Phobia Exposure Log Form
Record details of your phobia exposure session for tracking and reflection.
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Number
Phobia or Trigger
*
Exposure Activity
*
Duration of Exposure (minutes)
Peak Distress Level During Exposure (0 = none, 10 = extreme)
*
None (0)
0
1
2
3
4
5
6
7
8
9
Extreme (10)
10
0 is None (0), 10 is Extreme (10)
Distress Level After Exposure (0 = none, 10 = extreme)
None (0)
0
1
2
3
4
5
6
7
8
9
Extreme (10)
10
0 is None (0), 10 is Extreme (10)
Coping Strategies Used
Deep breathing
Positive self-talk
Grounding techniques
Distraction
Other
Outcome / Notes
Initials (for tracking, not full names)
Submit Log
Should be Empty: