Name
              
             
          
                
                
                  
                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              1. I'm disapproving and judgmental about my own flaws and inadequacies.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally  
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              2. When I'm feeling down I tend to obsess and fixate on everything that's wrong.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              3. When things are going badly for me, I see the difficulties as part of life that everyone goes through.
              
             
          
                
                
                
                  
                     1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              4. When I think about my inadequacies, it tends to make me feel more separate and cut off from the rest of the world.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              5. I try to be loving towards myself when I'm feeling emotional pain.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4. Fairly Often 
                  
                    5. Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              6.	When I fail at something important to me I become consumed by feelings of inadequacy.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              7.	When I'm down and out, I remind myself that there are lots of other people in the world feeling like I am.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              8.	When times are really difficult, I tend to be tough on myself.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              9.	When something upsets me I try to keep my emotions in balance.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              10.	When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              	11.	I'm intolerant and impatient towards those aspects of my personality I don't like.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              	12.	When I'm going through a very hard time, I give myself the caring and tenderness I need.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              	13.	When I'm feeling down, I tend to feel like most other people are probably happier than I am.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              	14.	When something painful happens I try to take a balanced view of the situation.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              15.	I try to see my failings as part of the human condition.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              16. When I see aspects of myself that I don't like, I get down on myself.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              17. When I fail at something important to me I try to keep things in perspective.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occaionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              18. When I'm really struggling, I tend to feel like other people must be having an easier time of it.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              	19.	I'm kind to myself when I'm experiencing suffering.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              20.	When something upsets me I get carried away with my feelings.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              21. I can be a bit cold-hearted towards myself when I'm experiencing suffering.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              	22.	When I'm feeling down I try to approach my feelings with curiosity and openness.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              23.	I'm tolerant of my own flaws and inadequacies.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              24.	When something painful happens I tend to blow the incident out of proportion.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              25.	When I fail at something that's important to me, I tend to feel alone in my failure.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              26.	I try to be understanding and patient towards those aspects of my personality I don't like.
              
             
          
                
                
                
                  
                    1 - Almost Never 
                  
                    2 - Occasionally 
                  
                    3 - About half the time 
                  
                    4 - Fairly Often 
                  
                    5 - Almost Always 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
              
                
            
              Total Score