Copy of questionnaire for survey5ED.

sav

General instructions

In this booklet are a number of scales and questions designed to measure your opinions,
beliefs and behaviour. Please answer the questions as honestly as possible, in a way that shows
how you really are, not how you would like to be or how you think you should be.

You may feel that some questions are very similar to others in the questionnaire. Each of the
different sets of questions is measuring different aspects so it is important that you answer each of
the questions. Don’t spend too much time thinking about your answers. The first answer that pops
into your head is what is needed.

Instructions are given for each of the different sets of questions. Please read these carefully
as they vary from section to section. Some sets of questions ask you to give an answer by ticking a
box. Others ask you to rate how much you agree or disagree using a 4 point scale, others use a 5, 6
or 7 point scale. It is important that you use the correct scale for each question.

Thank you very much for agreeing to participate in this study.

1. Sex: _____Male _____Female (please tick whichever applies)

2. Age: ___________ (in years)

3. What is your marital status: (please tick whichever best describes your current situation)

_____1. single _____2. in a steady relationship _____3. living with partner _____4. married for
first time

_____5. remarried _____6. separated _____7. divorced _____8. widowed

4. Do you have any children currently living at home with you: _____Yes _____No

5. What is the highest level of education that you have completed: (please tick the highest level you
have completed).

_____ primary school _____ some secondary school _____ completed high school

_____ some additional training

(apprenticeship, TAFE courses etc.) _____ completed undergraduate University

_____ completed postgraduate University

6. What are the major sources of stress in your life?

_________________________________________________________________________________

7. Do you smoke?: _____Yes _____No

If yes, how many cigarettes do you smoke per week ____________

1
Scale A

Please read through the following statements and decide how much you either agree or disagree with each.
Using the scale provided write the number that best indicates how you feel on the line next to each statement.

strongly disagree 1 2 3 4 5 strongly agree

______ 1. In uncertain times I usually expect the best.

______ 2. If something can go wrong for me it will.

______ 3. I’m always optimistic about my future.

______ 4. I hardly ever expect things to go my way.

______ 5. Overall I expect more good things to happen to me than bad.

______ 6. I rarely count on good things happening to me.

Scale B

Please indicate how much you either agree or disagree with each statement. Write a number from 1 to 4 on
the line next to each statement.

strongly disagree 1 2 3 4 strongly agree

1. ______ I have little control over the things that happen to me

2. ______ I can do just about anything I really set my mind to do

3. ______ There is really no way I can solve some of the problems I have

4. ______ There is little I can do to change many of the important things in my life

5. ______ What happens to me in the future mostly depends on me

6. ______ I often feel helpless in dealing with the problems of life

7. ______ Sometimes I feel that I'm being pushed around in life

2
Scale C

This scale consists of a number of words that describe different feelings and emotions. For each item indicate
to what extent you have felt this way during the past few weeks. Write a number from 1 to 5 on the line next to
each item.

very slightly or not a little moderately quite a bit extremely

at all
1 2 3 4 5

1. ______ interested 8. ______ distressed 15. ______ excited

2. ______ upset 9. ______ strong 16. ______ guilty
3. ______ scared 10. ______ hostile 17. ______ enthusiastic
4. ______ proud 11. ______ irritable 18. ______ alert
5. ______ ashamed 12. ______ inspired 19. ______ nervous
6. ______ determined 13. ______ attentive 20. ______ jittery
7. ______ active 14. ______ afraid

Scale D

Below are five statements with which you may agree or disagree. Using a 1 to 7 scale, indicate your
agreement with each item by placing the appropriate number on the line next to that item.

strongly disagree 1 2 3 4 5 6 7 strongly agree

1. ______ In most ways my life is close to ideal

2. ______ The conditions of my life are excellent

3. ______ I am satisfied with my life

4. ______ So far I have got the important things I want in life

5. ______ If I could live my life again, I would change almost nothing

3
Scale E

Please use the scale below to answer each of the following questions. Write a number from 1 to 5 in the space
provided.

never almost never sometimes fairly often very often

1 2 3 4 5

In the last few weeks:

______1. How often have you been upset because of something that happened unexpectedly?

______2. How often have you felt that you were unable to control the important things in your life?

______3. How often have you felt nervous and 'stressed’?

______4. How often have you felt confident about your ability to handle your personal problems?

______5. How often have you felt that things were going your way?

______6. How often have you found that you could not cope with all the things that you had to do?

______7. How often have you been able to control irritations in your life?

______8. How often have you felt that you were on top of things?

______9. How often have you been angered because of things that happened that were outside of
your control?

______10. How often have you felt difficulties were piling up so high that you could not overcome
them?

4
Scale F

Please indicate how much you agree or disagree with each of these statements using the scale provided
below. Write the number that best indicates how you feel in the space next to each statement.

strongly disagree 1 2 3 4 strongly agree

1. ______ I feel that I am a person of worth, at least on an equal basis with others

2. ______ I feel that I have a number of good qualities

3. ______ All in all, I am inclined to feel that I am a failure

4. ______ I am able to do things as well as most other people

5. ______ I feel I do not have much to be proud of

6. ______ I take a positive attitude toward myself

7. ______ I wish I could have more respect for myself

8. ______ On the whole, I am satisfied with myself

9. ______ I certainly feel useless at times

10. ______ At times I think I am no good at all

Scale G

Listed below are a number of statements concerning personal attitudes and traits. Read each item
and decide whether the statement is true or false as it relates to you.

Circle either True (T) or False (F) for each statement

T F 1. I’m always willing to admit it when I make a mistake

T F 2. I always try to practice what I preach
T F 3. I never resent being asked to return a favour
T F 4. I have never been irked when people expressed ideas very different from my own
T F 5. I have never deliberately said something that hurt someone’s feelings
T F 6. I like to gossip at times
T F 7. There have been occasions when I took advantage of someone
T F 8. I sometimes try to get even rather than forgive and forget
T F 9. At times I have really insisted on having things my own way
T F 10. There have been occasions when I felt like smashing things

5
Scale H

Using the scale provided, decide how much you either agree or disagree with each statement. Next to
each statement, write the number that best indicates how you feel.

strongly strongly
disagree 1 2 3 4 5 agree

______ 1. I don't have much control over my emotional reactions to stressful situations.

______ 2. When I'm in a bad mood I find it hard to snap myself out of it.

______ 3. My feelings are usually fairly stable.

______ 4. I can usually talk myself out of feeling bad.

______ 5. No matter what happens to me in my life I am confident of my ability to cope

emotionally.

______ 6. I have a number of good techniques that will help me cope with any stressful situation.

______ 7. I find it hard to stop myself from thinking about my problems.

______ 8. If I start to worry about something I can usually distract myself and think about
something nicer.

______ 9. If I realize I am thinking silly thoughts I can usually stop myself.

______ 10. I am usually able to keep my thoughts under control.

______ 11. I imagine there will be many situations in the future where silly thoughts will get the
better of me.

______ 12. I have a number of techniques which I am confident will help me think clearly and
rationally in any situation I might find myself.

______ 13. Even when under pressure I can usually keep calm and relaxed.

______ 14. I have a number of techniques or tricks that I use to stay relaxed in stressful situations.

______ 15. When I'm anxious or uptight there does not seem to be much that I can do to help
myself relax.

______ 16. There is not much I can do to relax when I get uptight.

______ 17. I have a number of ways of relaxing that I am confident will help me cope.

______18. If my stress levels get too high I know there are things I can do to help myself.

You have reached the end of the questionnaire.

Thank you very much for participating in this study.
Your assistance is greatly appreciated