DEMOGRAPHIC PROFILE
Age:
Gender:
Prior Romantic Experience:
o Yes
o No
Current Relationship Status:
o Girlfriend/Boyfriend
o Cohabiting
o Engaged
o Married
Close Parental Relationship:
o Mother
o Father
o Both
Parental Bonding Instrument (PBI)
MOTHER FORM
This questionnaire lists various attitudes and behaviours of parents. As you remember your MOTHER in your first
16 years would you place a tick in the most appropriate box next to each question.
Very Moderately Moderately Very
like like unlike unlike
1. Spoke to me in a warm and friendly voice
2. Did not help me as much as I needed
3. Let me do those things I liked doing
4. Seemed emotionally cold to me
5. Appeared to understand my problems and worries
6. Was affectionate to me
7. Liked me to make my own decisions
8. Did not want me to grow up
9. Tried to control everything I did
10. Invaded my privacy
11. Enjoyed talking things over with me
12. Frequently smiled at me
13. Tended to baby me
14. Did not seem to understand what I needed or wanted
15. Let me decide things for myself
16. Made me feel I wasn’t wanted
17. Could make me feel better when I was upset
18. Did not talk with me very much
19. Tried to make me feel dependent on her/him
20. Felt I could not look after myself unless she/he was around
21. Gave me as much freedom as I wanted
22. Let me go out as often as I wanted
23. Was overprotective of me
24. Did not praise me
25. Let me dress in any way I pleased
FATHER FORM
This questionnaire lists various attitudes and behaviours of parents. As you remember your FATHER in your first
16 years would you place a tick in the most appropriate box next to each question.
Very Moderately Moderately Very
like like unlike unlike
1. Spoke to me in a warm and friendly voice
2. Did not help me as much as I needed
3. Let me do those things I liked doing
4. Seemed emotionally cold to me
5. Appeared to understand my problems and worries
6. Was affectionate to me
7. Liked me to make my own decisions
8. Did not want me to grow up
9. Tried to control everything I did
10. Invaded my privacy
11. Enjoyed talking things over with me
12. Frequently smiled at me
13. Tended to baby me
14. Did not seem to understand what I needed or wanted
15. Let me decide things for myself
16. Made me feel I wasn’t wanted
17. Could make me feel better when I was upset
18. Did not talk with me very much
19. Tried to make me feel dependent of her/him
20. Felt I could not look after myself unless she/he was around
21. Gave me as much freedom as I wanted
22. Let me go out as often as I wanted
23. Was overprotective of me
[Link] not praise me
25. Let me dress in any way I pleased
Scoring instructions
Unlike the Intimate Bond Measure (IBM), not all items are scored in the same direction.
Care
Items: 1, 5, 6, 11, 12, 17: Very like = 3
Moderately like = 2
Moderately unlike = 1
Very unlike = 0
Items: 2, 4, 14, 16, 18, 24 Very unlike = 3
Moderately unlike = 2
Moderately like = 1
Very like = 0
Overprotection
Items: 8, 9, 10, 13, 19, 20, 23 Very like = 3
Moderately like = 2
Moderately unlike = 1
Very unlike = 0
Items: 3, 7, 15, 21, 22, 25 Very unlike = 3
Moderately unlike = 2
Moderately like = 1
Very like = 0
Parental bonding quadrants
In addition to generating care and protection scores for each scale, parents can be effectively
“assigned” to one of four quadrants:
“affectionate constraint” “affectionless control”
= high care and high protection = high protection and low care
“optimal parenting” “neglectful parenting”
= high care and low protection = low care and low protection
Assignment to “high” or “low” categories is based on the following cut-off scores:
• For mothers, a care score of 27.0 and a protection score of 13.5.
• For fathers, a care score of 24.0 and a protection score of 12.5.
EMOTION REGULATION QUESTIONNAIRE
Instructions: Please check the corresponding number that indicates how much you agree with each item by using
the following scale:
1 = Strongly Disagree
2 = Disagree
3 = Slightly Disagree
4 = Neutral
5 = Slightly Agree
6 = Agree
7 = Strongly Agree
Statement 1 2 3 4 5 6 7
1. When I want to feel more positive
emotions (such as joy or
amusement), I change my
thoughts.
2. I keep my emotions to myself.
3. When I'm faced with a stressful
situation, I think about it in a way
that helps me stay calm.
