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Republic of the Philippines

Mindanao State University- Iligan Institute of Technology


Andres Bonifacio Avenue, Tibanga, Iligan City
COLLEGE OF ARTS AND SOCIAL SCIENCES
DEPARTMENT OF PSYCHOLOGY
LEVEL IV AACCUP Accredited
________________________________________________________________________

Dear Respondents,

The undersigned are Psychology undergraduate students of MSU-Iligan Institute of Technology presently
conducting a study that seeks to examine the experiences of left-behind emerging adults (LBA) for the research
program of the Department of Psychology.
In this regard, we would like to ask for your cooperation and support to be one of the respondents of our study
by answering the questionnaires.
On our end, it is our goal and responsibility to use the information that you have shared honestly. We would
like to assure you the protection and utmost confidentiality of your identity.

________________________________________________________________________

Informed Consent

I have read and understood the background information that you have provided about your research. I recognize
the possible demands this research study requires and thus, I volunteer to take part in the research. My
participation is subject to the following conditions:

1. That adequate safeguard will be provided to maintain the privacy and confidentiality of my responses.
2. That my test results become part of the Department of Psychology, CASS, MSU-IIT. Release of such
information may be obtained only with prior approval from the Department Chairman.
3. I have the right to withdraw my participation from the study for some personal reasons.

I hereby agree to be one of the respondents in the said research study.

Respondent’s Name (Optional) Geotina, Misael Jr. A.

Respondent’s Signature

Contact Information

Thank you so much for your support and cooperation.

Respectfully,

Abbas, Amera D.
Anobling, Elaiza Rose M.
Cabudoy, Liezl Fritz L.
Esic, Zione Kathleen C.
Padre, Izzamae Kaite E.
Pulido, Ma. Careh May G.
RESEARCHERS

1
DEMOGRAPHIC PROFILE

Date: March 17, 2018


Name: Geotina, Misael Jr. A. Age: 20
Civil Status: ( X) Single ( ) Married ( ) Widow ( ) Live-in Sex: ( X) Male ( ) Female
College Level: ( ) First Year ( ) Second Year ( ) Third Year ( X) Fourth Year ( ) Fifth Year ( ) Other __________
Income Level:
Please indicate your family monthly income:
( ) Below 5,000 ( ) 35,001 – 45,000
( ) 5,001 – 15,000 ( ) 45,001 – 55,000
( ) 15,001 – 25,000 ( ) 50,001 – 65,000
( ) 25,001 – 35,000 (X ) 65,001 and Above
Ordinal Position of Siblings: ( ) Youngest (X ) Middle ( ) Oldest ( ) Others ______________
Number of Siblings:4
Mother’s Occupation: Plain house wife Father’s Occupation: Appplication Engineer

1. Who among your parent/s is/are economic migrant/s (OFW)?


( ) Mother (X ) Father ( ) Both
2. How long have you’ve been separated with your parent/s?
( ) 6-12 months ( ) 1-2 years ( ) 2-3 years ( ) 3-4 years
( ) 4-5 years ( X) more than 5 years
3. How old are you when your parent/s migrated for work? Since birth
4. Who are you currently living with?
( ) Parent ( ) Grandparents ( ) Aunt/ Uncle
(X ) Sibling ( ) Other Relative/s ( ) Other ____________________

________________________________________________________________________

USS
Instructions: How often have each of the following caused you stress over the past month? If any are not applicable
to you, encircle Not at all.

0 1 2 3
Not at All Sometimes Frequently Constantly

1. Academic/coursework demands 0 1 2 3
2. Procrastination 0 1 2 3
3. University/college environment 0 1 2 3
4. Finances and money problems 0 1 2 3
5. Housing/accommodation 0 1 2 3
6. Transport 0 1 2 3
7. Mental health problems 0 1 2 3
8. Physical health problems 0 1 2 3
9. Parenting issues 0 1 2 3
10. Childcare 0 1 2 3
11. Family relationships 0 1 2 3
12.Friendships 0 1 2 3
13. Romantic relationships 0 1 2 3
2
14. Relationship break-down 0 1 2 3
15. Work 0 1 2 3
16. Parental expectations 0 1 2 3
17. Study/life balance 0 1 2 3
18. Discrimination 0 1 2 3
19. Sexual orientation issues 0 1 2 3
20. Language/cultural issues 0 1 2 3
21. Other demands 0 1 2 3

SSI
Instructions: This inventory measures the stresses you have experienced in your study and everyday life in your campus.
There are no right and wrong answers. Read each statement and encircle the best describes your experiences.

