Stress Management Cessation Log Form
Log your stress management cessation progress and reflect on your journey.
Date of Log
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Status / Phase
*
Please Select
Initial
Active Cessation
Maintenance
Relapse
Other
Stress Trigger(s) Encountered
*
Work-related
Relationship
Financial
Health concerns
Unexpected event
Other
Coping Strategy Used
*
Please Select
Deep breathing
Physical activity
Meditation
Talking to someone
Journaling
Other
Duration of Stress Episode (minutes)
*
Intensity of Stress (1 = Very Low, 10 = Very High)
*
1
1
2
3
4
5
6
7
8
9
10
10
1 is 1, 10 is 10
Urge to Relapse (1 = None, 10 = Very Strong)
*
1
1
2
3
4
5
6
7
8
9
10
10
1 is 1, 10 is 10
Progress Notes
*
Next Planned Action
*
Preferred Follow-up or Check-in Method (optional)
Please Select
No follow-up needed
Email
Phone call
Text message
In-person check-in
Other
Submit Log
Should be Empty: