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Self Monitoring

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Self Monitoring

Self Monitoring is a crucial step in treating an Impulse Control Disorder.  We created a self monitoring form to help you easily track a number of factors.

It is an 8½ x 11 inches page that you fold into four.
We call it the “Impulse Monitoring Card”
We created 3 versions:

Version 1 – This 1 page allows you to track 1 whole day.
Small circles to “fill in” for each time you acted on or felt the urge (impulse).
Count the circles filled in & record the Total.
Describe 3 scenarios you acted on or interrupted the urge (impulse) that day.

Version 2 – This 1 page allows you to track 4 days.
Small circles to “fill in” for each time you acted or felt the urge (impulse) each day.
Describe 1 scenario you acted on or interrupted the urge (impulse) each day.

Version 3 – This 1 page allows you to track 4 days.
Small squares to “fill in” with a × for each time you acted or a √ for each time you felt the urge but did not act (impulse).
Describe 1 scenario you acted on or interrupted the urge (impulse) each day.

Describe scenario questionnaire:

Environment:
[lying in bed – where did the impulse take place]

For How Long (seconds/minutes):
[lasted for 30 seconds – how long did the impulse last]

Location (body):
[right arm]

Feelings / Thoughts /  Behaviors / Sensations:

1 Before
[what sensations do you experience before you act on the impulse]

2 During
[what sensations do you experience while acting or avoiding the impulse]

3 After
[what sensations do you experience after you acted or avoided the impulse]

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KnowMental offers various self-monitoring forms to assist you while in therapy.
CLICK HERE to access a FREE download of this tool and more…
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Preview of Self Monitoring Charts:

KnowMental
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