<?xml version="1.0" encoding="UTF-8"?>
<questionnaire id="344625">
  <title>Minimal English CORE-OM</title>
  <investigator/>
  <dataCollector/>
  <questionnaireInfo>
    <position>before</position>
    <text>Welcome to this limesurvey data entry form for CORE-OM data.  (Created by Chris Evans for CORE System Trust © https://www.coresystemtrust.org.uk/copyright.pdf.)</text>
    <administration>self</administration>
  </questionnaireInfo>
  <questionnaireInfo>
    <position>after</position>
    <text>THANK YOU FOR YOUR TIME IN COMPLETING THIS QUESTIONNAIRE&#13;
&#13;
&lt;p&gt;The CORE-OM is copyright to CORE System Trust: https://www.coresystemtrust.org.uk/copyright.pdf.&lt;/p&gt;</text>
    <administration>self</administration>
  </questionnaireInfo>
  <section id="204">
    <sectionInfo>
      <position>title</position>
      <text>Demographic questions from CORE-OM</text>
      <administration>self</administration>
    </sectionInfo>
    <sectionInfo>
      <position>before</position>
      <text>These are the questions in the box at the top of page one of the CORE-OM</text>
      <administration>self</administration>
    </sectionInfo>
    <question>
      <text>Please put your name and Email address here so your therapist knows the form is from you.   Without it, there is no way s/he can know!</text>
      <directive>
        <position>during</position>
        <text>You &lt;em&gt;must &lt;/em&gt;have a value for this.</text>
        <administration>self</administration>
      </directive>
      <response varName="IDparticipant">
        <free>
          <format>longtext</format>
          <length>40</length>
          <label/>
        </free>
      </response>
    </question>
    <question>
      <text>Date the CORE-OM was completed.</text>
      <directive>
        <position>during</position>
        <text>This is a mandatory question.</text>
        <administration>self</administration>
      </directive>
      <response varName="DateCOREOMcomp">
        <free>
          <format>date</format>
          <length>10</length>
          <label/>
        </free>
      </response>
    </question>
  </section>
  <section id="205">
    <sectionInfo>
      <position>title</position>
      <text>CORE-OM items</text>
      <administration>self</administration>
    </sectionInfo>
    <sectionInfo>
      <position>before</position>
      <text>OVER THE LAST WEEK.
&#13;
Please read each question carefully.
&#13;
Think how often you have felt like that in the last week and then select the option which is closest to this.</text>
      <administration>self</administration>
    </sectionInfo>
    <question>
      <text>Over the last week ... I have felt terribly alone and isolated</text>
      <response varName="COREOM01">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt tense, anxious or nervous</text>
      <response varName="COREOM02">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt I have someone to turn to for support when needed</text>
      <response varName="COREOM03">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt O.K. about myself</text>
      <response varName="COREOM04">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt totally lacking in energy and enthusiasm</text>
      <response varName="COREOM05">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have been physically violent to others</text>
      <response varName="COREOM06">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt able to cope when things go wrong</text>
      <response varName="COREOM07">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have been troubled by aches, pains or other physical problems</text>
      <response varName="COREOM08">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have thought of hurting myself</text>
      <response varName="COREOM09">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... Talking to people has felt too much for me</text>
      <response varName="COREOM10">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... Tension and anxiety have prevented me doing important things</text>
      <response varName="COREOM11">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have been happy with the things I have done</text>
      <response varName="COREOM12">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have been disturbed by unwanted thoughts and feelings</text>
      <response varName="COREOM13">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt like crying</text>
      <response varName="COREOM14">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt panic or terror</text>
      <response varName="COREOM15">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I made plans to end my life</text>
      <response varName="COREOM16">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt overwhelmed by my problems</text>
      <response varName="COREOM17">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have had difficulty getting to sleep or staying asleep</text>
      <response varName="COREOM18">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt warmth or affection for someone</text>
      <response varName="COREOM19">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... My problems have been impossible to put to one side</text>
      <response varName="COREOM20">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have been able to do most things I needed to</text>
      <response varName="COREOM21">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have threatened or intimidated another person</text>
      <response varName="COREOM22">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt despairing or hopeless</text>
      <response varName="COREOM23">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have thought it would be better if I were dead</text>
      <response varName="COREOM24">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt criticised by other people</text>
      <response varName="COREOM25">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have thought I have no friends</text>
      <response varName="COREOM26">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt unhappy</text>
      <response varName="COREOM27">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... Unwanted images or memories have been distressing me</text>
      <response varName="COREOM28">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have been irritable when with other people</text>
      <response varName="COREOM29">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have thought I am to blame for my problems and difficulties</text>
      <response varName="COREOM30">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt optimistic about my future</text>
      <response varName="COREOM31">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have achieved the things I wanted to</text>
      <response varName="COREOM32">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have felt humiliated or shamed by other people</text>
      <response varName="COREOM33">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
    <question>
      <text>Over the last week ... I have hurt myself physically or taken dangerous risks with my health</text>
      <response varName="COREOM34">
        <fixed>
          <category>
            <label>Not at all</label>
            <value>Not</value>
          </category>
          <category>
            <label>Only occasionally</label>
            <value>Only</value>
          </category>
          <category>
            <label>Sometimes</label>
            <value>Some</value>
          </category>
          <category>
            <label>Often</label>
            <value>Often</value>
          </category>
          <category>
            <label>Most or all the time</label>
            <value>Most</value>
          </category>
        </fixed>
      </response>
    </question>
  </section>
</questionnaire>
