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OCD Self Monitoring Form
Hi there, use this HIPAA-compliant form to track your OCD symptoms throughout the week.
7
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1
Name
*
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First Name
Last Name
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2
Date
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Approximately when did this Obsession / Compulsion cycle take place?
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Minutes
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3
Triggers for Obsessions
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Specific thoughts, situations, objects, people, etc. that provoke obsessive fears
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4
Anxiety / Fear / Distress / Discomfort Level
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0 = no anxiety/distress/discomfort; 10 = the most anxiety/distress/discomfort
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5
Compulsions
*
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What did you do in response to the obsession thought?
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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6
Time Spent on Compulsion
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Approximate time is okay
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7
Anything else to note?
A space for reflection - not required
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