| 1. |
I do things which nurture,
strengthen, relax and comfort my body. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 2. |
I am accepting of my vulnerable
feelings like sadness, fear, and anxiety? |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 3. |
When I look at myself in the mirror,
I tend to notice all my flaws. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 4. |
When Im upset emotionally, I
can comfort myself with positive thoughts. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 5. |
When I need comfort, I utilize
healthy activities such as exercise and hobbies vs. impusively turning to food, alcohol,
or other substances. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 6. |
When I need comfort, I am
comfortable going to my partner or friends to share those feelings with them. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 7. |
I am comfortable expressing my angry
feelings. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 8. |
I am comfortable asserting my needs
ie, asking for what I want and saying what I do not want. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 9. |
I am able to recognize and value my
need for solitude i.e. "alone time". |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 10. |
I am able to recognize and value my
need for fun and lightheartedness. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 11. |
I am as generous with praise toward
myself for my accomplishments as I am with others for theirs. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 12. |
When I make errors, I am
perfectionistic and self critical instead of being forgiving of myself. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often |
|
| 13. |
I actively pursue and maintain
friendships with others. |
|
a. hardly at all
b. somewhat
|
c. frequently
d. very often
|
|