4. I control my emotions by not
expressing them.
5. When I want to feel less negative
emotion (such as sadness or
anger), I change my thoughts.
6. I control my emotions by changing
the way I think about the situation
I'm in.
7. When feeling positive emotions, I
am careful not to express them.
8. When I'm faced with a situation
that could upset me, I think about
it in a way that helps me stay
calm.
9. I control my emotions by changing
what I think about.
10. When I feel negative emotions, I
make sure not to express them.
Score:
Score interpretation:
Items 1, 3, 5, 6, 8, and 9 assess cognitive reappraisal. Items 2, 4, 7, and 10 assess expressive suppression.
For cognitive reappraisal and expressive suppression, scores can range from 6 to 42 and 4 to 28, respectively. A
higher score indicates greater use of that emotion regulation strategy.
COUPLES SATISFACTION INDEX (CSI-32)
1. Please indicate the degree of happiness, all things considered, of your relationship.
Extremely Fairly A Little Very Extremely
Unhappy Unhappy Unhappy Happy Happy Happy Perfect
0 1 2 3 4 5 6
Most people have disagreements in their relationships. Please indicate below the approximate extent of
Almost Occa- Fre- Almost
Always Always sionally quently Always Always
Agree Agree Disagree Disagree Disagree Disagree
2. Amount of time spent together 5 4 3 2 1 0
3. Making major decisions 5 4 3 2 1 0
4. Demonstrations of affection 5 4 3 2 1 0
agreement or disagreement between you and your partner for each item on the following list.
All Most of More
the the time often than Occa-
time not sionally Rarely Never
5. In general, how often do you think that
things between you and your partner are going
well?
5 4 3 2 1 0
0 1 2 3 4 5
Not A Somewhat Almost
at all little TRUE Mostly
6. How often do you wish you hadn’t gotten into TRUE TRUE TRUE Completely Completely
this relationship? TRUE TRUE
7. I still feel a strong connection with my partner 0 1 2 3 4 5
8. If I had my life to live over, I would marry (or 0 1 2 3 4 5
live with / date) the same person
0 1 2 3 4 5
9. Our relationship is strong
10. I sometimes wonder if there is someone
else
out there for me
5 4 3 2 1 0
0 1 2 3 4 5
[Link] relationship with my partner makes me
happy
12.I have a warm and comfortable relationship
with my partner
0 1 2 3 4 50 1 2
3 4 5
13. I can’t imagine ending my relationship
with my partner
14. I feel that I can confide in my partner
about virtually anything
0 1 2 3 4 5
5 4 3 2 1 0
15. I have had second thoughts about this
relationship recently
16. For me, my partner is the perfect romantic
partner
17. I really feel like part of a team with my partner
18. I cannot imagine another person making me as
happy as my partner does
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
Not A Some- Almost at all little what Mostly Completely Completely
19. How rewarding is your relationship with 0 1 2 3 4 5 your partner?
20. How well does your partner meet your 0 1 2 3 4 5 needs?
21. To what extent has your relationship met 0 1 2 3 4 5 your original expectations?
22. In general, how satisfied are you with your 0 1 2 3 4 5 relationship?
Worse than all others Better than all others
(Extremely bad) (Extremely good)
23. How good is your relationship compared to most? 012345
Less than Once or Once or once a twice a twice a Once
More
Never month month week a day often
24. Do you enjoy your partner’s company? 0 1 2 3 4 5 25. How often do you and
your partner 0 1 2 3 4 5 have fun together?
For each of the following items, select the answer that best describes how you feel about your relationship. Base your
responses on your first impressions and immediate feelings about the item.
26. INTERESTING 5 4 3 2 1 0 BORING
27. BAD 0 1 2 3 4 5 GOOD
28. FULL 5 4 3 2 1 0 EMPTY
29. LONELY 0 1 2 3 4 5 FRIENDLY
30. STURDY 5 4 3 2 1 0 FRAGILE
31. DISCOURAGING 0 1 2 3 4 5 HOPEFUL
32. ENJOYABLE 5 4 3 2 1 0 MISERABLE
For scoring and interpreting the gathered numerical data, scores were valued within ranges and interpreted
accordingly based on the tables below.
Score ranges Interpretation
104.4 below Dissatisfied
104.5 or above Satisfied