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This questionnaire contains six items about experiences you may have in your daily life.To answer these items, please determine to what degree the experiences described in the questions applies to you.


0 = Never 1= Rarely 2 = Seldom 3= Often 4= Usually 5= Always

I can get out of bed every morning.
I eat my meals regularly.
I exercise regularly.
I am responsible for my daily schedule without having to be reminded by other people.
I can focus on the here and now even if I have difficulty with my past.
I am able to take care of myself and regulate my emotions.

© 2024 by Christine Poje TraumaTherapyAmerica

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