Client Homework Client Homework Client Homework Your Full Name * Email Address What exposure with response prevention (ERP) challenge did you attempt today? * How long did you stay with the exposure (minutes)? On a scale of 1-10, how high did your anxiety go? 1 2 3 4 5 6 7 8 9 10 On a scale of 1-10, what was your anxiety at the end of the exposure? 1 2 3 4 5 6 7 8 9 10 Did you accept (or better yet, embrace) uncertainty and discomfort? Yes No Does your anxiety disorder bother you? not at allmildlysomewhatmoderatelyhighlyseverely Does your anxiety disorder interfere with school, work or social functioning? does not interferemildly interferessomewhat interferesmoderately interfereshighly interferesseverely interferes What did you learn? I understand that e-mail is not a secure form of information. Use of this homework monitoring form is an added benefit for clients of the Coastal Center for Anxiety Treatment. Use of online monitoring is for clinical purposes only. This e-mail message is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you have received this communication in error, please notify the sender immediately by replying to the message and deleting it from your computer. * I understand.