1 2 3 4

Never Somewhat Frequent Frequent Always

1. Headaches 1 2 3 4
2. Back pain 1 2 3 4
3. Sleep problem 1 2 3 4
4. Difficulty breathing 1 2 3 4
5. Excessive worry 1 2 3 4
6. Stomach pain/nausea 1 2 3 4
7. Constant tiredness/fatigue 1 2 3 4
8. Sweating/sweaty hands 1 2 3 4
9. Frequent cold/flu/fever 1 2 3 4
10. Drastic weight loss 1 2 3 4
11. I find difficult to meet my high parent’s expectation. 1 2 3 4
12. My parents treat me as a helpless person. 1 2 3 4
13. I feel guilty if I fail to fulfill my parent’s hope. 1 2 3 4
14. My parents wish only for my success. 1 2 3 4
15. I find difficult to get along with group mates in doing academic task. 1 2 3 4
16. My friends did not care about me. 1 2 3 4
17. I feel disturbed when having problem with my boyfriend/girlfriend. 1 2 3 4
18. My families are not supportive. 1 2 3 4
19. My lecturers/ teachers are not supportive. 1 2 3 4
20. I feel frustrated by the lack of faculty management. 1 2 3 4
21. I have a financial problem because of the expenses of the university. 1 2 3 4
22. I find difficult to juggle time between study and social activity. 1 2 3 4
23. I feel nervous delivering the class presentation. 1 2 3 4
24. I feel stressed as submission deadline neared. 1 2 3 4
25. I feel stressed to sit for examination. 1 2 3 4
26. I find difficult to juggle time between study and society involvement. 1 2 3 4
27. I loss interest towards courses. 1 2 3 4
28. I feel burden of academic workloads. 1 2 3 4
29. I feel stressed dealing with difficult subject. 1 2 3 4
30. I feel difficult in handling my academic problem. 1 2 3 4
31. I have transportation problem. 1 2 3 4
32. I feel stressed with bad living condition of hostel. 1 2 3 4
33. Surrounding noise distracted me. 1 2 3 4
34. Pollution make me uneasy. 1 2 3 4
35. Hot weather make me avoid to go out. 1 2 3 4
36. Messy living conditions distracted me. 1 2 3 4
37. I feel frustrated of inadequate campus facilities. 1 2 3 4
38. Crowding make me feel uneasy. 1 2 3 4
39. Waited in a long line make me feel uneasy. 1 2 3 4
40. I feel scared being at the insecure place. 1 2 3 4

3
FACES III
Instructions: Read the statements and decide for each one how frequently, on a scale that ranges from 1 (almost
never) to 5 (almost always). Describe your family now. Encircle your answer.

1 2 3 4 5
Almost Never Once in a While Sometimes Frequently Almost Always

1. Family members ask each other for help. 1 2 3 4 5


2. In solving problems, the children’s suggestions are followed. 1 2 3 4 5
3. We approve of each other’s friends. 1 2 3 4 5
4. Children have a say in their discipline. 1 2 3 4 5
5. We like to do things with just our immediate family. 1 2 3 4 5
6. Different persons act as leaders in our family. 1 2 3 4 5
7. Family members feel closer to other family members than to people outside the family. 1 2 3 4 5
8. Our family changes its way of handling tasks. 1 2 3 4 5
9. Family members like to spend free time with each other. 1 2 3 4 5
10. Parent(s) and children discuss punishment together. 1 2 3 4 5
11. Family members feel very close to each other. 1 2 3 4 5
12. The children make the decisions in our family. 1 2 3 4 5
13. When our family gets together for activities, everybody is present. 1 2 3 4 5
14. Rules change in our family. 1 2 3 4 5
15. We can easily think of things to do together as a family. 1 2 3 4 5
16. We shift household responsibilities from person to person. 1 2 3 4 5
17. Family members consult other family members on their decisions. 1 2 3 4 5
18. It is hard to identify the leader(s) in our family. 1 2 3 4 5
19. Family togetherness is very important. 1 2 3 4 5
20. It is hard to tell who does which household chores. 1 2 3 4 5

PEQ
Instructions: PLEASE ANSWER EVERY QUESTION -- even if you are not entirely sure which answer is right for you.
Read each item carefully, and if you have any questions about the directions, you can ask the person administering
this questionnaire to clarify them. Circle One Letter for Each Parent

T t f F
Definitely True Probably True Probably False Definitely False

Mother Father
1. I can learn a lot of things from my parent. T t f F T t f F
2. I talk about my concerns and my experiences with my parent. T t f F T t f F
3. My parent often criticizes me. T t f F T t f F
4. My parent praises me when I do something well. T t f F T t f F
5. Before I finish saying something, my parent often interrupts me. T t f F T t f F
6. My parent doesn't know much about my hobbies. T t f F T t f F
7. I don't want my friends to meet my parent. T t f F T t f F
8. My parent loves me no matter what I do. T t f F T t f F
9. I often get good advice from my parent. T t f F T t f F
10. My parent often irritates me. T t f F T t f F
11. My parent has taught me useful things. T t f F T t f F
12. My parent is very much the same toward me from one day to the next. T t f F T t f F
13. Often there are misunderstandings between my parent and myself. T t f F T t f F
14. My parent only pays attention to me when I've done something wrong. T t f F T t f F
15. Often I don't get the support I need from my parent. T t f F T t f F
16. My parent wants me always to decide above all what is right and wrong
T t f F T t f F
and do what's right.
17. My parent seems to ignore my feelings. T t f F T t f F
18. My parent comforts me when I am discouraged or have had a
T t f F T t f F
disappointment.
4
19. I treat others with more respect than I treat my parents. T t f F T t f F
20. My parent often hurts my feelings. T t f F T t f F
21. My parent makes a good impression on my friends. T t f F T t f F
22. My parent does not seem to think highly of me. T t f F T t f F
23. My parent and I don't have much to talk about when we are together. T t f F T t f F
24. I want to be like my parent in a number of ways. T t f F T t f F
25. My parent tries to keep up with how well I do in school and/or in my
T t f F
T t f F
job.
T t f F
26. My parent makes it clear what she or he wants me to do or not to do. T t f F
T t f F
27. My parent often does not trust me to make my own decisions. T t f F
T t f F
28. My parent and I often get into arguments. T t f F
T t f F
29. I prefer not to talk about my personal problems with my parent. T t f F
T t f F
30. I often seem to anger or annoy my parent. T t f F
T t f F
31. My parent often loses her/his temper with me. T t f F
T t f F
32. My parent sometimes hits me in anger. T t f F
T t f F
33. It is important to my parent that I obey the law. T t f F
T t f F
34. I know my parent loves me. T t f F
T t f F
35. I really like my parent. T t f F
T t f F
36. Once in a while I have been really scared of my parent. T t f F
T t f F
37. My parent is proud of me. T t f F
38. My parent wants me to go to bed at a certain time before school or T t f F
T t f F
work days. T t f F
39. I am proud of my parent. T t f F T t f F
40. My parent doesn't seem to know much about how I do in school. T t f F T t f F
41. My parent and I do not do a lot of things together. T t f F T t f F
42. I respect my parent. T t f F T t f F
43. My parent likes others in the family better than she or he likes me. T t f F T t f F
44. I get along well with my parent. T t f F
T t f F
45. If I ask my parent for something I want but don't really need, she/he will
T t f F T t f F
usually say "No".
46. I don't feel very close to my parent. T t f F T t f F
47. If my parent promised to do something, she/he follows through with it. T t f F T t f F
48. My parent is pretty strict with me. T t f F T t f F
49. When my parent gives me a job, she/he usually expects me to finish it by
T t f F T t f F
myself.
50. My parent doesn't know much about how I spend my spare time. T t f F

