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Psychometric Assessments

If we have agreed to work together, please complete the forms below as discussed, thank you.

Filling Checklist Form
Impact of Event Scale-Revised (IES-R)

Instructions: Below is a list of difficulties people sometimes have after stressful life events. Please read each item, and then indicate how distressing each difficulty has been for you DURING THE PAST SEVEN DAYS with respect to the event. How much were you distressed or bothered by these difficulties?

1. Any reminder brought back feelings about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
2. I had trouble staying asleep
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
3. Other things kept making me think about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
4. I felt irritable and angry
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
5. I avoided letting myself get upset when I thought about it or was reminded of it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
6. I thought about it when I didn't mean to
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
7. I felt as if it hadn't happened or wasn't real
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
8. I stayed away from reminders about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
9. Pictures about it popped into my mind
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
10. I was jumpy and easily startled
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
11. I tried not to think about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
12. I was aware that I still had a lot of feelings about it, but I didn't deal with them
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
13. My feelings about it were kind of numb
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
14. I found myself acting or feeling as though I was back at that time
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
15. I had trouble falling asleep
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
16. I had waves of strong feelings about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
17. I tried to remove it from my memory
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
18. I had trouble concentrating
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
19. Reminders of it caused me to have physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
20. I had dreams about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
21. I felt watchful or on-guard
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
22. I tried not to talk about it
Not at all (0)
A little bit (1)
Moderately (2)
Quite a bit (3)
Extremely (4)
Reference

Weiss, D.S., & Marmar, C.R. (1997). The Impact of Event Scale-Revised. In J.P. Wilson, & T.M. Keane (Eds.), Assessing Psychological Trauma and PTSD: A Practitioner's Handbook (pp. 399-411). New York: Guilford Press. The original Impact of events Scale (IES) was developed in the 1980s.

GAD7 Anxiety Assessment

Over the last 2 weeks, how often have you been bothered by the following problems?

Q1. Feeling nervous, anxious or on edge
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q2. Not being able to stop or control worrying
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q3. Worrying too much about different things
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q4. Trouble relaxing
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q5. Being so restless that it is hard to sit still
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q6. Becoming easily annoyed or irritable
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q7. Feeling afraid, as if something awful might happen
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
PHQ9 Mood Assessment

Over the last 2 weeks, how often have you been bothered by the following problems?

Q1. Little interest or pleasure in doing things
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q2. Feeling down, depressed, or hopeless
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q3. Trouble falling or staying asleep, or sleeping too much
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q4. Feeling tired or having little energy
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q5.Poor appetite or overeating
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q7. Trouble concentrating on things, such as reading the newspaper or watching television
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q8. Moving or speaking so slowly that other people could have noticed? Or the opposite: being so fidgety or restless that you have been moving around a lot more than usual
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
Q9. Thoughts that you would be better off dead or of hurting yourself in some way
0 - Not at all
1 - Several days
2 - More than half the days
3 - Almost every day
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