3. Record on the homework form each time you do the Body Scan, Mindful Breathing, and Moment-to-Moment Awareness. Also, make a note of anything that up in the homework, so that you can discuss it with your therapist. 4. Complete the Pleasant Events Calendar (one per day). Use this as an opportunity to become really aware of the thoughts, feelings, and body sensations around one pleasant event each day. Notice and record, as soon as you can, in detail (use the actual words or images in which the thoughts came) the precise nature and location of bodily sensations. Sun Mon Tues Wed Fri Sat Completed: 5. Were any obstacles to completing this homework? List them: What can you do to ensure that obstacles do not prevent you from doing your homework next week? 6. How was doing this homework helpful to you? Has anything changed as a result of doing the homework? Describe the changes. Did the homework help you to have any new ideas or understandings about yourself? Explain. MINDFULNESS HOMEWORK RECORD FORM Body Scan or Moment-to-Moment Awareness Date Two 15-min Sessions of Mindful Breathing during Routine Activity Completed? Yes No Activity: _________________________ Thoughts: Thoughts: Feelings: Feelings: Sensations: Sensations: Completed? Yes No Activity: _________________________ Thoughts: Thoughts: Feelings: Feelings: Sensations: Sensations: Completed? Yes No Activity: _________________________ Thoughts: Thoughts: Feelings: Feelings:
3. Record on the homework form each time you do the Body Scan, Mindful Breathing, and Moment-to-Moment Awareness. Also, make a note of anything that up in the homework, so that you can discuss it with your therapist. 4. Complete the Pleasant Events Calendar (one per day). Use this as an opportunity to become really aware of the thoughts, feelings, and body sensations around one pleasant event each day. Notice and record, as soon as you can, in detail (use the actual words or images in which the thoughts came) the precise nature and location of bodily sensations. Completed: Sun Mon Tues Wed Fri Sat 5. Were any obstacles to completing this homework? List them: What can you do to ensure that obstacles do not prevent you from doing your homework next week? 6. How was doing this homework helpful to you? Has anything changed as a result of doing the homework? Describe the changes. Did the homework help you to have any new ideas or understandings about yourself? Explain. MINDFULNESS HOMEWORK RECORD FORM Date Body Scan or Two 15-min Sessions of Mindful Breathing Moment-to-Moment Awareness during Routine Activity Completed? Yes No Thoughts: Feelings: Sensations: Activity: _________________________ Thoughts: Feelings: Sensations: Completed? Yes No Thoughts: Feelings: Sensations: Activity: _________________________ Thoughts: Feelings: Sensations: Completed? Yes No Thoughts: Feelings: Activity: _________________________ Thoughts: Feelings:
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