HYPNOTIC QUESTIONNAIRE :: PSICOLOGOPZ

Name and surname

Email

Date of birth

Place of birth

Phone number

1. Have I ever undergone hypnosis in the past?

Yes

No

2. Do I believe in the healing power of hypnosis?

Yes

No

3. Would I like to undergo hypnosis during psychotherapy?

Yes

No

4. Do I imagine hypnosis as sleep?

Yes

No

5. Does a person lose consciousness in a hypnotic state?

Yes

No

6. Am I afraid of hypnosis?

Yes

No

7. Do I fall asleep easily when traveling by train?

Yes

No

8. Do I think I have a good imagination?

Yes

No

9. Have I ever been sleepwalking?

Yes

No

10. Were my parents or teachers particularly strict with me?

Yes

No

11. Can I relax easily?

Yes

No

12. If I do not lose consciousness during hypnosis, does this mean that I am resistant to hypnosis or that hypnosis does not affect me?

Yes

No

13. Have I had unpleasant experiences or disappointments caused by a doctor or psychologist in connection with hypnosis or in general?

Yes

No

14. Do I consider my relationship with my father to be good?

Yes

No

15. Do I consider my relationship with my mother to be good?

Yes

No

16. Have I experienced disappointment very often in my life?

Yes

No

17. Do I feel like a rebel in relation to authorities?

Yes

No

18. Do I like to dream with my eyes open?

Yes

No

19. Do I feel good when I imagine diving into a lake or sea?

Yes

No

20. Do I tend to have low blood pressure?

Yes

No

21. Have I ever had a visual, auditory or tactile hallucination?

Yes

No

22. Have I ever completed extrasensory training?

Yes

No

23. Do I consider myself a romantic person who lives in a world of dreams?

Yes

No

24. Do I get dizzy easily while dancing?

Yes

No

25. Have I ever participated in a performance with hypnosis (TV, circus, theater, cabaret)?

Yes

No

26. Did I ever practice autogenic training?

Yes

No

27. Did I ever practice yoga?

Yes

No

28. Did practicing autogenic training, extrasensory training and yoga help me improve my quality of life?

Yes

No

29. Do I tend to be submissive in interpersonal relationships?

Yes

No

30. Do I consider myself overly sensitive?

Yes

No

31. Do I consider myself mentally vulnerable?

Yes

No

32. Do I have difficulty concentrating?

Yes

No

33. Is it difficult for me to stop the flight of thoughts?

Yes

No

34. Did I go through religious education and upbringing?

Yes

No

35. Do my feelings prevail over rationality?

Yes

No

36. Have I often been criticized in my life?

Yes

No

37. Do I believe that I am artistically inclined?

Yes

No

38. Do I like listening to music?

Yes

No

39. Would I like to feel my body light?

Yes

No

40. Do I think I have a good imagination?

Yes

No

41. Do I tend to have high blood pressure?

Yes

No

42. Can I easily detach myself from my body and the reality that surrounds me?

Yes

No

43. Do I like acting in different roles or empathizing with different characters as if I were an actor?

Yes

No

44. Do I like to feel my body warm?

Yes

No

45. Do I often have feelings of guilt?

Yes

No

46. Do I find it difficult to release body tension?

Yes

No

47. Do I often allow myself to be psychologically influenced by other people?

Yes

No

48. Did my parents cuddle and caress me when I was a child?

Yes

No

49. Have you heard negative reviews about hypnosis?

Yes

No

50. Am I overly critical of other people?

Yes

No

51. Do I like poetry?

Yes

No

52. Do I like pleasant smells and perfumes?

Yes

No

53. Do I like listening to fairy tales?

Yes

No

54. Do I usually see myself as fearful and anxious?

Yes

No

55. Do I get along better with my boyfriends than with my girlfriends?

Yes

No

56. Do I like the cold?

Yes

No

57. Do I get nervous very easily?

Yes

No

58. Would I rather feel my body heavy?

Yes

No

59. Do I like physical contact?

Yes

No

60. Do I consider myself an ambitious person?

Yes

No

61. Do I feel like an introvert?

Yes

No

62. Do I live in a dream world that distances me from reality?

Yes

No

63. Are there people I trust blindly?

Yes

No

64. Do my eyes tire easily when reading?

Yes

No

65. When I should take the initiative or make an important decision, do I behave passively?

Yes

No

66. Is it difficult for me to comply and fulfill the wishes of others?

Yes

No

67. When I watch a movie, do I experience the story intensely together with its protagonists, as if I were with them on the screen?

Yes

No

68. Am I easily influenced by the environment that is around me?

Yes

No

69. Can I use any technique to help me fall asleep?

Yes

No

70. Do positive sensations and thoughts evoke pleasant feelings in me?

Yes

No

71. Do I have a strong tendency to somatize? Do emotions (both pleasant and unpleasant) affect me and cause physiological changes in my body?

Yes

No

72. Do I like to see confident behavior in other people?

Yes

No

73. Have I ever had heart problems?

Yes

No

74. Did any of my parents/grandparents/siblings have cardiovascular disease?

Yes

No

75. Have I heard good things about hypnosis?

Yes

No

76. Has anyone recommended that I try hypnosis?

Yes

No

77. Do I often feel faint?

Yes

No

78. Have I passed out?

Yes

No

79. Do I consider myself a person who is not affected by hypnosis?

Yes

No

80. Have I had any mystical experience or supernatural revelation?

Yes

No

81. Do I like to communicate and be with other people?

Yes

No

82. Do I often feel unable to control my reactions?

Yes

No

83. Do I get scared easily?

Yes

No

84. Am I comfortable showing off and performing in front of an audience?

Yes

No

85. Have I read any books on hypnosis?

Yes

No

86. Have I been beaten in the past?

Yes

No

87. Do I wake up often during the night?

Yes

No

88. Do I often have nightmares during the night?

Yes

No

89. Do I trust psychotherapists easily?

Yes

No

90. When I must wait somewhere, do I lose my composure and patience easily?

Yes

No

91. Do I often feel confused?

Yes

No

92. Do I consider myself infantile?

Yes

No

93. Do I like order and discipline?

Yes

No

94. Do I like to compete with others?

Yes

No

95. Do I consider myself an extrovert?

Yes

No

96. Do I resist pain easily?

Yes

No

97. Do I concentrate easily?

Yes

No

98. Do I feel happy when I am under protection?

Yes

No

99. Do I like giving orders and controlling others?

Yes

No

100. Was it difficult for me to answer the questions of this questionnaire?

Yes

No

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