Name:

Section (circle one): A B C

Answer each of the following questions after listening to the CD. Answer the questions with respect to the way you feel at the moment; don’t necessarily think about the way you typically feel.

Time 1

1. I feel that I'm a person of worth, at least on an equal plane with others.
Strongly Disagree 1 2 3 4 5 Strongly Agree

2. I feel that I have a number of good qualities.
Strongly Disagree 1 2 3 4 5 Strongly Agree

3. All in all, I am inclined to feel that I am a failure.
Strongly Disagree 1 2 3 4 5 Strongly Agree

4. I am able to do things as well as most other people.
Strongly Disagree 1 2 3 4 5 Strongly Agree

5. I feel I do not have much to be proud of.
Strongly Disagree 1 2 3 4 5 Strongly Agree

6. I have high self-esteem.
Strongly Disagree 1 2 3 4 5 Strongly Agree

Answer each of the following questions after listening to the CD. Answer the questions with respect to the way you feel at the moment; don’t necessarily think about the way you typically feel.

Time 2

1. I feel that I'm a person of worth, at least on an equal plane with others.
Strongly Disagree 1 2 3 4 5 Strongly Agree

2. I feel that I have a number of good qualities.
Strongly Disagree 1 2 3 4 5 Strongly Agree

3. All in all, I am inclined to feel that I am a failure.
Strongly Disagree 1 2 3 4 5 Strongly Agree

4. I am able to do things as well as most other people.
Strongly Disagree 1 2 3 4 5 Strongly Agree

5. I feel I do not have much to be proud of.
Strongly Disagree 1 2 3 4 5 Strongly Agree

6. I have high self-esteem.
Strongly Disagree 1 2 3 4 5 Strongly Agree