Please circle either “True” or “False” to indicate whether each statement is true or false for you. 

True	False	1.  Sometimes I feel and experience things as I did when I was a child.

True	False	2.  I can become deeply involved when reading or hearing about someone else.

True	False	3.  When I watch a boat on the lake I can almost feel what it would be like to be on it.

True	False	4.  I can be greatly moved by eloquent or poetic language.

True	False	5.  While watching a movie, a TV show, or a play, I may become so involved that I forget about myself and my surroundings and experience the story as if it were real and as if I were taking part in it.

True	False	6.  Sometimes I feel as if my mind could envelope the whole world.

True	False	7.  I like to watch cloud shapes change in the sky.

True	False	8.  If I wish, I can imagine or daydream some things so vividly that they hold my attention the way a good movie or story does.

True	False	9.  I sometimes “step outside” my usual self and experience an entirely different state of being.

True	False	10.  I think I really know what some people mean when they talk about mystical experiences.

True	False	11.  Sometimes I experience things as if they were doubly real.

True	False	12.  Textures – such as wool, sand, wood – sometimes remind me of colors or music.

True	False	13.  When I listen to music, I get so caught up in it that I don’t notice anything else.

True	False	14.  If I wish, I can imagine that my body is so heavy that I could not move it if I wanted to.

True	False	15.  Often I can somehow sense the presence of another person before I actually see or hear him or her.

True	False	16.  The crackle and flames of a wood fire stimulate my imagination.

True	False	17.  It is sometimes possible for me to be completely immersed in nature or in art and to feel as if my whole state of consciousness has somehow been temporarily altered.

True	False	18.  I can sometimes recollect certain past experiences in my life with such clarity and vividness that it is like living them again, or almost so.

True	False	19.  I am able to wander off into my own thoughts while doing a routine task and actually forget that I am doing the task, and then find a few minutes later that I have completed it.

True	False	20.  I have attempted to write poetry or fiction.

True	False	21.  Different colors have distinctive and special meanings for me.

True	False	22.  Things that might seem meaningless to others often make sense to me.

True	False	23.  While acting in a play I think I could really feel the emotions of the character and “become” him or her for the time being, forgetting both myself and the audience.

True	False	24.  My thoughts often don’t occur as words, but as visual images.

True	False	25.  I often take delight in small things (like the five-pointed star shape that appears when you cut an apple across the core, or the colors in soap bubbles).

True	False	26.  When listening to organ music or other powerful music, I sometimes feel as if I am being lifted into the air.

True	False	27.  Sometimes I can change noise into music by the way I listen to it.

True	False	28.  Some of my most vivid memories are called up by scents and smells.

True	False	29.  Certain pieces of music remind me of pictures or moving patterns of color.

True	False	30.  I often know what someone is going to say before he or she says it.

True	False	31.  I often have “physical memories”; for example, after I’ve been swimming I may still feel like I’m in the water.

True	False	32.  The sound of a voice can be so fascinating to me that I can just go on listening to it.

True	False	33.  At times I somehow feel the presence of someone who is not physically there.

True	False	34.  Sometimes thoughts and images come to me without the slightest effort on my part.

True	False	35.  I find that different odors have different colors.

True	False	36.  I can be deeply moved by a sunset.

True	False	1.  I look forward to the future with hope and enthusiasm.

True	False	2.  I might as well give up because I can’t make things better for myself.

True	False	3.  When things are going badly, I am helped by knowing they can’t stay that way forever.

True	False	4.  I can’t imagine what my life would be like in 10 years.

True	False	5.  I have enough time to accomplish the things I most want to do.

True	False	6.  In the future, I expect to succeed in what concerns me most.

True	False	7.  My future seems dark to me.

True	False	8.  I expect to get more of the good things in life than the average person.

True	False	9.  I just don’t get the breaks, and there’s no reason to believe I will in the future.

True	False	10.  My past experiences have prepared me well for my future.

True	False	11.  All I can see ahead of me is unpleasantness rather than pleasantness.

True	False	12.  I don’t expect to get what I really want.

True	False	13.  When I look ahead to the future, I expect I will be happier than I am now.

True	False	14.  Things just won’t work out the way I want them to.

True	False	15.  I have great faith in the future.

True	False	16.  I never get what I want so it’s foolish to want anything.

True	False	17.  It is very unlikely that I will get any real satisfaction in the future.

True	False	18.  The future seems vague and uncertain to me.

True	False	19.  I can look forward to more good times than bad times.

True	False	20.  There’s no use in really trying to get something I want because I probably won’t get it.

True	False	1.  I am very much afraid to die.

True	False	2.  The thought of death seldom enters my mind.

True	False	3.  It doesn’t make me nervous when people talk about death.

True	False	4.  I dread to think about having to have an operation.

True	False	5.  I am not at all afraid to die.

True	False	6.  I am not particularly afraid of getting cancer.

True	False	7.  The thought of death never bothers me.

True	False	8.  I am often distressed by the way time flies by so very rapidly.

True	False	9.  I fear dying a painful death.

True	False	10.  The subject of life after death troubles me greatly.

True	False	11.  I am really scared of having a heart attack.

True	False	12.  I often think about how short life really is.

True	False	13.  I shudder when I hear people talking about a World War III.

True	False	14.  The sight of a dead body is horrifying to me.

True	False	15.  I feel that the future holds nothing for me to fear.

903