Stress Attack Tracking Form
Log and reflect on your stress attack episodes to better understand your triggers, symptoms, and coping strategies.
Date and Time of Stress Attack
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Duration of Episode (minutes)
*
Severity of Stress Attack
*
Mild
1
2
3
4
5
6
7
8
9
Severe
10
1 is Mild, 10 is Severe
Symptoms Experienced (select all that apply)
*
Rapid heartbeat
Shortness of breath
Sweating
Trembling or shaking
Chest pain or discomfort
Nausea
Dizziness or lightheadedness
Other
Possible Triggers (select all that apply)
*
Work-related stress
Family or relationship issues
Financial concerns
Health worries
Crowded places
No clear trigger
Other
Where did the stress attack occur?
*
Please Select
At home
At work/school
Public place
In a vehicle
Other
How did you respond to the stress attack? (select all that apply)
*
Deep breathing
Left the situation
Talked to someone
Used medication
Tried to ignore it
Other
How effective were your coping strategies?
*
Not effective
1
2
3
4
Very effective
5
1 is Not effective, 5 is Very effective
Would you like to be contacted for support regarding this episode?
*
Yes
No
Additional Notes or Reflections
Submit Entry
Should be Empty: