Packet 3
How yesterday began
Please think about the beginning of the day yesterday, how it began.
Were you fully rested when you woke up? (circle a number)
Very tired
0
Completely rested
1
2
3
4
How many hours of sleep did you have? _____ hours
5
6
First Episode
Please look at your list of episodes in Packet 2 and select the earliest episode you noted,
right after you woke up. When did this first episode begin and end (e.g., 7:30am)? Please try
to remember the times as precisely as you can.
This episode began at__ ______ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted.
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to
Packet 4. Otherwise please continue until all of your episodes have been rated.
Episode # ____
Please look at your list of episodes and select the next episode you noted
This episode began at________ and ended at _________.
Before answering the questions below take a minute to re-live this episode in detail everything you were doing, the people you were with and what your feelings were.
Where were you?
__ home
__ at work
__ in a car
__ elsewhere ____________________
Were you alone?
__ Yes
__ No
Were you talking with anyone? (check one)
__No
__One person
__More than one
If you were interacting with anyone, was it (check all that apply):
__ Spouse, significant other
__ parents
__ co-workers
__ customer, student
__ children
__ friends, relatives
__ boss
__ Other people not listed
(specify)___________________________
What were you doing? (check all that apply)
__ commuting, traveling
__ working
__ shopping, errands
__ doing housework
__ preparing food
__ taking care of your children
__ talking, conversation
__ playing
__ watching television
__ listening to music
__ listening to radio, news
__ home computer
__ reading
__ relaxing, nothing special
__ grooming, self care
__ eating
__ exercising
__ walking, taking a walk
__ intimate relations
__ rest/sleep
__ praying/worshipping/meditating
__ Other not listed_____________
If you checked several things you were doing at the same time, please circle the one to
which you were paying most attention.
How did you feel during this episode?
Please rate each feeling on the scale given. A 0 means that you did not experience that
feeling at all. A 6 means that you experienced that feeling very strongly. Please circle the
number between 0 and 6 that best describes how you felt.
Not at all
Very strongly
Impatient for it to end .................. 0
1
2
3
4
5
6
Competent / confident ................ 0
1
2
3
4
5
6
Tense / stressed ......................... 0
1
2
3
4
5
6
Happy ......................................... 0
1
2
3
4
5
6
Depressed / blue ........................ 0
1
2
3
4
5
6
Interested / focused .................... 0
1
2
3
4
5
6
Affectionate / friendly .................. 0
1
2
3
4
5
6
Calm / relaxed ............................ 0
1
2
3
4
5
6
Angry / hostile............................. 0
1
2
3
4
5
6
Tired ........................................... 0
1
2
3
4
5
6
Frustrated ................................... 0
1
2
3
4
5
6
If you have completed this form for all the episodes in Packet 2 you can go on to Packet 4.
Otherwise please raise your hand for the attendant to give you additional forms and continue
until all of your episodes have been rated.