PTSD Symptom and Recovery Tracking Sheet

Patient Information

Name: ___________________ Date Range: //___ to //___

Daily Symptom Severity Rating

Rate each symptom from 0-10 (0 = None, 10 = Severe)

Re-experiencing Symptoms

• Intrusive memories: ___
• Nightmares: ___
• Flashbacks: ___
• Emotional distress to triggers: ___
• Physical reactions to triggers: ___

Avoidance Behaviors

• Avoiding thoughts/feelings: ___
• Avoiding places/activities: ___
• Social withdrawal: ___

Mood and Cognition

• Negative thoughts about self/others: ___
• Feeling disconnected: ___
• Difficulty experiencing positive emotions: ___

Coping Strategies Used Today

□ Deep breathing □ Grounding exercises □ Progressive muscle relaxation □ Mindfulness meditation □ Physical exercise □ Support group attendance □ Therapy homework □ Other: ________________

Medication Adherence

□ Took all medications as prescribed □ Missed doses (specify): ________________

Sleep Pattern

Hours slept: ___ Sleep quality (1-5): ___

Overall Daily Function

Ability to work/study (1-5): ___ Social interactions (1-5): ___

Notes

Triggers encountered: ________________________________________________ Effective coping strategies: __________________________________________

Emergency Contacts

Therapist: ________________ Crisis Hotline: 988 Emergency Contact: ________________