Worksheet

Self-Care
Assessment

This assessment was taken from The Intuitive Eating Workbook (2025) by Evelyn Tribole and Elyse Resch. To complete it, check each statement that applies to you, then complete the self-care reflection tab. Be candid, this audit is for you alone.

Progress
0 / 0 checked
Positive Behaviors

Physical

0
I get enough sleep to feel rested and restored when I wake up
I get regular medical and dental checkups
I take time off work or school when I'm sick
I wear clothes that I like and that feel comfortable
I take vacations
I engage in a physical activity that I enjoy at least 5× per week
Other:

Emotional & Psychological

0
I make time for self-reflection
I am aware of my thoughts, without judgement
I'm aware of my feelings, without judgment
I write in a journal
I identify comforting activities and places and seek them out
I make time to relax
I make time to play
I find things that make me laugh
I have hobbies and interests outside of work or school
I have compassion for myself and others
I seek therapy when needed
Other:

Relational

0
I spend time with people whom I enjoy and who sustain and support me
I have someone in my life who would listen to me if I were upset or just needed to talk (friends, family, a therapist, or clergy)
I stay in contact with important people in my life
I make time to spend with my family
Other:

Spiritual

0
I spend time in nature
I make time for reflection
I seek or participate in spiritual connection or community
I am aware of nonmaterial aspects of life
I seek experiences of awe
I have a meditation practice
I pray
I read or study inspirational books or articles
Other:

Boundaries

0
I maintain a manageable schedule at work or school, which includes taking breaks
I take breaks from electronic media, including my computer, smartphone or TV
I say no to extra projects or responsibilities if I am overscheduled
I set limits with my family and friends
I set limits with volunteer projects
I set limits with work, such as not working while on vacation
I strive for balance among work, family, school, play, relationships and rest
I speak up when others attempt to cross my boundaries
Other:
Attunement Disruptors

Physical

0
I often skip meals when I am pressed for time
I watch more than two hours of TV a day
I exercise too much, such as when I'm sick or injured
I smoke (or vape)
I go long periods of time without eating
I eat beyond comfortable fullness or undereat when I am stressed
I often multitask while I eat, watching television, checking email, or reading
I am often sleep deprived
I drink more than the recommended levels of alcohol (more than one or two drinks per day)
Other:

Emotional & Psychological

0
I have a difficult time managing stress, whether it's about interpersonal, political or social justice issues
I feel guilty if I am not productive or doing something important
I do not know how to relax
I engage in harsh or critical self-talk
I don't allow myself to feel my feelings or cry
I self-silence my thoughts and feelings
My life feels out of control
Other:

Relational

0
I don't like to burden my friends or family with my problems
My family doesn't support me when I have problems
I worry about what people think of me
I withdraw from people when I am stressed out
Other:

Spiritual

0
I am mainly drawn to material things
I don't take any time to reflect on the meaning of my life
I always believe that I don't have enough
I don't consider the things in my life for which I am grateful
I don't consider that I have a purpose in this life
Other:

Boundaries

0
I have a hard time saying no to people's requests
I feel the need to make others happy
I feel selfish if I say no to a request
I tend to take on too many projects and activities
I automatically say yes to requests, without reflecting on my schedule or prior commitments
I take pride in being super busy
Other:
Self-Care Reflection
Positive Behaviors
0
checked
Attunement Disruptors
0
checked

Reflection Questions

Using the information from your assessment, answer the following questions:

Self-Care Practices to Increase

Review the self-care practices from your assessment. Describe one or two strategies you are willing to consistently implement to improve your self-care.

Physical

Example: I will work on consistently getting enough sleep by getting to bed, with lights out, by 10:30pm.

Emotional & Psychological

Example: I will spend 30 minutes relaxing when I'm done with work.

Boundaries

Example: I will politely decline new volunteer projects until I finish my current commitment.

Spiritual

Example: I will start meditating for 10 minutes a day at a time that will work for me.

Relational

Example: I will reach out by phone to at least one of my good friends once a week.

Attunement Disruptors to Decrease

Review each of the attunement disruptor categories from your assessment. Describe one or two issues on which you are willing to work.

Physical

Example: I often eat while multitasking. I will eat at least one meal a day without distraction.

Emotional & Psychological

Example: I do not know how to relax. I will give myself permission to relax by reading something fun at least five times per week.

Boundaries

Example: I automatically say yes to requests. I will practice saying "I need to check my schedule and will get back to you tomorrow."

Spiritual

Example: I have no spiritual practice. I will read one inspirational article each week.

Relational

Example: I frequently isolate myself when stressed. I will accept at least one social invitation per week.

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