| Possible Distractions | Yes (Y) No (N) | Controllable (C) Uncontrollable (U) | Solutions? |
| Cell phone | |||
| Internet (e.g., Twitter/Instagram) | |||
| Gaming/videos/music | |||
| Sports/hobbies | |||
| Television/online videos | |||
| Lack of sleep | |||
| Relationship problems | |||
| Meals/snacks | |||
| Daydreaming | |||
| Perfectionism | |||
| Errands/shopping | |||
| Lost items | |||
| Worries/stress | |||
| Socializing/friends | |||
| Multitasking | |||
| Illness (yours or someone else's) | |||
| Work schedule | |||
| Pleasure reading | |||
| Family members |