PROFILE OF ADAPTATION OF LIFE FORM

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001700210075-0
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 4
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 75
• Publication Date: January 1, 1978
• Content Type: SS

Approved For Release 2003/09/10 : CIA-RDP96-00788R001700210075-0
PROFILE: OF ADAPTATION LIFE
(A) r4ODD SCALE
J=. ~_AST Wi EK, U)i.,O 70-,Ay, hCX OFTEN hAVE 11 FELT .
io se r-'_J .the a,;s,ee? ~ t each that cent dese2.r?'bes
"2"'_t t!i - -5t tw42t. kia e uou,^ aa?ruCit &,c L'.6, Lire this:
OLRI`+3 THE PAST WEEK,
,AV YOU FELT . . .
'igorous?
Full of oep?
H appy?
Ce.m and relaxed?
Secure?
Confidence in yourself?
Inner calm and peace?
~RINO THE PAST WEEK,
hA'VE YOU FELT .
:answer choices
-- 2 3 4
Rarely Some- Often Almost
Answer choices
'lever Rarely Some- Often
times
Discouraged?
Uneasy
- aPpy?
n edge?
Gloomy?
B 1 iue ?
Like crying?
worried?
Tense?
9o red?
A^ncyed, irritated?
I 1 i t
r,?
11!1? 5 n W a s
i i 2
OL'RING THE PAST ! ONTH, EVE
;Pi'er,se arbt;c` t cock 51. ttc'nern.t betowl
Enjoyed talking with others
Felt trusting of people
Found work useful and interesting
Enjoyed people I live with
Found people accept me as I am
Seer, involved, interested in things
Felt needed and useful
Controlled ry negative thinking
and increased my positive thinking
Found things I've needed coming to
me by "coincidence" or "chance"
t tswt choices
I_l 2 4
Sow- hirost
Rarely times Often Always
fs I ! 211
@_ _I l
L-~
Ans
wer choices
1 2
3 4
Never Rarely
Some-
times Often
-
7
1
30
A lack of order around me
31
Dissatisfied with myself
32
Critical of others
33
Annoyed, irritated
34
ulse to hurt someone
An im
p
35
Left out of things
36
That people treated me unfairly
37
Bothered by sloppiness around me
38
Disappointed in people
I
39
Worried about debts
i -i
4J
Uncertain about who I really am
Unhappy about the work I do
My family finds fault with me
No one seemed interested in how I
really feel inside
topyright 11975, INSTIT!T: FOR PROGRAM EVA UAT10N
BOX 4654, ROANOKE, V1RGI; l19QWd For Release 2003/09/10 : CIA-RDP96-00788R001700210075-0
 Approved For Release 2003/09/10 : CIA-RDP96-00788R001700210075-0
(C) PHYSICAL HEALTH INVENTORY
P:'e::ae matk one ana`o' each question
tt 'Lk ucuA answer Pike this: or this f , i
DjRTNG THE LAST MONTH, HAVE YOU
Had headaches? (Past month)
Felt faint?
Felt hot, feverish?
Had spells of dizziness?
Had difficulty falling asleep?
Had chest pains?
Noticed your heart beating fast?
had difficulty breathing?
Felt physically ill?
Had back pains?
Seen bothered by itching?
Had coughing spells?
Had neck or shoulder pains?
Had pains in legs or arms?
Had trouble with your vision?
Felt exhausted, fatigued?
Waken from sleep feeling tired?
Had a poor appetite?
Been constipated (hard stools)?
Had an upset stomach?
Had nausea (sick to stomach)?
Had indigestion?
Had stomach pain after eating?
Had trouble digesting food?
Had diarrhea (loose bowels)?
Answer choices '
2 3
Some-
Never times Often
( 44
Li
57
58
I I I l 66
4
67
45
46
47
--i
L__~
1 49
F-151
1 _
LJ
IT IS MY OPINION THAT . . .
(Please answer each statement below)
A person's soul or spirit continues after death
People will be reborn to live again on earth
Mental telepathy (ESP) is a reality
People have out of body experiences (astral travel)
There are spiritual or non-physical forces
acting in today's world
Sooner or later people will treat you as
you've treated others
Spiritual or psychic healing is often as
effective as medical treatment
i 2 3 4
Not Not Agree
Agree sure Agree Strongly
1 69
i770
f` 1
{_.J I
___1
T 73
It's wrong to kill any living thing.
Problems in life are really opportunities
to learn and grow
People create their own reality by the kinds
of thoughts they let themselves have
IT IS MY OPINION THAT THE SOLUTIONS TO MAN'S
PROBLEMS IN LIVING WILL BE FOUND It . .
