· Web viewFive Paths of Spiritual Practice Path Habitually Often Occasionally Rarely Love I am a...
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Appendix A
Comprehensive Yoga Therapy Assessments
Please use these assessments with clients as a means of understanding them deeply. These assessments were designed to expose individual differences and assist you in formulating an individualized, comprehensive lifestyle program for each client.
Most assessments follow the same format. For example, in the Gunas Assessment, the third answer is always representing a sattvic practice or personality, or in the Five Paths Assessment, “Habitually” indicates a strong aptitude for that path.
Some assessments, however, have mixed results. For example, in the Chakras Assessment, “Habitually” will sometimes expose healthy energy flow and other times the same answer with indicate an area of concern.
With each client, read the Assessments thoroughly and consider the “whole person” as you contemplate the results and best course of action. Remember, Assessments are tools to help hone your dialogue with clients and the directions of your sessions, they are not the ultimate in understanding clients or in designing the program that is best. Rather, Assessments open the door for sincere questions and enquiry into each client’s healing path.
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Restraining Behaviors (Yamas) Habitually Often Occasionally Rarely
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Non-harmingI act out my anger physicallyI say mean or hurtful thingsI think about hurting othersI worry I'm not good enoughI push myself beyond what is healthy
Truthfulness I make up things that didn't happenI tell white liesI won’t tell someone something that might get me in troubleI can’t speak easily about painful or uncomfortable things I fantasize about things that haven't happened yetI exaggerate
Non-stealing I take things that aren't mineI am unsure how to give myself and others space to be as they areI don’t think much about the far-reaching implications of my choices (political, environmental, etc.)I forget what I am grateful forI complain
Continence I go to extremesI spread myself too thinI sleep with people outside of committed relationshipsI overeat I lay around a lotI over exercise
Non-coveting I long for things I don't haveI wish things were differentI'm jealous of others' success or possessionsI look forward to my life being different/better
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Positive Habits (Niyamas) Often Sometimes RarelyPurity I practice good personal hygiene
My home is cleanMy workspace is neat and organizedI choose virtuous thoughtsI eat whole foods
Contentment I'm happy with the way my life isIt's okay if things don't work outI don’t want things I don't yet haveI believe that all is well in my life
Discipline/Austerity I maintain a daily routineI perform tasks even when I don't want toI incorporate spiritual thought into daily actsI do my best
Self-Study I read uplifting, personal growth, or spiritual worksI learn about myself in various situationsI seek to see myself clearlyI endeavor towards improving myself
Surrender There are lessons in all circumstancesI am okay not knowing the ultimate reason(s) things happenI have strong faithI trust a higher power/intelligenceI let go of the end results of my efforts
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Psychospiritual Body (Chakras) Habitually Often Sometimes RarelyEnergy Anatomy
I sense energy moving within me
I notice the “feel” of a locationI am aware of others' energyI notice areas in my body that are more energetically sensitive than othersI have reoccurring aches, pains, or organ/gland troublesI often feel low, lethargic, or “blocked”
Root I feel connected to the earthI feel safe and groundedThere are few serious issues with my family of originMy finances are soundMy digestion is sluggish or too quickI have problems with leg muscles or lower joints
Sacral I am in touch with physical sensations My reproductive organs are healthyI am creativeMy urinary organs are healthyI am aware of my true emotional feelingsI enjoy sexI have trouble with my reproductive functionsI have issues with my low back or sacrum
Solar Plexus I have a sense of purposeI am confidentMy stomach is healthyI have low self-esteemI experience stomachachesI have acid refluxI have problems with my middle backI slouch
Heart I experience joy in lifeI freely give I easily receive loveMy heart and circulation are healthyI have moved through my griefI have upper back issuesI have chest painsI have rounded shoulders
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Throat I speak the truthI express myself kindlyI am able to listen, even when I don't like what I'm hearingMy neck and shoulders are relaxedI voice my feelings when appropriateI talk too much I often get sore throats I have neck and shoulder tension/pain
Third Eye I see situations clearlyI follow my intuitionMy mind is clear and calmI have strong visual sensesI get headachesI am prone to migraines
Crown I spend time in spiritual companyMy bones are strongMy skin is clear and healthyI am a spiritual personI have rigid beliefs
Self-Report Areas I most notice tension/blockages are:
I believe my main chakra/energetic issues are:
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Life Force Winds (Prana Vayus) Habitually Often Occasionally RarelyPrana - Heart to Throat: Respiration
