MVA Study
CSE 2/2/00
Participation # ______ Date______
Relate the following to your motor vehicle accident. For each situation described below,
please rate how capable you are that you can successfully deal with it. Please rate them
as you currently believe, not as it was the day of the accident. Because people differ
from each other in the ways that they deal with a car accident there is no single correct
answer. Answer with your immediate response rather than spending a lot of time
thinking about your answer. Please write your answer in the blank provided.
1__________2___________3___________4___________5___________6___________7
Not Capable
A little Capable
Pretty Capable
Very Capable
_____1.Dealing with every day activities such as bathing, dressing, moving, cooking, ect.
_____2.Coping with headaches and other bodily pain.
_____3.Dealing with medication side-effects (dry mouth, stomach ache, stupor,drooling).
_____4.Getting back to my job.
_____5.Being dependent on other people.
_____6.Dealing with feelings of guilt or responsibility (others being injured or killed).
_____7.Dealing with physical changes caused by my accident (scars, etc.).
_____8.Handling demands of keeping the housework completed.
_____9.Coping with my family responsibilities (e.g., spouse, partner, children).
_____10.Handling difficulties with concentration.
_____11.Dealing with all of my appointments (rehabilitation, car repair, insurance, etc.).
_____12.Complying with my medication prescriptions (taking the medications on time
the correct number of times a day).
_____13.Trusting others to drive me around.
_____14.Dealing with financial burdens since the accident.
_____15.Dealing with my emotions since the accident (anger, fear, anxiety, depression,
helplessness).
_____16.Returning to life as it was before my accident.
_____17.Handling all of the insurance and/or legal issues related to my accident.
_____18.Expressing my feelings about the accident.
_____19.Finding some greater meaning to justify what happened.
_____20.Having conversations about what happened.
MVA Study
CSE 2/2/00
Participation # ______ Date______
1__________2___________3___________4___________5___________6___________7
Not Capable
A little Capable
Pretty Capable
Very Capable
_____21.Accepting what happened.
_____22.Not losing my temper.
_____23.Dealing with thoughts about the accident itself (e.g., reliving the accident).
_____24.Coping with painful memories of the accident.
_____25.Dealing with fears of having another accident.
_____26.Handling thoughts about myself dying.
_____27.Controlling painful images of the accident.
_____28.Dealing with distressing dreams about the accident.
_____29.Handling reminders of the accident (e.g., the car, the place of the accident, etc.).
_____30.Managing feelings of losing emotional control.
_____31.Being strong emotionally.
_____32.Handling thoughts about my loved ones possibly dying in the car accident.
_____33.Trusting other people driving me around.
_____34.Complying with medical restrictions (e.g., diet, alcohol consumption, etc.).
_____35.Feeling that others just don’t understand my situation.
_____36.Trusting others in general.
_____37.Having to report the accident over and over (to insurance people, police, family,
etc.).
_____38.Coping with feelings of anger toward the one responsible for the accident.
_____39.Managing my fears of getting into a car now.
_____40.Getting around (transportation difficulties).
_____41.Being afraid that other bad things are going to happen to me.