HeartSync Research Project - Assessment Tools "*" indicates required fields Step 1 of 6 16% This assessment consists of four separate assessment tools. For each tool, answer each question to the best of your ability, and then click the "Next" button to go to the next section. Please note that every question is required; if you miss one, you will get an error message that will highlight which question you still need to answer. When you have finished the fourth assessment, click the submit button. Identifying Information:Client ID*Date* MM slash DD slash YYYY I am taking these assessments:* Before my first session At my fifth session At the end of my tenth (last) session 90 Days after my last session Assessment 1 of 4 - Satisfaction with Life Scale (SWLS) Below are five statements that you may agree or disagree with. Indicate your agreement with each item by tapping the appropriate box, from strongly agree, to strongly disagree. Please be open and honest in your responding.1. In most ways my life is close to my ideal.* Strongly agree Agree Slightly agree Neither agree or disagree Slightly disagree Disagree Strongly disagree 2. The conditions of my life are excellent.* Strongly agree Agree Slightly agree Neither agree or disagree Slightly disagree Disagree Strongly disagree 3. I am satisfied with my life.* Strongly agree Agree Slightly agree Neither agree or disagree Slightly disagree Disagree Strongly disagree 4. So far I have gotten the important things I want in life.* Strongly agree Agree Slightly agree Neither agree or disagree Slightly disagree Disagree Strongly disagree 5. If I could live my life over, I would change almost nothing.* Strongly agree Agree Slightly agree Neither agree or disagree Slightly disagree Disagree Strongly disagree Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction with Life Scale.Journal of Personality Assessment, 49, 71-75. http://internal.psychology.illinois.edu/~ediener/SWLS.html Assessment 2 of 4 - GAD-7 Anxiety Over the last two weeks, how often have you been bothered by the following problems?1. Feeling nervous, anxious, or on edge* Not at all Several days More than half the days Nearly every day 2. Not being able to stop or control worrying* Not at all Several days More than half the days Nearly every day 3. Worrying too much about different things* Not at all Several days More than half the days Nearly every day 4. Trouble relaxing* Not at all Several days More than half the days Nearly every day 5. Being so restless that it is hard to sit still* Not at all Several days More than half the days Nearly every day 6. Becoming easily annoyed or irritable* Not at all Several days More than half the days Nearly every day 7. Feeling afraid, as if something awful might happen* Not at all Several days More than half the days Nearly every day If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?* Not difficult at all Somewhat difficult Very Difficult Extremely Difficult Not applicable Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr. Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved. Reproduced with permission Assessment 3 of 4 - Patient Health Questionaire (PHQ-9) Over the last two weeks, how often have you been bothered by any of the following problems?1. Little interest or pleasure in doing things* Not at all Several days More than half the days Nearly every day 2. Feeling down, depressed, or hopeless* Not at all Several days More than half the days Nearly every day 3. Trouble falling or staying asleep, or sleeping too much* Not at all Several days More than half the days Nearly every day 4. Feeling tired or having little energy* Not at all Several days More than half the days Nearly every day 5. Poor appetite or overeating* Not at all Several days More than half the days Nearly every day 6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down* Not at all Several days More than half the days Nearly every day 7. Trouble concentrating on things, such as reading the newspaper or watching television* Not at all Several days More than half the days Nearly every day 8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or restless that you have been moving around a lot more than usual* Not at all Several days More than half the days Nearly every day 9. Thoughts that you would be better off dead, or of hurting yourself* Not at all Several days More than half the days Nearly every day If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?* Not difficult at all Somewhat difficult Very Difficult Extremely Difficult Not applicable Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD© is a trademark of Pfizer Inc. Assessment 4 of 4 - Center for Epidemiologic Studies Depression Scale (CES-D), NIMH Below is a list of the ways you might have felt or behaved. Please tell me how often you have felt this way during the past week. 1. I was bothered by things that usually don’t bother me.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 2. I did not feel like eating; my appetite was poor.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 3. I felt that I could not shake off the blues even with help from my family or friends.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 4. I felt that I was just as good as other people.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 5. I had trouble keeping my mind on what I was doing.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 6. I felt depressed.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 7. I felt that everything I did was an effort.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 8. I felt hopeful about the future.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 9. I thought my life had been a failure.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 10. I felt fearful.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 11. My sleep was restless.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 12. I was happy.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 13. I talked less than usual.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 14. I felt lonely.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 15. People were unfriendly.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 16. I enjoyed life.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 17. I had crying spells.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 18. I felt sad.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 19. I felt that people dislike me.* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) 20. I could not get “going.”* Rarely or none of the time (less than 1 day) Some or a little of the time (1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days) Copyright 2025 © Renewal Christian Counseling Center