Consent Form

I Faiqa Sabir (student of M.Sc- III), am going to conduct my research under the

supervision of Ms. Nousheen Ramzan from the Institute of Applied psychology,

University of the Punjab, Lahore. This research has been designed to assess that how

Resilience, Self-compassion and Mindfulness contributes towards the Emotional

Well-being of doctors working in critical care and non-critical care units of the

patients. In this research you will be required to fill the Bio-graphical Form and will

answer the questionnaires related to topic stated above. It will take approximately

thirty minutes to complete the questionnaire. Do not hesitate in answering all the

questions. There is no right or wrong answers.

Your participation is voluntary and you can refuse further participation anytime

you like during research activity. Moreover, this exercise does not involve any risk or

penalty. Your provided information will be kept confidential and will be used only for

research purpose. In the end, if you have any query, please do not hesitate to ask. If

you agree to participate, please sign the consent form.

Thank you for your cooperation.

Signature of the Respondent Signature of the Researcher

Date
 Demographic sheet

Gender Male Female

Age in years

Marital Status Single Married Divorced

Family System Joint Nuclear

Monthly Family Income

Education

Name of Relevant Department

Job Experience in years

Questionnaire I

Following are the statements which describe resilience. Read each statement carefully
before answering. Please respond to each item by marking one box per row.

No Items Strongly Disagree Neutral Agree Strongly

Disagree Agree
1 I tend to bounce back quickly 1 2 3 4 5
after hard times.
2 I have a hard time making it 5 4 3 2 1
through stressful events.
3 It does not take me long to 1 2 3 4 5
recover from a stressful event.
4 It is hard for me to snap back 5 4 3 2 1
when something bad happens.
5 I usually come through difficult 1 2 3 4 5
times with little trouble.
6 I tend to take a long time to get 5 4 3 2 1
over set-backs in my life.
 Questionnaire II

HOW I TYPICALLY ACT TOWARDS MYSELF IN DIFFICULT TIMES

Please read each statement carefully before answering. To the left of each item,
indicate how often you behave in the stated manner.

Item Items Almost Almost

no Never Always
1 2 3 4 5
1 I’m disapproving and
judgmental about my own
flaws and inadequacies. 1 2 3 4 5
2 When I’m feeling down I
tend to obsess and fixate on
everything that’s wrong. 1 2 3 4 5
3 When things are going badly
for me, I see the difficulties
as part of life that everyone
goes through. 1 2 3 4 5
4 When I think about my
inadequacies, it tends to
make me feel more separate
and cut off from the rest of
the world. 1 2 3 4 5
5 I try to be loving towards
myself when I’m feeling
emotional pain. 1 2 3 4 5
6 When I fail at something
important to me I become
consumed by feelings of
inadequacy. 1 2 3 4 5
7 When I'm down and out, I
remind myself that there are
lots of other people in the
world feeling like I am. 1 2 3 4 5
8 When times are really
difficult, I tend to be
tough on myself. 1 2 3 4 5
9 When something upsets me I
try to keep my emotions in
balance. 1 2 3 4 5
10 When I feel inadequate in
some way, I try to remind
myself that feelings of
inadequacy are shared by
most people. 1 2 3 4 5
11 I’m intolerant and impatient
towards those aspects of my 1 2 3 4 5
personality I don't like.
12 When I’m going through a
 very hard time, I give myself Almost Almost
the caring and tenderness I Never always
need. 1 2 3 4 5
13 When I’m feeling down, I
tend to feel like most other
people are probably happier
than I am. 1 2 3 4 5
14 When something painful
happens I try to take a
balanced view of the
situation. 1 2 3 4 5
15 I try to see my failings as
part of the human condition. 1 2 3 4 5
16 When I see aspects of myself
that I don’t like, I get down
on myself. 1 2 3 4 5
17 When I fail at something
important to me I try to keep
things in perspective. 1 2 3 4 5
18 When I’m really struggling, I
tend to feel like other people
must be having an easier
time of it. 1 2 3 4 5
19 I’m kind to myself when I’m
experiencing suffering. 1 2 3 4 5
20 When something upsets me I
get carried away with my
feelings. 1 2 3 4 5
21 I can be a bit cold hearted
towards myself when I'm
experiencing suffering. 1 2 3 4 5
22 When I'm feeling down I try
to approach my feelings with
curiosity and openness. 1 2 3 4 5
23 I’m tolerant of my own flaws
and inadequacies. 1 2 3 4 5
24 When something painful
happens I tend to blow the
incident out of proportion. 1 2 3 4 5
25 When I fail at something
that's important to me, I tend
to feel alone in my failure. 1 2 3 4 5
26 I try to be understanding and
patient towards those aspects
of my personality I don't
like. 1 2 3 4 5
 Questionnaire III

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 very Somewhat Somewhat Very Almost
Always Frequently Frequently Infrequently Infrequently Never

Item items Almost Very Somewhat Somewhat Very Almost

no Always Frequently Frequently In- Infrequently Never
Frequently
1 2 3 4 5 6
1 I could be experiencing some
emotion and not be conscious
of it until sometime later. 1 2 3 4 5 6
2 I break or spill things because
of carelessness, not paying
attention, or
thinking of something else. 1 2 3 4 5 6
3 I find it difficult to stay
focused on what’s happening
in the present. 1 2 3 4 5 6
4 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
5 I tend not to notice feelings
of physical tension or
discomfort until they really
grab my attention. 1 2 3 4 5 6
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
7 It seems I am “running on
automatic,” without much
awareness of what I’m doing. 1 2 3 4 5 6
8 I rush through activities
without being really attentive
to them. 1 2 3 4 5 6
9 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
10 I do jobs or tasks
automatically, without being
aware of what I'm doing. 1 2 3 4 5 6
11 I find myself listening to Almost Very Somewhat Somewhat Very Almost
someone with one ear, doing Always Frequently Frequently In- Infrequently Never
something else at the same Frequently
time. 1 2 3 4 5 6
12 I drive places on ‘automatic
pilot’ and then wonder why I
went there. 1 2 3 4 5 6
13 find myself preoccupied with
the future or the past. 1 2 3 4 5 6
14 I find myself doing things
without paying attention. 1 2 3 4 5 6
15 I snack without being aware
that I’m eating. 1 2 3 4 5 6
 Questionnaire IV

Please think about what you have been doing and experiencing during the past four
weeks. Then report how much you experienced each of the following feelings, using
the scale below. For each item, select a number from 1 to 5, and write that number on
the line next to the feeling.

1 Very rarely or never

2 Rarely
3 Sometimes
4 Often
5 Very often or always

Item Items Very Rarely Sometimes Often Very

no rarely or often or
never always
1 2 3 4 5
1 Positive 1 2 3 4 5
2 Negative 1 2 3 4 5
3 Good 1 2 3 4 5
4 Bad 1 2 3 4 5
5 Pleasant 1 2 3 4 5
6 Contented 1 2 3 4 5
7 Interested 1 2 3 4 5
8 Stressed 1 2 3 4 5
9 Unpleasant 1 2 3 4 5
10 Happy 1 2 3 4 5
11 Sad 1 2 3 4 5
12 Angry 1 2 3 4 5
13 Afraid 1 2 3 4 5
14 Loving 1 2 3 4 5
15 Depressed 1 2 3 4 5
16 Joyful 1 2 3 4 5