Jealousy Assessment

Please provide contact information (the email is essential):

Birthdate (day/month/year)

Gender (Male/Female)

The Format of profiling your experience of JEALOUSY is 

1. WHEN (you identify the triggering or activating events)

2. I FEEL (you identify the level of impact that accompanies JEALOUSY)

3. I RESPOND BY (you identify the behaviours or actions that accompany you feeling JEALOUSY)

4. BECAUSE (you identify the thinking that accompanies the experience of JEALOUSY)

WHEN

A threat to my significent relationship by another person

Other WHENs

I experience FEELINGS associated with Jealousy

to this level  1. The absence of any distress. Feeling calm and totally relaxed 2. Neutral feeling or just OK, not as relaxed as could be 3. Increased discomfort, unpleasant, but in control 4. Noticeable discomfort or distress, perhaps agitation, but tolerable 5. Discomfort is very uncomfortable, but I can stand it. 6. Discomfort worsens and affects my life 7. Discomfort is severe and emotional pain interferes with my life. 8. Discomfort increases and it is in my thoughts constantly 9. Discomfort is nearly intolerable 10. Discomfort is extreme and the worst imaginable. I feel panicky and overwhelmed.

I RESPOND BY

Monitoring the actions and feelings of my partner as closely as I can
Searching for evidence that my partner is involved with someone else

Other Responses you make

BECAUSE

I tend to see threats to my relationship when none really exist
I think the loss of my relationship is imminent
I misconstrue my partner's actions
(ref. above) their ordinary conversations with others
(ref. above) that they have romantic or sexual connotations
I construct visual images of my partner's infidelity (unfaithfulness)
If my partner tells me another is attractive I take it personally
I think (because of above) that my partner will leave me
I seek constant reassurance that I am loved

Other Becauses

Please add comments you feel I need to know to understand you and your experience of Jealousy?