GAD-7
Instructions: Over the last 2 weeks, how often have you been bothered by the following problems? Encircle to
indicate your answer.

0 1 2 3
Nearly Every Day
Not at All Several Days More than half the days

1. Feeling nervous, anxious or on edge. 0 1 2 3


2. Not being able to stop or control worrying. 0 1 2 3
3. Worrying too much about different things. 0 1 2 3
4. Trouble relaxing. 0 1 2 3
5. Being so restless that it is hard to sit still. 0 1 2 3
6. Becoming easily annoyed or irritable. 0 1 2 3
7. Feeling afraid as if something awful might happen. 0 1 2 3

5
LSAS
Instructions: Please indicate the degree of fear and anxiety and avoidance with the corresponding situation by
encircling your answer. Fear or anxiety is characterized by perceiving a social situation as stressful and frightening.
Avoidance is characterized by the frequency of escaping bothersome social situations.

Fear or Anxiety:
0 1 2 3
None Mild Moderate Severe

Avoidance:
0 1 2 3
Never Occasionally Often Usually

Fear or Anxiety Avoidance


1. Telephoning in public. 0 1 2 3 0 1 2 3
2. Participating in small groups. 0 1 2 3 0 1 2 3
3. Eating in public places. 0 1 2 3 0 1 2 3
4. Drinking with others in public places. 0 1 2 3 0 1 2 3
5. Talking to people in authority. 0 1 2 3 0 1 2 3
6. Acting, performing or giving a talk in front of an audience. 0 1 2 3 0 1 2 3
7. Going to a party. 0 1 2 3 0 1 2 3
8. Working while being observed. 0 1 2 3 0 1 2 3
9. Writing while being observed. 0 1 2 3 0 1 2 3
10. Calling someone you don’t know very well. 0 1 2 3 0 1 2 3
11. Talking with people you don’t know very well. 0 1 2 3 0 1 2 3
12. Meeting strangers. 0 1 2 3 0 1 2 3
13. Urinating in a public bathroom. 0 1 2 3 0 1 2 3
14. Entering a room when others are already seated. 0 1 2 3 0 1 2 3
15. Being the center of attention. 0 1 2 3 0 1 2 3
16. Speaking up at a meeting. 0 1 2 3 0 1 2 3
17. Taking a test. 0 1 2 3 0 1 2 3
18. Expressing a disagreement or disapproval to people you don’t know very
0 1 2 3 0 1 2 3
well.
19. Looking at people you don’t know very well in the eyes. 0 1 2 3 0 1 2 3
20. Giving a report to a group. 0 1 2 3 0 1 2 3
21. Trying to pick up someone. 0 1 2 3 0 1 2 3
22. Returning goods to a store. 0 1 2 3 0 1 2 3
23. Giving a party. 0 1 2 3 0 1 2 3
24. Resisting a high pressure salesperson. 0 1 2 3 0 1 2 3

SAQ-A30
Instructions: Below are a series of social situations that may or may not cause you UNEASE, STRESS or NERVOUSNESS.
Please encircle the number next to each social situation that best reflects your reaction, where "1" represents no
unease, stress or nervousness and "5" represents very high or extreme unease stress, or nervousness.
If you have never experienced the situation described, please imagine what your level of UNEASE, STRESS, or
NERVOUSNESS might be if you were in that situation and rate how you imagine you would feel by encircling the
corresponding number.
Please rate all the items and do so honestly; do not worry about your answer because there are no right or
wrong ones. Thank you very much for your collaboration.

1 2 3 4 5
Not at all or very Very high or
Slight Moderate High
slight extremely high

1. Greeting someone and being ignored. 1 2 3 4 5


2. Having to ask a neighbor to stop making noise. 1 2 3 4 5
3. Speaking in public. 1 2 3 4 5
4. Asking someone attractive of the opposite sex for a date. 1 2 3 4 5

6
5. Complaining to the waiter about my food. 1 2 3 4 5
6. Feeling watched by people of the opposite sex. 1 2 3 4 5
7. Participating in a meeting with people in authority. 1 2 3 4 5
8. Talking to someone who isn’t paying attention to what I am saying. 1 2 3 4 5
9. Refusing when asked to do something I don’t like doing. 1 2 3 4 5
10. Being mugged or robbed by an armed gang. 1 2 3 4 5
11. Making new friends. 1 2 3 4 5
12. Telling someone that they have hurt my feelings. 1 2 3 4 5
13. Having to speak in class, at work, or in a meeting. 1 2 3 4 5
14. Maintaining a conversation with someone I’ve just met. 1 2 3 4 5
15. Expressing my annoyance to someone that is picking on me. 1 2 3 4 5
16. Greeting each person at a social meeting when I don’t know most of them 1 2 3 4 5
17. Being teased in public. 1 2 3 4 5
18. Talking to people I don’t know at a party or a meeting. 1 2 3 4 5
19. Being asked a question in class by the teacher or by a superior in a meeting. 1 2 3 4 5
20. Looking into the eyes of someone I have just met while we are talking. 1 2 3 4 5
21. Being asked out by a person I am attracted to. 1 2 3 4 5
22. Making a mistake in front of other people. 1 2 3 4 5
23. Attending a social event where I know only one person. 1 2 3 4 5
24. Starting a conversation with someone of the opposite sex that I like. 1 2 3 4 5
25. Being reprimanded about something I have done wrong. 1 2 3 4 5
26. While having dinner with colleagues, classmates or workmates, being asked to speak on
1 2 3 4 5
behalf of the entire group.
27. One of my parents getting seriously ill. 1 2 3 4 5
28. Telling someone that their behavior bothers me and asking them to stop. 1 2 3 4 5
29. Asking someone I find attractive to dance. 1 2 3 4 5
30. Being criticized. 1 2 3 4 5
31. Talking to a superior or a person in authority. 1 2 3 4 5
32. Telling someone I am attracted to that I would like to get to know them better. 1 2 3 4 5

