Pain / Fatigue Diary
Pain and/or Fatigue Diary
When
Date / Time
0% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Situation
What was I doing, where, who with, how long for?
16% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Pain / Fatigue
Describe and Rate
0 (none) - 10 (max)
33% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Emotion/s
Frustrated, anxious, angry, depressed, sad, scared etc.
50% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Thoughts
What went through my mind at that time?
What did that mean to me or say about me?
What really upset me about that?
66% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Alternative, more helpful Thought & Response
Is there another way of looking at this?
What would be more helpful - for me and for the situation?
84% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
| When | Situation | Pain / Fatigue | Emotion/s | Thoughts | Alternative, more helpful Thought & Response |
|---|---|---|---|---|---|
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
Answer Question to Complete Worksheet |
| When |
|---|
Answer Question to Complete Worksheet |
| Situation |
Answer Question to Complete Worksheet |
| Pain / Fatigue |
Answer Question to Complete Worksheet |
| Emotion/s |
Answer Question to Complete Worksheet |
| Thoughts |
Answer Question to Complete Worksheet |
| Alternative, more helpful Thought & Response |
Answer Question to Complete Worksheet |
© Carol Vivyan 2009, permission to use for therapy purposes.
100% Complete
Your responses are private. They are not viewed by a clinician. If you feel like you need help, contact one of our therapists. Visit Education and Resources Page for Pain Management to learn more about Pain Management and to get in touch with one of iTherapy's counselors.
Thanks to www.getselfhelp.co.uk for this template.
