Do I have to take part?
Appendix 4- 3 Online consent form
Thank you for reading the information sheet for this study, and for your interest in participating. Before commencing the survey, please read the statements below and tick if you agree with them. If you would like further information before consenting to participate, please e-mail me at [email protected].
Tick to agree
I confirm that I have read the information sheet and understand what I will be asked to do as part of the study.
I understand that I do not have to participate in the study, and that I am free to withdraw at any time without giving any reason.
I understand that my survey responses will be completely anonymous – they will not have any identifying information, such as my name or e-mail address, attached to them.
I understand that once my responses have been submitted it will not be possible for them to be withdrawn, as the researcher won’t know which data is mine.
I understand that the research data will be saved on a secure encrypted drive accessible only to the researcher.
I understand that the information from my responses will be pooled with other participants’ responses, anonymised and may be published.
I understand that the anonymous pooled data will be shared with the research supervisors in order to guide the analysis.
I understand that if I provide my email address that this will be kept confidential and will not be kept with the anonymous data that I provide within the survey.
I understand that if I contact the researcher directly that there may be circumstances in which the researcher may need to break confidentiality
Appendix 4-4
Full Survey
Thank you for taking the time to complete this survey. You are free to discontinue the survey at any time. If you have any queries, please contact the researcher (Aoife Clarke) at [email protected]. If you feel distressed by any of the questions, please contact one of the services I have provided the contact details of.
There are 5 sections to this survey. Please read the instructions carefully at the start of each section. At the end of the survey you will be asked to enter your email address if you wish to be entered in to a prize draw, or if you wish to receive feedback on the overall study findings. This is completely optional – you do not have to provide your email address if you don’t want to. Your e-mail address will not be linked in any way to your survey responses, which will always be received in an anonymous format.
This questionnaire asks you for some basic information about yourself. This is so that we can describe our sample, and know who are findings are most relevant to.
Demographic Questionnaire
What age are you?
What is your gender?
What is your nationality?
What is the highest level of education you have currently completed?
Are you currently (please circle): - Working - Studying - Unemployed
Please briefly indicate the nature of the traumatic event you experienced (e.g. sexual assault, combat, road traffic accident)
Have you experienced severe trauma (e.g. abuse) in childhood? (please answer yes or no)
This questionnaire is concerned with how you feel about yourself. Please consider your feelings since your experience of the traumatic event. When responding to the statements below, please circle the appropriate number according to the following definitions: 1 = Strongly disagree; 2 = Very much disagree; 3 = Slightly disagree; 4 = Neither agree nor disagree; 5 = Slightly agree; 6 = Very much agree; 7 = Strongly agree.
Strongly disagree Strongly agree
I find myself repulsive 1 2 3 4 5 6 7
I am proud of who I am. 1 2 3 4 5 6 7
I am sickened by the way I behave. 1 2 3 4 5 6 7
Sometimes I feel tired. 1 2 3 4 5 6 7
I can’t stand being me. 1 2 3 4 5 6 7
I enjoy the company of others. 1 2 3 4 5 6 7
I am revolting for many reasons. 1 2 3 4 5 6 7
I consider myself attractive 1 2 3 4 5 6 7
People avoid me 1 2 3 4 5 6 7
I enjoy being outdoors 1 2 3 4 5 6 7
I feel good about the way I behave. 1 2 3 4 5 6 7
I do not want to be seen. 1 2 3 4 5 6 7
I am a sociable person. 1 2 3 4 5 6 7
I often do things I find revolting. 1 2 3 4 5 6 7 I avoid looking at my reflection. 1 2 3 4 5 6 7
Sometimes I feel happy. 1 2 3 4 5 6 7
I am an optimistic person. 1 2 3 4 5 6 7
I behave as well as everyone else. 1 2 3 4 5 6 7 It bothers me to look at myself. 1 2 3 4 5 6 7
Sometimes I feel sad. 1 2 3 4 5 6 7
I find the way I look nauseating. 1 2 3 4 5 6 7
We all differ in how we relate to other people. This questionnaire lists different thoughts, feelings and ways of behaving in relationships with others.
Thinking generally about how you relate to other key people in your life, please use a tick to show how much each statement is like you. Key people could include family members, friends, partner or mental health workers. There are no right or wrong answers
Not at all A little Quite a bit Very much
1. I prefer not to let other people know my ‘true’ thoughts and feelings.
(..) (..) (..) (..)
2. I find it easy to depend on other people for support with problems or difficult situations.
(..) (..) (..) (..)
3. I tend to get upset, anxious or angry if other people are not there when I need them.
(..) (..) (..) (..)
4. I usually discuss my problems and concerns with other people.
(..) (..) (..) (..)
5. I worry that key people in my life won’t be around in the future.
(..) (..) (..) (..)
6. I ask other people to reassure me that they care about me.
(..) (..) (..) (..)
7. If other people disapprove of something I do, I get very upset.
(..) (..) (..) (..)
8. I find it difficult to accept help from other people when I have problems or difficulties.
(..) (..) (..) (..)
9. It helps to turn to other people when I’m stressed.
(..) (..) (..) (..)
10. I worry that if other people get to
know me better, they won’t like me. (..) (..) (..) (..)
