1-test-form

Below is a list of common difficult emotions that you may have experienced, please check any that concern you:

Please indicate on a scale of 1 – 10 how much these feelings negatively impact your life (where 1 = the feelings have no real impact on the way l live my life and 10 = the feelings dominate how l live my life)

Below is a list of common behaviors that can be influenced by our emotions and mental state, please check any that apply to you?

Please indicate on a scale of 1 – 10 how much control you feel you have over this behaviour currently (where 1 =l have full control and can act or avoid acting this way l choose and 10 = l can’t help but act this way)

Please read each statement and select a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. The rating scale is as follows: 0 = Did not apply to me at all 1 = Applied to me to some degree, or some of the time 2 = Applied to me to a considerable degree, or good part of the time 3 = Applied to me very much, or most of the time