For people who are experiencing challenges, research suggests that, in addition to receiving medical care, developing self-care practices can help create and maintain senses of mental health, well-being, and stability.
To what extent do you agree you have taken action on each specific self-care practice suggested below?
Use the following scale to rate your agreement with each statement.
5 – Strongly agree
4 – Agree
3 – Neutral
2 – Disagree
1 – Strongly Disagree
_____ 1. I have taken prescribed medication(s) at the correct time(s) each day and in the correct dose(s).
_____ 2. I attended medical appointments, scheduled a medical appointment, or checked my calendar to remind myself of upcoming medical appointments.
_____ 3. I am working on establishing a regular schedule for myself to support my stability. I am working on radically accepting the paradox that imposing structure on my days gives me the freedom to more fully live them as I choose.
_____ 4. I have been aware of my basic needs, such as food, shelter, and clothing, and have done what I can to help get my needs met.
_____ 5. I have practiced sleep hygiene and I am working on establishing a regular sleep pattern for myself.
_____ 6. I have centered my diet around nutrient-rich foods and have eaten on a regular schedule. I help myself stay neither too hungry nor too full. I drink plenty of water.
_____ 7. I have engaged in daily physical movement and/or physical activity.
_____ 8. I have monitored my consumption of caffeine and have maintained, reduced, or eliminated it. I have attempted to eliminate caffeine within 6 hours of going to bed.
_____ 9. I do not use nicotine or have monitored my use of nicotine through tobacco products and vaping and have cut back where I could.
_____ 10. I monitor the sources of stress in my life. I use awareness skills to keep stressors from pushing me to a breaking point.
_____ 11. I am becoming aware of what has my attention. I can engage, disengage, and shift my attention based on what I think is beneficial for me. I can pair awareness with action.
_____ 12. I have become aware of my physical sensations, feelings, thoughts, and actions without judging or criticizing myself or my experience. I consult my inner wisdom – wherein my values and priorities reside – for guidance when faced with a choice or decision.
_____ 13. I am learning to observe and identify my patterns of feeling, thinking, behaving, relating, and working.
_____ 14. I have listened for negative self-talk. I can sort my thoughts into the categories of “helpful” and “unhelpful.” I attempt to shift my attention to helpful thoughts. I can see the difference between facts and beliefs, and between wishes and reality.
_____ 15. I have become conscious of when I am experiencing strong sensory states, strong states of emotion, many thoughts at once, thoughts that don’t make sense, or thoughts that concern me. I am aware of when I am in emotional or physical pain. I have used supportive self-talk and other tools to calm myself enough to be able to think before taking action. I am learning to tolerate distress and to regulate my emotions.
_____ 16. I am learning new skills and practicing them. I pair awareness with action. When I want and need these skills, they will be there for me.
_____ 17. I have attended individual counseling sessions, and/or skills-focused group counseling sessions if needed and as needed, and/or engaged in personal growth work based on sound psychological theory or research.
_____ 18. I have met with, held video conferences with, talked on the phone with, or texted people who support my efforts.
_____ 19. I monitor my patterns of relating to others and adjust as needed to respect myself and others. I am learning interpersonal effectiveness skills.
_____ 20. I have worked on building a network of support, social connections, a social network, community membership, and a sense of belonging. I may have attended support groups, either in-person or online. I may have joined community groups and common interest groups, volunteer organizations, sports teams and/or engaged in other group activities. I seek enough social interaction to feel connected and stimulated, but not so much that I feel overwhelmed and over-stimulated.
_____ 21. I am exploring and discovering my preferences and personal interests. I am trying different activities, pastimes and hobbies to see which ones engage me.
_____ 22. I am attempting to taper out avoidance strategies and to taper in what helps me handle reality, regardless of how challenging that might be.
_____ 23. I am working on believing in my worth and learning my strengths. I acknowledge myself when I believe I can do something, say I will do it, and try it. I am learning to support my sense of self-efficacy.
_____ 24. I am discovering purpose and meaning through self-reflection, self-discovery, and interactions with others. I am taking action on my purpose through paid work, volunteer work, and/or education.
_____ 25. I track my expenses and know how much it costs to be me. This knowledge helps inform me when I make decisions about money.
_____ 26. I engage in self-care practices I find personally effective and helpful.
(Please describe briefly.)
__________________________________________________________________
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_____ 27. I organize my self-care materials. I track my medical care. I store medical and therapeutic documents and receipts. If I am involved with authorities with regard to any issues, I obtain evidence documenting all my attendance at required and optional appointments and events. I document my compliance with required actions and activities.
TOTAL
• Please add up your score, perhaps using your phone’s calculator.
• 135 would be a 100% self-care score, 27 questions x 5 points each.
• 67.5 would be a 50% self-care score.
• What range of self-care scores do you think would help you achieve your personal goals using a Goldilocks approach: Not too much effort, not too little effort, but “just right”?
• What one small action could you take today to move your score closer to your desired range?
“[Audre Lorde] casually summed up her concept of self-care in the epilogue to her influential diary essay A Burst of Light: Living with Cancer. ‘Caring for myself’,’ she writes, ‘is not self-indulgence, it is self-preservation, and that is an act of political warfare.’…Self-care in this sense is an exceedingly radical idea.”
– Daniel Schreiber, Alone: Reflections on Solitary Living (p. 101). August 1, 2023. Reaktion Books. Kindle Edition.
Last updated 2/28/2024
This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
