SLE - Modified: Example 1) Misplaced Your Keys

SLE – modified
(adapted from Bieliauskas, Conte, & Glandon, 1995)
Listed below are a number of events that sometimes change the lives of the people they happen to.
For each event,
please draw a slash to show when the event happened,
circle yes or no to answer whether it was stressful for you, and
circle yes or no to answer if you felt that you controlled whether or not the event happened.
When you think of when the event happened, please do you best to remember when it happened.
When you think about how much you controlled whether or not the event happened, try not to include you
response to the event.
If the event did not happen to you in the last 6 months, please circle “did not happen” and go to the next event.
Some of these questions may be things that have been happening for a long time for you. For these questions
we are most interested in recent changes or new events.
For example, if you misplaced your keys 5 months ago, found it very stressful, and felt that you had some control over losing your
keys, your responses would look like this:
Example 1) Misplaced your keys
a) When did this happen? did not 0 months ago 3 months ago 6 months ago
happen |_______________|_______________|
b) Was this a stressful event? YesNo
c) Did you control whether or not this event happened (not your response to it)? YesNo
But, if you never misplaced your wallet, your responses would look like this:
Example 2) Misplaced your wallet
happen |_______________|_______________|
Page 1 of 13
Please answer every question.
1. The death of your spouse or partner
happen |_______________|_______________|
a) Was this a stressful event? YesNo
b) Did you control whether or not this event happened (not your response to it)? YesNo
2. The death of another close family member
happen |_______________|_______________|
3. The death of a close friend
b) When did this happen? did not 0 months ago 3 months ago 6 months ago
happen |_______________|_______________|
c) Was this a stressful event? YesNo
d) Did you control whether or not this event happened (not your response to it)? YesNo
4. The death or loss of a pet
happen |_______________|_______________|
5. Divorce from your spouse or partner
happen |_______________|_______________|
6. Marital separation from your spouse or partner without divorce
happen |_______________|_______________|
7. Major decline in the closeness of family members
happen |_______________|_______________|
Page 2 of 13
8. More personal difficulty in your relationship with your spouse or partner
happen |_______________|_______________|
9. More personal difficulty in your relationships with family members (other than spouse or partner)
happen |_______________|_______________|
10. More personal difficulty with a close friend
happen |_______________|_______________|
11. You no longer attend a social gathering (church group, neighborhood association, etc.)
happen |_______________|_______________|
12. Minor personal injury or illness
happen |_______________|_______________|
13. Minor decline in the health of a family member or close friend
happen |_______________|_______________|
14. Serious personal injury or illness
happen |_______________|_______________|
Page 3 of 13
15. Serious injury or illness to a family member or close friend
happen |_______________|_______________|
16. You took responsibility for a sick or elderly family member
happen |_______________|_______________|
17. Personal move to nursing home care
happen |_______________|_______________|
18. Your spouse or partner moved to nursing home care
happen |_______________|_______________|
19. Home health care began for your spouse or partner
happen |_______________|_______________|
20. A decline in your spouse or partner’s thinking abilities or personality
happen |_______________|_______________|
21. Your son or daughter left home
happen |_______________|_______________|
Page 4 of 13
22. Your son or daughter separated or divorced
happen |_______________|_______________|
23. A major decline in the type or amount of family get-togethers
happen |_______________|_______________|
24. Your retirement from work or volunteer position
happen |_______________|_______________|
25. You are no longer in an important role other than work (e.g.- deacon in church, committee
membership, etc.)
happen |_______________|_______________|
26. Trouble with your employer or at your volunteer position
happen |_______________|_______________|
27. You took out a significant loan
happen |_______________|_______________|
28. You failed to qualify for a loan
happen |_______________|_______________|
Page 5 of 13
29. Recent increase in financial difficulties or decrease in income
happen |_______________|_______________|
30. Your spouse or partner retired or changed jobs
happen |_______________|_______________|
31. Appeared in court or paid fines for a minor law violation
happen |_______________|_______________|
32. You moved or changed residence
happen |_______________|_______________|
33. You were assaulted or robbed
happen |_______________|_______________|
34. You stopped driving or lost your driver’s license
happen |_______________|_______________|
35. A decrease in your physical mobility
happen |_______________|_______________|
Page 6 of 13
36. Other decrease in physical capability (e.g.- hearing, vision, etc.)
(what decreased? ____________________________________)
happen |_______________|_______________|
37. Your health insurance benefits were significantly reduced
happen |_______________|_______________|
38. You were unable to get treatment for an illness or injury
happen |_______________|_______________|
