Schema Therapy


SAMPLE ITEMS FROM THE YRAI - 1


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Name___________________________________________________________Date________________




INSTRUCTIONS:  

Listed below are statements that a person might use to describe himself or herself.  Please read each statement and decide how well it describes you.  Then choose the highest rating from 1 to 6 that best describes you and write the number in the space before the statement.



RATING SCALE:

1 = Completely untrue of me
2 = Mostly untrue of me
3 = Slightly more true than untrue
4 = Moderately true of me
5 = Mostly true of me
6 = Describes me perfectly



EXAMPLE:

A.      4         I try not think about things that bother me.



1._______I try not to think about things that upset me.

2._______I drink alcohol to calm myself.

3._______I am happy most of the time.

4._______I rarely feel sad or blue.

5._______I value reason over emotions.

6._______I believe that I should not get angry, even at people I don't like.

7._______I use drugs to feel better.

8._______I don't feel much when I remember my childhood.

9._______I smoke when I'm upset.  

10._______I suffer from gastrointestinal problems (e.g. indigestion, ulcers, colitis).

11._______I feel numb.

12._______I often get headaches.

13._______I withdraw when I'm angry.



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COPYRIGHT 2014 Jeffrey Young, Ph.D. and Jayne Rygh, Ph.D.  Unauthorized reproduction without written consent of the authors is prohibited.