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Confusion

How often are you experiencing confusion when you think about the infidelity?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Looping Thoughts

How often do you find yourself looping on the affair throughout the day?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Heightened Anxiety

Do you have heightened anxiety?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Irritability

Are you extra irritable?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Rage

Are you experiencing rage internally and/or externally?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Worry

How often are you experiencing worry throughout your day?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Nightmares

How often are you having nightmares related to the infidelity or the feelings around the infidelity?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Fear

How often are you experiencing fear throughout your day?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Isolation

How much does feeling isolated interfere with your ability to connect with supportive people in your life?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Becoming Triggered Easily

Have you been experiencing yourself being triggered easily?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Trust Issues

How often do trust issues interfere with your daily relationships and decisions?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Commitment Issues

Are you having trouble committing to things, yourself, or others?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Hopelessness

How often are you feeling hopeless about situation, relationship and/or life?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Poor Emotional Regulation

Are your emotions controlling you more than normal?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Insomnia

How often do you find yourself having a hard time falling asleep or waking up in the middle of the night?

NEVER RARELY SOMETIMES OFTEN ALWAYS

Poor Appetite

How often are you experiencing a poor appetite, food not being desirable or not eating as much?

NEVER RARELY SOMETIMES OFTEN ALWAYS

How prepared are you to invest in your healing?

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