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In This Moment

Daily Hassles and Helpers Log

Daily Hassles and Helpers Log

Day of week and time Daily hassle Daily helper

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Facet 1—Observe

Exercise: Self-­Assessment for Facet 1—Observe


Below is a collection of statements from the FFMQ that ask about your everyday experience in using observ-
ing skills. Using the scale of 1 to 5 below, indicate, on the line to the left of each statement, how frequently or
infrequently you’ve had each experience in the last month. Please answer according to what really reflects your
experience rather than what you think your experience should be.

1 = never or very rarely true


2 = not often true
3 = sometimes true, sometimes not true
4 = often true
5 = very often or always true

    1. When I’m walking, I deliberately notice the sensations of my body moving.

   2. When I take a shower or a bath, I stay alert to the sensations of water on my body.

   3. I notice how foods and drinks affect my thoughts, bodily sensations, and emotions.

   4. I pay attention to sensations, such as the wind in my hair or sun on my face.

   5. I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing.

   6.  I notice the smells and aromas of things.

   7. I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light
and shadow.

   8. I pay attention to how my emotions affect my thoughts and behaviors.

   Observe score

Take a moment to think about your strengths in this area. Do you find it easier to be an observer of your
experience in some contexts than in others? Do you have some natural cues you use to help remind you to
adopt the observer approach when you’re stressed? People differ in these regards. Some people like to use a
catchphrase, such as “Just notice, don’t react,” while others generate a mental image, like being a bird watcher
looking at thoughts or emotions through binoculars, to help them kick into the observer mode.
After considering your strengths in this area, write a brief summary statement about those strengths below.
If you have ideas about particular situations where it’s easier for you to activate your observing skills, note those
as well.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Facet 2—Describe

Exercise: Self-­Assessment for Facet 2—­Describe


Below is a collection of statements from the FFMQ that ask about your everyday experience in using describing
skills. Using the scale of 1 to 5 below, indicate, on the line to the left of each statement, how frequently or infre-
quently you’ve had each experience in the last month. Note that for questions 3, 4, and 5, you need to subtract
the number associated with your answer from 6 to obtain the score for the item. For example, if your answer to
statement 3 is 4 (often true), you’ll subtract 4 from 6, resulting in a score of 2. Please answer according to what
really reflects your experience rather than what you think your experience should be.

1 = never or very rarely true


2 = not often true
3 = sometimes true, sometimes not true
4 = often true
5 = very often or always true

   1. I’m good at finding words to describe my feelings.

   2. I can easily put my beliefs, opinions, and expectations into words.

6–­       3. It’s hard for me to find the words to describe what I’m thinking.

6–       4. I have trouble thinking of the right words to express how I feel about things.

6–       5. When I have a sensation in my body, it’s hard for me to describe it because I can’t find the right
words.

   6. Even when I’m feeling terribly upset, I can find a way to put it into words.

   7. My natural tendency is to put my experiences into words.

   8. I can usually describe how I feel at the moment in considerable detail.

   Describe score

Take a moment to think about your strengths in this area. Do you find it easier to label your experience
in some contexts than in others? Do some methods, such as writing, help you better label your experiences?
People differ in these regards. Some people like to describe their experience to others, while others prefer to
write their descriptions, and still others prefer to describe silently, without talking or writing.
After considering your strengths in this area, write a brief summary statement about those strengths below. If you
have ideas about particular situations where it’s easier for you to activate your describing skills, note those as well.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Facet 3—Detach

Exercise: Self-­Assessment for Facet 3—Detach


Below is a collection of statements from the FFMQ that ask about your everyday experience in using detach-
ing skills. Using the scale of 1 to 5 below, indicate, on the line to the left of each statement, how frequently or
infrequently you’ve had each experience in the last month. Please answer according to what really reflects your
experience rather than what you think your experience should be.

