MBCT Delivery Format

 
The purpose of this research survey study is to determine which format that individuals like you would prefer to receive information on mindfulness therapy: internet, a one-on-one meeting, or a group session. We will use this information to help design a future study of mindfulness therapy.

The survey will take 5-10 minutes to complete. There are seven questions in total. You will answer questions about your preferences for each format of mindfulness therapy: internet, a one-on-one meeting, or a group session. You will also answer questions about any anxiety and depression symptoms you may be having. Finally, you will answer questions about you, like your age and gender.

Some of the questions in the survey may seem very personal or embarrassing. You may leave any of the questions that you do not wish to answer blank. You may or may not personally benefit from being in this study. However, by serving as a participant, you may help us learn how to benefit patients in the future.

Your answers are all anonymously collected, stored and analyzed – no one will be able to associate your name with the answers.

If you have any questions about this research study or if you believe you have been injured or harmed while participating in this research, you may contact Dr. Helané Wahbeh 503-494-3528. If you have any questions regarding your rights as a research subject, you may contact the OHSU Research Integrity Office at (503) 494-7887.

Your participation in this research survey is completely voluntary and you may refuse to participate at any time without any penalty or loss of benefits.

Thank you for your participation!
Imagine that you will participate in a research study on three different mindfulness therapy formats. All formats will present the same material. All formats will have a one-hour session each week for six weeks.
*
1. How interested would you be in the following formats?
Would refuse to take this versionDoesn’t interest meNeutralInterests meVery interested in this version
Internet format which includes visiting a website from any location and reviewing the material online.
Individual format which includes visiting the clinic and reviewing the material with a teacher one-on-one.
Group format which includes visiting the clinic and reviewing the material with a teacher in a group session with other participants.
*
2. Now, if you had to choose just one format...
InternetIndividualGroup
Which would be your first choice
Which would be your last choice
Thank you! We would now like to see if you have any symptoms that are related to our future study.
3. Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully; then check the circle on the right to indicate how much you have been bothered by that problem IN THE PAST MONTH.
Not at allA little bitModeratelyQuite a bitExtremely
Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?
Feeling very upset when something reminded you of a stressful experience from the past?
Avoiding activities or situations because they reminded you of a stressful experience from the past?
Feeling distant or cut off from other people?
Feeling irritable or having angry outbursts?
Having difficulty concentrating?
4. During the past month.....
YesNo
Have you often been bothered by feeling down, depressed, or hopeless?
Have you often been bothered by little interest or pleasure in doing things?
Thank you! Finally, we would like to learn a bit more about you.
*
5. How old are you?
*
6. Are you male or female?
7. I see myself as:
Disagree stronglyDisagree moderatelyDisagree a littleNeither agree nor disagreeAgree a littleAgree moderatelyAgree strongly
Extraverted, enthusiastic.
Critical, quarrelsome.
Dependable, self-disciplined.
Anxious, easily upset.
Open to new experiences, complex.
Reserved, quiet.
Sympathetic, warm.
Disorganized, careless.
Calm, emotionally stable.
Conventional, uncreative.
Thank you for participating!
Powered by SurveyMonkey
Check out our sample surveys and create your own now!