Welcome! We appreciate your participation in this AEDP research study. On this page, you will be asked to answer a few questions about your background.
Please note:
Please proceed to the next section ONLY if you answer NO to all 6 questions below.  If you answer yes to any of these questions, unfortunately you are not a fit at the current time for our study.  If you answered yes to any question, please be in touch with your referring therapist to determine if you can work together outside of the research study or receive referrals to other therapists in your area.

1) Have you started or stopped taking an antidepressant, anti anxiety medication or any other psychiatric medication in the last 3 months?

2) Have you ever been diagnosed with DID, PTSD, autism, bipolar disorder, an impulse disorder or psychosis?

3) Have you in the last month experienced any strong suicidal thoughts or feelings?

4) Do you use marijuana, alcohol or other substances on a regular basis (more than 1 - 2 times a week)?

5) Did you used to use marijuana, alcohol or other substances on a regular basis (more than 1 - 2 times a week) but have stopped doing so within the last 3 months?

6) Regardless of frequency, do you use marijuana, alcohol or other substances in a way that is of concern to you or to others? 

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If you answered NO to all 6 questions above, please proceed to the following section:
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The information that you provide will not be shared with your therapist or anyone outside the research team. Your answers to the psychological scales and questionnaires will be stored separately from your identifying information to maintain your anonymity throughout this research project. Upon request, we will provide you with general feedback about the research study, when we have preliminary results.

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* 1. User ID

Please create your user ID. It should be your first and last initials, your therapist’s last name and the last four digits of your social security number.

For example:  if Anna Smith is seeing her therapist Jenny Young, and the last four digits of her social security number are 9999, Anna’s user ID would be ASYoung9999. 

Your will use your user ID every time you log in, please write it down somewhere where you will remember it. We will use your user ID to sort the data.

The username above is all that’s needed: please enter it in this box and remember it for the future; nothing else is necessary.

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* 2. Email

Please give us an email address for us to use to contact you for reminders to complete scales and to follow up at the end of your treatment for an interview.

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* 3. Telephone Number

Please provide a phone number for us to use to contact you for reminders to complete the scales and to follow up at the end of your treatment for an interview.

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* 4. Gender

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* 5. Age

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* 6. Date on which you contacted your therapist (please leave blank if you do not remember a specific date)

Date

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* 7. Ethnic or cultural background

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* 8. Highest level of education

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* 9. Primary work status over the last 12 months

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* 10. Marital status

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* 11. Are you currently taking any medication for psychological symptoms?

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* 12. If yes, please indicate the duration

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