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Mind Reboot
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Please tell me what your unique participant number is.
Use digits only
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2
How often do you experience feelings of anxiety per week?
Continually
A few times a day
About once a day
A few times a week
Once a week
Less than once a week
not applicable
3
On a scale of 1-10 how strong are your feelings of anxiety?
4
How easily are you able to change your emotional state when you realise how you feel?
Select one or more answers
Very difficult
Difficult
Neither easy nor difficult
Easy
Very easy
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5
How often do you experience low mood per week?
Select one or more answers
Continually
A few times a day
About once a day
A few times a week
Once a week
Less than once a week
not applicable
6
On a scale of 1-10 how strong are your feelings of low mood?
7
How easily are you able to change your emotional state when you realise how you feel?
Select one or more answers
Very difficult
Difficult
Neither easy nor difficult
Easy
Very easy
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8
How often do you experience symptoms of stress per week?
Select one or more answers
Continually
A few times a day
About once a day
A few times a week
Once a week
Less than once a week
not applicable
9
On a scale of 1-10 how strong are your symptoms of stress?
10
How easily are you able to change your emotional state when you realise how you feel?
Select one or more answers
Very difficult
Difficult
Neither easy nor difficult
Easy
Very easy
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11
How often do you procrastinate per week?
Continually
A few times a day
About once a day
A few times a week
Once a week
Less than once a week
not applicable
12
On a scale of 1-10 how intense is your procrastination?
(1 =put it off till after a cup of tea- 10= miss deadlines)
13
How easily are you able to change your emotional state when you realise how you feel?
Select one or more answers
Very difficult
Difficult
Neither easy nor difficult
Easy
Very easy
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14
Can you think of any major life events that have caused you emotional distress?
(Deaths, break-ups, abuse, health issues, assult...)
Yes
No
15
On a scale of 1-10 how intense are the emotions when you remember those events?
16
How often do you avoid circumstances that feel similar to any of these distressing or emotional memories?
Continually
A few times a day
About once a day
A few times a week
Once a week
Less than once a week
not applicable
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17
How many hours sleep do you get on average a night?
18
Is your answer based on data from a sleep app?
Select one answer
Yes
No
19
How often do you wake in the night?
Select one or more answers
Always
Usually
Sometimes
Rarely
Never
20
If you wake in the night what is usually the reason?
Select one or more answers
Physical reasons - discomfort, needing the loo, temperature regulation
Negative feelings
21
If you wake, how easily do you go back to sleep?
Select one or more answers
Very difficult
Difficult
Neither easy nor difficult
Easy
Very Easy
22
How often do you remember your dreams?
Select one or more answers
Always
Usually
Sometimes
Rarely
Never
23
Do you experience nightmares?
Select one or more answers
Always
Usually
Sometimes
Rarely
Never
24
Do you ever sleep walk
Select one or more answers
Always
Usually
Sometimes
Rarely
Never
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25
How often do you experience situations that evoke anger, frustration, aggravation or annoyance?
Select one or more answers
Continually
A few times a day
Once a day
Couple of days a week
Once a week
Less than once a week
Never
26
On a scale of 1-10 how strong is the emotion when it happens?
(1 =put it off till after a cup of tea- 10= miss deadlines)
27
How often do you experience situations that evoke sadness?
Select one or more answers
Continually
A few times a day
Once a day
Couple of days a week
Once a week
Less that once a week
Never
28
On a scale of 1-10 how strong is the emotion when it happens?
(1 =put it off till after a cup of tea- 10= miss deadlines)
29
How often do you experience situations that evoke hurt?
Select one or more answers
Continually
A few times a day
Once a day
Couple of days a week
Once a week
Less that once a week
Never
30
On a scale of 1-10 how strong is the emotion when it happens?
(1 =put it off till after a cup of tea- 10= miss deadlines)
31
How often do you experience situations that evoke guilt?
Select one or more answers
Continually
A few times a day
Once a day
Couple of days a week
Once a week
Less than once a week
Never
32
On a scale of 1-10 how strong is the emotion when it happens?
(1 =put it off till after a cup of tea- 10= miss deadlines)
33
How often do you experience situations that evoke fear?
Select one or more answers
Continually
A few times a day
Once a day
Couple of days a week
Once a week
Less that once a week
Never
34
On a scale of 1-10 how strong is the emotion when it happens?
(1 =put it off till after a cup of tea- 10= miss deadlines)
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35
Self Esteem - On a scale of 0-10 how much do you like yourself?
36
Confidence - On a scale of 0-10 how comfortable and capable do you feel you are in interactions and situations?
37
Resourcefulness - On a scale of 0-10, in the future, how confident do you feel that you will find a way to overcome any obstacle to your goals?
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