Strongly Disagree | Disagree | Disagree a Little | Agree a Little | Agree | Strongly Agree | |
---|---|---|---|---|---|---|
a) The things I am responsible for do not fit very well with what I want to do. |
1
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2
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3
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4
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5
|
6
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b) I am not sure that I can accept any more responsibility than I have right now. |
1
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2
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3
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4
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5
|
6
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c) I am not always able to be the person I want to be when I am with my spouse/partner/parent. |
1
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2
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3
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4
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5
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6
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d) It is difficult for me to accept all the responsibility for my spouse/partner/parent. |
1
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2
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3
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4
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5
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6
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e) I am having trouble accepting the way I relate to my spouse/partner/parent. |
1
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2
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3
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4
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5
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6
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f) It is difficult for me to accept any more responsibility that I now have to assume. |
1
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2
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3
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4
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5
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6
|
Not At All | A Little | Moderately | A Lot | A Great Deal | |
---|---|---|---|---|---|
a) caused conflicts with your relative? |
1
|
2
|
3
|
4
|
5
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b) decreased time you have to yourself? |
1
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2
|
3
|
4
|
5
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c) created a feeling of hopelessness? |
1
|
2
|
3
|
4
|
5
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d) given your life more meaning? |
1
|
2
|
3
|
4
|
5
|
e) increased the number of unreasonable requests made by your relative? |
1
|
2
|
3
|
4
|
5
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f) kept you from recreational activities? |
1
|
2
|
3
|
4
|
5
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g) made you nervous? |
1
|
2
|
3
|
4
|
5
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h) made you more satisfied with your relationship? |
1
|
2
|
3
|
4
|
5
|
Not At All | A Little | Moderately | A Lot | A Great Deal | |
---|---|---|---|---|---|
a) caused you to feel that your relative makes demands over and above what he/she needs? |
1
|
2
|
3
|
4
|
5
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b) caused your social life to suffer? |
1
|
2
|
3
|
4
|
5
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c) depressed you? |
1
|
2
|
3
|
4
|
5
|
d) given you a sense of fulfillment? |
1
|
2
|
3
|
4
|
5
|
e) made you feel you were being taken advantage of by your relative? |
1
|
2
|
3
|
4
|
5
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f) changed your routine? |
1
|
2
|
3
|
4
|
5
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g) made you anxious? |
1
|
2
|
3
|
4
|
5
|
h) left you feeling good? |
1
|
2
|
3
|
4
|
5
|
Not At All | A Little | Moderately | A Lot | A Great Deal | |
---|---|---|---|---|---|
a) increased attempts by your relative to manipulate you? |
1
|
2
|
3
|
4
|
5
|
b) given you little time for friends and relatives? |
1
|
2
|
3
|
4
|
5
|
c) caused you to worry? |
1
|
2
|
3
|
4
|
5
|
d) made you enjoy being with your relative more? |
1
|
2
|
3
|
4
|
5
|
e) left you with almost no time to relax? |
1
|
2
|
3
|
4
|
5
|
f) made you cherish your time with your relative? |
1
|
2
|
3
|
4
|
5
|
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) | All of the time (5-7 Days) | |
---|---|---|---|---|
a) I was bothered by things that usually don't bother me. |
1
|
2
|
3
|
4
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b) I had trouble keeping my mind on what I was doing. |
1
|
2
|
3
|
4
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c) I felt depressed. |
1
|
2
|
3
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4
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d) I felt that everything I did was an effort. |
1
|
2
|
3
|
4
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e) I felt hopeful about the future. |
1
|
2
|
3
|
4
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f) I felt fearful. |
1
|
2
|
3
|
4
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g) My sleep was restless. |
1
|
2
|
3
|
4
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h) I was happy. |
1
|
2
|
3
|
4
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i) I felt lonely. |
1
|
2
|
3
|
4
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j) I could not "get going". |
1
|
2
|
3
|
4
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