ASA-27
Instructions: The following statements refer to symptoms that you might have experienced as an adult (over the age
of 18 years). Please encircle the appropriate brackets for each item, according to whether you have experienced any
of these symptoms for the past 6 months or more. Please remember to answer all questions.

0 1 2 3
This Has Never Happened This Happens Occasionally This Happens Fairly Often This Happens Very Often

1. Have you felt more secure at home when you are with people that are close to you? 0 1 2 3
2. Have you experienced difficulty in staying away from home for several hours at a time? 0 1 2 3
3. Have you been carrying around something in your purse or wallet that gives you a sense of
0 1 2 3
security or comfort?
4. Have you experienced extreme stress before leaving home to go on a long trip? 0 1 2 3
5. Have you suffered from nightmares or dream about being separated from someone close to you? 0 1 2 3
6. Have you experienced extreme stress before leaving someone close to you when going away on a
0 1 2 3
trip?
7. Have you become very upset when your usual daily routine is disrupted? 0 1 2 3
8. Have you been worried about the intensity of your relationship with those people closest to you,
0 1 2 3
e.g. that you are too strongly attached?
9. Have you experienced symptoms such as headaches, stomach-aches or nausea (or other) before
0 1 2 3
leaving for work or other regular activity outside the home?
10. Do you find that you talk a lot in order to keep people close to you? 0 1 2 3
11. Have you been especially concerned about where people close to you are going when you are
0 1 2 3
separated from them, e.g. when you leave them to go to work or go out of the house?
12. Have you experienced difficulty in sleeping alone at night, e.g. is your sleep better if someone
0 1 2 3
close to you is in the house?
13. Have you noticed that you are better able to go off to sleep if you can hear the voices of people
0 1 2 3
you are close to or the sound of the TV or the radio?
7
14. Have you become very distressed when thinking about being away from people that are close to
0 1 2 3
you?
15. Have you suffered from nightmares or dreams about being away from home? 0 1 2 3
16. Have you been worrying a lot about people close to you coming to serious harm, for example,
0 1 2 3
meeting with a car accident, or suffering from a fatal illness?
17. Have you become very upset with changes to your usual daily routine if they interfere with your
0 1 2 3
contact with persons close to you?
18. Have you been worrying a lot about people you care about leaving you? 0 1 2 3
19. Have you found that you sleep better if the lights are on in the house or in the bedroom? 0 1 2 3
20. Have you tried to avoid being at home alone especially when people close to you are out? 0 1 2 3
21. Have you suffered from sudden bouts of anxiety or panic attacks (e.g. sudden shaking, sweating,
shortness of breath, pounding heart) when thinking about leaving people close to you or about 0 1 2 3
them leaving you?
22. Have you found that you get anxious if you do not speak to people that are close to you on the
0 1 2 3
telephone regularly, e.g. daily?
23. Have you been afraid that you would not be able to cope or could not go on if someone you
0 1 2 3
cared about left you?
24. Have you suffered from sudden bouts of anxiety or panic attacks (e.g. sudden shaking, sweating,
0 1 2 3
shortness of breath, pounding heart) when separated from people close to you?
25. Have you been worrying a lot about possible events that may separate you from those close to
0 1 2 3
you e.g. because of work requirements?
26. Have people close to you mentioned that you ‘talk a lot’? 0 1 2 3
27. Have you been worrying that your relationships with some people are so close that it may cause
0 1 2 3
them problems?

SOSA
Instructions: Below is a list of events that may have bothered you for the past six (6) months. For each item, please
encircle the number that corresponds to how much and how often you have been bothered by these experiences. If
you have not experienced the indicated symptom, encircle “1” in Frequency, and leave the Degree of being bothered
by these experiences BLANK.

Frequency:

1 2 3 4 5
Once or twice a
None Once a week Twice a week Almost everyday
month

Degree of being bothered by these experiences:

1 2 3 4 5
Not at all bothered A little bit bothered Moderately bothered Quite a bit bothered Extremely bothered

