Step 1 of 16 6% Section One Please answer the following questions as honestly as you can. Answer as you actually feel, not as you think you should feel. There is no right or wrong answer, only what is true for you at this time. Pairs of statements bracket each response slider below. Please read each pair and decide which of the two best describes how you feel. Using the slider, indicate your degree of agreement with the statements. 1 indicates agreement with the top-left statement, 7 indicates agreement with the bottom-right. The world is an unsafe place.* I feel safe in the world. I worry about being "safe, warm, and dry."* I know I will be physically secure no matter what happens in the world. I am not really able to take an idea and make it happen in the world (e.g., find a job, go back to school, etc.).* I have the ability to take an idea and make it happen in the world (e.g., find a job, go back to school, etc.) My physical needs were not met as an infant and that influences my feelings of vulnerability today.* My physical needs were met as an infant and that influences my feelings of safety today. I have trouble providing the necessities of life for myself (and my family).* I am able to provide the necessities of life for myself (and my family). I am not able to protect myself from the negative intent of others (e.g., physical assault, prejudice, hatred).* I am able to protect myself from the negative intent of others (e.g., physical assault, prejudice, hatred). I really do not have a place to call my home.* I have a place to call my home. I am basically on my own in this world, and unsupported by others.* I feel the companionship and support of others in this world. My feelings of self worth are dependent upon my possessions (house, car, etc.) or position (job title, salary, etc.).* My feelings of self worth are not dependent upon my possessions (house, car, etc.) or position (job title, salary, etc.). My feelings about myself are tied to how I look physically (thin/fat, sexy/homely, etc.)* My feelings about myself remain the same no matter what I look like on the outside. I am currently in an emotionally, physically, or sexually abusive relationship, one in which my boundaries are not respected.* My boundaries are respected in my current relationships; I am not hurt emotionally, physically, or sexually. I feel controlled by the other person (people) in my current relationship(s); I do not feel free to be who I am.* In my current relationship(s), I feel free to be who I am; I do not feel controlled by the other person (people). I feel guilty or disgusted by my sexuality.* I embrace and enjoy my sexuality. I feel guilty about the way I parent my child(ren); I wish I could do a better job.* I feel good about the way I parent my child(ren); I know I’m doing the best I am. I do not make enough money to meet my material needs.* I make enough money to meet my material needs. I feel victimized by others or discriminated against because of my race, nationality, sex, religion, sexual orientation, etc..* I feel accepted by others even though I may be of a different race, nationality, sex, religion, sexual orientation, etc.. I find it necessary to lie to others in my life (lover, family, coworkers, etc.)* I am able to be honest with others in my life (lover, family, coworker, etc) I am afraid of being poor and impoverished.* I know that my material needs will always be met. I don't believe I can trust my own gut instincts or intuition regarding how to direct my own life.* I do believe I can trust my own gut instincts or intuition regarding how to direct my own life. I feel fearful and unable to make my own decisions about my life and so rely upon others for guidance and directions.* I feel empowered to make my own decisions about my life and feel no need to rely upon the guidance of others. I feel intimidated by the important people in my life.* The important relationships in my life are based upon mutuality and trust. In times of crisis and emotional need, other people are my only source of comfort and support.* In times of crisis and emotional need, I am able to rely upon myself and inner resources as well as other people. I believe, basically, that other people are not trustworthy and/or not of goodwill.* I believe, basically, that other people are trustworthy and of goodwill. I often feel rage and/or hatred over th way other people treat me in my life.* I usually have positive feelings over the way other people treat me in my life. I resent the fact that the other people in my adult relationships are not self-reliant, and depend on me to take care of them.* The other people in my adult relationships are basically self-reliant, and do not depend on me to take care of them. I rely upon other people to help make my life work (finances, needs, ideas, plans, actions).* I rely upon myself to make my life work (finances, needs, ideas, plans, actions). I am angry that my personal choices are limited and/or invalidated by the important people in my life.* The important people in my life support and respect my personal choices, even if they disagree with me. I feel resentful or angry that I give to others and never seem to receive in return.* I feel that my relationships are balanced with respect to giving and receiving. I'm afraid of being criticized by other people.* I can handle the criticism of other people. I am critical of other people who do not live up to my expectations for their behavior.* I accept other people who do not live up to my expectations for their behavior. I'm afraid that I will fail to accomplish the important goals and projects in my life.* I’m confident that I can successfully accomplish the important goals and projects in my life. I feel ashamed about my use of alcohol and/or drugs.* I feel comfortable about my use of alcohol and/or drugs. I feel badly about the way I treat my child(ren), spouse, family members.