INTERNET ADDICTION TEST

Name
Male Female
Age Years Online Do you use the Internet for work? Yes No

This questionnaire consists of 20 statements. After reading each statement carefully, based upon
the 5-point Likert scale, please select the response (0, 1, 2, 3, 4 or 5) which best describes you. If
two choices seem to apply equally well, circle the choice that best represents how you are most
of the time during the past month. Be sure to read all the statements carefully before making
your choice. The statements refer to offline situations or actions unless otherwise specified.

0 = Not Applicable
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Often
5 = Always

1. How often do you find that you stay 11. How often do you find yourself
online longer than you intended? anticipating when you will go online again?
2. How often do you neglect household 12. How often do you fear that life without
chores to spend more time online? the Internet would be boring, empty, and
3. How often do you prefer the excitement joyless?
of the Internet to intimacy with your 13. How often do you snap, yell, or act
partner? annoyed if someone bothers you while you
4. How often do you form new are online?
relationships with fellow online users? 14. How often do you lose sleep due to
5. How often do others in your life being online?
complain to you about the amount of time 15. How often do you feel preoccupied with
you spend online? the Internet when off-line, or fantasize about
6. How often do your grades or school being online?
work suffer because of the amount of time 16. How often do you find yourself saying
you spend online? "just a few more minutes" when online?
7. How often do you check your email 17. How often do you try to cut down the
before something else that you need to do? amount of time you spend online and fail?
8. How often does your job performance or 18. How often do you try to hide how long
productivity suffer because of the Internet? you've been online?
9. How often do you become defensive or 19. How often do you choose to spend more
secretive when anyone asks you what you time online over going out with others?
do online? 20. How often do you feel depressed,
10. How often do you block out disturbing moody, or nervous when you are off-line,
thoughts about your life with soothing which goes away once you are back online?
thoughts of the Internet?

COPYRIGHT © by Dr. Kimberly S. Young

All rights reserved. Center for Internet Addiction Recovery, P.O. Box 632, Bradford, PA 16701
 SCORING

The IAT total score is the sum of the ratings given by the examinee for the 20 item responses.
Each item is rated on a 5-point scale ranging from 0 to 5. The maximum score is 100 points. The
higher the score is, the higher is the severity of your problem. Total scores that range from 0 to
30 points are considered to reflect a normal level of Internet usage; scores of 31 to 49 indicate
the presence of a mild level of Internet addiction; 50 to 79 reflect the presence of a moderate
level; and scores of 80 to 100 indicate a severe dependence upon the Internet.

If you have any queries or doubts related to this scale or your responses, you can email us on
[email protected]

Questionnaire Credit: Dr. Kimberly Young, Centre for

Internet Addiction, formerly at the University of Pittsburgh,
Bradford.

COPYRIGHT © by Dr. Kimberly S. Young

All rights reserved. Center for Internet Addiction Recovery, P.O. Box 632, Bradford, PA 16701
Screen-time Questionnaire

For the following set of questions, primary activity is defined as the main activity you are engaged in
rather than using a television/other screen in the background while performing another activity such as
cooking or exercising.

Screen use on an average weekday

Thinking of an average weekday (from when you wake up until you go to sleep), how much time do
you spend using each of the following types of screen as the primary activity?
You must answer both hours and minutes. If zero please type "0" in the box.

Hours Minutes
Television
TV-connected devices (e.g. streaming
devices, video game consoles)
Laptop/computer
Smartphone
Tablet

Screen use on an average weeknight

Now, thinking of an average weeknight (from when you return from work until you go to sleep), how
much time do you spend using each of the following types of screen as the primary activity?
You must answer both hours and minutes. If zero please type "0" in the box.

Hours Minutes
Television
TV-connected devices (e.g. streaming
devices, video game consoles)
Laptop/computer
Smartphone
Tablet

Screen use on an average weekend day

Now, thinking of an average weekend day (Saturday or Sunday), how many hours over the course of
the whole day (from when you wake up until you go to sleep) do you spend using each of the following
types of screen as the primary activity?
You must answer both hours and minutes. If zero please type "0" in the box.

