Sample Stress Diary Template
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2iStudy for Success Modules-Stress Management
SAMPLE STRESS DIARY
Name__Nancy ______________________________
Is this a typical day? Yes _X__ No ____
Date ___April 26, 2004 _______________________
More ____ Less ____
Circle One: S M T W Th F S
Review the sample diary form below for directions on completing the Stress Diary.
Intensity
Situation
Time of
Duration
Triggering Event
Emotional Behavioral Reaction
of Stress
(circumstance, location,
Day
of Stress
(preceding event)
(your feelings about the event)
(1-7)
people)
Woke up too late and missed
I went to a fun party that
I got mad at my roommate that she
9:00am
4
30 min
the first class.
lasted until 2:00 a.m.
didn’t call me for the class at 7:00.
yesterday.
I couldn’t finish the assignment
Set unrealistic time frame
I was extremely nervous because of
that was due by class today
for the assignment
not being able to finish the
7
1 hour
although I worked very hard
assignment on time.
4:00pm
all morning. It took longer
to finish than I expected.
I have too many assignments
I put off doing all of my
I worried about the assignments and
due by the end of this week.
assignments until the last
kept muttering and complaining
All
minute and now need to
about having too many assignments.
6:00pm
6
evening
finish all the assignments
I feel pain in my neck and lower
in one week under
back every time I think about having
deadline pressure.
so many assignments to do.
8:00pm
3
1 hour
The weather was too cold.
I didn’t wear enough
It was really cold and I was angry
clothes when I went out
about the unexpected cold weather in
for a walk.
this region.
iStudy for Success Modules-Stress Management
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Parent category: Life