* I feel proud about the way I treat my child(ren), spouse, family members. I was abused and/or neglected as a child and still feel very angry and/or resentful; it continues to impact me terribly today.* I have reconciled and/or forgiven my parents for having abused or neglected me as a child, and realize they did the best they could. I feel guilty about the way I've treated other people in my life.* I feel proud of the way I’ve treated other people in my life. I feel undeserving or unworthy of being loved.* I feel deserving and worthy of being loved. I resent the fact that other people in my life get more love and attention than I do.* I feel that I receive as much love and attention as other people in my life do. I feel emotionally frozen because of my loneliness.* I feel surrounded by many loving people in my life. I think that some groups of people (forms of life) are inferior to me in their attitudes and behavior.* I accept all people (and forms of life) as equal to me, even if they differ from me in their attitudes and behavior. I still feel pain from the hurts and resentments of the past; I just cannot let them go.* I have been able to forgive or reconcile with the past, to release and let go. I am in an important relationship that is abusive or emotionally unfulfilling.* I feel safe and emotionally fulfilled in the important relationships in my life. I am staying in a marriage or job even though "my heart is not in it anymore."* I feel that my heart is still in my marriage and/or job. I do what is expected of me in life, rather than "follow my dreams."* I “follow my dreams” and try to make them happen in my life. I'm afraid to try something new or venture into the unknown.* I can do anything I set my mind to, even the new or unknown. As a child, I did not have the freedom to make my own choices or decisions, or they were ridiculed or criticized by others, and this still effects me today.* As a child, I was encouraged to make my own choices and to trust my own decisions, an this serves me well today. I would not describe my self as a creative person.* I would describe myself as a creative person. I feel blocked from expressing my true emotions (sorrow, anger, joy) and ideas.* I feel free to express my true emotions (sorrow, anger, joy) and ideas. I am sometimes unable to control my emotions, and have outbursts of anger, rage, or physical abuse.* I am able to control my emotions, and never have outbursts of anger, rage, or physical abuse. I am dishonest with people about my true feelings and about who I really am.* I am honest with people about my true feelings and about who I really am. I am not able to say "I'm sorry," or "I love you," or "I forgive you," to another and really mean it.* I am able to say “I’m sorry,” or “I love you,” or “I forgive you,” to another and really mean it. I withdraw from the things in my life that frighten or intimidate me.* I am able to face the things in my life that frighten or intimidate me. I think it's better to "keep the peace" and go along with the wishes of the family or group.* I let others in my family or group know my personal preferences and desires in situations. I enjoy sharing gossip.* I consider gossip a waste of my time. I have difficulty taking care of my basic life needs (physical needs, getting to work, paying bills on time, etc.).* I have established routines for taking care of my basic life needs (physical needs, getting to work, paying bills on time, etc.). I don't really stop to think about my life, and prefer to keep busy.* I enjoy taking time to think about my life, time for introspection. I believe the events in my life are random occurences.* I believe the events in my life are teaching me things I would not otherwise learn. I do not believe in God or in the Divine.* I do believe in God or in the Divine. I find myself experiencing the same painful situations over and over again.* I have made changes in my life so that I do not keep repeating the same painful patterns. I do not believe there is life after death.* I do believe there is life after death. I think life is basically without meaning or purpose.* I have a philosophic or spiritual outlook on the purpose of my life. I am without Divine guidance in my life.* I do receive Divine guidance in my life. Most of the really painful experiences in my life were the result of other people doing things to me that I did not deserve.* I can understand the part I played in some of the really painful experiences in my life. There are people who are trying to make my life difficult and painful.* I understand that the causes for pain in my life are not all external. I truly dread each day, and wish I were dead.* I truly value each day, and consider it a gift. Most of the time, life feels like a chore or burden.* I am usually enthusiastic and excited about life. I am not sure who I really am, or what I can realistically expect from myself.* I know myself well, and I am realistic about what I expect from myself. Most of the time, I feel depressed, exhausted, or without energy.* Most of the time, I feel energized and full of vitality. I am basically a pessimist.* I am basically an optimist. I don't really have faith in God or the Divine.* I really do have faith in God or the Divine. I often feel overwhelmed and paralyzed by the crises in my life.* I am able to face life’s crises and have faith in my ability to cope with them. My life feels meaningless.* My life feels meaningful. I do not believe in the concept of life force, Divine spark, prana, or chi.* I do believe in the concept of life force, Divine spark, prana, or chi. The people in my life often disappoint me by not seeing and meeting my needs.* I am usually aware of the needs of others in my life and am able to respond to them. My life feels stagnant, as though I'm going nowhere.