Post-Medicine Questionnaire Name First Name Last Name Today's Date - Month - Day Year Date Date of Birth - Month - Day Year Date Emotional Breakthrough Inventory (EBI) How much are the following six statements true of your experience: I faced emotionally difficult feelings that I usually push aside. No, not more than usually. 0 1 2 3 4 5 6 7 8 9 Yes, entirely or completely 10 0 is No, not more than usually., 10 is Yes, entirely or completely I experienced a resolution of a personal conflict/trauma. No, not more than usually. 0 1 2 3 4 5 6 7 8 9 Yes, entirely or completely 10 0 is No, not more than usually., 10 is Yes, entirely or completely I felt able to explore challenging emotions and memories. No, not more than usually. 0 1 2 3 4 5 6 7 8 9 Yes, entirely or completely 10 0 is No, not more than usually., 10 is Yes, entirely or completely I had an emotional breakthrough. No, not more than usually. 0 1 2 3 4 5 6 7 8 9 Yes, entirely or completely 10 0 is No, not more than usually., 10 is Yes, entirely or completely I was able to get a sense of closure on an emotional problem No, not more than usually. 0 1 2 3 4 5 6 7 8 9 Yes, entirely or completely 10 0 is No, not more than usually., 10 is Yes, entirely or completely I achieved an emotional release followed by a sense of relief. No, not more than usually. 0 1 2 3 4 5 6 7 8 9 Yes, entirely or completely 10 0 is No, not more than usually., 10 is Yes, entirely or completely EBI Score Back Next Mystical Experience Questionnaire (MEQ-30) Looking back on the entirety of your session, please rate the degree to which at any time during that session you experienced the following phenomena. Answer each question according to your feelings, thoughts, and experiences at the time of the session. None, not at all So slight cannot decide Slight Moderate Strong (equivalent in degree to any previous strong experience) Extreme (more than ever before in my life and stronger than 4) Freedom from the limitations of your personal self and feeling a unity or bond with what was felt to be greater than your personal self. Experience of pure being and pure awareness (beyond the world of sense impressions). Experience of oneness in relation to an “inner world” within. Experience of the fusion of your personal self into a larger whole. Experience of unity with ultimate reality. Feeling that you experienced eternity or infinity. Experience of oneness or unity with objects and/or persons preceived in your surroundings. Experience of the insight that “all is One”. Awareness of the life or living presence in all things. Gain of insightful knowledge experienced at an intuitive level. Certainty of encounter with ultimate reality (in the sense of being able to “know” and “see” what is really real at some point during your experience. You are convinced now, as you look back on your experience, that in it you encountered ultimate reality (i.e., that you “knew” and “saw” what was really real). Sense of being at a spiritual height. Sense of reverence. Feeling that you experienced something profoundly sacred and holy. Experience of amazement. Feelings of tenderness and gentleness. Feelings of peace and tranquility. Experience of ecstasy. Sense of awe or awesomeness. Feelings of joy. Loss of your usual sense of time. Loss of your usual sense of space. Loss of usual awareness of where you were. Sense of being “outside of” time, beyond past and future. Being in a realm with no space boundaries. Experience of timelessness. Sense that the experience cannot be described adequately in words. Feeling that you could not do justice to your experience by describing it in words. Feeling that it would be difficult to communicate your own experience to others who have not had similar experiences. MEQ-30 Score Type a question Worst 1 2 3 4 Best 5 1 is Worst, 5 is Best Submit Should be Empty:
