Activity Diary

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Activity Diary
Write briefly in each box: What you did (brief description), one word that describes your Mood, and rate the intensity of your mood on a scale of 0 –
100%, your sense of Achievement for the activity on a scale of 0-10 (A0 – 10) your sense of Closeness to others (C0 – 10), and sense of Enjoyment
(E 0-10). An activity may be sitting down, or lying in bed, not only washing dishes, walking etc.
(Write in each box) Example : Watching TV with son, Sad 60%, A0, C7, E4
Day
Time
6 – 8 am
8 - 10 am
10am – 12noon
12 - 2pm
2 - 4pm
4 - 6pm
6 - 8pm
8 - 10pm
10pm – 12mn
After completing the diary, you might notice patterns in your mood variations, and how particular activities affect your mood. You will then be able to
plan a more healthy range of activities which give you a sense of Achievement, Enjoyment and Closeness (using another blank form).

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