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Self Monitoring Log

Date / Time:


Place / Activity:


Sensation:
0-100 (SUDS)



Trigger(s):


Image(s) /
Mental Picture(s):




Cognition(s) / Thought(s):



Emotion(s):
Sad, Angry, etc.




Date / Time:


Place / Activity:


Sensation:
0-100 (SUDS)



Trigger(s):


Image(s) /
Mental Picture(s):




Cognition(s) / Thought(s):



Emotion(s):
Sad, Angry, etc.




Date / Time:


Place / Activity:


Sensation:
0-100 (SUDS)



Trigger(s):


Image(s) /
Mental Picture(s):




Cognition(s) / Thought(s):



Emotion(s):
Sad, Angry, etc.