Degree of being
Frequency
bothered
1. I feel distressed and bothered at the thought of or being separated from 1 2 3 4 5 1 2 3 4 5
home or from the people close to me (such as parents, siblings, and
caregivers).
2. I feel worried that something bad will happen to people who are 1 2 3 4 5 1 2 3 4 5
important to me.
3. I have worries that something bad will happen to me (such as getting 1 2 3 4 5 1 2 3 4 5
lost, having an accident, kidnapped or becoming sick) that will separate
me from people whom I love most.
4. I am afraid to go out from home to school or elsewhere as I might be 1 2 3 4 5 1 2 3 4 5
separated from people important to me.
5. I am afraid of being alone or away from people I love most at home or 1 2 3 4 5 1 2 3 4 5
elsewhere.
6. I cannot sleep away from home or without being near to those who are 1 2 3 4 5 1 2 3 4 5
close to me.
7. I have nightmares about being left alone. 1 2 3 4 5 1 2 3 4 5
8. I feel sick (such as headaches, stomachaches, nausea, vomiting) when I 1 2 3 4 5 1 2 3 4 5
think about being separated from those who are important to me.
9. I am afraid of situations where other people can scrutinize what I say or 1 2 3 4 5 1 2 3 4 5
do (such as social interactions, being observed, or performing in front of
others).
10. I am afraid that I might show how nervous I am that will be talked 1 2 3 4 5 1 2 3 4 5
negatively about or made fun of.
11. Social situations or gatherings (for example, parties, classes or meetings) 1 2 3 4 5 1 2 3 4 5
almost always make me feel afraid or anxious.
12. I avoid or endure social gatherings (for example, parties, meetings, 1 2 3 4 5 1 2 3 4 5
classes) with feelings of fear and worry.
13. People tell me my fear or worry is exaggerated compared to the 1 2 3 4 5 1 2 3 4 5
situations I avoid.

ADNM 20
Instructions: The events you have just indicated can have numerous consequences for our well-being and behavior.
Below you will find various statements about which reactions these types of event can trigger. First of all, please
indicate how often the respective statement applies to you (“never” to “often”).

Then secondly, please indicate for how long you have had this reaction for. It can be for less than one month (< 1
month), between one month and half a year (1-6 months) or longer than 6 months (6 months – 2 years). This may not
be very easy to indicate, but please try to give a rough estimation of the duration of the reaction. If you did not indicate
any stressful life event in the list above, then you can skip the following questions. Encircle your answer.

How Often:
1 2 3 4
Never Rarely Sometimes Often

How Long:
1 2 3
Less than 1 month 1-6 months 6 months to 2 years

How Often How Long


1. Since the stressful situation, I feel low and sad. 1 2 3 4 1 2 3
2. I have to think about the stressful situation repeatedly. 1 2 3 4 1 2 3
3. I try to avoid talking about the stressful situation whenever possible. 1 2 3 4 1 2 3
4. I have to think about the stressful situation a lot and this is a great burden to
1 2 3 4 1 2 3
me.
5. I rarely do those activities which I used to enjoy anymore since my parent/s
1 2 3 4 1 2 3
migration.
6. If I think about the stressful situation, I find myself in a real state of anxiety. 1 2 3 4 1 2 3
7. I avoid certain things that might remind me of the stressful situation. 1 2 3 4 1 2 3
8. I am nervous and restless since the stressful situation 1 2 3 4 1 2 3
9. Since the stressful situation, I lose my temper much quicker than I used to,
1 2 3 4 1 2 3
even over small things.
10. Since the stressful situation, I find it difficult to concentrate on certain things 1 2 3 4 1 2 3
11. I try to dismiss the stressful situation from my memory. 1 2 3 4 1 2 3
12. I have noticed that I am becoming more irritable due to the stressful
1 2 3 4 1 2 3
situation.
13. I constantly get memories of the stressful situation and can’t do anything to
1 2 3 4 1 2 3
stop them.
14. I try to suppress my feelings about my parent/s migration because they are
1 2 3 4 1 2 3
a burden to me.
15. My thoughts often revolve around anything related to the stressful
1 2 3 4 1 2 3
situation.
16. Since the stressful situation, I am scared of doing certain things or of getting
1 2 3 4 1 2 3
into certain situations.
17. Since the stressful situation, I do not like going to work or carrying out the
1 2 3 4 1 2 3
necessary tasks in everyday life.
9
18. I have been feeling dispirited since the stressful situation and have little
1 2 3 4 1 2 3
hope for the future.
19. Since the stressful situation, I can no longer sleep properly. 1 2 3 4 1 2 3
20. All in all, the situation causes serious impairment in my social or
1 2 3 4 1 2 3
occupational life, my leisure time, and other important areas of functioning.

PHQ – 9
Instructions: How often have you been bothered by each of the following symptoms during the past 7 days? For each
symptom encircle the number that best describes how you have been feeling.

0 1 2 3
Not at all At several days More than half of days Nearly everyday

1. Feeling down, depressed, irritable, or hopeless? 0 1 2 3


2. Little interest or pleasure in doing things? 0 1 2 3
3. Trouble falling asleep, staying asleep, or sleeping too much? 0 1 2 3
4. Poor appetite, weight loss, or overeating? 0 1 2 3
5. Feeling tired, or having little energy? 0 1 2 3
6. Feeling bad about yourself—or feeling that you are a failure, or that you have let yourself or your
0 1 2 3
family down?
7. Trouble concentrating on things like school work, reading, or watching TV? 0 1 2 3
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so
0 1 2 3
fidgety or restless that you were moving around a lot more than usual?
9. Thoughts that you would be better off dead, or of hurting yourself in some way? 0 1 2 3

K-10
Instructions: These questions concern how you have been feeling over the past 30 days. Encircle each question that best represents
how you have been.
1 2 3 4 5
None of the time A little of the time Some of the time Most of the time All of the time

1. During the last 30 days, about how often did you feel tired out for no good reason? 1 2 3 4 5
2. During the last 30 days, about how often did you feel nervous? 1 2 3 4 5
3. During the last 30 days, about how often did you feel so nervous that nothing could calm you
1 2 3 4 5
down?
4. During the last 30 days, about how often did you feel hopeless? 1 2 3 4 5
5. During the last 30 days, about how often did you feel restless or fidgety? 1 2 3 4 5
6. During the last 30 days, about how often did you feel so restless you could not sit still? 1 2 3 4 5
7. During the last 30 days, about how often did you feel depressed? 1 2 3 4 5
8. During the last 30 days, about how often did you feel that everything was an effort? 1 2 3 4 5
9. During the last 30 days, about how often did you feel so sad that nothing could cheer you up? 1 2 3 4 5
10. uring the last 30 days, about how often did you feel worthless? 1 2 3 4 5

AUDIT
Instructions: Please indicate the degree of alcohol consumption with the corresponding situations. Encircle your answer.