1 = never or very rarely true


2 = not often true
3 = sometimes true, sometimes not true
4 = often true
5 = very often or always true

   1. I perceive my feelings and emotions without having to react to them.

   2. I watch my feelings without getting lost in them.

   3. In difficult situations, I can pause without immediately reacting.

   4. When I have distressing thoughts or images, I am able just to notice them without reacting.

   5. When I have distressing thoughts or images, I feel calm soon after.

   6. When I have a distressing thought or image, I sit back and am aware of the thought or image
without getting taken over by it.

   7. When I have distressing thoughts or images, I just notice them and let them go.

   Detach score

Take a moment to think about your strengths in this area. Do you find it easier to detach in some contexts
than in others? For example, is it easier to detach when a coworker makes a snide remark than it is when your
spouse criticizes your appearance? Are there mental cues you use to remind yourself to detach when you’re
getting hooked by your reactions to a stressful situation or interaction, such as “Just let go”?
After considering your strengths in this area, write a brief summary statement about those strengths below. If
you have ideas about particular strategies or situations that make it easier for you to activate your detachment
skills, note those as well.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Facet 4—Love Yourself

Exercise: Self-­Assessment for Facet 4—­Love Yourself


Below is a collection of statements from the FFMQ that ask about your everyday experiences with loving your-
self. Using the scale of 1 to 5 below, indicate, on the line to the left of each statement, how frequently or infre-
quently you’ve had each experience in the last month. Note that for all of the items you need to subtract the
number associated with your answer from 6 to obtain the score. For example, if your answer to statement 1 is 2
(not often true), you’ll subtract 2 from 6, resulting in a score of 4. Please answer according to what really reflects
your experience rather than what you think your experience should be.

1 = never or very rarely true


2 = not often true
3 = sometimes true, sometimes not true
4 = often true
5 = very often or always true

6–­       1. I criticize myself for having irrational or inappropriate emotions.

6–­       2. I tell myself that I shouldn’t be feeling the way I’m feeling.

6–­       3. I believe that some of my thoughts are abnormal or bad and I shouldn’t think that way.

6–­       4. I make judgments about whether my thoughts are good or bad.

6–­       5. I tell myself I shouldn’t be thinking the way I’m thinking.

6–­       6. I think some of my emotions are bad or inappropriate and I shouldn’t feel them.

6–­       7. I disapprove of myself when I have irrational ideas.

6–­       8. When I have distressing thoughts or images, I judge myself as good or bad, depending on what
the thought or image is about.

   Loving yourself score

Take a moment to think about your strengths in this area. Do you find it easier to show kindness to yourself
in some situations and more difficult in others? For example, is it easier to care for yourself when you’ve worked
hard and feel physically exhausted, and more difficult when you’ve missed a deadline because you simply forgot
about it? Do you have any mental or verbal cues that remind you to take it easy on yourself when you aren’t
doing well, such as “No one is perfect”?
After considering your strengths in this area, write a brief summary statement about those strengths below.
If there have been times in your life when you were less critical and more accepting of yourself, write about that
below as well, as it may provide some clues about how to reactivate that ability.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Facet 5—Act Mindfully

Exercise: Self-­Assessment for Facet 5—­Act Mindfully


Below is a collection of statements from the FFMQ that ask about your everyday experience with acting mind-
fully. Using the scale of 1 to 5 below, indicate, on the line to the left of each statement, how frequently or infre-
quently you’ve had each experience in the last month. Note that for all of the items you need to subtract the
number associated with your answer from 6 to obtain the score. For example, if your answer to statement 1 is 2
(not often true), you’ll subtract 2 from 6, resulting in a score of 4. Please answer according to what really reflects
your experience rather than what you think your experience should be.

1 = never or very rarely true


2 = not often true
3 = sometimes true, sometimes not true
4 = often true
5 = very often or always true

6–­       1. I find it difficult to stay focused on what’s happening in the present.

6–­       2. It seems I am “running on automatic” without much awareness of what I’m doing.

6–­       3. I rush through activities without being really attentive to them.