My body feels light and ableI feel filled with energyMy heart feels physically/emotionally stableMy lungs feel strongI have a strong inhalationI can inhale for a long timeMy senses are clear
Apana - Navel to Soles: Elimination
My body elimination is strong and regularI feel fluid sexual energy, physically and mentallyI have a strong exhalationI can exhale for a long timeI easily let things goI feel groundedI am confusedOther people affect my thoughts, feelings, and decisionsI am lazy
Samana - Navel to Heart: Discrimination/ Assimilation
My digestion is balanced and strong (it is easy to eat a variety of foods; I don’t experience upset stomach)I seek out what is good for me in lifeI feel fire and power in the bodyMy emotions sit in the stomachMy digestion is hot and acidicMy digestion is weak and cool/gassyI experience greed, anger, and/or lust
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Udana - Throat to Head: Uplifting
I have clear speechI express words as well as thoughts I have a joyful perception of lifeI easily communicate what I’m thinkingI feel energy in my head when meditating/breathingI have respiratory issuesI experience chronic sore throat
Vyana – Pervasive: Circulation
I am physically strongI experience a solid mind-body connection via the nervous systemI feel united with my authentic selfI experience a sense of “flow” in lifeI am balanced, physically and mentallyI quickly adapt to changes in environmentI have healthy interpersonal boundaries
Therapist Observation
The strength of inhale:
The strength of exhale:
Client’s energy level:Ask where energy (fire) is spent:
Note client’s ability to translate meaning through words:
Other:
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Facets of Reality - GUNAS
Reflecting on your behavior over the last 4 months, please choose which of the following three statements is most accurate for you:
O I don’t go to bed on time and my sleep is disrupted periodically through the nightO Sleep is great and it's a challenge to get up sometimesO Sleep is a regular part of my routine
O I recharge by resting, reading, watching TVO I recharge by exercising, socializing, cleaningO I recharge through meditation, prayer, and spiritual practice
O When stressed, I generally crave chocolate, candy, and chipsO When stressed, I generally crave caffeine, meat, or spicy foodsO When stressed, I generally crave vegetables, grains, and nuts
O My thoughts are slow and my mind tends to feel cloudyO My thoughts tend to race and my mind often feels fullO My thoughts are changing and my mind watches this
O I have few relationships and am often lonelyO My relationships are full and activeO I have a few, close relationships
O Other people do a better job than I doO I work hard to make sure things are the way they should beO I do my best so it doesn't bother me if things don't work out
O When faced with an addictive substance, I avoid it completely so it won't get a hold on meO When faced with an addictive substance, I consume it and enjoy the effect it has on meO When faced with an addictive substance, I evaluate whether or not it is the best choice to consume it
O I worry I’m not good enoughO I work hard to prove myselfO I feel worthy
O It’s hard to get goingO I am ambitiousO I work at a measured pace
O I’m lazyO I’m high energyO I’m active and restful
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Five Paths of Spiritual Practice
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Path Habitually Often Occasionally RarelyLove I am a people person(Bhakti) I feel spiritually connected when loving and giving
I feel spiritually inspired in relationshipsI am a religious personI am devoted to a Higher Power or spiritualityI follow my heart not my head
Knowledge I seek to understand spirituality (Jnana) I study spiritual works
I study myself I learn about myself in relation to spiritual textsI am introspectiveI seek the larger pictureI surrender my entire ego and act as pure Spirit
Psychology I meditate(Raja) I seek inner balance
I learn about the workings of my egoI am interested in the workings of the mindI see spirituality in psychologyI follow the eight-fold path of the Yoga Sutras
Work My efforts serve others and the community at large(Karma) I perform to the best of my abilities in all situations
I see my work as a spiritual opportunity, no matter the job/taskI am living a purposeful life (I have a personal purpose to my actions)I let go of the end results, before, during, and after my work on the task
Physical I learn about and spend time improving my health(Tantra) I practice Hatha Yoga (poses, breathing, mind)
I study the chakras/bioenergy systems of the bodyI enjoy nutritious food and exerciseSex is sacred or a form of meditation/spiritual practiceI balance the energies of the body, nature, and medicine
When performing a daily task, such as cooking, I think of [choose one]:A. Cooking as a practice of love and devotion towards those who will be fedB. Cooking as a duty; there no attachment to how it turns out or is enjoyed, as long as I did my bestC. The chance to practice body awareness, proper posture and movement, and deep breathingD. Finding a meditative zone while cookingE. Seeing the larger picture and organizing an effortless meal
Bhakti Yoga - Path of Love and Devotion Habitually Often Occasionally Rarely
