FEEL IMAGERY Record
(Feeling Experiences Enriches Living)
Date: ____________________________ Time: _________________ a.m./p.m.
0	1	2	3	4	5	6	7	8	9	10	
Low 					Moderate			Extreme	

Exercise	Sensations Intensity
(0–10)	
Anxiety Level
(0–10)	Willingness to Experience
(0–10)	Struggle with Experience
(0–10)	Avoidance of Experience
(0–10)