6–­       4. I do jobs or tasks automatically, without being aware of what I’m doing.

6–­       5.  I find myself doing things without paying attention.

6–­       6. When I do things, my mind wanders off and I’m easily distracted.

6–­       7. I don’t pay attention to what I’m doing because I’m daydreaming, worrying, or otherwise
distracted.

6–­       8.  I am easily distracted.

   Act mindfully score

Take a moment to think about your strengths in this area. Do you find it easier to act mindfully in some situ-
ations and more difficult in others? For example, is it easier for you to show up for a talk with your spouse when
you take a walk together? Is it more difficult for you to maintain your attention on a task when you’re worried
about a personal problem? Do you have any strategies that help you focus your attention or that help you expe-
rience impulses without acting on them?
After considering your strengths in this area, write a brief summary statement about those strengths below.
If you have ideas about particular situations where it’s easier for you to employ your skills in acting mindfully,
note those as well.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Describing Daily Hassels and Your Responses to Them

Exercise: Describing Daily Hassles and Your Responses to Them

Daily hassle Feeling tone Response tendency Emotional response


(describe with a witness (pleasant, unpleasant, (approach, ignore, or (sad, mad, anxious,
perspective) or neutral) avoid) fearful, guilty, happy,
excited, and so on)

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Reeling In Evaluations Gone Wild

Exercise: Reeling In Evaluations Gone Wild

Stressful situation Witness perspective Evaluations gone wild

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Making Descriptive Requests

Exercise: Making Descriptive Requests

Interpersonal stress Desired outcome Descriptive request

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment You Are Awesome!

Exercise: You Are Awesome!

My strength Why I love it

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment You Are Flawsome!

Exercise: You Are Flawsome!

My flaw Why it bothers me

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Deliberance

Practice: Deliberance

Activity Deliberance practice plan

Getting out of bed in the morning

Eating meals

Taking walks

Washing dishes

Doing laundry

Taking breaks at work

Eating lunch at work

Tending to houseplants

Doing yard work

Housecleaning

Doing household repairs

Going through a bedtime routine

Other:

Other:

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Identifying What Matters

Exercise: Identifying What Matters

Area of life Things that matter to me

Work, study, and career pursuits

Intimate relationships

Family relationships

Friendships

Relaxation and leisure pursuits

Spiritual development

Contribution to social good

Personal growth and development

Health and well-being

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Creating a Vision-Action Plan

Exercise: Creating a Vision-Action Plan

Area of life Action plan

Work, study, and career pursuits

Intimate relationships

Family relationships

Friendships

Relaxation and leisure pursuits

Spiritual development

Contribution to social good

Personal growth and development

Health and well-being

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment True North Worksheet

True North Worksheet

What are your values in What are your current strategies, and are they working?
areas of life such as love,
work, and play?

What obstacles are getting in your way?

North

W E

What skills will you need to make the journey?

Action Plan (Make sure it’s specific and doable; for example, I decide       , or I tell       .)

1.

2.

3.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Identifying Daily Helpers

Exercise: Identifying Daily Helpers

Day of week and time Daily helper Category Helper impact


(personal, social, work) (1–5)

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Creating a Daily Hassles Coping Plan

Exercise: Creating a Daily Hassles Coping Plan

Day of week Daily hassle Category Hassle impact Controllability


and time (personal, relationships, work or (1–5) (low, medium, high)
school, social or environmental)

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Assessing Have-To, Ought-To, and Want-To Activities

Exercise: Assessing Have-To, Ought-To, and Want-To Activities

Have-to How Ought-to How Want-to How Activities that foster


often often often mindfulness

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment State of Mind Matrix

State of Mind Matrix


Outward

Restless mind Quiet mind


(Negative) (Positive)

Inward

Restless mind and outward focus Quiet mind and outward focus
Angry Mistrustful Amicable Kind

