Pornography Addiction Recovery Worksheet
A compassionate guide to understanding, healing, and building a healthy relationship with sexuality
Understanding Your Current Situation
How would you rate the current impact of pornography use on your life?
Current patterns and behaviors - Check all that apply:
When did you first realize this might be a problem?
What motivated you to work on this today?
Impact Assessment
Rate the impact on different areas of your life (1 = No impact, 5 = Severe impact):
Life Area | Impact Rating (1-5) | Specific Effects |
---|---|---|
Romantic/Sexual Relationships | ||
Work/School Performance | ||
Family Relationships | ||
Friendships/Social Life | ||
Self-Esteem/Mental Health | ||
Physical Health | ||
Spiritual/Values Alignment | ||
Time Management |
What has been the most significant consequence or loss from your pornography use?
Understanding Your Triggers
Common triggers - Check all that apply to you:
Your top 3 most powerful triggers:
Trigger | When/Where It Happens | What You're Seeking |
---|---|---|
1. | ||
2. | ||
3. |
Describe the typical cycle - What thoughts, feelings, and events lead up to viewing pornography?
Healthy Coping Strategies
Immediate Techniques (0-5 minutes)
Quick strategies to interrupt urges
Short-term Activities (5-30 minutes)
Engaging activities to redirect energy
Long-term Wellness
Building resilience and life satisfaction
Emotional Regulation
Healthy ways to process difficult emotions
Create a personalized coping plan for your top trigger:
When I experience: ____________________ (your main trigger)
Instead of viewing pornography, I will:
Recovery Goals & Planning
Your recovery goals:
Time Frame | Specific Goal | How You'll Measure Success |
---|---|---|
This Week | ||
This Month | ||
3 Months | ||
6 Months |
Environmental changes to support recovery:
Additional environmental or lifestyle changes you'll make:
Building Support & Accountability
Types of support you're open to:
Your support network:
Person/Resource | Type of Support | When to Contact |
---|---|---|
Relapse Prevention & Self-Compassion
Warning signs that a relapse might be approaching:
If I have a setback, I will:
- Immediately:
- Within 24 hours:
- To learn and grow:
Self-Compassion Reminders
Recovery involves setbacks. Practice self-compassion with these reminders:
Personal Recovery Commitment
Today, I commit to my recovery by:
The life I want to create through recovery:
One specific action I will take today to support my recovery: