Post-Course Five Facet Mindfulness Questionnaire
We hope you've had a very meaningful learning experience in the MLP Mindfulness Foundations Course. Thank you for taking the time to answer the following questions once again. You will receive a copy of your responses by email after you complete the questionnaire.

This instrument is based on a factor analytic study of five independently developed mindfulness questionnaires. The analysis yielded five factors that appear to represent the elements of mindfulness as it is currently conceptualized. The five facets are observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience.

Please rate each of the following statements using the scale provided. Write the number in the blank that describes your own opinion of what is generally true for you.

1. never or very rarely true                    
2. rarely true
3. sometimes true
4. often true
5. always true      
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Email *
Foundations Course Start Date
Name of your instructor *
When I am walking, I deliberately notice the sensations of my body moving. *
never or very rarely true
very often or always true
I'm good at finding words to describe my feelings. *
never or very rarely true
very often or always true
I criticize myself for having irrational or inappropriate emotions. *
never or very rarely true
very often or always true
I perceive my feelings and emotions without having to react to them. *
never or very rarely true
very often or always true
When I do things, my mind wanders off and I am easily distracted. *
never or very rarely true
very often or always true
When I take a shower or bath, I stay alert to the sensations of water on my body. *
never or very rarely true
very often or always true
I can easily put my beliefs, opinions, and expectations into words. *
never or very rarely true
very often or always true
I don't pay attention to what I'm doing because I'm daydreaming, worrying, or otherwise distracted. *
never or very rarely true
very often or always true
I watch my feelings without getting lost in them. *
never or very rarely true
very often or always true
I tell myself I shouldn't be feeling the way I'm feeling. *
never or very rarely true
very often or always true
I notice how foods and drinks affects my thoughts, bodily sensations, and emotions. *
never or very rarely true
very often or always true
It's hard for me to find the words to describe what I'm thinking. *
never or very rarely true
very often or always true
I am easily distracted. *
never or very rarely true
very often or always true
I believe some of my thoughts are abnormal or bad and I shouldn't think that way. *
never or very rarely true
very often or always true
I pay attention to sensations, such as the wind in my hair or sun on my face. *
never or very rarely true
very often or always true
I have trouble thinking of the right words to express how I feel about things. *
never or very rarely true
very often or always true
I make judgements about whether my thoughts are good or bad. *
never or very rarely true
very often or always true
I find it difficult to stay focused on what's happening in the present. *
never or very rarely true
very often or always true
When I have distressing thoughts or images, I "step back" and am aware of the thought or image without getting taken over by it. *
never or very rarely true
very often or always true
I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing. *
never or very rarely true
very often or always true
In difficult situations, I can pause without immediately reacting. *
never or very rarely true
very often or always true
When I have a sensation in my body, it's difficult for me to describe it because I can't find the right words. *
never or very rarely true
very often or always true
It seems I am "running on automatic" without much awareness of what I'm doing. *
never or very rarely true
very often or always true
When I have distressing thoughts or images, I feel calm soon after. *
never or very rarely true
very often or always true
I tell myself that I shouldn't be thinking the way I'm thinking. *
never or very rarely true
very often or always true
I notice the smells and aromas of things. *
never or very rarely true
very often or always true
Even when I'm feeling terribly upset, I can find a way to put it into words. *
never or very rarely true
very often or always true
I rush through activities without being really attentive to them. *
never or very rarely true
very often or always true
When I have distressing thoughts or images, I am able just to notice them without reacting. *
never or very rarely true
very often or always true
I think some of my emotions are bad or inappropriate and I shouldn't feel them. *
never or very rarely true
very often or always true
I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light and shadow. *
never or very rarely true
very often or always true
My natural tendency is to put my experiences into words. *
never or very rarely true
very often or always true
When I have distressing thoughts or images, I just notice them and let them go. *
never or very rarely true
very often or always true
I do jobs or tasks automatically without being aware of what I'm doing. *
never or very rarely true
very often or always true
When I have distressing thoughts or images, I judge myself as good or bad, depending on what the thought/image is about. *
never or very rarely true
very often or always true
I pay attention to how my emotions affect my thoughts and behavior. *
never or very rarely true
very often or always true
I can usually describe how I feel at the moment in considerable detail. *
never or very rarely true
very often or always true
I find myself doing things without paying attention. *
never or very rarely true
very often or always true
I disapprove of myself when I have irrational ideas. *
never or very rarely true
very often or always true
Thank you for taking the time to complete this questionnaire!
Learn more about our other mindfulness resources at www.mindfullifeprogram.org.
A copy of your responses will be emailed to the address you provided.
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