Print It is important to gain insight into your daily activities, how enjoyable they are and how they affect your mood.
You can write down your activities.
This form will help you to register which activities you have done, when you did them, how much you enjoyed the activity, how competent you felt and what mood you were in during the activities.
How do I fill in the Activity Form?
Record every activity you do every day for at least a week (e.g. breakfast, walking, drinking coffee, shopping, showering, etc.).
Then fill out the following things:
- How enjoyable the activity was on a scale of 0-10 (0 = not at all pleasant / ‘must’, 10 = very pleasant)
- How competent you felt on a scale of 0-10 (0 = not competent at all, 10 = extremely competent).
- What mood you were in on a scale of 0-10 (0 = very depressed, 10 = not depressed at all)
During your next session, you will discuss the completed list with your practitioner and see how your activities and mood may influence each other.
Activity form
Date: ________________
| Time of day | Activity | Enjoyment
(0-10) * |
Competence (0-10) ** | Mood (0-10) *** |
* Enjoyment: Take notes on how enjoyable the activity was. P-score 0-10 (0 = not at all pleasant / must, 10 = very pleasant)
** Competence: Write down how well you were able to carry out the activity. B-score 0-10 (0 = not competent at all, 10 = extremely competent).
*** Mood: 0-10 (0 = very depressed, 10 = not depressed at all)
An example of a completed activity form
Date: Monday, August 5
| Time of Day | Activity | Enjoyment
(0-10) * |
Competence (0-10) ** | Mood (0-10) *** |
| Morning | Get up | 1 | 3 | 2 |
| Morning | Breakfast | 2 | 5 | 3 |
| Morning | Yoga lesson | 7 | 7 | 7 |
| Afternoon | Grocery shopping | 0 | 3 | 2 |
| Afternoon | Coffee | 5 | 7 | 6 |
| Afternoon | Cleaning the house | 0 | 3 | 3 |
| Evening | I had dinner but wasn’t hungry. | 1 | 3 | 3 |
| Evening | Watching TV. | 6 | 6 | 6 |
* Enjoyment: Take notes on how enjoyable the activity was. P-score 0-10 (0 = not at all pleasant / must, 10 = very pleasant)
** Competence: Write down how well you were able to carry out the activity. B-score 0-10 (0 = not competent at all, 10 = extremely competent).
*** Mood: 0-10 (0 = very depressed, 10 = not depressed at all)
References: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten
