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Questionnaire

To better understand your unique situation and assess the impact and effectiveness of my services, I kindly ask you to complete the following questionnaire.


By filling out the same questionnaire at the end of our sessions/program, we can track any changes and progress over time.

The questionnaire takes approximately 5–10 minutes to complete. Some questions may seem similar, but each one serves a distinct purpose—please answer them individually.

The best approach is to respond intuitively and avoid overthinking; simply select the option that feels most accurate.


Rest assured that all information will be handled with the utmost confidentiality and will not be shared with anyone.


Thank you for your time and participation!

In the last week, how often have you:

1. Been upset because something that happened unexpectedly? (S)
0. Never
1. Almost never
2. Sometimes
3. Fairly often
4. Very often
2. Felt that you have been unable to control important things in your life? (S)
0. Never
1. Almost never
2. Sometimes
3. Fairly often
4. Very often
3. Felt nervous and ‘stressed’? (S)
0. Never
1. Almost never
2. Sometimes
3. Fairly often
4. Very often
4. Found that you could NOT cope with all the things you had to do? (S)
0. Never
1. Almost never
2. Sometimes
3. Fairly often
4. Very often
5. Been angered because of things that happened that were out of your control? (S)
0. Never
1. Almost never
2. Sometimes
3. Fairly often
4. Very often
6. Felt difficulties were piling up so high that you could not overcome them? (S)
0. Never
1. Almost never
2. Sometimes
3. Fairly often
4. Very often
7. Felt confident about your ability to handle your personal problems? (S)
0. Very often
1. Fairly often
2. Sometimes
3. Almost never
4. Never
8. Felt things were going your way? (S)
0. Very often
1. Fairly often
2. Sometimes
3. Almost never
4. Never
9. Been able to control irritations in your life? (S)
0. Very often
1. Fairly often
2. Sometimes
3. Almost never
4. Never
10. Felt that you were on top of things? (S)
0. Very often
1. Fairly often
2. Sometimes
3. Almost never
4. Never

Over the last week, how often have you been bothered by the following problems:

11. Feeling nervous, anxious or on edge? (A)
0. Not at all
1. Several days
2. Most of the days
3. Every day
12. Not being able to stop or control worrying? (A)
0. Not at all
1. Several days
2. Most of the days
3. Every day
13. Feeling down, depressed or hopeless? (D)
0. Not at all
1. Several days
2. Most of the days
3. Every day
14. Little interest or pleasure in doing things? (D)
0. Not at all
1. Several days
2. Most of the days
3. Every day
15. Repeated, disturbing memories, thoughts, or images of a stressful experience? (P)
1. Not at all
2. A little
3. Moderate
4. Quite a bit
5. Extremely
16. Feeling very upset when something reminded you of a stressful experience? (P)
1. Not at all
2. A little
3. Moderate
4. Quite a bit
5. Extremely
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Wil je contact met mij?

Dank voor je bericht!

Telefoon nummer

+31 (0)6 22 04 47 38

E-mail adres

​

 

Tessavannes@kpnmail.nl

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