Hours Minutes
Television
TV-connected devices (e.g. streaming
devices, video game consoles)
Laptop/computer
Smartphone
Tablet
For the following set of questions, background screen is defined as the use of a television or another
screen near you while performing other activities such as exercising, cooking, and interacting with
family/friends.

Thinking about a regular weekday (Monday through Friday), on average, how many hours over the
course of the whole day (from when you wake up until you go to sleep) are you exposed to background
screen use?

Example: If you exercise in the morning for one hour while watching the TV news, you use your
smartphone for one hour while eating lunch and an additional 30 minutes while eating dinner, you would
estimate that you are exposed to 2 hours and 30 minutes of background screen use per day.

Hours Minutes
Background screen use on a
regular weekday

Now we want to ask about background screen use during the evening specifically. On average, how
many hours per evening (Monday through Friday) are you exposed to background screen use from when
you return from work until you go to sleep?

Example: If you regularly prepare dinner with the television on for one hour, and you keep the television
on for an additional hour while using your smartphone for social media use, you can estimate that you
are exposed to 2 hours of background screen use every evening.

Hours Minutes
Background screen use on a
regular weeknight

Now we want to ask about background screen use during the weekend. Thinking about a regular
weekend day (Saturday or Sunday), on average, how many hours over the course of the whole day (from
when you wake up until you go to sleep) are you exposed to background screen use?

Example: If you have the television on while you do some online shopping for two hours, and you keep
the television on when friends come over to visit for an additional two hours, you can estimate that you
are exposed to 4 hours of background screen use every evening.

Hours Minutes
Background screen use on a
regular weekend day

Questionnaire Credit: Dr. Urie Bronfenbenner, formerly at the University Of Michigan, and
Harvard University.
 ATQ

Here are some different ways that people can feel about working and concentrating. Please indicate how
strongly each statement applies to you.

1 = Almost never
2 = Sometimes
3 = Often
4 = Always

1. It’s very hard for me to concentrate on a difficult task 1 2 3 4

when there are noises around.

2. When I need to concentrate and solve a problem, 1 2 3 4

I have trouble focusing my attention.

3. When I am working hard on something, 1 2 3 4

I still get distracted by events around me.

4. My concentration is good even if 1 2 3 4

there is music in the room around me.

5. When concentrating, I can focus my attention so that 1 2 3 4

I become unaware of what’s going on in the room around me.

6. When I am reading or studying, I am easily distracted 1 2 3 4

if there are people talking in the same room.

7. When trying to focus my attention on something, 1 2 3 4

I have difficulty blocking out distracting thoughts.

8. I have a hard time concentrating when 1 2 3 4

I’m excited about something.

9. When concentrating I ignore feelings of hunger or thirst. 1 2 3 4

10. I can quickly switch from one task to another. 1 2 3 4

11. It takes me a while to get really involved in a new task. 1 2 3 4

12. It is difficult for me to coordinate my attention between 1 2 3 4

the listening and writing required when taking notes
during lectures.

13. I can become interested in a new topic very quickly 1 2 3 4

when I need to.

14. It is easy for me to read or write while I’m also talking 1 2 3 4

on the phone.
 1 = Almost never
2 = Sometimes
3 = Often
4 = Always

15. I have trouble carrying on two conversations at once. 1 2 3 4

16. I have a hard time coming up with new ideas quickly 1 2 3 4

17. After being interrupted or distracted, I can easily 1 2 3 4

shift my attention back to what I was doing before.

18. When a distracting thought comes to mind, it is easy 1 2 3 4

for me to shift my attention away from it.

19. It is easy for me to alternate between two different tasks. 1 2 3 4

20. It is hard for me to break from one way of thinking about 1 2 3 4

something and look at it from another point of view.

Questionnaire Credit Citation: Derryberry, D. & Reed,

M. (2002). Anxiety-Related Attentional Biases and
Their Regulation by Attentional Control. Journal of
Abnormal Psychology, 111, 225-236.
The Mindful Attention Awareness Scale (MAAS)

The trait MAAS is a 15-item scale designed to assess a core characteristic of mindfulness,
namely, a receptive state of mind in which attention, informed by a sensitive awareness of what
is occurring in the present, simply observes what is taking place.

