DEMOGRAPHIC VARIABLE

INITIAL OF THE SUBJECT:

AGE:

GENDER: FEMALE / MALE.

EDUCATIONAL QUALIFICATION:

PROFESSION: TEACHER / IT WORKERS.

POSITION IN THE WORK PLACE: EXPERIENCE:

INCOME: BELOW 20,000 / 20,000 – 50,000 / 50,000 – 1, 00,000 / ABOVE 1, 00,000.

AREA OF LIVING: URBAN / RURAL.

INSTRUCTIONS: Listed below are a variety of thoughts that pop into people’s heads. Please
read each thought and indicate how frequently, if at all, the thought occurred to you over the last
week. Please read each item carefully and circle the appropriate answers on the answer sheet.
Note the frequency in the on the left side column and Degree of belief on the right side of the
column of each question as stated as:

1- Not at all. 2- Somewhat. 3- Moderately. 4- Very much and 5- Totally.

FREQUENCY ITEMS DEGREE OF BELIEF

1 2 3 4 5 1 2 3 4 5
1. I feel like I’m up against the world.
2. I’m no good.
3. Why can’t I ever succeed?
4. No one understands me.
5. I have let people down.
6. I don’t think I can go on.
7. I wish I were a better person.
8. I’m so week.
9. My life’s not going the way I want it
to.
10. I’m so disappointed in myself.
11. Nothing feels good anymore.
12. I can’t stand this anymore.
13. I can’t get started.
14. What’s wrong with me?
15. I wish I were somewhere else.
16. I can’t get things together.
17. I hate myself.
 1 2 3 4 5 18. I’m worthless. 1 2 3 4 5
19. Wish I could just disappear.
20. What’s the matter with me?
21. I’m a loser.
22. My life is a mess.
23. I’m a failure.
24. I’ll never make it.
25. I feel so helpless.
26. Something has to change.
27. There must be something wrong with
me.
28. My future is bleak.
29. It’s just not worth it.
30. I can’t finish anything.

INSTRUCTIONS: These are the following questions which may or may not describe how you
are feeling right now. Please read the questions carefully and rate your feelings. Note that each
statement is rated based on your feelings right at this moment. The ratings include:

1- Not feeling this way. 2- Rarely feeling in between 1 and 3. 3- Feeling this way somewhat.

4- Feeling often between 3 and 5. 5- Very strongly feeling this way.

S.NO ITEMS 1 2 3 4 5
.
1 I feel like good about myself.
2 I want to sink into the floor and disappear.
3 I feel remorse, regret
4 I feel worthwhile, valuable.
5 I feel small.
6 I feel tension about something I have done.
7 I feel capable, useful.
8 I feel like I am a bad person.
I cannot stop thinking about something bad I have
9
done.
10 I feel proud.
11 I feel humiliated, disgraced.
12 I feel like apologizing, confessing.
13 I feel pleased about something I have done.
14 I feel worthless, powerless.
15 I feel bad about something I have done.
INSTRUCTIONS: The following questions are related to how you typically act towards
yourself in difficult times. Please read each questions and carefully answer the questions. For
each question given below to its right side indicates ‘how often you behave in the stated
manner’: 1- Almost never. 2- Rarely. 3- Sometime. 4- Often. 5. Almost always.

S.NO ITEMS 1 2 3 4 5
.
When I fail at sometimes important to me I become consumed by
1
feelings of inadequacy.
I try to be understanding and patient towards those aspects of my
2
personality I don’t like.
When something painful happens I try to take a balanced view of
3
the situation.
When I’m feeling down, I tend to feel like most other people are
4
probably happier than I am.
5 I try to see my failings as part of the human condition.
When I’m going through a very hard time, I give myself the
6
caring and tenderness I need.
7 When something upsets me I try to keep my emotions in balance.
When I fail at something that’s important to me, I tend to feel
8
alone in my failure.
When I’m feeling down I tend to obsess and fixate on everything
9
that’s wrong.
When I feel inadequate in some way, I try to remind myself that
10
feelings of inadequacy are shared by most people.
I’m disapproving and judgmental about my own flaws and
11
inadequacies.
I’m intolerant and impatient towards those aspects of my
12
personality I don’t like.