Not at all A little Quite a bit Very much
11. When I’m feeling stressed, I prefer being on my own to being in the company of other people.
(..) (..) (..) (..)
12. I worry a lot about my relationships with other people.
(..) (..) (..) (..)
13. I try to cope with stressful situations on my own.
(..) (..) (..) (..)
people, they won’t want to know me anymore.
15. I worry about having to cope with problems and difficult situations on my own.
(..) (..) (..) (..)
16. I feel uncomfortable when other people want to get to know me better.
(..) (..) (..) (..)
Below is a list of difficulties people sometimes have after stressful life events. Please read each item and then indicate how distressing each difficulty has been for you during the past 7 days or other agreed time:
0 = Not at all 1 = A little 2 = Moderately 3 = A lot 4 = Extremely
Any reminder brought back feelings about it 0 1 2 3 4
I had trouble staying asleep 0 1 2 3 4
Other things kept making me think about it 0 1 2 3 4
I felt irritable and angry 0 1 2 3 4
I avoided letting myself get upset when I thought about it or was reminded of it
0 1 2 3 4
I thought about it when I didn’t mean to 0 1 2 3 4 I felt as if it hadn’t happened or it wasn’t real. 0 1 2 3 4
I stayed away from reminders about it 0 1 2 3 4
Pictures about it popped in to my mind 0 1 2 3 4
I was jumpy and easily startled 0 1 2 3 4
I tried not to think about it 0 1 2 3 4
I was aware that I still had a lot of feeling about it but I didn’t deal with them.
0 1 2 3 4
My feelings about it were kind of numb. 0 1 2 3 4 I found myself acting or feeling like I was back at that time. 0 1 2 3 4
I had trouble falling asleep 0 1 2 3 4
I had waves of strong feelings about it. 0 1 2 3 4
I tried to remove it from my memory 0 1 2 3 4
I had trouble concentrating 0 1 2 3 4
Reminders of it caused me to have physical reactions 0 1 2 3 4
I had dreams about it 0 1 2 3 4
I felt watchful and on-guard 0 1 2 3 4
This questionnaire consists of twenty-eight questions about experiences that you may have in your daily life. We are interested in how often you have these experiences. It is important, however, that your answers show how often these experiences happen to you when you are not under the influence of alcohol or drugs.
Fill in the answer that shows how much this happens to you. a. Never
b. It has happened once or twice c. No more than once a year d. Once every few months e. At least once a month f. At least once a week
____ 1. Some people have the experience of driving a car and suddenly realizing that they don’t remember what has happened during all or part of the trip.
____ 2. Some people find sometimes that they are listening to someone talk and they suddenly realize that they did not hear part or all of what has just been said.
____ 3. Some people have the experience of finding themselves in a place and they have no idea how they got there.
____ 4. Some people have the experience of finding themselves dressed in clothes that they don’t remember putting on.
____ 5. Some people have the experience of finding new things among their belongings that they do not remember buying.
____ 6. Some people sometimes find that they are approached by people that they do not know who call them by name or insist that they have met before
____ 7. Some people sometimes have the experience of feeling as though they are standing next to themselves or watching themselves do something and they actually see themselves as if they were looking at another person. ____ 8. Some people are told that they sometimes do not recognize friends or family members.
____ 9. Some people find that they have no memory for some important events in their lives, for example a wedding or graduation
____ 10. Some people had the experience of being accused of lying when they do not think that they have lied. ____ 11. Some people have the experience of looking in a mirror and not recognizing themselves.
____ 12. Some people sometimes have the experience of feeling that other people, objects, and the world around them are not real.
____ 13. Some people sometimes have the experience of feeling that their body does not seem to belong to them. ____ 14. Some people have the experience of sometimes remembering a past event so vividly that they feel as if they were reliving that event.
____ 15. Some people have the experience of not being sure if things that they remember happening really did happen or whether they just dreamed them
____ 16. Some people have the experience of being in a familiar place and finding it strange and unfamiliar. ____ 17. Some people find that when they are watching television or a movie they become so absorbed in the story that they are unaware of other events happening around them.
____ 18. Some people find that they become so involved in fantasy or daydream that it feels as though it were really happening to them.
____ 19. Some people find that they are sometimes able to ignore pain.
____ 20. Some people find that they sometimes sit staring off into space thinking of another event and are not aware of the passage of time.
____ 21. Some people sometimes find that when they are alone they sometimes talk out loud to themselves. ____ 22. Some people find that in one situation they may act so differently compared to another situation that they feel almost as if they were two different people.
____ 23. Some people sometimes feel that in some situations they are able to do things with amazing ease and spontaneity that would usually be difficult for them, for example, sports or social situations, etc.
____ 24. Some people sometimes find that they cannot remember whether they have done something or have just thought about doing that things, for example, whether they have just mailed a letter or just thought about mailing it. ____ 25. Some people sometimes find evidence that they have done things that they do not remember doing. ____ 26. Some people sometimes find writings, drawing, or notes among their belongings that they must have done but cannot remember doing.
____ 27. Some people sometimes find that they hear voices in their head that tell them to do things or comment on what they are doing.
____ 28. Some people sometimes feel as if they are looking at the world through a fog so that people or objects appear far away or unclear.