"*" indicates required fields PCL5 Questionnaire Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then select one of the responses in the drop down box underneath to indicate how much you have been bothered by that problem in the past month.Name* First Last Email* In the past month, how much were you bothered by: Repeated, disturbing, and unwanted memories of the stressful experience?*Not at allA little bitModeratelyQuite a bitExtremelyRepeated, disturbing dreams of the stressful experience?*Not at allA little bitModeratelyQuite a bitExtremelySuddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?*Not at allA little bitModeratelyQuite a bitExtremelyFeeling very upset when something reminded you of the stressful experience?*Not at allA little bitModeratelyQuite a bitExtremelyHaving strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?*Not at allA little bitModeratelyQuite a bitExtremelyAvoiding memories, thoughts, or feelings related to the stressful experience?*Not at allA little bitModeratelyQuite a bitExtremelyAvoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?*Not at allA little bitModeratelyQuite a bitExtremelyTrouble remembering important parts of the stressful experience?*Not at allA little bitModeratelyQuite a bitExtremelyHaving strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?*Not at allA little bitModeratelyQuite a bitExtremelyBlaming yourself or someone else for the stressful experience or what happened after it?*Not at allA little bitModeratelyQuite a bitExtremelyHaving strong negative feelings such as fear, horror, anger, guilt, or shame?*Not at allA little bitModeratelyQuite a bitExtremelyLoss of interest in activities that you used to enjoy?*Not at allA little bitModeratelyQuite a bitExtremelyFeeling distant or cut off from other people?*Not at allA little bitModeratelyQuite a bitExtremelyTrouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?*Not at allA little bitModeratelyQuite a bitExtremelyIrritable behaviour, angry outbursts, or acting aggressively?*Not at allA little bitModeratelyQuite a bitExtremelyTaking too many risks or doing things that could cause you harm?*Not at allA little bitModeratelyQuite a bitExtremelyBeing “superalert” or watchful or on guard?*Not at allA little bitModeratelyQuite a bitExtremelyFeeling jumpy or easily startled?*Not at allA little bitModeratelyQuite a bitExtremelyHaving difficulty concentrating?*Not at allA little bitModeratelyQuite a bitExtremelyTrouble falling or staying asleep?*Not at allA little bitModeratelyQuite a bitExtremelyConsent I agree to the CPE privacy policy in relation to the processing of my data.HiddenR1HiddenR2HiddenR3HiddenR4HiddenR5HiddenR6HiddenR7HiddenR8HiddenR9HiddenR10HiddenR11HiddenR12HiddenR13HiddenR14HiddenR15HiddenR16HiddenR17HiddenR18HiddenR19HiddenR20HiddenCriterion BHiddenCriterion CHiddenCriterion DHiddenCriterion ECriterionBCDE Price: HiddenTotal ScoreHiddenCriteriaValidPhoneThis field is for validation purposes and should be left unchanged.
