Self-Sabotaging Behavior Assessment
Evaluate your patterns, triggers, and the impact of self-sabotaging behaviors to gain self-awareness and identify areas for personal growth.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
How often do you engage in the following self-sabotaging behaviors?
*
Rows
Never
Rarely
Sometimes
Often
Almost Always
Procrastination
1
2
3
4
5
Negative self-talk
6
7
8
9
10
Avoiding responsibilities
11
12
13
14
15
Perfectionism
16
17
18
19
20
Self-criticism
21
22
23
24
25
Overcommitting and then withdrawing
26
27
28
29
30
Deliberately missing opportunities
31
32
33
34
35
Engaging in unhealthy habits (e.g., overeating, lack of sleep)
36
37
38
39
40
Which of the following situations are most likely to trigger your self-sabotaging behaviors? (Select all that apply)
*
Stressful situations
Fear of failure
Fear of success
Criticism from others
Pressure to perform
Uncertainty about the future
Relationship conflicts
Other
In which areas of your life do you feel self-sabotaging behaviors have the most impact? (Select all that apply)
*
Work or studies
Personal relationships
Physical health
Mental health
Financial situation
Personal goals
Other
How aware are you of your self-sabotaging behaviors?
*
Not at all aware
Slightly aware
Moderately aware
Very aware
How motivated are you to change these behaviors?
*
Not motivated
Somewhat motivated
Motivated
Highly motivated
On a scale from 1 (Not at all) to 10 (Extremely), how much do you feel self-sabotage is affecting your overall well-being?
*
Not at all
1
2
3
4
5
6
7
8
9
Extremely
10
1 is Not at all, 10 is Extremely
Describe a recent situation where you noticed yourself engaging in self-sabotaging behavior.
What strategies, if any, have you tried to overcome self-sabotaging behaviors?
Is there anything else you would like to share about your experiences with self-sabotage?
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