Physical Indicators

Todays Date

After One Week

After Two Weeks

Headaches

Indigestion

Stomach aches

Sweaty palms

Sleep difficulties

Dizziness

Fast, shallow breathing

Back pain

Tight neck, shoulders

Racing heart

Restlessness

Cold hands

Pain on a 1-10 scale

Behavioral Indicators

Excess smoking

Bossiness

Screaming/shouting

Compulsive gum chewing

Critical of others and/or self

Pacing finger/foot taping

Grinding of teeth

Overuse of alcohol

Compulsive eating

Inability to get things done

Unable to sit still

Biting fingernails

Cognitive Indicators

Trouble thinking clearly

Forgetfulness

Lack of creativity

Memory loss

Inability to make decisions

Thoughts of running away

Constant worry

Loss of sense of humor

Excessive, compulsive thoughts

Emotional Indicators

Crying

Nervousness, anxiety

Boredom - no meaning to things

Edginess - ready to explode

Feeling powerless to change things

Overwhelming sense of pressure

Anger

Loneliness

Unhappiness for no reason

Easily upset

Spiritual Indicators

Apathy

Emptiness

Lack of purpose

Unworthiness

Shame

Hopelessness

Separateness

Unable to surrender/let go

Fearful

Powerlessness