Headstrong – Data Tracking Form

  • MM slash DD slash YYYY
  • Please select and mark ONE relevant response to items 1-11 as they pertain to symptoms in the past 7- 30 days. Overall improvement refers only to symptom changes since the beginning of treatment. Please do not ask the veteran to score, but make your own assessment based on your clinical contact. If you wish, provide details.
  • e.g. intrusion, flashbacks, nightmares
  • e.g. aggressive, reckless, outbursts of anger, irritable, self-destructive behavior, easily startled/distracted, jumpy, on edge, "on guard"
  • e.g. detachment/engagement, distant or cut off from people, spouse, family, friends
  • e.g. difficulty enjoying things, hard to imagine having a long life span and fulfilling goals
  • *Use DSM-5 criteria
  • *Use DSM-5 criteria
  • e.g. supportive, EMDR, DBT, IFS, SE, hypnosis, neuro-feedback. (May be more than one.)