1. When dealing with change, my anxiety level is ...

non-existent. Looking forward to it!

low. I'm kind of nervous, but that's about it.

average. I may worry a little, but am also curious about the new outcome.

high. I worry a lot about it.

extremely high. I may have a panic attack.

2. When something goes wrong ...

I acknowledge the error, take full responsibility & turn my thoughts to possible solutions

I feel bad for a short time, but am able to find a way to work through it

I feel bad, but eventually I get over it

I tend to hold on to negative feelings for a long time

I immediately find someone to blame and hold resentment towards

3. The unknown:

I have no preference whether things are planned in advance or left open. I can deal easily with either.

I prefer a good mix of situations that are somewhat defined and in control as well as open-ended.

I prefer things to be well-defined and planned and I try to minimize the unknown

I prefer things to be open-ended and undefined. If things are overly scripted or constrained I get ‘claustrophobic.’

Regardless of whether things are planned or left open, I get stressed out.

4. When something goes wrong ...

I ask empowering questions to find a solution.

I look for solutions, but don't ask empowering questions.

I feel bad for a while and then try to work through it the best I can.

I feel bad for a long time.

I feel bad, hold resentment & blame others.

5. My thoughts & feelings include self criticism, negativity and/or depression ...

never

hardly ever

50/50

often

24/7

6. When I hear a criticism, …

it doesn't affect me at all

I feel bad, but the negative feeling goes away quickly

I take it in and it takes me several days or weeks to get over it

I feel anger and immediately seek to defend myself

I choose avoidance because I can't take it. The feeling may stay with me for years or more.

7. When I hear a compliment I ...

genuinely appreciate it

half-heartedly acknowledge it

try to accept it yet hear negative thoughts

share doubts and put the nice words down

8. When I think about a task I ...

have no problem prioritizing and completing the task

may put the task off for just a bit in order to accomplish more timely tasks

put the task off for some time prior to getting worked up to finishing it

put the task off indefinitely but ultimately will accomplish it

put the task off and generally never complete it even though I may start on it

never get around to starting the task

9. I have patience ...

pretty much all the time. I am relaxed and easy going.

most of the time. There are certain situations where I act impatiently.

about half the time.

sometimes. Most of the time I do not have patience.

never.

10. On an average day, I feel fearful ...

less than 1% of the time.

occasionally. I am mostly fine.

about half of the time.

between 50% to 75% of the time.

more than 75% of the time.

11. I appreciate how my body looks ...

always

usually

sometimes

rarely

never

12. A relaxed and tranquil state of mind and being is easy for me to achieve:

always

often

sometimes

infrequently

never

13. When it comes to cleanliness ...

I keep things very clean and get rid of unused things on a regular basis.

I keep things mostly clean. I have a few areas that need to be cleaned out or let go of.

I do have many things that need to be let go of. I clean mainly when people come to visit.

I hoard things on a regular basis. Occasionally, I will let go of some things.

I have a difficult time letting go of anything and I live in a big mess.

14. When I think about a task I ...

never hear thoughts putting me down

sometimes hear thoughts putting me down

regularly hear thoughts putting me down

try to distract thoughts putting me down

always fight the thoughts putting me down

15. I hear negative voices in my head ...

never

seldom, but I do hear them

when I do something uncomfortable

most of the time

all the time

16. Happiness is easy for me to achieve:

always

often

sometimes

infrequently

never

17. My dreams ...

teach me things on a regular basis.

will provide a bit of inspiration every so often.

are things I don't pay much attention to.

are mostly nonsense and I rarely remember them.

are actually nightmares. If I remember them, they scare me.

18. I have trouble remembering what I did before ...

I never have trouble remembering

every once in a while when I'm nervous

when I am pressured to recall something

during normal conversation

all the time

19. I let go of anger easily ...

always

mostly

sometimes

rarely

never

20. I am peaceful ...

almost always

most of the time

sometimes

hardly ever

never

21. I would rate my listening skills to be ...

excellent

above average

average

below average

really bad

22. It’s easy for me to feel happy ...

all the time

most of the time

about 50/50

some of the time

never

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