:

1 1 1 1 1 1 1
After: After: After: After: After: After: After:
1 1 1 1 1 1 1

Exercise: Before: Before: Before: Before: Before: Before: Before:

1 1 1 1 1 1 1
After: After: After: After: After: After: After:
1 1 1 1 1 1 1

Michael H. Antoni, Gail Ironson, Neil Schneiderman

Cognitive-Behavioral Stress Management: Session 1: Stressors and Stress Responses /
Progressive Muscle Relaxation for 16 Muscle Groups Copyright © 2007 by Oxford University Press

Oxford Clinical Psychology | Oxford University Press