Diary Form

SITUATIO N (Were am I, with whom and what is happening?): Date and time: 02-05-02, 19.55

I'm at the supermarket. It's crowded because it's nearly closing time. At the checkout there are seven people in front of me.

PHYSICAL SENSATIONS

O

chest pain or discomfort

O

numbness or tingling sensations

sweating

chills or hot flushes

O

trembling or shaking

pounding hart, accelerated heart rate

sensation of shortness of breath or smothering

O

derealization, feelings of unreality

O

feeling of choking

O

O

nausea

feeling dizzy or lightheaded

EMOTION (anxious, sad, happy, angry): Intensity of the emotion (0-100)

Anxious!!!

95

(After leaving the supermarket I felt sad and cried)

(What thoughts were associated with the emotion mentioned above? What thoughts caused you to feel like this in this situation?)

AUTOMATIC THOUGHTS

(What thoughts were associated with the emotion mentioned above? What thoughts caused you to feel like this in this situation?)

If I'm not out of this supermarket soon, I'll faint. If I faint, nobody will help me and I might even die. If I faint, people will thinkI'm crazy or stupid.

BEHAVI OUR (What did you do when you started feeling like that?):

I parked the shopping trolley in a corner of the supermarket, left all the groceries in it and I just got out of the supermarket as quickly as I could.

Figure 4.1 Diary form: a tool for self-monitoring problem behaviour.

specific instructions about what to observe, thereby precluding interpretations. Another example concerns patients with compulsive behaviours. It can be helpful to have patients perform the compulsive behaviours in their natural environment (usually at home) in the presence of the therapist. These observations often provide the therapist with a much clearer understanding of both the problem behaviour and specific triggering stimuli.

In addition to in vivo observations, as described above, it can be useful to role-play problematic past situations. An example may clarify this point. Albert is a patient who is afraid of conflict and arguments but claims not to avoid these situations. During conflict role-play Albert indeed does not avoid arguments. However, when expressing criticism Albert becomes visibly tense and immediately takes back his critical comments, which in turn reduces his tension. Role-play especially can be informative in regards to interpersonal problems.

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