Blaming Righteous Benevolent Loving

Frustrated Skeptical Caring Passionate

Hostile Suspicious Compassionate Peaceful

Impatient Vengeful Connected Transcendent

Irritable Victimized Empathic Warmhearted

Humane

Restless mind and inward focus Quiet mind and inward focus
Abandoned Guilty Accepting Peaceful

Afraid Lonely Blissful Restful

Agitated Melancholy Calm Satisfied

Anxious Sad Detached Self-­confident

Apprehensive Self-­critical Harmonious Serene

Blue Self-­doubting Mellow Tranquil

Bored Nonjudgmental Unconcerned

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment Exploring Your Social Spheres

Exercise: Exploring Your Social Spheres


In each column, list people who fall into that social sphere and rate the intensity of your relationship with each
person using a scale of 1 to 10, where 1 is very superficial and 10 is very intense.

Intimate Children Parents and Friends Casual


relationships siblings acquaintances

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment FFMQ-SF

Five Facet Mindfulness Questionnaire –­


Short Form (FFMQ-­SF)
Below is a collection of statements about your everyday experience. Using the scale of 1 to 5 below, please
indicate, on the line to the left of each statement, how frequently or infrequently you’ve had each experience in
the last month (or other agreed-­upon time period). Please answer according to what really reflects your experi-
ence, rather than what you think your experience should be.

1 = never or very rarely true


2 = not often true
3 = sometimes true, sometimes not true
4 = often true
5 = very often or always true

   1.  I’m good at finding the words to describe my feelings.

    2. I can easily put my beliefs, opinions, and expectations into words.

    3.  I watch my feelings without getting carried away by them.

    4.  I tell myself that I shouldn’t be feeling the way I’m feeling.

    5. It’s hard for me to find the words to describe what I’m thinking.

    6. I pay attention to physical experiences, such as the wind in my hair or the sun on my face.

    7. I make judgments about whether my thoughts are good or bad.

    8. I find it difficult to stay focused on what’s happening in the present moment.

    9. When I have distressing thoughts or images, I don’t let myself be carried away by them.

    10. Generally, I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing.

    11. When I feel something in my body, it’s hard for me to find the right words to describe it.

    12. It seems I am running on automatic without much awareness of what I’m doing.

    13. When I have distressing thoughts or images, I feel calm soon after.

    14. I tell myself I shouldn’t be thinking the way I’m thinking.

    15.  I notice the smells and aromas of things.

    16. Even when I’m feeling terribly upset, I can find a way to put it into words.

    17. I rush through activities without being really attentive to them.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment FFMQ-SF

    18. When I have distressing thoughts or images, I can just notice them without reacting.

    19. I think some of my emotions are bad or inappropriate and I shouldn’t feel them.

    20. I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light and
shadow.

    21. When I have distressing thoughts or images, I just notice them and let them go.

    22. I do jobs or tasks automatically without being aware of what I’m doing.

    23. I find myself doing things without paying attention.

    24. I disapprove of myself when I have illogical ideas.

Scoring the FFMQ-­SF


(Note: R = reverse-­scored item. For your score on these items, subtract your rating from 6. Also, we have slightly
revised the names of the categories below to reflect the terms we use in this book.)

Observing: Sum responses to items 6, 10, 15, and 20.

Describing: Sum responses to items 1, 2, 5R, 11R, and 16.

Detaching: Sum responses to items 3, 9, 13, 18, and 21.

Acting mindfully: Sum responses to items 8R, 12R, 17R, 22R, and 23R.

Loving yourself: Sum responses to items 4R, 7R, 14R, 19R, and 24R.

