1. Are you feeling "on edge" most of the time
at work, with family, or at social gatherings?
[] yes [] no
2. Are you sad to the bone due to a recent
death of a loved one or loss of something
significant in your life?
[] yes [] no
3. Are you plagued with always feeling not
good enough, no matter how well educated
and smart you are?
[] yes [] no
4. Do you often have the feeling you are
standing outside your own life while others
are on the inside getting what they want?
[] yes [] no
5. Do you feel like you have been hiding the
real you, in order to get along with others?
[] yes [] no
6. Are you constantly physically tired, and
drained of emotional energy?
[] yes [] no
7. Are your days filled with mental confusion,
scattered attention, faulty communications,
or unmet goals?
[] yes [] no
8. Is your life working as well as you need it to?
[] yes [] no
9. Are you tired of hurting emotionally and
having no confidence in your abilities?
[] yes [] no
10. Do you need to get over feeling afraid to
risk yourself emotionally, socially, or spiritually?
[] yes [] no