| RPT |
.| .| Five Facet Mindfulness Questionnaire| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB:
attention to sensations, such as the wind in my hair or sun on my face.| <*Answer_5482*>| 16. I have trouble thinking of the right words to express how I feel about things.| <*Answer_5483*>|
17. I make judgments about whether my thoughts are good or bad.| <*Answer_5484*>| 18. I find it difficult to stay focused on what's happening in the present.| <*Answer_5485*>| 19. When I have
distressing thoughts or images, I "step back" and am aware of the thought or image without getting taken over by it.| <*Answer_5486*>| 20. I pay attention to sounds, such as clocks ticking, birds
chirping, or cars passing.| <*Answer_5487*>| 21. In difficult situations, I can pause without immediately reacting.| <*Answer_5488*>| 22. When I have a sensation in my body, it's difficult
for me to describe it because I can't find the right words.| <*Answer_5489*>| 23. It seems I am "running on automatic" without much awareness of what I'm doing.| <*Answer_5490*>| 24. When I
have distressing thoughts or images, I feel calm soon after.| <*Answer_5491*>| 25. I tell myself that I shouldn't be thinking the way I'm thinking.| <*Answer_5492*>| 26. I notice the smells
and aromas of things.| <*Answer_5493*>| 27. Even when I'm feeling terribly upset, I can find a way to put it into words.| <*Answer_5494*>| 28. I rush through activities without being really
attentive to them.| <*Answer_5495*>| 29. When I have distressing thoughts or images I am able just to notice them without reacting.| <*Answer_5496*>| 30. I think some of my emotions are bad
or inappropriate and I shouldn't feel them.| <*Answer_5497*>| 31. I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light and shadow.|
<*Answer_5498*>| 32. My natural tendency is to put my experiences into words.| <*Answer_5499*>| 33. When I have distressing thoughts or images, I just notice them and let them go.|
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | Mindfulness Scales| | Observe: <-Observe->| Describe: <-Describe->| Act With Awareness: <-ActWithAwareness->|
<*Answer_5500*>| 34. I do jobs or tasks automatically without being aware of what I'm doing.| <*Answer_5501*>| 35. When I have distressing thoughts or images, I judge myself as good or bad,
depending what the thought/image is about.| <*Answer_5502*>| 36. I pay attention to how my emotions affect my thoughts and behavior.| <*Answer_5503*>| 37. I can usually describe how I feel at
the moment in considerable detail.| <*Answer_5504*>| 38. I find myself doing things without paying attention.| <*Answer_5505*>| 39. I disapprove of myself when I have irrational ideas.|
<*Answer_5506*>| | $~
Nonjudge: <-Nonjudge->| Nonreact: <-Nonreact->| | Questions and Answers| | 1. When I'm walking, I deliberately notice the sensations of my body moving.| <*Answer_5468*>| 2. I'm good at finding
words to describe my feelings.| <*Answer_5469*>| 3. I criticize myself for having irrational or inappropriate emotions.| <*Answer_5470*>| 4. I perceive my feelings and emotions without having
to react to them.| <*Answer_5471*>| 5. When I do things, my mind wanders off and I'm easily distracted.| <*Answer_5472*>| 6. When I take a shower or bath, I stay alert to the sensations of
water on my body.| <*Answer_5473*>| 7. I can easily put my beliefs, opinions, and expectations into words.| <*Answer_5474*>| 8. I don't pay attention to what I'm doing because I'm
daydreaming, worrying, or otherwise distracted.| <*Answer_5475*>| 9. I watch my feelings without getting lost in them.| <*Answer_5476*>| 10. I tell myself I shouldn't be feeling the way I'm
feeling.| <*Answer_5477*>| 11. I notice how foods and drinks affect my thoughts, bodily sensations, and emotions.| <*Answer_5478*>| 12. It's hard for me to find the words to describe what I'm
thinking.| <*Answer_5479*>| 13. I am easily distracted.| <*Answer_5480*>| 14. I believe some of my thoughts are abnormal or bad and I shouldn't think that way.| <*Answer_5481*>| 15. I pay
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