DBT–WCCL
Your birthdate helps us identify your data accurately.
Sign in to Google to save your progress. Learn more
Birthday *
MM
/
DD
/
YYYY
Your First Name *
Filled out by *

The following questions below represent ways that you may have coped with stressful events in your life.

Decide how often you used each thought/behavior in the last MONTH:    

0 = never used  /  1 = rarely used  /  2 = sometimes used  /  3 = regularly used (4 – 5 times per week)

Be as honest as possible in your responses. All questions refer to the past month.

In the last month, I have...

In the last month, I have...
 *
0 — Never Used
1 — Rarely Used
2 — Sometimes Used
3 — Regularly Used
Bargained or compromised to get something positive from the situation
Counted my blessings
Blamed myself
Concentrated on something good that could come out of the whole thing
Kept feelings to myself
Made sure I'm responding in a way that doesn’t alienate others
Figured out who to blame
Hoped a miracle would happen
Tried to get centered before taking any action
Talked to someone about how I’ve been feeling
In the last month, I have...
 *
0 — Never Used
1 — Rarely Used
2 — Sometimes Used
3 — Regularly Used
Stood my ground and fought for what I wanted
Refused to believe that it had happened
Treated myself to something really tasty
Criticized or lectured myself
Took it out on others
Came up with a couple of different solutions to my problem
Wished I were a stronger person — more optimistic and forceful
Accepted my strong feelings, but not let them interfere with other things too much
Focused on the good things in my life
Wished that I could change the way that I felt
In the last month, I have...
 *
0 — Never Used
1 — Rarely Used
2 — Sometimes Used
3 — Regularly Used
Found something beautiful to look at to make me feel better
Changed something about myself so that could deal with the situation better
Focused on the good aspects of my life and gave less attention to negative thoughts or feelings
Got mad at the people or things that caused the problem
Felt bad that I couldn't avoid the problem
Tried to distract myself by getting active
Been aware of what has to be done, so I've been doubling my efforts and trying harder to make things work
Thought that others were unfair to me
Soothed myself by surrounding myself with a nice fragrance of some kind
Blamed others
In the last month, I have...
 *
0 — Never Used
1 — Rarely Used
2 — Sometimes Used
3 — Regularly Used
Listened to or played music that I found relaxing
Gone on as if nothing had happened
Accepted the next best thing to what I wanted
Told myself things could be worse
Occupied my mind with something else
Talked to someone who could do something concrete about the problem
Tried to make myself feel better by eating, drinking, smoking, taking medications, etc
Tried not to act too hastily or follow my own hunch
Changed something so things would turn out right
Pampered myself with something that felt good to the touch (e.g., a bubble bath or a hug)
In the last month, I have...
 *
0 — Never Used
1 — Rarely Used
2 — Sometimes Used
3 — Regularly Used
Avoided people
Thought how much better off I was than others
Just took things one step at a time
Did something to feel a totally different emotion (like watching a funny movie when sad)
Wished the situation would go away or somehow be finished
Kept others from knowing how bad things were
Focused my energy on helping others
Found out what other person was responsible
Made sure to take care of my body and stay healthy so that I was less emotionally sensitive
Told myself how much I had already accomplished
In the last month, I have...
 *
0 — Never Used
1 — Rarely Used
2 — Sometimes Used
3 — Regularly Used
Made sure I respond in a way so that I could still respect myself afterwards
Wished that I could change what had happened
Made a plan of action and followed it
Talked to someone to find out about the situation
Avoided my problem
Stepped back and tried to see things as they really are
Compared myself to others who are less fortunate
Increased the number of pleasant things in my life so that I had a more positive outlook
Tried not to burn my bridges behind me, but leave things open somewhat
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of DBT San Diego.

Does this form look suspicious? Report

Google Forms