General Life Experience Worksheet

This survey worksheet is based on industry-standard questions related to post-traumatic stress disorder, depression, anxiety, and other self-limiting, sabotaging, and self-destructive thoughts, emotions, and behaviors. This worksheet like the others is designed to be taken when you begin the course, at the end of lesson four around 30 days, and again after lesson eight at around 60 days. This is structured to help you chart progress over time. When you fill out and submit the worksheets they are sent to the course registration email address. While the worksheets, exercises, and techniques in this course are easy to understand and perform, one of the greatest challenges you may face is being more honest with yourself. So, for best results and maximum benefit do your best at all times and be as honest as possible. The worksheets are designed to provide you with a temporary and useful snapshot of your current mental and emotional, and physical states as you progress through this course. It is recommended you do not look at previously submitted worksheets to complete your answers. When the last series of worksheets have been submitted while completing lesson eight at around 60 days print and view all the versions side by side to see your progress over time. It is recommended you continue to use the worksheets to better evaluate your progress beyond 60 days. This course is free and available to use as long as you like.

Name

First NameLast Name

Email

example@example.com

Date Submitted

Date

For best results in session, please answer all questions as accurately as possible.
(Select the answer that best applies)

1. Have you ever had any frightening, traumatizing or upsetting life experiences that have resulted in persistent and/or recurring thoughts of the experiences?

2. Do you, or have you had persistent and/or recurring nightmares related to the experiences in question 1?

3. Do you struggle with controlling negative thoughts related to or go out of your way to avoid similar situations that reminded you of the experiences related to question 1?

4. Do you feel numb or detached from family, friends, other people in general or your surrounding environments related to any of the previous questions?

Over the last 30 days, how often have you been troubled by the following problems?
(Select the answer that best applies)

5. Having difficulty concentrating on things, such as reading or watching TV?

6. Don't feel hungry or over eat?

7. Little interest or pleasure in doing things you used to enjoy?

8. Feeling depressed, emotionally down or hopeless?

9. Moving or speaking so slowly other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual?

10. Feeling bad about yourself, low self confidence or that you have let yourself or others down?

11. Feeling tired or have low energy throughout the day?

12. Trouble falling asleep or staying asleep, or sleeping too much?

13. Thoughts that you would be better off dead, or of hurting yourself?

14. Do you have what you think are good ideas but lack motivation or give up before achieving your goals or desired outcomes?

15. Have you tried more than one self-help methodology?

16. If you have tried more than one book or online self-help program, how many have you tried?

17. Have you hired a Psychologist, Hypnotherapist, Marriage Counselor, Life Coach, NLP Practitioner, or another self-help specialist to help you improve your life?

18. If so, which methodologies have offered the best results that still help you today?

19. Do you still have deep-rooted emotional issues that you would like to get rid of?

20. If a reliable results-based program was available at a reasonable cost, would you be interested in taking the program in the next 30 days?

What is a reasonable and affordable cost you find acceptable if you were able to achieve most of the results you wanted?

From 1 to 10, what level of emotion did you experience while completing this worksheet? 1 = no emotion, 10 = high level of emotion.

Emotional Experiences

Please write the emotions you experienced while completing this worksheet.

Please remember to complete the worksheets at the end of lesson four and during lesson eight to help you track progress over time.