YSEI Form

Yager Subjective Effects Inventory
Enter Your Name
What Is Your Presenting Problem?
Average of Responses
For each question that follows, please tick the number that provides your best answer.
If an item does not apply, skip that item.
___________________________________________________________________________________________
During the past — (Choose one)
_________________________________________________________________________________
To what extent are the symptoms present in your life?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your social life?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your family life?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your sexual life?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your spiritual life?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your memory?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your sleep?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your appetite?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your work life?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem interfered with your ability to concentrate?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem been a cause of personal distress?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem caused you to feel depressed?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem caused you to feel anxious?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
To what extent has the above problem caused any other problems?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Severe
_________________________________________________________________________________
If the treatment has been completed, were you satisfied with the results?

1 2 3 4 5 6 7 8 9 10
1 is Not At All, 10 is Very Much
Should be Empty:

Yager Subjective Effects Inventory