Please note that all fields followed by an asterisk must be filled in.
First Name*
First Name*
E-mail Address*
E-mail Address*
Country*
Country*
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1. I feel bored, stressed or frustrated with work, life or relationships.
2. I feel overwhelmed by time constraints and too much to do
3. I feel blocked, stuck or drifting without direction
4. I am prone to negative Self talk
5. I can't seem to get beyond my own imperfections
6. I feel guilty whenever I say no to someone's request for help
7. I don't feel that I deserve love or attention
8. I have a deep need for approval
9. I don't trust my own judgment
10. I allow others to direct my life
11. I never have enough energy to do what I want
12. I feel confused and don't know what I want to do with my life
13. I find it impossible to relax
14. I can't seem to slow down
15. My schedule leaves me no time for me-time
16. I resist regular exercise
17. I indulge my addictions (coffee, cigarettes, comfort food)
18. My eating habits are all over the place - I skip meals, eat just before bed, or eat too much in one sitting.
19. My greatest source of satisfaction comes from my work
20. I have trouble getting to sleep
21. I suffer from insomnia
22. I have recurring physical aches and pains (neck & shoulder tension, headaches, stomach aches, back pain etc)
23. I feel isolated - all alone, with no one to speak to about issues or concerns
24. I avoid looking at myself or really seeing myself when I look in the mirror
25. I have a difficult time being kind with myself, even when I am sick
26. I tend to take control of the situation
27. I don't like to acknowledge when I make mistakes.
28. People come to me for support
29. I tend to cast judgments
30. I tend to worry what other people might think about me
31. I don't like silence, being by myself or sitting still for any length of time
32. I don't trust myself or my intuition
33, I have high expectations of myself and others
34. I have difficulty making decisions and setting priorities
35. I don’t trust others easily
36. I tend to feel disappointed or frustrated when I don’t get results I expect
37. I don’t like being praised in public.
38. I find it difficult to receive and accept presents
39. I find it difficult to set and maintain personal boundaries.
40. I worry about the state of the world and our future(environment, politics, economy
41. I feel depleted and frustrated unable to get satisfaction from things that used to fulfill me.
42. I feel ensnared and trapped - like I never have enough time, energy or commitment for my own self care.
43. What feelings were evoked by this self-care primer?