* I expect new opportunities to emerge in my life. Section Two Please complete the following few pages to complete the Interactive Course. Please answer the following questions as honestly as you can. Answer as you actually feel, not as you think you should feel. Please indicate your ethnicity: Hispanic or Latino Not Hispanic or Latino Please indicate your race (check all that apply): American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Please rate your level of familiarity with the chakra system: None Some A Great Deal An Expert Research Code Symptoms Checklist: Check the symptoms that you currently experience. Depressed mood Loss of interest or pleasure in the things you used to enjoy Significant weight change (loss or gain) Frequent eating between meals Insomnia Hypersomnia Sleep walking Agitation Sluggishness, slow to function Fatigue, low energy, feeling tired all the time Symptoms Checklist 2 Check the symptoms that you currently experience. Feelings of worthlessness or guilt Difficulty concentrating, thinking, and remembering Indecisiveness Recurrent thoughts of death or suicide Suicide attempts Nervous exhaustion Worrying excessively or being anxious Frequent crying Being extremely shy or sensitive Being sickly Lumps or swelling in your neck Blurring of vision Seeing double Seeing colored halos around lights Pains or itching around the eyes Excess blinking or watering of the eyes Loss of vision Difficulty hearing Ear ache Running ear Symptoms Checklist 3 Buzzing or other noises in the ears Motion sickness Teeth or gum problems Sore or sensitive tongue Change in the sense of taste Nose stuffed up Runny nose Sneezing spells Frequent head colds Bleeding from the nose Sore throat even without a cold Enlarged tonsil Hoarse voice even without a cold Difficulty or pain in swallowing Wheezing or difficulty in breathing Coughing spells Coughing up a lot of phlegm Coughing up blood Chest colds more than once a month High blood pressure Check the symptoms that you currently experience. Symptoms Checklist 4 Check the symptoms that you currently experience. Low blood pressure Heart trouble Thumping or racing heart Pain or tightness in the chest Shortness of breath Heartburn Feeling bloated Excess belching Discomfort in the pit of your stomach Nausea Vomiting blood Peptic ulcer Change in appetite Digestive problems Excess hunger Getting up frequently at night to urinate Urinating more than five to six times a day Unable to control your urine Burning or pain when you urinate Black, brown, or bloody urine Symptoms Checklist 5 Check the symptoms that you currently experience. Difficulty starting to urinate Constant urge to urinate Constipation Diarrhea Black or bloody bowel movement Grey bowel movement Pain when you move your bowels Bleeding from your rectum Stomach pains which double you up Frequent stomach trouble Intestinal worms Hemorrhoids Yellow jaundice Biting your nails Stuttering or stammering Any kind of problem with your genital or sexual organs Sexual problems Hernia or rupture Kidney or bladder disease Stiff or painful muscles or joints Symptoms Checklist 6 Check the symptoms that you currently experience. Swelling joints Pain in your back or shoulders Painful feet Swelling in your armpits of groin Trouble with swollen feet or ankles Cramps in your legs at night or with walking Itching or burning skin xcess bleeding from a small cut Easy burning skin Dizziness or light headedness Feeling faint or fainting Numbness in any part of your body Cold hands or feet even in hot weather Paralysis Blacking out Fits, convulsions, or epilepsy Change in your handwriting Tendency to shake or tremble Tendency to be too hot or too cold Sweating more than usual Symptoms Checklist 7: Hot flashes Being short of breath with minimal effort Failure to get adequate exercise Being overweight Being underweight Having lost more than half of your teeth Bleeding gums Badly coated tongue A lot of small accidents or injuries Varicose veins Headaches Other aches and pains Feeling pessimistic or hopeless Have had any kind of surgery within the past year Being easily upset by criticism Having little annoyances get on your nerves and make you angry Getting angry easily Getting nervous around strangers Feeling lonely Having difficulty relaxing Check the symptoms that you currently experience. Symptoms Checklist 8: Check the symptoms that you currently experience. Being troubled by frightening dreams or thoughts Being disturbed by work or family problems Wishing that you could get psychological or psychiatric help Being tense or jittery Being easily upset Being in low spirits Being in very low spirits Believing that your life is out of your hands and controlled by external forces Feeling that life is empty, filled with despair Having no goals or aims at all Having failed to make progress towards your life goals Feeling that you are completely bound by factors outside yourself Feeling sad, blue, or down in the dumps Feeling slowed down or restless and unable to sit still Frequent illness Being confined to bed by illness For Men Only Check the symptoms that you currently experience. Having a urine stream that’s very weak or very slow Having prostate trouble Having unusual burning or discharge from your penis Having swelling or lumps in your testicles Painful testicles Having trouble getting erections For Women Only: Having trouble with your menstrual period Bleeding between your periods Getting bloated or irritable before your periods Taking birth control pills in the last year Having lumps in your breasts Having excess discharge from your vagina Feeling weak or sick with your periods Having to lie down when your periods start Feeling tense and jumpy with your periods Having constant hot flashes and sweats Have had a hysterectomy or on hormonal replacement Check the symptoms that you currently experience.