Please indicate for each statement below the degree to which this change occurred in your life as a result of your experience:

1.  My priorities about what is important in life changed.
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

2.  I developed an appreciation for the value of my own life. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

3.  I developed new interests. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

4.  I developed a feeling of self-reliance. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

5.  I developed a better understanding of spiritual matters. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

6.  I know that I can count on others in times of trouble. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

7.  I established a new path for my life. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

8.  I developed a sense of closeness with others. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

9.  I developed a willingness to express my emotions. 
            0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

10.  I know I can handle difficulties. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

11.  I’m able to do better things with my life. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

12.  I am able to accept the way things work out. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

13.  I appreciate each day. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

14.  New opportunities are available which wouldn’t have been otherwise. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

15.  I have compassion for others. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree 

16.  I put effort into my relationships. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

17.  I’m more likely to try to change things which need changing. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

18.  I have a stronger religious or spiritual faith. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

19.  I discovered that I’m stronger than I thought I was. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

20.  I learned a great deal about how wonderful people are. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

21.  I accept needing others. 
        0----------------1----------------2----------------3----------------4----------------5
  not at all	  to a very        to a small      to a moderate     to a great         to a very
  	           small degree       degree             degree             degree          great degree

 	Please indicate how much you agree with the following statements as they apply to you over the last month.  If a particular situation has not occurred recently, answer according to how you think you would have felt.

1.  I am able to adapt when changes occur.
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

2.  I have at least one close and secure relationship which helps me when I am stressed. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

3.  When there are no clear solutions to my problems, sometimes fate or God can help. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

4.  I can deal with whatever comes my way. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

5.  Past successes give me confidence in dealing with new challenges and difficulties. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

6.  I try to see the humorous side of things when I am faced with problems. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

7.  Having to cope with stress can make me stronger. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

8.  I tend to bounce back after illness, injury, or other hardships. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

9.  Good or bad, I believe that most things happen for a reason. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

10.  I give my best effort, no matter what the outcome may be. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

11.  I believe I can achieve my goals, even if there are obstacles. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

12.  Even when things look hopeless, I don’t give up. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

13.  During times of stress/crisis, I know where to turn for help. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

14.  Under pressure, I stay focused and think clearly. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

15.  I prefer to take the lead in solving problems, rather than letting others make all the decisions. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

16.  I am not easily discouraged by failure. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

17.  I think of myself as a strong person when dealing with life’s challenges and difficulties. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

18.  I can make unpopular or difficult decisions that affect other people, if it is necessary. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

19.  I am able to handle unpleasant or painful feelings like sadness, fear and anger. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

20.  In dealing with life’s problems, sometimes you have to act on a hunch, without knowing why. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

21.  I have a strong sense of purpose in life. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

22.  I feel in control of my life. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

23.  I like challenges. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

24.  I work to attain my goals, no matter what roadblocks I encounter along the way. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

25.  I take pride in my achievements. 
      0----------------1----------------2----------------3--------------4
  not at 	 rarely	        sometimes	often	    true nearly
 all true	  true	 	 true	   	 true        all the time

903
Copyright © 2001, 2003 by Kathryn M. Connor, M.D., and Jonathan R. T. Davidson, M.D.