CORE-OM

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IMPORTANT – PLEASE READ THIS FIRST
This form has 34 statements about how you have been OVER THE LAST WEEK.
Please read each statement and think how often you felt that way last week.

Client ID

Date

I have felt terribly alone and isolated *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt tense, anxious or nervous *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt I have someone to turn to for support when needed *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt O.K. about myself *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt totally lacking in energy and enthusiasm *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have been physically violent to others *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt able to cope when things go wrong *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have been troubled by aches, pains or other physical problems *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have thought of hurting myself *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

Talking to people has felt too much for me *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

Tension and anxiety have prevented me doing important things *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have been happy with the things I have done *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have been disturbed by unwanted thoughts and feelings *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt like crying *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt panic or terror *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I made plans to end my life *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt overwhelmed by my problems *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have had difficulty getting to sleep or staying asleep *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt warmth or affection for someone *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

My problems have been impossible to put to one side *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have been able to do most things I needed to *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have threatened or intimidated another person *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt despairing or hopeless *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have thought it would be better if I were dead *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt criticised by other people *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have thought I have no friends *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt unhappy *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

Unwanted images or memories have been distressing me *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have been irritable when with other people *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have thought I am to blame for my problems and difficulties *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt optimistic about my future *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have achieved the things I wanted to *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have felt humiliated or shamed by other people *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

I have hurt myself physically or taken dangerous risks with my health *

Not at all
Only occasoinally
Sometimes
Often
Most or all of the time

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About
Cognitive Behavioural Therapy
Retrain Your Brain Mood Food
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Who We Work With
- For Individuals and Groups
- For Businesses And Projects
Associate Trainers
Testimonials
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Contact Us
- Privacy Policy

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