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I love spiritual practice/GodI derive spiritual gratification from my relationshipsI ask for feedback in relationshipsI reach out to othersMy mind is still when I am with othersI accept myself as I amI accept others as they areI am open about who I am and rarely “put on a face”I understand the roots of my emotional needsI am able to receive what I need emotionallyI seek counseling for my emotional issuesI am not defensive when others ask me to change a behaviorI compromise easilyI consider others’ ideas and listen to their concernsI listen to others and try to understand where they are coming from I learn as much as I can about those I loveWhen I have an aversion to a task or new idea, I consider the reason of its greater goodI look for the soul or authentic self in everyoneI follow through on what I say I will do for othersI am bright and enthusiastic at workI am loving and devoted towards those I care aboutI help people who are helping othersI support those who are sad or illI let go of unsupportive friendships I don’t pay attention to negative or harming peopleI try to make others happyMy romantic partnership is stressful (if applicable)I think of my own needs in relationships before others’I feel inadequate in relationshipsI am afraid of abandonment or people being mad at meI have unresolved issues with my family of originI want things from those around meI focus on what others should changeI feel frustrated when loved ones don’t agree with meWhen others speak, I think of what I’m going to say next, or how to respond I offer adviceI have a lot to sayI complain to others
Karma Yoga - Path of Work and Action Habitually Often Occasionally Rarely
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I enjoy my jobMy mind is calm at workI am bright and enthusiastic at workI am willing to take risks at workI am willing to perform all of my work tasksI focus on the task at handI focus on solutionsI focus on obstacles and challengesI break tasks down into smaller, more manageable tasksI set clear and measurable daily and weekly goalsI do my best in all areas of workI meet my deadlinesExcellence is important to me, no matter how small the jobI do not worry about the results of my hard workI am not defensive when receiving constructive feedbackI ask for feedback about my performanceOthers would say I have an excellent attitude about workI compromise with my coworkersI consider others’ ideas and listen to coworkers’ concernsI learn as much as I can about the company I work for, including others’ roles in the wholeI care about the company I work forI feel my pay is on par with the work I performMy job gives me a sense of purposeWhen I have an aversion to a task or new idea, I consider the reason of its greater goodI inspire coworkersI support others’ workI am generous with my time, skills, and possessionsI am punctual I rarely call in sickMy workspace is clean and organizedI help customers, clients, and coworkers to the best of my abilities when they are rude or aggressiveI am inspired by lifeI prioritize my personal/spiritual growth above all elseI put family or work above my personal growth needsI work more than 40 hours per weekI bring work home with me, either physically or mentallyMy job is stressfulI feel inadequate at workI am afraid of failureWhen others have less work to do, I expect them to help me with my workI have troubled relationships with coworkers or supervisors
Layers of Human Existence - Koshas Habitually Often Occasionally Rarely
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BodyI exercise regularlyI follow a healthy nutritional planI get 6-9 hours of sleep per nightI connect to the purpose of eatingI eat when I’m hungryMy doctor supports and advocates for holistic wellnessI frequently contract colds or feel under the weather
Breath/ Energy
I regularly practice slowing and deepening my breathI am aware of the subtleties of my experiencesI am aware of the energy in foodMy daily routine supports stress-free livingMy energy levels are steady and regularI hold or shorten my breath without noticing
Mind I am kind to myselfI spend time in natureI am strongly affected by sensory stimuliI live in a busy areaI am driven by my emotionsI experience eyestrain, ringing in ears, or other sensory afflictions I have to see it to believe itI keep music or the television on most of the timeI am easily distractedMy emotions guide my choicesPast experiences effect my current emotions
IntellectI read spiritual resourcesI witness my feelings and experiencesI observe my inner environment impassivelyI am logicalI am aware of the effect of nutrition, exercise, breathing, spirituality, and creativity on my well-beingI use thoughts to calm my emotionsI am often accused of “not getting it”Past experiences effect my thoughts and perceptions
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SpiritI make time for spiritual reflectionI am aware of spiritual context or beauty in everyday situationsI am comforted by a connection to "something more"My daily actions lead to spiritual fulfillmentI meditate or have spiritual practice at the same time each dayI feel fulfilledI am a member of a spiritual or artistic communityI have spiritual mentors and teachersI have had “peak experiences” or moments of profound personal meaning in lifeMy community supports holistic livingI have strong, unwavering beliefs
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Koshas Self-Assessment Diary: Nutrition for the Whole Person
Instructions: Throughout the day, (every time you change activities; every hour; at significant times) log what you are “feeding” yourself on each level of being. Follow this format/make copies and stick to the process for at least one week.