Brown, K.W. & Ryan, R.M. (2003). The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, 84, 822-848.

Carlson, L.E. & Brown, K.W. (2005). Validation of the Mindful Attention Awareness Scale in a
cancer population. Journal of Psychosomatic Research, 58, 29-33.

Instructions: Below is a collection of statements about your everyday experience. Using the 1-6
scale below, please indicate how frequently or infrequently you currently have each experience.
Please answer according to what really reflects your experience rather than what you think your
experience should be. Please treat each item separately from every other item.

1 2 3 4 5 6
almost very somewhat somewhat very almost never
always frequently frequently infrequently infrequently

_____ 1. I could be experiencing some emotion and not be conscious of it until some time
later.
_____ 2. I break or spill things because of carelessness, not paying attention, or thinking of
something else.
_____ 3. I find it difficult to stay focused on what’s happening in the present.
_____ 4. I tend to walk quickly to get where I’m going without paying attention to what I
experience along the way.
_____ 5. I tend not to notice feelings of physical tension or discomfort until they really grab
my attention.
_____ 6. I forget a person’s name almost as soon as I’ve been told it for the first time.
_____ 7. It seems I am “running on automatic,” without much awareness of what I’m doing.
_____ 8. I rush through activities without being really attentive to them.
_____ 9. I get so focused on the goal I want to achieve that I lose touch with what I’m doing
right now to get there.
_____ 10. I do jobs or tasks automatically, without being aware of what I'm doing.
_____ 11. I find myself listening to someone with one ear, doing something else at the same
time.
_____ 12. I drive places on ‘automatic pilot’ and then wonder why I went there.
_____ 13. I find myself preoccupied with the future or the past.
_____ 14. I find myself doing things without paying attention.
_____ 15. I snack without being aware that I’m eating.

Scoring: To score the scale, simply compute a mean (average) of the 15 items.

Questionnaire Credit Citation: (2003) Journal of

Personality and Social Psychology

The benefits of being present: Mindfulness and

its role in psychological well-being

Brown, K. W. Ryan, R. M.
STABLE RESOURCE TOOLKIT

The Suicide Behaviors Questionnaire-Revised (SBQ-R) - Overview

The SBQ-R has 4 items, each tapping a different dimension of suicidality:1

n Item 1 taps into lifetime suicide ideation and/or suicide attempt.
n Item 2 assesses the frequency of suicidal ideation over the past twelve months.
n Item 3 assesses the threat of suicide attempt.
n Item 4 evaluates self-reported likelihood of suicidal behavior in the future.

Clinical Utility
Due to the wording of the four SBQ-R items, a broad range of information is obtained in a
very brief administration. Responses can be used to identify at-risk individuals and specific
risk behaviors.

Scoring
See scoring guideline on following page.

Psychometric Properties1
Cutoff score Sensitivity Specificity
Adult General Population ≥7 93% 95%
Adult Psychiatric Inpatients ≥8 80% 91%

1. Osman A, Bagge CL, Guitierrez PM, Konick LC, Kooper BA, Barrios FX., The Suicidal Behaviors Questionnaire-
Revised (SBQ-R): Validation with clinical and nonclinical samples, Assessment, 2001, (5), 443-454.
STABLE RESOURCE TOOLKIT

SBQ-R - Scoring

Item 1: taps into lifetime suicide ideation and/or suicide attempts

Selected response 1 Non-Suicidal subgroup 1 point
Selected response 2 Suicide Risk Ideation subgroup 2 points
Selected response 3a or 3b Suicide Plan subgroup 3 points ___________
Selected response 4a or 4b Suicide Attempt subgroup 4 points Total Points

Item 2: assesses the frequency of suicidal ideation over the past 12 months
Selected Response: Never 1 point
Rarely (1 time) 2 points
Sometimes (2 times) 3 points
Often (3-4 times) 4 points ___________
Very Often (5 or more times) 5 points Total Points

Item 3: taps into the threat of suicide attempt

Selected response 1 1 point
Selected response 2a or 2b 2 points ___________
Selected response 3a or 3b 3 points Total Points

Item 4: evaluates self-reported likelihood of suicidal behavior in the future

Selected Response: Never 0 points
No chance at all 1 point
Rather unlikely 2 points
Unlikely 3 points
Likely 4 points
Rather Likely 5 points ___________
Very Likely 6 points Total Points

Sum all the scores circled/checked by the respondents.

