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Building Emotional Intelligence Managing Emotions - Toronto

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Instruction: Please answer all of the questions in this questionnaire to the best of your ability.

指示：请尽最大努力回答所有的问题。

Personal Information / 个人信息

Information in this section will be encrypted when stored on our server, but it is recommended that you submit this form over a private (e.g. home) network.
這部分的資料會被加密存儲在我們的服務器,但建議你通過專用網絡(例如家裡的網絡)提交此表格。

Psychosocial Screen / 心理與社交健康的評估表

This questionnaire provides you with a means of reporting problems that you may be having as an individual or in your relationships with your family and others whom you know or work with. It is not a test, so there are no right or wrong answers. Answer each item as carefully and as accurately as you can.

這問卷是用來量度你個人所面對的困難或你與家人,同儕,朋友或同事之間的人際關係的問題。這不是一個測驗,所以沒有對或錯的答案。請盡量小心並準確和誠實地選出最適合的答案。

Does not apply / 與我無關None of the time / 極少A little of the time / 些少Some of the time / 有時Good part of the time / 頗多Most or all of the time / 時常
1. I feel depressed. / 我感到情緒低落。 *
2. I have a low sense of self-esteem. / 我感到自卑。 *
3. I feel unhappy. / 我感到不快樂。 *
4. I feel afraid. / 我感到懼怕。 *
5. I feel anxious. / 我感到擔憂。 *
6. I feel nervous. / 我感到緊張。 *
7. I have disturbing thoughts or fantasies. / 我有令我感到不安的思想或幻想。 *
8. I have problems with my own anger. / 我有憤怒或暴躁的問題。 *
9. I have nightmares. / 我夜間做惡夢。 *
10. I have a problem with my own sense of identity. / 我對我的身份感到有問題。 *
11. I have problems with my personal sex life. / 我在我個人的性生活上感到有困難。 *
12. The quality of my work is poor. / 我工作的質素是差的。 *
13. I have problems in my relationships with friends. / 我與我朋友的關係有困難。 *
14. I have problems with people I work with. / 我與我同事的關係有困難。 *
15. There are problems in our family relationships. / 我們的家庭關係有困難。 *
16. I have problems with one or more of my children. / 我與我子女的關係有困難。 *
17. My partner and I have problems in our relationship. / 我與我配偶的關係有困難。 *
18. My partner and I have problems with our sexual relationship. / 我與我配偶的性關係有困難。 *
19. My mother and I have problems in our relationship. / 我與我母親的關係有困難。 *
20. My father and I have problems in our relationship. / 我與我父親的關係有困難。 *

Problem checklist / 问题询问表

Please check any of the following items that are currently problems for you. If none apply, check "None of the above" at the bottom of the list.

请勾选任何以下对你目前有关的问题。如果没有项目跟你有关，在列表的底部勾选“以上皆无”。

Burns Depression Checklist / 情緒低落程度評估表

Instruction: Please indicate how much you have experienced each of the following during the past week, including today.

請選出你最近一星期裡(包括今天)所經歷的。 (譯自:David D. Burns, 1996新版)

Thoughts and Feelings / 情緒低落的思想和感覺

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多Extremely / 極多
1. Feeling sad or down in the dumps / 傷心或低落 *
2. Feeling unhappy or blue / 不開心 *
3. Crying spells or tearfulness / 哭或流淚 *
4. Feeling discouraged / 失望或沮喪 *
5. Feeling hopeless / 絕望 *
6. Low self-esteem / 自我形像低,覺得自己衰老或沒有吸引力 *
7. Feeling worthless or inadequate / 認為自己沒有價值或能力不足 *
8. Guilt or shame / 內疚或羞恥 *
9. Criticizing yourself or blaming yourself / 自我批評或怪責 *
10. Difficulty making decisions / 猶豫不決,難以作出決定 *

Activities and Personal Relationships / 活動和個人關係

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多Extremely / 極多
11. Loss of interest in family, friends, colleagues / 對家庭,朋友或同事失去興趣 *
12. Loneliness / 孤單 *
13. Spending less time with family or friends / 少與家人或朋友同在一起 *
14. Loss of motivation / 失去動力,要强迫自己去做事 *
15. Loss of interest in work or other activities / 對事業和別的活動失去興趣 *
16. Avoiding work or other activities / 避免工作或其他的活動 *
17. Loss of pleasure or satisfaction in life / 對人生失去樂趣和滿足感 *

