Daily ACT Ratings
Life Enhancement Exercise Record Form
At the end of each day, please make a rating for each of the following four questions using the scale below. Ratings for each question can range from 0 (not at all) to 10 (extreme amount):

0	1	2	3	4	5	6	7	8	9	10	
None / Not at all						Extreme amount	
Suffering: How upset and distressed over anxiety were you today overall? ___________________
Struggle: How much effort did you put into making anxiety-related feelings or thoughts go away today (for example, by suppressing them; distracting yourself; reassuring yourself or seeking reassurance from someone else)? 
___________________
Workability: If life in general were like today, to what degree would today be part of a vital, workable way of living for you? ___________________
Valued Action: How much have you engaged in behaviors (actions) today that accord with your values and life goals? ___________________

Day	Suffering
0–10	Struggle
0–10	Workability
0–10	Valued Action
0–10	
Monday	

Tuesday	

Wednesday	

Thursday	

Friday	

Saturday	

Sunday