individual arousal control reflection
Arousal Recording Sheet – KINS263
Circle the number that best describes your feelings of activation/arousal/anxiety.
|
Day 1: |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
|
Day 2: |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
|
Day 3: |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
|
Day4 |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
|
Day 5: |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
|
Day6 |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
|
Day 7: |
|
Time: |
|
Comments/Reflection |
|||||||
|
|
|
|
|
|
|
|
|
|
|||
|
Pre CD |
How do you feel right now? |
|
|
|
|
|
|
||||
|
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
|
Highly Charged |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
|
High Anxiety |
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post CD |
How do you feel right now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Activation |
|
|
|
Highly Charged |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
How anxious do you feel now? |
|
|
|
|
|
|||||
|
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
No Anxiety |
|
|
|
High Anxiety |
|
Comments/Reflection: