Daily Stress and Coping Entry Form
Day # _____
Using the following scales, circle the response that best responds to how you feel before and after engaging in your relaxation technique.
Pre-relaxation
Right now, my overall mood is:
1 2 3 4 5 6 7
Very negative Neutral Very positive
Right now, I feel:
1 2 3 4 5 6 7
Very agitated Neutral Very calm
Post-relaxation
Right now, my overall mood is:
1 2 3 4 5 6 7
Very negative Neutral Very positive
Right now, I feel:
1 2 3 4 5 6 7
Very agitated Neutral Very calm
Prof. Goodwill
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