2 to 4 2 to 3 4 or more
Monthly or
1. How often do you have a drink containing Never times a times a times a
less
alcohol? 0 month week week
1
2 3 4
2. How many drinks containing alcohol do you have 1 or 2 3 or 4 5 or 6 7, 8, or 9 10 or more
on a typical day when you are drinking? 0 1 2 3 4

10
Items 3-8:
0 1 2 3 4
Never Less than monthly Monthly Weekly Daily or almost daily

3. How often do you have six or more drinks on one occasion? 0 1 2 3 4


4. How often during the last year have you found that you were not able to stop drinking once
0 1 2 3 4
you had started?
5. How often during the last year have you failed to do what was normally expected from you
0 1 2 3 4
because of drinking?
6. How often during the last year have you needed a first drink in the morning to get yourself
0 1 2 3 4
going after a heavy session?
7. How often during the last year have you had a feeling of guilt or remorse after drinking? 0 1 2 3 4
8. How often during the last year have you been unable to remember what happened the night
0 1 2 3 4
before because you had been drinking?

Items 9-10:
0 1 2 3 4
No Yes, but not in the Yes, during the last
last year year

9. Have you or someone else been injured as a result of your drinking? 0 1 2 3 4


10. Has a relative or friend or a doctor, or another health worker been concerned about your
0 1 2 3 4
drinking or suggested you cut down?

RTQ-10
Instructions: In this questionnaire, we are interested in understanding how you respond to distressing situations.
Please recall how you tend to respond when you feel distressed or upset. How true (1-5) are each of these
statements with respect to your experience when you are distressed or upset? Encircle your answer.

1 2 3 4 5
Not true at all Somewhat True Very True

1. I have thoughts or images about all my shortcomings, failings, faults, mistakes. 1 2 3 4 5


2. I have thoughts or images about events that come into my head even when I do not wish to 1 2 3 4 5
think about them again.
3. I have thoughts or images that “I won’t be able to do my job/ work because I feel so badly.” 1 2 3 4 5
4. I have thoughts of images that are difficult to forget. 1 2 3 4 5
5. Once I start thinking about the situation, I can’t stop. 1 2 3 4 5
6. I notice that I think about the situation. 1 2 3 4 5
7. I have thoughts or images of the situation that I try to resist thinking about. 1 2 3 4 5
8. I think about the situation all the time. 1 2 3 4 5
9. I know I shouldn’t think about the situation, but can’t help it. 1 2 3 4 5
10. I have thoughts or images about the situation and wish it would go better. 1 2 3 4 5

PTQ-15
Instructions: In this questionnaire, you will be asked to describe how you typically think about negative experiences
or problems. Please read the following statements and rate the extent to which they apply to you when you think
about negative experiences or problems. Encircle your answer.

0 1 2 3 4
Never Rarely Sometimes Often Almost Always

1. The same thoughts keep going through my mind again and again. 0 1 2 3 4
2. Thoughts intrude into my mind. 0 1 2 3 4
3. I can’t stop dwelling on them. 0 1 2 3 4
4. I think about many problems without solving any of them. 0 1 2 3 4
5. I can’t do anything else while thinking about my problems. 0 1 2 3 4

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6. My thoughts repeat themselves. 0 1 2 3 4
7. Thoughts come to my mind without me wanting them to. 0 1 2 3 4
8. I get stuck on certain issues and can’t move on. 0 1 2 3 4
9. I keep asking myself questions without finding any answers. 0 1 2 3 4
10. My thoughts prevent me from focusing on other things. 0 1 2 3 4
11. I keep thinking about the same issues all the time. 0 1 2 3 4
12. Thoughts just pop into my mind. 0 1 2 3 4
13. I feel driven to continue dwelling on the same issue. 0 1 2 3 4
14. My thoughts are not much help to me. 0 1 2 3 4
15. My thoughts take up all my attention. 0 1 2 3 4

IUS
Instructions: You will find below a series of statements which describe how people may react to the uncertainties of
life. Please use the scale below to describe to what extent each item is characteristic of you. Please encircle a number (1
to 5) that describes you best.

1 2 3 4 5
Not at All Somewhat Entirely
Characteristic of Me Characteristic of Me Characteristic of Me

1. Uncertainty stops me from having a firm opinion. 1 2 3 4 5


2. Being uncertain means that a person is disorganized. 1 2 3 4 5
3. Uncertainty makes life intolerable. 1 2 3 4 5
4. It’s unfair not having any guarantees in life. 1 2 3 4 5
5. My mind can't be relaxed if I don't know what will happen tomorrow. 1 2 3 4 5
6. Uncertainty makes me uneasy, anxious, or stressed. 1 2 3 4 5
7. Unforeseen events upset me greatly. 1 2 3 4 5
8. It frustrates me not having all the information I need. 1 2 3 4 5
9. Uncertainty keeps me from living a full life. 1 2 3 4 5
10. One should always look ahead so as to avoid surprises. 1 2 3 4 5
11. A small unforeseen event can spoil everything, even with the best of planning. 1 2 3 4 5
12. When it's time to act, uncertainty paralyses me. 1 2 3 4 5
13. Being uncertain means that I am not first rate. 1 2 3 4 5
14. When I am uncertain, I can't go forward. 1 2 3 4 5
15. When I am uncertain I can't function very well. 1 2 3 4 5
16. Unlike me, others always seem to know where they are going with their lives. 1 2 3 4 5
17. Uncertainty makes me vulnerable, unhappy, or sad. 1 2 3 4 5
18. I always want to know what the future has in store for me. 1 2 3 4 5
19. I can't stand being taken by surprise. 1 2 3 4 5
20. The smallest doubt can stop me from acting. 1 2 3 4 5
21. I should be able to organize everything in advance. 1 2 3 4 5
22. Being uncertain means that I lack confidence. 1 2 3 4 5
23. I think it's unfair that other people seem sure about their future. 1 2 3 4 5
24. Uncertainty keeps me from sleeping soundly. 1 2 3 4 5
25. I must get away from all uncertain situations. 1 2 3 4 5
26. The ambiguities in life stress me. 1 2 3 4 5
27. I can't stand being undecided about my future. 1 2 3 4 5

DTS
Instructions: Think of times that you feel distressed or upset. Select the item from the menu that best describes
your beliefs about feeling distressed or upset by encircling it.

