1. On a scale of 1 to 10, how heavy does your body or mood feel right now? 1 2 3 4 5 6 7 8 9 10 (1 = Light and energized, 10 = I can barely move or think) 2. What best describes your current energy level? I'm energized I'm a bit tired I’m exhausted but pushing through I can’t get off the couch 3. When you think about doing something — anything — what’s your usual reaction? Let’s go Ugh, okay What’s the point? I physically or mentally can’t 4. On a scale of 1 to 10, how much are you stuck in negative thoughts right now? 1 2 3 4 5 6 7 8 9 10 (1 = Almost none, 10 = Constant loop of self-blame or hopelessness) 5. What best describes your motivation level? I'm motivated and moving I'm going through the motions I want to care, but I don’t Everything feels pointless 6. How much do you feel like depression is in control of your day right now? 1 2 3 4 5 6 7 8 9 10 (1 = Not at all, 10 = It’s steering the whole ship) 7. What’s your experience with small tasks right now? I knock them out easily I get through them with effort They feel huge Even brushing my teeth is hard 8. What kind of thoughts have been most common lately? I’ve got this I’m tired, but okay I’m not good enough Nothing matters 9. What do you feel when someone offers help or support? Grateful Mixed — I feel guilty or undeserving I don’t believe them I ignore or reject it 10. What describes your sense of hope for tomorrow? Hopeful Wary, but willing Numb None What is your email?
