Emotion Regulation and Experiential Avoidance Assessment Emotion Regulation Email(Required) Please indicate the extent to which you agree or disagree with each of the following statementsI'm quick to leave any situation that makes me feel uneasy(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree When unpleasant memories come to me, I try to put them out of my mind(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree I won't do something until I absolutely have to(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree Fear or anxiety won't stop me from doing something important(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree I rarely do something if there is a chance that it will upset me(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree I try to put off unpleasant tasks for as long as possible(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree I go out of my way to avoid uncomfortable situations(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree I work hard to keep out upsetting feelings(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree Pain always leads to suffering(Required) Strongly disagree Moderately disagree Slightly disagree Slightly agree Moderately agree Strongly agree When I'm upset, I feel like I am weak.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I believe that I will remain that way for a long time.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I have difficulty controlling my behaviors.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, my emotions feel overwhelming.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I believe that there is nothing I can do to make myself feel better.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I have difficulty getting work done.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I believe that I'll end up feeling very depressed.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I have difficulty focusing on other things.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I become out of control.(Required) Almost Never Sometimes About half the time Most of the time Almost Always When I'm upset, I become irritated with myself for feeling that way.(Required) Almost Never Sometimes About half the time Most of the time Almost Always It frustrates me not having all the information I need.(Required) Entirely like me Very much like me Somewhat like me Slightly like me Not at all like me I can’t stand being taken by surprise.(Required) Entirely like me Very much like me Somewhat like me Slightly like me Not at all like me When it’s time to act, uncertainty paralyzes me.(Required) Entirely like me Very much like me Somewhat like me Slightly like me Not at all like me The smallest doubt can stop me from acting.(Required) Entirely like me Very much like me Somewhat like me Slightly like me Not at all like me A small, unforeseen event can spoil everything, even with the best of planning.(Required) Entirely like me Very much like me Somewhat like me Slightly like me Not at all like me I was basically on “auto-pilot” most of the time.(Required) Strongly Disagree Disagree Neither agree nor disagree Agree Strongly Agree I was proud about how I lived my life.(Required) Strongly Disagree Disagree Neither agree nor disagree Agree Strongly Agree I continued to get better at being the kind of person I want to be.(Required) Strongly Disagree Disagree Neither agree nor disagree Agree Strongly Agree When things didn’t go according to plan, I gave up easily.(Required) Strongly Disagree Disagree Neither agree nor disagree Agree Strongly Agree Review and uncheck if not applicable I am a current or possible future client of Karuna Healing Recovery Coaching and Therapy Services and consent to allow my therapist or coach to view my report in order to analyze and discuss the results with me.
