Peak Experience Survey

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Review your entire Breathwork experience and rate how you felt any of the sensations during the session. Answer each question according to your feelings, thoughts, and experiences at the time of the session. Use the following scale:
0 – none; not at all
1 – so slight cannot decide
2 – slight
3– moderate
4 – strong
5– extreme

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Transcendence of Time and Space

Loss of your usual sense of time.

None

Extreme

Clear selection

Loss of your usual sense of space.

None

Extreme

Clear selection

Loss of usual awareness of where you were.

None

Extreme

Clear selection

Sense of being “outside of” time, beyond past and future.

None

Extreme

Clear selection

Being in a realm with no space boundaries.

None

Extreme

Clear selection

Experience of timelessness.

None

Extreme

Clear selection

Positive Mood

Experience of amazement.

None

Extreme

Clear selection

Feelings of tenderness and gentleness.

None

Extreme

Clear selection

Experience of ecstasy.

Clear selection

Sense of awe or awesomeness.

Clear selection

Feelings of joy.

Clear selection

Transcendent

Beyond the range of normal human experience.

Freedom from your personal limitations and feeling of unity with something greater than your personal self.

Clear selection

Experience of pure being and pure awareness (beyond the world of sense impressions).

Clear selection

Experience of oneness in relation to an “inner world” within.

Clear selection

Experience of merging your personal self into a larger whole.

Clear selection

Experience of unity with ultimate reality.

Clear selection

Feeling that you experienced eternity or infinity.

Clear selection

Experience of oneness or unity with objects and/or persons perceived in your surroundings.

Clear selection

Experience of the insight that “all is One”.

Clear selection

Awareness of the life or living presence in all things.

Clear selection

Gain of insightful knowledge experienced at an intuitive level.

Clear selection

The certainty of encounter with ultimate reality (in the sense of being able to “know” and “see” what is really real at some point during your experience.

Clear selection

You are convinced now, as you look back on your experience, that in it you encountered ultimate reality (i.e., that you “knew” and “saw” what was really real).

Clear selection

Sense of being at a spiritual peak.

Clear selection

Sense of reverence.

Clear selection

Feeling that you experienced something profoundly sacred and holy.

Clear selection

Ineffability

Can't be described in words

Sense that the experience cannot be described adequately in words.

Clear selection

Feeling that you could not do justice to your experience by describing it in words.

Clear selection

Anything else you would like to share about your experience?

Is there anything the facilitators could have done to help you?

A copy of your responses will be emailed to the address you provided.

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