1 2 3 4 5
Strongly Agree Mildly Agree Agree and Disagree Mildly Disagree Strongly Disagree
Equally

1. Feeling distressed or upset is unbearable to me. 1 2 3 4 5


12
2. When I feel distressed or upset, all I can think about is how bad I feel. 1 2 3 4 5
3. I can’t handle feeling distressed or upset. 1 2 3 4 5
4. My feelings of distress are so intense that they completely take over. 1 2 3 4 5
5. There’s nothing worse than feeling distressed or upset. 1 2 3 4 5
6. I can tolerate being distressed or upset as well as most people. 1 2 3 4 5
7. My feelings of distress or being upset are not acceptable. 1 2 3 4 5
8. I’ll do anything to avoid feeling distressed or upset. 1 2 3 4 5
9. Other people seem to be able to tolerate feeling distressed or upset better than I can. 1 2 3 4 5
10. Being distressed or upset is always a major ordeal for me. 1 2 3 4 5
11. I am ashamed of myself when I feel distressed or upset. 1 2 3 4 5
12. My feelings of distress or being upset scare me. 1 2 3 4 5
13. I’ll do anything to stop feeling distressed or upset. 1 2 3 4 5
14. When I feel distressed or upset, I must do something about it immediately. 1 2 3 4 5
15. When I feel distressed or upset, I cannot help but concentrate on how bad the distress
1 2 3 4 5
actually feels.

ERQ
Instructions: We would like to ask you some questions about your emotional life, in particular, how you control (that
is, regulate and manage) your emotions. The questions below involve two distinct aspects of your emotional life.
One is your emotional experience, or what you feel like inside. The other is your emotional expression, or how you
show your emotions in the way you talk, gesture, or behave. Although some of the following questions may seem
similar to one another, they differ in important ways. Encircle your answer.

1 2 3 4 5 6 7
Strongly
Neutral Strongly Agree
Disagree

1. When I want to feel more positive emotion (such as joy or amusement), I change
1 2 3 4 5 6 7
what I’m thinking about.
2. I keep my emotions to myself. 1 2 3 4 5 6 7
3. When I want to feel less negative emotion (such as sadness or anger), I change
1 2 3 4 5 6 7
what I’m thinking about.
4. When I am feeling positive emotions, I am careful not to express them. 1 2 3 4 5 6 7
5. When I’m faced with a stressful situation, I make myself think about it in a way that
1 2 3 4 5 6 7
helps me stay calm.
6. I control my emotions by not expressing them. 1 2 3 4 5 6 7
7. When I want to feel more positive emotion, I change the way I’m thinking about
1 2 3 4 5 6 7
the situation.
8. I control my emotions by changing the way I think about the situation I’m in. 1 2 3 4 5 6 7
9. When I am feeling negative emotions, I make sure not to express them. 1 2 3 4 5 6 7
10. When I want to feel less negative emotion, I change the way I’m thinking about
1 2 3 4 5 6 7
the situation.

DERS
Instructions: Please indicate how often the following statements apply to you by encircling the appropriate number.

1 2 3 4 5
Almost Never Sometimes About Half the Time Most of the Time Almost Always

1. I am clear about my feelings. 1 2 3 4 5


2. I pay attention to how I feel. 1 2 3 4 5
3. I experience my emotions as overwhelming and out of control. 1 2 3 4 5
4. I have no idea how I am feeling. 1 2 3 4 5
5. I have difficulty making sense out of my feelings. 1 2 3 4 5
6. I am attentive to my feelings. 1 2 3 4 5
7. I know exactly how I am feeling. 1 2 3 4 5
8. I care about what I am feeling. 1 2 3 4 5

13
9. I am confused about how I feel. 1 2 3 4 5
10. When I’m upset, I acknowledge my emotions. 1 2 3 4 5
11. When I’m upset, I become angry with myself for feeling that way. 1 2 3 4 5
12. When I’m upset, I become embarrassed for feeling that way. 1 2 3 4 5
13. When I’m upset, I have difficulty getting work done. 1 2 3 4 5
14. When I’m upset, I become out of control. 1 2 3 4 5
15. When I’m upset, I believe that I will remain that way for a long time. 1 2 3 4 5
16. When I’m upset, I believe that I’ll end up feeling very depressed. 1 2 3 4 5
17. When I’m upset, I believe that my feelings are valid and important. 1 2 3 4 5
18. When I’m upset, I have difficulty focusing on other things. 1 2 3 4 5
19. When I’m upset, I feel out of control. 1 2 3 4 5
20. When I’m upset, I can still get things done. 1 2 3 4 5
21. When I’m upset, I feel ashamed at myself for feeling that way. 1 2 3 4 5
22. When I’m upset, I know that I can find a way to eventually feel better. 1 2 3 4 5
23. When I’m upset, I feel like I am weak. 1 2 3 4 5
24. When I’m upset, I feel like I can remain in control of my behaviors. 1 2 3 4 5
25. When I’m upset, I feel guilty for feeling that way. 1 2 3 4 5
26. When I’m upset, I have difficulty concentrating. 1 2 3 4 5
27. When I’m upset, I have difficulty controlling my behaviors. 1 2 3 4 5
28. When I’m upset, I believe there is nothing I can do to make myself feel better. 1 2 3 4 5
29. When I’m upset, I become irritated at myself for feeling that way. 1 2 3 4 5
30. When I’m upset, I start to feel very bad about myself. 1 2 3 4 5
31. When I’m upset, I believe that wallowing in it is all I can do. 1 2 3 4 5
32. When I’m upset, I lose control over my behaviors. 1 2 3 4 5
33. When I’m upset, I have difficulty thinking about anything else. 1 2 3 4 5
34. When I’m upset I take time to figure out what I’m really feeling. 1 2 3 4 5
35. When I’m upset, it takes me a long time to feel better. 1 2 3 4 5
36. When I’m upset, my emotions feel overwhelming. 1 2 3 4 5