39. You were asked to drink less or stop drinking alcohol (who asked: ______________________ )
happen |_______________|_______________|
40. You were asked to stop smoking or smoke less (who asked: ________________________ )
happen |_______________|_______________|
41. Another negative event which has not been asked about yet but which you believe is important
What: _________________________________________________________________________
happen |_______________|_______________|
Page 7 of 13
What: _________________________________________________________________________
Page 8 of 13
happen |_______________|_______________|
What: _________________________________________________________________________
happen |_______________|_______________|
44. A recent personal achievement (What: _____________________________________________ )
happen |_______________|_______________|
45. A new grandchild or great-grandchild was born
happen |_______________|_______________|
46. You took a vacation
happen |_______________|_______________|
47. You celebrated a holiday or a personal celebration (birthday, anniversary)
happen |_______________|_______________|
48. Your son, daughter, grandson, granddaughter, great-grandson or great-granddaughter married
happen |_______________|_______________|
PSI II Robins, et al. (1994)
Here are a number of statements about personal characteristics. Please read each one carefully and indicate whether you agree disagree, and to what extent, by circling a number.
Page 9 of 13
Strongly Slightly Slightly Strongly
Disagree Disagree Disagree Agree Agree Agree
Page 10 of 13
1. I often put other people’s needs before
my own. 1 2 3 4 5 6
2. I tend to keep other people at a distance. 1 2 3 4 5 6
3. I find it difficult to be separated from
people I love. 1 2 3 4 5 6
4. I am easily bothered by other people
making demands of me. 1 2 3 4 5 6
5. I am very sensitive to the effects I have
on the feelings of other people. 1 2 3 4 5 6
6. I don’t like relying on others for help. 1 2 3 4 5 6
7. I am very sensitive to criticism by 1 2 3 4 5 6
others.
8. It bothers me when I feel that I am only
average and ordinary. 1 2 3 4 5 6
9. I worry a lot about hurting or offending
other people. 1 2 3 4 5 6
1. When I’m feeling blue, I don’t like to
be offered sympathy. 1 2 3 4 5 6
2. It is hard for me to break off a
relationship even if it is making me
unhappy. 1 2 3 4 5 6
3. In relationships, people are often too
demanding of one another. 1 2 3 4 5 6
4. I am easily persuaded by others. 1 2 3 4 5 6
5. I usually view my performance as either
a complete success or a complete
failure. 1 2 3 4 5 6
6. I try to please other people too much. 1 2 3 4 5 6
7. I don’t like people to invade my 1 2 3 4 5 6
privacy.
8. I find it difficult if I have to be alone all
day. 1 2 3 4 5 6
18. It is hard for me to take instructions
from people who have authority over
me. 1 2 3 4 5 6
Page 11 of 13
19. I often feel responsible for solving other
people’s problems. 1 2 3 4 5 6
20. I often handle big decisions without
telling anyone else about them. 1 2 3 4 5 6
21. It is very hard for me to get over the
feeling of loss when a relationship has
ended. 1 2 3 4 5 6
22. It is hard for me to have someone
dependent on me. 1 2 3 4 5 6
23. It is very important to me to be liked or
admired by others. 1 2 3 4 5 6
24. I feel badly about myself when I am not
actively accomplishing things. 1 2 3 4 5 6
25. I feel I have to be nice to other people. 1 2 3 4 5 6
26. It is hard for me to express admiration
or affection. 1 2 3 4 5 6
27. I like to be certain that there is
somebody close I can contact in case
something unpleasant happens to me. 1 2 3 4 5 6
28. It is difficult for me to make a long-term
commitment to a relationship. 1 2 3 4 5 6
29. I am too apologetic to other people. 1 2 3 4 5 6
30. It is hard for me to open up and talk
about my feelings and other personal
things. 1 2 3 4 5 6
31. I am very concerned with how people
react to me. 1 2 3 4 5 6
32. I have a hard time forgiving myself
when I feel I haven’t worked up to my
potential. 1 2 3 4 5 6
33. I get very uncomfortable when I’m not
sure whether or not someone likes me. 1 2 3 4 5 6
34. When making a big decision, I usually
feel that advice from others is intrusive. 1 2 3 4 5 6
Page 12 of 13
35. It is hard for me to say “no” to other
people’s requests. 1 2 3 4 5 6
36. I resent it when people try to direct my
behavior or activities. 1 2 3 4 5 6
37. I become upset when something
happens to me and there’s nobody
around to talk to. 1 2 3 4 5 6
38. Personal questions from others usually
feel like an invasion of my privacy. 1 2 3 4 5 6
39. I am most comfortable when I know my
behavior is what others expect of me. 1 2 3 4 5 6
40. I am very upset when other people or
circumstances interfere with my plans. 1 2 3 4 5 6
41. I often let people take advantage of me. 1 2 3 4 5 6
42. I rarely trust the advice of others when
making a big decision. 1 2 3 4 5 6
43. I become very upset when a friend
breaks a date or forgets to call me as
planned. 1 2 3 4 5 6
44. I become upset more than most people I
know when limits are placed on my
personal independence and freedom. 1 2 3 4 5 6
45. I judge myself based on how I think
others feel about me. 1 2 3 4 5 6
46. I become upset when others try to
influence my thinking on a problem. 1 2 3 4 5 6
47. It is hard for me to let people know
when I am angry with them. 1 2 3 4 5 6
48. I feel controlled when others have a say
in my plans. 1 2 3 4 5 6
Page 13 of 13

SLE - Modified: Example 1) Misplaced Your Keys

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SLE – modified

(adapted from Bieliauskas, Conte, & Glandon, 1995)

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