Time Activity Body Breath Mind Intellect Spirit8am Prepare for work Omelet, juice,
teaRapid, shallow Fearful, stressed
Surrounded by noise (TV, radio)
Making lists, planning day
Largely ignored; noticed birds in tree
10am Morning Break Did yoga poses Deep during poses
Found quiet placeRelaxation happened
Slowed down Grateful for time for myself and effects of poses
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Koshas Inspiration Chart
Instructions: Now that you have completed the Self-Assessment Diary for a consistent period of time, you are more aware of your habits and “nutrition” for all levels of your being. For the next week (at least) follow the same format, this time adding suggestions about how you may offer your entire self a more nourishing life.
Time Activity Body Breath Mind Intellect Spirit8am Prepare for
workOmelet, juice, tea
Rapid, shallow Fearful, stressed Surrounded by noise (TV, radio)
Making lists, planning day
Largely ignored; noticed birds in tree
Modify Be mindful Say grace; taste food
Deepen breath
Enjoy music from one source, or silence
MindfulnessBe present rather than project future
Appreciate and be grateful for morning experiences
10am Morning Break Did yoga poses
Deep during poses
Found quiet placeRelaxation happened
Slowed down Grateful for time for myself and effects of poses
Modify Allow effects of practice to remain through other activities
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Food Nutrition Habitually Often Occasionally RarelyI eat whole foodsI eat 4 servings of vegetables per dayI eat 2 servings of whole fruit per dayMy heart palpitates if meals are missed or delayedMost of my protein comes from plant sourcesI eat 2 to 3 servings (the size of my fist) of protein per dayI drink at least 1 liter of water per dayI move my bowels at least once per dayI limit prescription medications I limit recreational drugsI limit alcoholI do not eat dessertI limit even hidden sugars in foodsI drink coffeeI drink 2 glasses of fruit juice per dayI limit convenience foodsI limit white flour and refined foods I limit caffeineI limit fast foodsI don’t use artificial sweetenersI drink one or more soft drinks per dayI have an excessive appetiteI have a low appetiteI eat when I’m nervousI get lightheaded if meals are delayedIf I am feeling fatigued, eating relieves it
List any drug, supplement or food allergies: _________________________________________________
Please list all current medications and supplements: _________________________________________
Are you or have you ever been on any special diets? If yes, please list: ___________________________
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Food Self-Assessment Diary: Food Relationships
Instructions: You may use this form as a template, make copies of it, or find your own way to discover similar things. Notice your physical and emotional state, your breath and thoughts, before and during each meal. If you don’t notice anything (you might not at first) just say “fine”. Stick to the process for at least one week. Do not judge yourself or feel guilty, just notice and be honest. This process will help you understand yourself and make healthy, long term changes in food as well as physical and emotional well-being. If you miss recording a meal, do your best to remember or just skip it and record the next one.