ASI-3
Instructions: Please rate each item by selecting one of the five answers for each question. Please answer each
statement by encircling the number that best applies to you.

0 1 2 3 4
Very Little A Little Some Much Very Much

1. It is important for me not to appear nervous. 0 1 2 3 4


2. When I cannot keep my mind on a task, I worry that I might be going crazy. 0 1 2 3 4
3. It scares me when my heart beats rapidly. 0 1 2 3 4
4. When my stomach is upset, I worry that I might be seriously ill. 0 1 2 3 4
5. It scares me when I am unable to keep my mind on a task. 0 1 2 3 4
6. When I tremble in the presence of others, I fear what people might think of me. 0 1 2 3 4
7. When my chest feels tight, I get scared that I won’t be able to breathe properly. 0 1 2 3 4
8. When I feel pain in my chest, I worry that I am going to have a heart attack. 0 1 2 3 4
9. I worry that other people will notice my anxiety. 0 1 2 3 4
10. When I feel “spacey” or spaced out I worry that I may be mentally ill. 0 1 2 3 4
11. It scares me when I blush in front of people. 0 1 2 3 4
12. When I notice my heart skipping a beat, I worry that there is something seriously wrong with
0 1 2 3 4
me.
13. When I begin to sweat in a social situation, I fear people will think negatively of me. 0 1 2 3 4
14. When my thoughts seem to speed up, I worry that I might be going crazy. 0 1 2 3 4
15. When my throat feels tight, I worry that I could choke to death. 0 1 2 3 4
16. When I have trouble thinking clearly, I worry that there is something wrong with me. 0 1 2 3 4
17. I think it would be horrible for me to faint in public. 0 1 2 3 4
18. When my mind goes blank, I worry there is something terribly wrong with me. 0 1 2 3 4

14
BEAQ
Instructions: Please indicate the extent to which you agree or disagree with each of the following statements
by encircling the corresponding number.

1 2 3 4 5 6
Moderately Moderately
Strongly Disagree Slightly Disagree Slightly Agree Strongly Agree
Disagree Agree

1. The key to a good life is never feeling any pain. 1 2 3 4 5 6


2. I'm quick to leave any situation that makes me feel uneasy. 1 2 3 4 5 6
3. When unpleasant memories come to me, I try to put them out of my mind. 1 2 3 4 5 6
4. I feel disconnected from my emotions. 1 2 3 4 5 6
5. I won't do something until I absolutely have to. 1 2 3 4 5 6
6. Fear or anxiety won't stop me from doing something important. 1 2 3 4 5 6
7. I would give up a lot not to feel bad. 1 2 3 4 5 6
8. I rarely do something if there is a chance that it will upset me. 1 2 3 4 5 6
9. It's hard for me to know what I'm feeling. 1 2 3 4 5 6
10. I try to put off unpleasant tasks for as long as possible. 1 2 3 4 5 6
11. I go out of my way to avoid uncomfortable situations. 1 2 3 4 5 6
12. One of my big goals is to be free from painful emotions. 1 2 3 4 5 6
13. I work hard to keep out upsetting feelings. 1 2 3 4 5 6
14. If I have any doubts about doing something, I just won't do it. 1 2 3 4 5 6
15. Pain always leads to suffering. 1 2 3 4 5 6

AAQ-II
Instructions: Below you will find a list of statements. Please rate how true each statement is for you by using the
scale below, encircle your choice.

1 2 3 4 5 6 7
Very Seldom Sometimes Frequently Almost Always
Never True Seldom True Always True
True True True True

1. My painful experiences and memories make it difficult for me to live a life that I
1 2 3 4 5 6 7
would value.
2. I’m afraid of my feelings. 1 2 3 4 5 6 7
3. I worry about not being able to control my worries and feelings 1 2 3 4 5 6 7
4. My painful memories prevent me from a having a fulfilling life. 1 2 3 4 5 6 7
5. Emotions cause problems in my life. 1 2 3 4 5 6 7
6. It seems like most people are handling their lives better than I am. 1 2 3 4 5 6 7
7. Worries get in the way of my success. 1 2 3 4 5 6 7

PANAS – N
Instructions: Recall the last time you felt especially distressed or upset. Briefly describe this situation in terms of
what happened and what you did. Think about how you felt at the time of the situation. Rate how strongly you felt
each of the following emotions by encircling the number.

1 2 3 4 5
Very Slightly or Not
A Little Moderately Quite a Bit Very Much
at All
1. Distressed 1 2 3 4 5
2. Upset 1 2 3 4 5
3. Guilty 1 2 3 4 5
4. Scared 1 2 3 4 5
5. Hostile 1 2 3 4 5
6. Irritable 1 2 3 4 5
7. Ashamed 1 2 3 4 5
8. Nervous 1 2 3 4 5
9. Jittery 1 2 3 4 5
10. Afraid 1 2 3 4 5

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