Physical Symptoms / 身體的症狀

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多Extremely / 極多
18. Feeling tired / 感到疲倦 *
19. Difficulty sleeping or sleeping too much / 夜間不能有好的睡眠或睡得太多 *
20. Decreased or increased appetite / 胃口改變,失去食慾或突然食得過量 *
21. Loss of interest in sex / 失去性慾,對性失去興趣 *
22. Worrying about your health / 擔心自己的健康 *

Suicidal Urges / 自殺傾向

Anyone with suicidal urges should seek help from a mental health professional immediately
若有自殺傾向,必需向專業人士求助,盡快見家庭醫生,精神科醫生,心理學家,社工或輔導員

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多Extremely / 極多
23. Do you have any suicidal thoughts? / 有否自殺的意念？ *
24. Would you like to end your life? / 有否想結束你的生命？ *
25. Do you have a plan for harming yourself? / 有否傷害自己的計劃？ *

Burns Anxiety Inventory / 緊張程度評估表

Category I: Anxious Feelings / 緊張的感覺

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多
1. Anxiety, nervousness, worry, or fear / 緊張，不安，掛慮，恐懼 *
2. Feeling that things around you are strange or unreal / 覺得週圍的事物很怪或很虛幻 *
3. Feeling detached from all or part of your body / 覺得與自己的身體完全或部份分開 *
4. Sudden unexpected panic spells / 突然感到恐懼 *
5. Apprehension or a sense of impending doom / 憂慮或惡運將臨的感覺 *
6. Feeling tense, stressed, "uptight", or on edge / 感覺緊張，有壓力，不安，急躁 *

Category II: Anxious Thoughts / 緊張的思想

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多
7. Difficulty concentrating / 難以集中 *
8. Racing thoughts / 胡思亂想 *
9. Frightening fantasies or daydreams / 可怕的幻想或白日夢 *
10. Feeling that you're on the verge of losing control / 覺得自己瀕臨失控 *
11. Fears of cracking up or going crazy / 懼怕將會精神崩潰或瘋狂 *
12. Fears of fainting or passing out / 怕會暈倒或昏迷 *
13. Fears of physical illnesses or heart attacks or dying / 對疾病,心臟病發或垂死的恐懼 *
14. Concerns about looking foolish or inadequate / 擔心會顯得笨拙或不足 *
15. Fears of being alone, isolated, or abandoned / 懼怕孤單,被隔離,或被遺棄 *
16. Fears of criticism or disapproval / 怕被別人批評或拒絕 *
17. Fears that something terrible is about to happen / 恐懼會發生一些可怕的事 *

Category III: Physical Symptoms / 身體的症狀

Not at all / 沒有Somewhat / 有些Moderately / 頗多A lot / 很多
18. Skipping, racing or pounding of the heart (palpitations) / 脈膞或心跳加速 *
19. Pain, pressure, or tightness in the chest / 胸部痛楚,有壓力,收緊 *
20. Tingling or numbness in the toes or fingers / 腳趾/手趾痳脾 *
21. Butterflies or discomfort in the stomach / 胃部不適 *
22. Constipation or diarrhea / 便秘或肚瀉 *
23. Restlessness or jumpiness / 坐立不安 *
24. Tight, tense muscles / 肌肉收緊 *
25. Sweating not brought on by heat / 不是由於熱而流汗 *
26. A lump in the throat / 喉嚨哽住 *
27. Trembling or shaking / 身體顫抖 *
28. Rubbery or "jelly" legs / 腳軟或無力 *
29. Feeling dizzy, lightheaded, or off balance / 頭暈,腳步浮浮,不平衡 *
30. Choking, smothering sensations or difficulty breathing / 呼吸困難，幾乎窒息 *
31. Headaches or pains in the neck or back / 頭痛,頸痛或背痛 *
32. Hot flashes or cold chills / 覺得身發熱或發冷顫 *
33. Feeling tired, weak, or easily exhausted / 感疲倦,衰弱,很易疲累 *

Relationship Satisfaction Scale / 關係滿足評估表

Select the category that best describes the amount of satisfaction you feel in your closest relationship.