Time Food (preparation, amount) Hunger (0-5) Physical Mind/Mood Situation7am Whole wheat toast w coconut butter, 2-
egg omelet with broccoli, peppers, avocado, 1/2c. juice with protein powder
4 Deep breathingNeck ache
Hurried;Happy to eat
Preparing for workPlanning day
10am Carrots and hummusCraved chocolate bar; didn’t buy one
2 Rapid breathNeck and headache
Work stressHard to focus on food
Ate at desk; Others nearby talking about major work project
12pm ¼ pound hamburger, 2 handfuls of French fries, 12 oz. soft drink
3 Sad, Rapid/ Shallow breath, low energy
Worried Depressed
Trying to take a break from stressful day
3pm Chocolate bar 1 Low energy, shallow breath, fatigued
Stressed, hard to concentrate
Wanted to sleep; thought sugar would wake me up
6pm Steamed Fish and Veggies 4 Before Eating achy, tired After Eating breathing calm/deep
Clear/At peace Happy
Optimistic; made healthy dinner choice and felt better
10pm Herbal tea 2 Deep breathing, tired
Content, calming down for sleep
Bedtime
7am Granola and organic yoghurt, green juice (celery, kale, ginger, apple), 1 hardboiled egg
5 Hard to wake up, body tired after restless night
Spent time deep breathing while packing nutritious lunch; content
Optimistic; plan to have a better day
10am Leafy greens, goat cheese, walnuts, almonds, figs, prunes salad
3 Relaxed, consciously taking deep breaths; chewed slowly
Choosing thoughts to keep stress away – affirmations and mantra
Work stress continues; not worrying just working
12pm Avocado, Swiss chard, beet, tomato, soy cheese wrap with cashew gravy. Protein shake
3 Body tight, breath shallow
Used lunchtime to relax, deepen breath
Choosing thoughts; eating in park across from office
3pm Carrot sticks; almonds, Finish protein shake; Craved chocolate bar; didn’t buy one
2 Eyes hurt, neck ache
Run down angry with boss
6pm Bean chili, brown rice, plain yoghurt, green onions
3 Fatigued, more relaxed
Frustrated from work week; trying to calm self
Glad to be home; going out to movie with friend
11pm Herbal tea 1 Sleepy; ache gone, breath deep
Feel restored and happy from friend
Glad it’s Friday – no work tomorrow
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Food Self-Assessment Diary: Food Relationships
Instructions: You may use this form as a template, make copies of it, or find your own way to discover similar things. Notice your physical and emotional state, your breath and thoughts, before and during each meal. If you don’t notice anything (you might not at first) just say “fine”. Stick to the process for at least one week. Do not judge yourself or feel guilty, just notice and be honest. This process will help you understand yourself and make healthy, long term changes in food as well as physical and emotional well-being. If you miss recording a meal, do your best to remember or just skip it and record the next one.
Time Food (preparation, amount) Hunger (0-5) Physical Mind/Mood Situation
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PHYSICAL QUESTIONAIRRE
MOVEMENT
What are the physical/movement requirements of your job? ___________________________________
What sports and activities do you participate in? _____________________________________________
SKELETAL
Are you concerned about your bone density? ________________________________________________
Have you had a bone density test and if so, what were the results? ______________________________
Do you experience joint pain? ____________________________________________________________
Repetitive clicks/cracks: _________________________________________________________________
SPINE
Do you have back problems? _____________________________________________________________ _____________________________________________________________________________________
Have you ever been diagnosed with a spinal condition? ________________________________________
*Note articulation of spine through 4 directions: _____________________________________________
*Posture standing and seated: ____________________________________________________________
NERVES
How easy is it for you to relax? ___________________________________________________________
Are you easily stressed? _________________________________________________________________
*Affective presentation: _________________________________________________________________MUSCLES
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How flexible are you? ___________________________________________________________________
If not flexible, did you lose flexibility over time or have you never been flexible? ____________________
Considering your size, how strong are you? _________________________________________________
Range of motion: ______________________________________________________________________
*Timed resistance (plank): _______________________________________________________________
ORGAN FUNCTION
Are you concerned about the health of any systems in your body? (heart, lungs, digestive, etc) ________
If so, why? ____________________________________________________________________________
Have you ever been diagnosed with a condition in any organ or any other chronic condition (describe)?
