Name
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NHS number
Date of birth
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Contact number
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Group / course name
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Scale one: expressing compassion for others
People will take advantage of me if they see me as too compassionate
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Being compassionate toward people who have done bad things is letting them off the hock
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
There are some people in life who don't deserve compassion
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that being too compassionate makes people an easy target
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
People take advantage of you if you are too forgiving an compassionate
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I worry that if I am compassionate, vulnerable people can be drawn to me and drain my emotional resources
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Need to help themselves rather than waiting for others to help them
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I am compassionate, some people will become too dependent upon me
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Being too compassionate makes people soft and easy to take advantage of
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
For some people, I think discipline and proper punishment are more helpful than being compassionate to them
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Scale two: responding to the expression of compassion from others
Wanting others to be kind to oneself is a weakness
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that when I need people to be kind and understanding they won't be
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I am fearful of becoming dependent on the care from others because they might not always be available or willing to give it
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I often wonder whether displays of warmth and kindness from others are genuine
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Feelings of kindness from others are somehow frightening
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
When people are kind and compassionate towards me I feel anxious or embarrassed
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
If people are friendly and kind I worry they will find out something bad about me that will change their mind
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I worry that people are only kind and compassionate if they want something from me
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
When people are kind and compassionate towards me I feel empty and sad
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
If people are kind I feel they are getting too close
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Even though other people are kind to me, I have rarely felt warmth from my relationships with other
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I try to keep my distance from others even if I know they are kind
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
If I think someone is being kind and caring towards me, I put up a barrier
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Scale three: expressing kindness and compassion towards yourself
I feel that I don't deserve to be kind and forgiving to myself
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
If I really think about being kind and gentle with myself it makes me sad
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
Getting on in life is about being tough rather than compassionate
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I would rather not know what being kind and compassionate to myself feels like
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
When I try and feel kind and warm to myself I just feel kind of empty
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I start to feel compassion and warmth for myself, I will feel overcome with a sense of loss/grief
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I become kinder and less self-critical to myself then my standards will drop
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I am more self-compassionate I will become a weak person
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I have never felt compassion for myself, so I would not know where to begin to develop these feelings
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I worry that if I start to develop compassion for myself I will become dependent on it
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I become too compassionate to myself I will lose my self-criticism and my flaws will show
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I develop compassion for myself, I will become someone I do not want to be
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I become too compassionate to myself others will reject me
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I find it easier to be critical towards myself rather than compassionate
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely
I fear that if I am too compassionate towards myself, bad things will happen
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0 – not at all 1 – a little bit 2 – moderately 3 – quite a bit 4 – extremely