First published in E. Bohlmeijer, P. M. ten Klooster, M. Fledderus, M. Veehof, and R. A. Baer. 2011. “Psycho-
metric Properties of the Five Facet Mindfulness Questionnaire in Depressed Adults and Development of a Short
Form.” Assessment 18:308–­320. Used with permission. Used here by permission of the authors.
In This Moment FFMQ

Five Facet Mindfulness Questionnaire (FFMQ)


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

1 = never or very rarely true

2 = not often true

3 = sometimes true, sometimes not true

4 = often true

5 = very often or always true

      1.  When I’m walking, I deliberately notice the sensations of my body moving.

      2.  I’m good at finding words to describe my feelings.

      3.  I criticize myself for having irrational or inappropriate emotions.

      4.  I perceive my feelings and emotions without having to react to them.

      5.  When I do things, my mind wanders off and I’m easily distracted.

      6.  When I take a shower or bath, I stay alert to the sensations of water on my body.

      7. I can easily put my beliefs, opinions, and expectations into words.

      8. I don’t pay attention to what I’m doing because I’m daydreaming, worrying, or otherwise distracted.

      9.  I watch my feelings without getting lost in them.

    10.  I tell myself I shouldn’t be feeling the way I’m feeling.

    11.  I notice how foods and drinks affect my thoughts, bodily sensations, and emotions.

    12.  It’s hard for me to find the words to describe what I’m thinking.

    13.  I am easily distracted.

    14.  I believe some of my thoughts are abnormal or bad and I shouldn’t think that way.

    15.  I pay attention to sensations, such as the wind in my hair or sun on my face.

    16.  I have trouble thinking of the right words to express how I feel about things.

    17.  I make judgments about whether my thoughts are good or bad.

    18.  I find it difficult to stay focused on what’s happening in the present.

© 2015 Kirk D. Strosahl and Patricia J. Robinson / New Harbinger Publications.


Permission is granted to the reader to reproduce this form for personal use.
In This Moment FFMQ

    19. When I have distressing thoughts or images, I step back and am aware of the thought or image
without getting taken over by it.

    20.  I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing.

    21.  In difficult situations, I can pause without immediately reacting.

    22. When I have a sensation in my body, it’s difficult for me to describe it because I can’t find the right
words.

    23.  It seems I am running on automatic, without much awareness of what I’m doing.

    24.  When I have distressing thoughts or images, I feel calm soon after.

    25.  I tell myself that I shouldn’t be thinking the way I’m thinking.

    26.  I notice the smells and aromas of things.

    27.  Even when I’m feeling terribly upset, I can find a way to put it into words.

    28.  I rush through activities without being really attentive to them.

    29.  When I have distressing thoughts or images, I am able just to notice them without reacting.

    30.  I think some of my emotions are bad or inappropriate and I shouldn’t feel them.

    31. I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light and
shadow.

    32.  My natural tendency is to put my experiences into words.

    33.  When I have distressing thoughts or images, I just notice them and let them go.

    34.  I do jobs or tasks automatically without being aware of what I’m doing.

    35. When I have distressing thoughts or images, I judge myself as good or bad depending what the
thought or image is about.

    36.  I pay attention to how my emotions affect my thoughts and behavior.

    37.  I can usually describe how I feel at the moment in considerable detail.

    38.  I find myself doing things without paying attention.

    39.  I disapprove of myself when I have irrational ideas.


In This Moment FFMQ

Scoring the FFMQ


(Note: R = reverse-scored item. For your score on these items, subtract your rating from 6. Also, we have slightly
revised the names of the categories below to reflect the terms we use in this book.)

Observing: Sum responses to items 1, 6, 11, 15, 20, 26, 31, and 36.

Describing: Sum responses to items 2, 7, 12R, 16R, 22R, 27, 32, and 37.

Detaching: Sum responses to items 4, 9, 19, 21, 24, 29, and 33.

Acting mindfully: Sum responses to items 5R, 8R, 13R, 18R, 23R, 28R, 34R, and 38R.

Loving yourself: Sum responses to items 3R, 10R, 14R, 17R, 25R, 30R, 35R, and 39R.

First published in R. A. Baer, G. T. Smith, J. Hopkins, J. Krietemeyer, and L. Toney. 2006. “Using Self-Report
Assessment Methods to Explore Facets of Mindfulness.” Assessment 13:27–45. Used here by permission of the
authors.

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