Do you experience irregular or rapid heartbeat? _____________________________________________
Do you have regular bowel movements? ____________________________________________________
GLANDS
Have you ever been told by a health professional you have abnormal hormone levels? ______________
Do you experience night sweats or hot flashes? ______________________________________________
Are you very sensitive to ambient temperature? _____________________________________________
Are you over or underweight, independent of your diet and exercise? ____________________________
BREATHING
Count the number of seconds of the average breath:Average inhale _____ secondsAverage pause after inhale _____ secondsAverage exhale _____ secondsAverage pause after exhale _____ seconds
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Notice your breath through the course of the day:My breath is shortest/more rapid/erratic at _________________ time of dayMy breath is longest/steadiest/deepest at _________________ time of dayOther observations: _________________________________________________________________
Notice your breath in various postures, such as in bed, on the couch, at the computer, driving, exercising, standing in line, etc.:Side of my body I tend to constrict: _______________________________________________________
Breathing dominance through either nostril or mouth: ________________________________________
Areas of my lungs I tend to constrict (diaphragm, intercostals, chest): ____________________________
Phase of breath I tend to limit (inhale, exhale, pause after either): _______________________________
Symptoms of erratic breathing (stutters, phases, shakiness, etc): ________________________________
Relate any of these observations to emotional state or thought patterns: _________________________
Other observations: ____________________________________________________________________
LIFESTYLE
What medications are you on? ___________________________________________________________
What are the side effects of these medications? ______________________________________________
Do these side effects impact your concentration? ____________________________________________
What supplements do you take? __________________________________________________________
Do you eat 5 servings of vegetables per day, where at least one is a leafy green? ___________________
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What are you ready to work on? __________________________________________________________
What will you not change? _______________________________________________________________
Who else is on your personal health care team and what role do they play? _______________________
On one page, list all the activities you do each week and the times. Include your work schedule, meal times and general type of food, television time, spiritual practice, social life, exercise, etc. Also include on the list any dreams and future plans.
On a second page, place "balanced health" with a circle around it in the center of the page. Draw another circle that divides the remaining space in half. Inside of this second circle draw a few arrows toward the center, and outside the circle draw a few arrows pointing away from the center. Place the activities that keep you in balanced health in the first circle (practice Yoga, visit parents, exercise, etc.) and the activities that take you away from health (drinking alcohol, over-working, etc.) in the outside circle. We will attempt to work on shifting all activities to the circle leading to balanced health or limiting the activity if it cannot be changed.
Psychological Blocks - KLESAS
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Ignorance (Avidya) Habitually Often Occasionally RarelyI believe in "something more"I regularly connect to my spirit or a sense of peaceI get over hurts and tragedies quicklyI am aware of the spiritual in everyday momentsMy regular activities offer spiritual benefitsWhen painful circumstances arise, I sufferI become very sad, angry, or negative when my body is injured or in painI am my bodyI am very sad when happy occasions endI need something to look forward toI get lost in stressors and worries
Describe a time when you felt a "peak experience", such as something breathtaking, unexplainable, touching, or profound. __________________________________________________________________
List the activities you perform regularly to connect to your spirit or a Higher Power? _______________
Ego (Asmita) Habitually Often Occasionally RarelyI see myself without the bias of others’ expectations I work for the welfare of myself and othersI easily see others’ points of viewI accept others’ quirks and shortcomingsI accept my quirks and shortcomingsI feel “less than” others or experience low self-esteemI think, therefore I amI take things personallyI have a busy mindI talk a lot
Who are you? _________________________________________________________________________
Attachment (Dvesha) Habitually Often Occasionally Rarely
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I have a list of "wants" I know what I likeI seek pleasureI indulge in junk foods, alcohol, drugs, television, Internet usage, pornography, or other sensual pleasuresI tend to seek happiness outside of myselfI am jealous, clingy, or possessiveOnce I find a yoga center, church, or other community, I stick with it exclusivelyRight is right and wrong is wrongWhen I am not around what makes me happy, I am no longer happyWhen I like something, I want more of itWhen I lose something I love, I feel like a part of myself is gone
List your likes: _________________________________________________________________________
Aversion (Raga) Habitually Often Occasionally RarelyI am compassionate to my own emotionsI stay away from things I don’t likeI avoid things and people I don’t likeI wish my body or personality were differentI wish my life were differentI have a hard time thinking about/focusing on things or situations I don’t likeI feel sick when I think about/am around things/people/situations I don’t likeI pray to avoid painful or “bad” situationsI need something to look forward to
List your dislikes: _______________________________________________________________________
Fear (Abinivesha) Habitually Often Occasionally Rarely
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I cope well with changeIf I died tomorrow, I would be satisfied with my legacy OR reflect upon my life without regretsI don’t like changeI am frightened about my mortalityI am concerned about the futureI have many worriesI am fearfulI lack strong faithI make sure my life is carefully planned
What do you think happens when we die? __________________________________________________
Other comments about your fears: ________________________________________________________
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