Instructions:
Looking back, rate the degree to which you have experienced any of the following phenomena. Answer each question according to your feelings, thoughts and experiences at that time. In making each of your ratings, use the following scale:
0 - none; 1 - so mild that I am unable to remember; 2 - mild; 3 – moderate;
4 - strong (equivalent in degree to any other solid experience);
5– extreme (more than at any other time in my life and stronger than 4)
Thank you for submitting your questionnaire.