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ERP Homework Tracking
Hi there, use this HIPAA-compliant form to track your ERP homework completion throughout the week.
11
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1
Name
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First Name
Last Name
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2
Date
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Date
Month
Day
Year
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3
Exposure Type
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Please Select
In-Vivo (real-life)
Imaginal (imagination, recordings, scenarios, worst-case scenarios)
Interoceptive
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Please Select
In-Vivo (real-life)
Imaginal (imagination, recordings, scenarios, worst-case scenarios)
Interoceptive
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4
Interoceptive Exposures
Physical Exercise -Run quickly on the spot (lift knees high) – 1 min
Physical Exercise - Step up and down on a stair (hold the handrail for balance) – 2 min
Spinning & Shaking - Spin while sitting in an office chair (as fast as you can) – 2 min
Spinning & Shaking - Spin around while standing up (ensure space & seat available after) – 1 min
Spinning & Shaking - Shake your head from side to side, then look straight ahead (eyes open) – 30 sec
Breathing - Overbreathe – breathe forcefully, fast and deep – 2 min
Breathing - Breathe through a straw – hold your nose and breathe through a drinking straw – 2 min
Breathing - Hold your breath – 30 sec
Head-Rush / Dizziness - Put your head between your legs then sit up quickly – 1 min
Head-Rush / Dizziness - Lie down & relax for at least one minute, then sit up quickly – 1 min
Unreality / Derealization - Stare at yourself in a mirror – concentrate hard without blinking – 2 min
Unreality / Derealization - Stare at a blank wall – concentrate hard without blinking – 2 min
Unreality / Derealization - Stare at a fluorescent light and then try to read something – 1 min
Tension - Tense all body muscles – 1 min
Other
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5
Exposure
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List the exposure you completed
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6
Obsessions / Triggers
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What fears / discomfort are you facing during this exposure?
Contamination (germs, chemicals, bodily fluids, dirt)
Fear of spreading contamination to others
Fear of becoming contaminated by people, thoughts, or objects
Fear of illness, disease, or infection
Fear of vomiting or seeing others vomit (emetophobia)
Fear of food poisoning or contamination from eating
Health or body-focused obsessions (cancer, heart attack, etc.)
Somatic focus (breathing, blinking, swallowing, heartbeat)
Harm fears (fear of harming self or others)
Fear of losing control and acting violently
Fear of causing an accident or tragedy
Fear of being responsible for harm through negligence
Fear of having violent or disturbing thoughts
Sexual intrusive thoughts
Fear of being sexually inappropriate or immoral
Fear of attraction to “wrong” people (pedophilia, same-sex, family)
Fear of acting on sexual thoughts
Fear of being aroused by intrusive content
“Just right” sensations or symmetry themes
Fear of things feeling uneven, incomplete, or wrong
Need for exactness or order
Fear of inner discomfort until things feel balanced
Relationship OCD (ROCD)
Fear of being in the wrong relationship
Fear of not loving one’s partner “enough”
Fear of making the wrong choice or hurting someone emotionally
Religious or moral scrupulosity
Fear of sinning or moral failure
Fear of offending God or violating religious rules
Fear of being dishonest, impure, or unethical
Existential fears (meaning, reality, life/death concerns)
Fear of never finding answers to “big questions”
Fear of going crazy thinking about existence or consciousness
Perfectionism
Fear of mistakes or imperfection
Fear of not doing something the “right” way
Fear of disapproval or failure
Responsibility or guilt themes
Fear of being responsible for others’ pain or misfortune
Fear of guilt or regret
Fear of sexually harming a child
Fear of saying or doing something offensive or harmful
Fear of disclosing private information
Fear of losing control (emotionally, physically, or mentally)
Fear of blurting out something inappropriate
Fear of acting impulsively
Fear of memory loss or uncertainty about the past (“false memory OCD”)
Fear of being secretly a bad person or criminal
Fear of hidden motives or moral corruption
Fear of uncertainty itself
Fear of never feeling 100% sure
Other
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7
Compulsions
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What compulsions did you work to prevent during this exposure?
Arranging / lining things up until it feels "just right"
Avoidance
Checking / Rechecking
Comparing
Confession
Counting
Cleaning
Praying in a certain way
Repeating an action over and over
Reassurance Seeking - Researching / Googling
Reassurance Seeking - from others
Reassurance Seeking - reassuring yourself repeatedly
Rumination - Mental Review (trying to figure something out by going over it in your mind)
Rumination - Directing attention / monitoring
Rumination - Keeping guard up
Rumination - Pushing away thoughts, trying not to let them enter awareness
Rumination - using mindfulness or "bad distraction"
Rumination - engaging in self talk
Saying or thinking certain words, phrases, prayers or numbers
Self-punishment
Testing feelings
Thought Neutralization
Touching or tapping things in a certain way
Trying to do or think things in a "just right" way
Trying to have "good" thoughts or images
Washing
Insisting others engage in certain behaviors / say things a certain way
Other
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8
SUDS Rating Before Exposure
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Anxiety / Fear / Distress / Discomfort Level
0 = no anxiety/distress/discomfort; 10 = the most anxiety/distress/discomfort
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9
Highest SUDS Rating During Exposure
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Anxiety / Fear / Distress / Discomfort Level
0 = no anxiety/distress/discomfort; 10 = the most anxiety/distress/discomfort
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10
SUDS Rating After Exposure
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Anxiety / Fear / Distress / Discomfort Level
0 = no anxiety/distress/discomfort; 10 = the most anxiety/distress/discomfort
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11
Time Spent on Exposure
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How much time did it take you to complete this exposure?
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12
Brief reflection on your experience.
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What happened before, during, and/or after this exposure? Was the outcome what you anticipated?
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