Below is a collection of statements about your everyday experience. Please indicate how frequently or infrequently you currently have each experience. Please answer according to what really reflects your experience rather than what you think your experience should be. Please treat each item separately from every other item.
Please answer according to the scale below
1 = Almost Always 2 = Very Frequently 3 = Somewhat Frequently 4 = Somewhat Infrequently 5 = Very Infrequently 6 = Almost Never
1. I could be experiencing some emotion and not be conscious of it until some time later.
Almost Always
Almost Never
Clear selection
2. I break or spill things because of carelessness, not paying attention, or thinking of something else.
Almost Always
Almost Never
Clear selection
3. I find it difficult to stay focused on what’s happening in the present.
Almost Always
Almost Never
Clear selection
4. I tend to walk quickly to get where I’m going without paying attention to what I experience along the way.
Almost Always
Almost Never
Clear selection
Please answer according to the scale below
1 = Almost Always 2 = Very Frequently 3 = Somewhat Frequently 4 = Somewhat Infrequently 5 = Very Infrequently 6 = Almost Never
5. I tend not to notice feelings of physical tension or discomfort until they really grab my attention.
Almost Always
Almost Never
Clear selection
6. I forget a person’s name almost as soon as I’ve been told it for the first time.
Almost Always
Almost Never
Clear selection
7. It seems I am “running on automatic,” without much awareness of what I’m doing.
Almost Always
Almost Never
Clear selection
8. I rush through activities without being really attentive to them.
Almost Always
Almost Never
Clear selection
Please answer according to the scale below
1 = Almost Always 2 = Very Frequently 3 = Somewhat Frequently 4 = Somewhat Infrequently 5 = Very Infrequently 6 = Almost Never
9. I get so focused on the goal I want to achieve that I lose touch with what I’m doing right now to get there.
Almost Always
Almost Never
Clear selection
10. I do jobs or tasks automatically, without being aware of what I'm doing.
Almost Always
Almost Never
Clear selection
11. I find myself listening to someone with one ear, doing something else at the same time.
Almost Always
Almost Never
Clear selection
12. I drive places on ‘automatic pilot’ and then wonder why I went there.
Almost Always
Almost Never
Clear selection
Please answer according to the scale below
1 = Almost Always 2 = Very Frequently 3 = Somewhat Frequently 4 = Somewhat Infrequently 5 = Very Infrequently 6 = Almost Never
13. I find myself preoccupied with the future or the past.
Almost Always
Almost Never
Clear selection
14. I find myself doing things without paying attention.