___________
The total score should range from 3-18.
Total Score

AUC = Area Under the Receiver Operating Characteristic Curve; the area measures
discrimination, that is, the ability of the test to correctly classify those with and
without the risk. [.90-1.0 = Excellent; .80-.90 = Good; .70-.80 = Fair; .60-.70 = Poor]

Sensitivity Specificity PPV AUC

Item 1: a cutoff score of ≥ 2
• Validation Reference: Adult Inpatient 0.80 0.97 .95 0.92
• Validation Reference: Undergraduate College 1.00 1.00 1.00 1.00
Total SBQ-R : a cutoff score of ≥7
• Validation Reference: Undergraduate College 0.93 0.95 0.70 0.96
Total SBQ-R: a cutoff score of ≥ 8
• Validation Reference: Adult Inpatient 0.80 0.91 0.87 0.89

©Osman et al (1999)
STABLE RESOURCE TOOLKIT

SBQ-R Suicide Behaviors Questionnaire-Revised

Patient Name ______________________________________ Date of Visit ________________

Instructions: P lease check the number beside the statement or phrase that best
applies to you.

1. Have you ever thought about or attempted to kill yourself? (check one only)
1. Never
2. It was just a brief passing thought
3a. I have had a plan at least once to kill myself but did not try to do it
3b. I have had a plan at least once to kill myself and really wanted to die
4a. I have attempted to kill myself, but did not want to die
4b. I have attempted to kill myself, and really hoped to die

2. How often have you thought about killing yourself in the past year? (check one only)
1. Never
2. Rarely (1 time)
3. Sometimes (2 times)
4. Often (3-4 times)
5. Very Often (5 or more times)

3. Have you ever told someone that you were going to commit suicide,
or that you might do it? (check one only)
1. No
2a. Yes, at one time, but did not really want to die
2b. Yes, at one time, and really wanted to die
3a. Yes, more than once, but did not want to do it
3b. Yes, more than once, and really wanted to do it

4. How likely is it that you will attempt suicide someday? (check one only)
0. Never 4. Likely
1. No chance at all 5. Rather likely
2. Rather unlikely 6. Very likely
3. Unlikely

© Osman et al (1999) Revised. Permission for use granted by A.Osman, MD

 Brief Resilience Scale (BRS)

Respond to each statement below Strongly Strongly

Disagree Neutral Agree
by circling ​one answer per row. Disagree Agree

BRS I tend to bounce back quickly after

1
1 2 3 4 5
hard times.

BRS I have a hard time making it through

2
5 4 3 2 1
stressful events.

BRS It does not take me long to recover

3
1 2 3 4 5
from a stressful event.

BRS It is hard for me to snap back when

4
5 4 3 2 1
something bad happens.

BRS I usually come through difficult

5
1 2 3 4 5
times with little trouble.

BRS I tend to take a long time to get over

6
5 4 3 2 1
setbacks in my life.

Scoring: ​Add the value (1-5) of your responses for all six items, creating a range from 6-30.
Divide the sum by the total number of questions answered (6) for your final score.

Total score: ​_____ / 6

My score:​ _____ (average)

BRS Score Interpretation

1.00 - 2.99 Low resilience

3.00 - 4.30 Normal resilience

4.31 - 5.00 High resilience

Smith, B.W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P. and Bernard, J. (2008). The Brief Resilience Scale:
Assessing the Ability to Bounce Back. ​International Journal of Behavioral Medicine​, 15, 194-200.