Instructions

1. Choose a quiet place, while taking the test.

2. The administration of this test should not be immediately after some mental trauma or unsteady period.

3. Answer all questions by selecting under the appropriate answer.

Please read each statement and record a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past two weeks. There are no right or wrong answers. Do not spend too much time on any one statement. This assessment is not intended to be a diagnosis.

0 = Strongly disagree 1 = Disagree 2 = Agree 3 = Strongly agree

Below is a list of statements dealing with your general feelings about yourself. Please indicate how strongly you agree or disagree with each statement.