
1
Day-to-Day Experiences
Instructions: Below is a collection of statements about your everyday experience. Using the
1-6 scale below, please indicate how frequently or infrequently you currently have each
experience. Please answer according to what
really reflects
your experience rather than
what you think your experience should be. Please treat each item separately from every
other item.
1 2 3 4 5 6
Almost
Always
Very
Frequently
Somewhat
Frequently
Somewhat
Infrequently
Very
Infrequently
Almost
Never
I could be experiencing some emotion and not be conscious of
it until some time later. 1 2 3 4 5 6
I break or spill things because of carelessness, not paying
attention, or thinking of something else. 1 2 3 4 5 6
I find it difficult to stay focused on what’s happening in the
present. 1 2 3 4 5 6
I tend to walk quickly to get where I’m going without paying
attention to what I experience along the way. 1 2 3 4 5 6
I tend not to notice feelings of physical tension or discomfort
until they really grab my attention. 1 2 3 4 5 6
I forget a person’s name almost as soon as I’ve been told it
for the first time. 1 2 3 4 5 6
It seems I am “running on automatic,” without much awareness
of what I’m doing. 1 2 3 4 5 6
I rush through activities without being really attentive to them. 1 2 3 4 5 6
I get so focused on the goal I want to achieve that I lose touch
with what I’m doing right now to get there. 1 2 3 4 5 6
I do jobs or tasks automatically, without being aware of what
I'm doing. 1 2 3 4 5 6
I find myself listening to someone with one ear, doing
something else at the same time. 1 2 3 4 5 6