First Name
1. I am able to notice and identify my emotions (e.g., I can tell when I feel sad, angry, anxious, joyful, or ashamed).
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I struggle to notice or put words to my emotions.
I can sometimes recognize my emotions, but they are vague or unclear.
I can often recognize some emotions, but miss others.
I regularly notice and identify my emotions.
I am highly aware of my emotions and can easily identify them.
2. I am able to accept my emotions, even the hard ones (e.g., I can allow myself to feel sadness, fear, or anger without pushing it away or judging it).
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When I notice emotions, I often criticize or blame myself for having them.
I usually see emotions as problems, though occasionally I can stay neutral.
I sometimes add judgment, but I’m also able to observe without being critical at times.
I am generally curious or neutral about my emotions, with only occasional judgment.
I consistently notice my emotions with acceptance, compassion, and curiosity rather than judgment.
3. I notice when I’m activated (e.g., anxious, edgy, overwhelmed, restless, hopeless, numb).
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I usually don’t realize when I’m activated until after I’ve reacted.
I sometimes catch that I’m activated, but mostly after the fact.
I can recognize activation in the moment on occasion, though not consistently.
I regularly notice when I’m activated.
I’m highly aware and reliably recognize when I’m activated.
4. I notice what’s happening in my body (e.g., I can tell when my shoulders are tense, my stomach is tight, my breath is shallow, or my chest feels open).
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I struggle to notice or put words to my physical sensations.
I can sometimes name what I feel in my body, but it’s vague or unclear.
I can identify certain sensations, though I often miss or confuse them.
I can usually name my physical sensations with accuracy.
I can reliably name a wide range of physical sensations..
5. I can pause and check in with my body when I'm activated. (E.g., “Before reacting, I can take a breath and ask myself what’s happening in my body.”)
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When I’m activated, I react automatically without checking in with my body.
I occasionally remember to pause, but most of the time I go straight into reaction.
I can interrupt myself and check in with my body some of the time, though it’s inconsistent.
I regularly pause before reacting and can usually notice what’s happening in my body.
I reliably take a breath and check in with my body before responding when I’m activated.
6. I have ways of helping my body regulate when I feel off. (E.g., “I know what helps me settle, ground, or return to calm.”)
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I don’t know what helps me settle, ground, or return to calm.
I know one strategy that sometimes helps me regulate.
I have a small handful of strategies, though they don’t always feel reliable.
I know multiple strategies that usually help me settle and return to calm.
I have a wide variety of strategies, and I can choose what works best in different situations.
7. I make decisions with the input from both my thoughts and my body. (E.g., “I've learned to trust my gut or my 'full-body yes/no' over time.")
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I make decisions almost entirely from my thoughts and rarely consider signals from my body.
I sometimes notice my body’s input, but I don’t usually factor it into my decisions.
I occasionally check in with my body and weigh it alongside my thoughts when deciding.
I regularly consider both my thoughts and my body’s cues when making decisions.
I consistently use both my thoughts and my body’s signals to guide me.