Form: Short Self-Regulation Questionnaire, SSRQ

1 – Strongly Disagree
2 – Disagree
3 – Uncertain or Unsure
4 – Agree
5 – Strongly Agree
¹
1
2
3
4
5
1
I usually keep track of my progress towards my goals.
2
I have trouble making up my mind about things.
3
I get easily distracted from my plans.
4
I don't notice the effects of my actions until it is too late.
5
I am able to accomplish goals I set for myself.
6
I put off making decisions.
7
It's hard for me to notice when I've “had enough” (alcohol, food, sweets).
8
If I wanted to change, I am confident that I could do it.
9
When it comes to deciding about a change, I feel overwhelmed by the choices.
10
I have trouble following through with things once I've made up my mind to do something.
11
I don't seem to learn from my mistakes.
12
I can stick to a plan that's working well.
13
I usually only have to make a mistake one time in order to learn from it.
14
I have personal standards, and try to live up to them.
15
As soon as I see a problem or challenge, I start looking for all possible solutions.
16
I have a hard time setting goals for myself.
17
I have a lot of willpower.
18
When I'm trying to change something, I pay a lot of attention to how I'm doing.
19
I have trouble making plans to help me reach my goals.
20
I am able to resist temptation.
21
I set goals for myself and keep track of my progress.
22
Most of the time I don't pay attention to what I'm doing.
23
I tend to keep doing the same thing, even when it doesn't work.
24
I can usually find several different possibilities when I want to change something.
25
Once I have a goal, I can usually plan how to reach it.
26
If I make a resolution to change something, I pay a lot of attention to how I'm doing.
27
Often I don't notice what I'm doing until someone calls it to my attention.
28
I usually think before I act.
29
I learn from my mistakes.
30
I know how I want to be.
31
I give up quickly.

The presented answer sheet is not an original form and is not intended for printing or use as a handout.

The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.