Trauma Assessment (PUBLIC)

Gateway CTI-100

The Gateway Process – Complex Trauma Index
Name

First NameLast Name
Email*
example@example.com
Instructions

Rate each statement based on your experiences in the past two
weeks using this scale:

0 = Not at all
1 = A little
2 = Sometimes
3 = Often
4 = Almost always
Nervous System Instability
1. I feel constantly tense or on edge (anxiety / wired).*

Not at allA littleSometimesOftenAlmost always
2. I get overwhelmed easily by normal daily demands (overload / meltdown).*

Not at allA littleSometimesOftenAlmost always
3. When I get upset or anxious, I struggle to return to a calm state (stay stressed)*

Not at allA littleSometimesOftenAlmost always
4. I feel jumpy or startled easily (hypervigilance / jump-scare response).*

Not at allA littleSometimesOftenAlmost always
5. My body feels frozen, numb, or shut down (collapse / shutdown mode).*

Not at allA littleSometimesOftenAlmost always
Emotional Dysregulation
6. My emotions shift quickly and intensely (emotional swings).*

Not at allA littleSometimesOftenAlmost always
7. I feel disconnected from joy or pleasure (numb / checked-out).*

Not at allA littleSometimesOftenAlmost always
8. I feel sadness or grief without knowing why (waves / heavy heart).*

Not at allA littleSometimesOftenAlmost always
9. I feel shame, guilt, or self-blame often (inner critic / self-attack).*

Not at allA littleSometimesOftenAlmost always
10. I shut down or withdraw when things feel difficult (collapse response).*

Not at allA littleSometimesOftenAlmost always
Cognitive Disruptions
11. I have difficulty concentrating or staying focused (brain fog / distractibility).*

Not at allA littleSometimesOftenAlmost always
12. I replay conversations, problems, or worries in my mind (ruminating / mental loops).*

Not at allA littleSometimesOftenAlmost always
13. I feel disconnected from the present moment (dissociation / checked-out).*

Not at allA littleSometimesOftenAlmost always
14. I have difficulty experiencing positive feelings (disconnect from pleasure).*

Not at allA littleSometimesOftenAlmost always
15. I have been feeling more irritable or frustrated (irritability).*

Not at allA littleSometimesOftenAlmost always
Relational Impact
16. I avoid people, situations, or conversations (isolation / withdrawal).*

Not at allA littleSometimesOftenAlmost always
17. I feel like I am surviving instead of living (stuck / autopilot).*

Not at allA littleSometimesOftenAlmost always
18. I struggle to trust others or let people close (protective walls).*

Not at allA littleSometimesOftenAlmost always
19. I feel responsible for others’ emotions or needs (fawn / people-pleasing).*

Not at allA littleSometimesOftenAlmost always
20. I feel unseen, misunderstood, or disconnected (lonely in a room full of people).*

Not at allA littleSometimesOftenAlmost always
Physical & Behavioral Patterns
21. My sleep is disrupted or not restorative (tired-but-wired).*

Not at allA littleSometimesOftenAlmost always
22. I use coping habits to numb or escape (overeating / scrolling / substances / shutdown).*

Not at allA littleSometimesOftenAlmost always
23. I hold chronic tension, pain, or pressure in my body (body armor / somatic stress).*

Not at allA littleSometimesOftenAlmost always
24. I struggle to relax or rest without guilt (can’t pause / productivity survival mode).*

Not at allA littleSometimesOftenAlmost always
25. I feel unsafe or not fully comfortable around others (hypervigilance / scanning).*

Not at allA littleSometimesOftenAlmost always
TOTAL
Thank you for completing the Gateway CTI-100 Assessment

Once you complete this assessment, you will receive an email containing your total score and a clear explanation of what your results mean for your nervous system and trauma patterns.

Please make sure your email address is correct before submitting.
Should be Empty:

Gateway CTI-100

Nervous System Instability

Emotional Dysregulation

Cognitive Disruptions

Relational Impact

Physical & Behavioral Patterns