GRID
You will be presented with a series of problems that people sometimes have. Read each item carefully and indicate your present level of concern about the item. Please answer questions as honestly as possible.
Email address *
1. Difficulty concentrating *
No Concern
Most Concerned
2. Discrimination or harassment *
No Concern
Most Concerned
3. Feelings of failure *
No Concern
Most Concerned
4. Conflict in relationship *
No Concern
Most Concerned
5. Feeling left out of things *
No Concern
Most Concerned
6. Mood swings *
No Concern
Most Concerned
7. Sexual assault or abuse *
No Concern
Most Concerned
8. Physical abuse or assault *
No Concern
Most Concerned
9. Lack of life goals or purpose *
No Concern
Most Concerned
10. Internal conflict or confusion *
No Concern
Most Concerned
11. Pain *
No Concern
Most Concerned
12. Sexual concerns *
No Concern
Most Concerned
13. Difficulty with children *
No Concern
Most Concerned
14. Being laughed at or criticized *
No Concern
Most Concerned
15. Financial problems *
No Concern
Most Concerned
16. Problems sleeping *
No Concern
Most Concerned
17. Feelings of fear or panic *
No Concern
Most Concerned
18. Family conflict *
No Concern
Most Concerned
19. Unable to forget past mistakes *
No Concern
Most Concerned
20. Nervous around people *
No Concern
Most Concerned
21. Nightmares *
No Concern
Most Concerned
22. Conflict with others *
No Concern
Most Concerned
23. Feeling hopeless *
No Concern
Most Concerned
24. Difficulty reaching goals *
No Concern
Most Concerned
25. Problems at work *
No Concern
Most Concerned
26. Poor eating habits *
No Concern
Most Concerned
27. Church attendance *
No Concern
Most Concerned
28. Health problems *
No Concern
Most Concerned
29. Having very unusual experiences *
No Concern
Most Concerned
30. Worried about a family member *
No Concern
Most Concerned
31. Hear or see things other people don't see or hear *
No Concern
Most Concerned
32. Death *
No Concern
Most Concerned
33. Boredom *
No Concern
Most Concerned
34. Feeling like things are not real *
No Concern
Most Concerned
35. Distrust of others *
No Concern
Most Concerned
36. Lack of exercise *
No Concern
Most Concerned
37. Unhappy too often *
No Concern
Most Concerned
38. Fear of insanity *
No Concern
Most Concerned
39. Concern about physical appearance *
No Concern
Most Concerned
40. Thinking about same thing over and over *
No Concern
Most Concerned
41. Crying *
No Concern
Most Concerned
42. Anger *
No Concern
Most Concerned
43. Recent difficult changes *
No Concern
Most Concerned
44. Want to die *
No Concern
Most Concerned
45. Difficulty coping *
No Concern
Most Concerned
46. Good relationship with God *
No Concern
Most Concerned
47. Loneliness *
No Concern
Most Concerned
48. Unloveable *
No Concern
Most Concerned
49. Memory problems *
No Concern
Most Concerned
50. Alcohol or drug use *
No Concern
Most Concerned
51. Need to be perfect *
No Concern
Most Concerned
52. Stupid people *
No Concern
Most Concerned
53. Problem with body weight *
No Concern
Most Concerned
54. Lack of self-control *
No Concern
Most Concerned
55. Disappointed with yourself *
No Concern
Most Concerned
56. Feeling like you don't fit-in *
No Concern
Most Concerned
57. Racing thoughts *
No Concern
Most Concerned
58. Difficulty speaking up *
No Concern
Most Concerned
59. No one to talk with *
No Concern
Most Concerned
60. Others concerned about my drug or alcohol use *
No Concern
Most Concerned
61. Unable to relax *
No Concern
Most Concerned
62. Emotional abuse *
No Concern
Most Concerned
63. Feeling out of control *
No Concern
Most Concerned
64. Too busy *
No Concern
Most Concerned
65. Legal problems *
No Concern
Most Concerned
66. Guilt *
No Concern
Most Concerned
67. Thoughts of killing or hurting someone *
No Concern
Most Concerned
68. Fatigue *
No Concern
Most Concerned
69. Low self-esteem *
No Concern
Most Concerned
70. Habits interfere with daily activities *
No Concern
Most Concerned
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