Note: Although this test assesses your marriage or most intimate relationship, you can also use it to evaluate your relationship with a friend, family member, or colleague. If you do not have any intimate relationships at this time, you can simply think of people in general when you take the test.

請選出你在最親密的關係中所感到的滿足程度。雖然這問卷是用來評估你的婚姻或最親密的關係,也可以用來評估你與朋友、家人、同學和同事之間的關係。若果你現今沒有親密的關係,可以用來評估你與其他人的關係。(譯自:David D. Burns, Ten Days to Self-Esteem, New York: William Morrow, 1993)

Very Dissatisfied / 非常不滿Moderately Dissatisfied / 相當不滿Slightly Dissatisfied / 有些不滿Neutral / 中立Slightly Satisfied / 有些滿足Moderately Satisfied / 相當滿足Very Satisfied / 非常滿足
1. Communication and openness / 溝通與坦誠 *
2. Resolving conflicts and arguments / 處理衝突的方法 *
3. Degree of affection and caring / 感情和關心 *
4. Intimacy and closeness / 親密與親近 *
5. Satisfaction with your role in the relationship / 你自己的角色 *
6. Satisfaction with the other person's role / 對方的角色 *
7. Overall satisfaction with your relationship / 整體關係的滿足 *

Index of Self-Esteem / 自我形象評估表

This questionnaire is designed to measure how you see yourself. It is not a test, so there are no right or wrong answers. Please answer each item as carefully and accurately as you can by selecting the option that describes the extent of these feelings.

這問卷是用來量度你的自尊和自我形象。這不是一個測驗,所以沒有對或錯的答案。請盡量小心，並準確和誠實地選出最適合的答案。(譯自Index of Self Esteem, The Dorsey Press, 1982)

Rarely or none of the time / 極少或沒有A little of the time / 些少Some of the time / 有時A good part of the time / 頗多Most or all of the time / 多數或時常
1. I feel that people would not like me if they really knew me well. / 我感到當別人真正的認識我,他們不會喜歡我。 *
2. I feel that others get along much better than I do. / 我認為其他人的人際關係比我的好得多。 *
3. I feel that I am a beautiful person. / 我認為我是一個有吸引力的人。 *
4. When I am with other people I feel they are glad I am with them. / 我覺得別人因與我作伴而感到高興。 *
5. I feel that people really like to talk with me. / 我感到別人真的喜歡與我說話。 *
6. I feel that I am a very competent person. / 我認為我是一個非常能幹的人。 *
7. I think I make a good impression on others. / 我認為我給別人好的印象。 *
8. I feel that I need more self-confidence. / 我感到需要更多的自信。 *
9. When I am with strangers I am very nervous. / 當我與陌生人在一起,我會非常的緊張。 *
10. I think that I am a dull person. / 我認為我是一個相當無趣，無聊的人。 *
11. I feel ugly. / 我感到我是一個難看的人。 *
12. I feel that others have more fun than I do. / 我認為別人比我有更多的歡趣。 *
13. I feel that I bore people. / 我認為我會令到別人覺得悶。 *
14. I think my friends find me interesting. / 我認為我的朋友覺得我是個很有趣的人。 *
15. I think I have a good sense of humor. / 我認為我是一個幽默的人。 *
16. I feel very self-conscious when I am with strangers. / 當我與陌生人在一起,我會非常注意自己的表現。 *
17. I feel that if I could be more like other people I would have it made. / 我認為如果我可以更像別的人，我便會更成功。 *
18. I feel that people have a good time when they are with me. / 我認為當別人與我在一起時,他們會很快樂。 *
19. I feel like a wallflower when I go out. / 當我出去時,我感到我是牆花。 *
20. I feel I get pushed around more than others. / 我認為我受欺壓比其他人多。 *
21. I think I am a rather nice person. / 我認為我是一個相當好的人。 *
22. I feel that people really like me very much. / 我感到別人非常喜歡我。 *
23. I feel that I am a likeable person. / 我認為我是一個可愛的人。 *
24. I am afraid I will appear foolish to others. / 我懼怕我在別人面前表現得愚眛。 *
25. My friends think very highly of me. / 我的朋友都非常的佩服我。 *