THOUGHT LOG
THIS LOG IS FOR THERAPEUTIC PURPOSES ONLY AND IS NOT MEANT TO BE USED DURING A CRISIS TO REQUEST ASSISTANCE. IF YOU ARE EXPERIENCING A CRISIS YOU SHOULD CALL 988 TO BE CONNECTED WITH THE SUICIDE PREVENTION LIFE LINE OR CALL 911 / EMS OR IF ABLE TO DO SO SAFELY TRANSPORT YOURSELF TO THE NEAREST EMERGENCY ROOM.
Name:
First Name
Last Name
Email:
example@example.com
Date of episode:
-
Month
-
Day
Year
Date
Time Episode Started:
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
How long did the episode last (minutes)
What did you experience during this episode? Describe your feelings and behaviors that were causing the problem.
INTENSITY OF EMOTIONS: Rate the intensity of the emotions experienced remember that 1 is the most minor while 10 is the most severe (severe meaning I need to go to the hospital).
1
2
3
4
5
6
7
8
9
10
MINOR
SEVERE
1 is MINOR, 10 is SEVERE
When you began struggling did you attempt to distract yourself with any healthy coping skills. Remember healthy coping skills are not use to solve the problem but they are used to prevent what we are experience from becoming any worse (examples: taking deep breaths, progressive muscle relaxation, imagery exercises, Self Soothing Techniques etc):
YES
NO
If you did which skills did you attempt to use?
Submit
Should be Empty: