Identify areas in your life you wish to regain a greater sense of connection.
| Meaning | ||||
| 1 | 2 | 3 | 4 | 5 | 
| Life is filled with purpose and meaning | Life is good. I have things I want to accomplish | I feel generally motivated | I lack interest in life. I have little motivation to accomplish goals | Life has become meaningless | 
| Relatedness | ||||
| 1 | 2 | 3 | 4 | 5 | 
| I feel a strong sense of connection with life | I feel connected to those important to me | Most important areas of my life seem balanced | I feel some distance from key relationships in my life | I feel disassociated or alienated from someone, things, and my Self | 
| Forgiveness | ||||
| 1 | 2 | 3 | 4 | 5 | 
| I feel a deep sense of reconciliation towards myself and others | There are no outstanding issues that are calling for forgiveness that I am aware of | I have made progress in forgiving others, including myself | I know areas I needs to work on to forgive others | I feel a strong sense of unforgiving towards myself and/or others | 
| Universality | ||||
| 1 | 2 | 3 | 4 | 5 | 
| I have faith in myself and the world; we are connected, we are one. | I sense greater forces in the universe that extend beyond me. | I generally trust what the future holds for me | I sometimes question ‘why me?’ | I am experiencing disconnected and hopelessness. | 