Fiore money for scientific research
More formal education for people
Redistributing the wealth
A return to organized religion
Social reform through better laws
Daily meditation
Spiritual reawakening (personal enlightirent)
Protecting the environment, natural resources
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59
60
I~
76 Subj s 80
s
Not Not
Agree Sure
I _ ! i
3
Agree
L
74
75
j 2
Agree
Strongly
10
L.._.e1
~ IL
 Approved For Release 2003/09/10 : CIA-RDP96-00788R001700210075-0
Answer choices
WRING THE PAST MONTH, HOW OFTEN HAVE YiO_I,Rarely i-2
3-5
P.;za.5e arL we,, zach
qu., a.%SAr :lei'
v_'
or
Tines
Times
Each
Never
/Week
/Week
Day
Dpent time with a close friend?
Shared personal problems with a friend?
Washed the dishes?
Done household clearing?
Prepared meals?
Washed clothes?
;one physical exercise?
Taken part in active sports?
Listened no mls',c ency?
aCen time to be ov vouirself?
Medi cared?
Enjoyed contact wits ani,:als?
-.:,en care of house plane?
Eat.-,. rec meat ;tee', Eaten .sn or pouitr:?
._ten sweets candy, cake, pie, etc. ?rJ.nK soft drinks (Cake, etc. ~?
Eaten fresh fruits apcles, Oran es,
Eaten natural foods (dried fruit, n--s,
whole grains)?
Kept up with currant events, (read news-
paper, magazines, watch TV news)?
Read something about mystical
spiritual or psychic things?
Read something about personal
sychclogicai growth?
22
23
30
Answer ceoices
1 2 3 4
1-2 times 1-2 times Almost
Never per north per week Daily
outside the home?
Attended meetings of civic, or other
organizations?
Enterta fined friends in your home-,
Attended a religious service?
Scent tine o~tdoors enjoying nature?
Played cards cr Other table Games?
Visited with the neighbors?
Done grocery shopping;
Danced?
Read fiction for en,oy.rert?
Participated ir, a study group?
Taker medication for headacne?
a,en medication to help you sleep?
en ,ed - cat;on for your stoma!
Tale Roc cati^_?n for- a cold or allergy'
Taken tranquil ? ers'.
Taken laxatives?
Gotten high on alcohol or drugs?
DURING THE LAST MONTH, HAS ALCOHOL OR
DRUG USE CAUSED PROBLEMS . . .
Between you and family mem;ers?
With work (difficulty working well
or going to work)?
With your Physical health?
in your thinking clearly?
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134
L-J
54
 Approved For Release 2003/09/10 : CIA-RDP96-00788R001700210075-0
7 S,
j No , If you --`erkec
e! THE ?AST MD'`s?,. A'eE YOU AND iDUR
_:2N: !CANT OTHER (spouse, parent, __c.) . . . Rarely
. Stared personal feelings with each other:
2. Beer able to talk it through when angry?
Acreed ut fnances and budget,'
Soent en oVabie `, mmes to, etoer?
5. Discussed mrorta',t :r.aters'
FEit c'cse to each other?
Acreed social activities and
rie",ds]..
Sra-ea cai'y events that !-aapened to
each of you?
THERE CH L: WHERE YOU LiVE. (Mark one`
No (If ycu marked "No", skip to Section H below)
Yes (if v, marked "yes", answer the next 6 cuest_ions)
---- Answer choices
...'i:~ THE LAST M.0'4TH, HAVE 'DU AND THE
:L0(REN) .
Spen tine ta'xir3 with ea:.!', other?
2. Scent -e doin- _.ings together.
Openly expressed feelings to each other?
4. Treated each torn with resp_?ct?
Felt close to each other?
6. Done things for each other?
1 2 3 _ 4
Sore- Airast
Rarely times Often Always
2 3 4
Some- AImost
nes Often Always
80
?'?3R SOURCE OF I'OCCYC
(Check only one answer)
,Money earned from work
co now
(2)_ Fror spouse, relative, or
friend
(3) investments or inheritance
I i
60
I ~ i
iV
I i
(4) Welfare or public assistance
(5) Retirement or social security
`MOOKE :GAPET-, ;?
(1) N31 at n. l i
(2) Less than pack per dal
(3) About r2 pack per day
(4 About 1 pack per day
(5) Over 1, pack per day
6. DRINY COFFEE?
(6Une mp'oyment compensation ) e 'ie rare cup
Scholarship or student stItenc (2) __ Abcu; 1-2 cups, per day
(8i Al irony or child support (3i,_ 2-4 c p per day
ire cups per day
(9) Veterans benefits i(4) -5 j
Separated, divorcee, or
widowed
8. R ERAGE POURS OF SLEEP
?1`
4-5 hours
(2)
5-6 hours
r8
3)
6-? hours
69
High school gradua-e
(2j
(4)
7-8 hours
_
iv
(3) Some college (5)
3 or more hours
(4) College graduate (7YPe
72
(H) DO YOU HAVE _NCQ GH MONEY TO . . . Rarely times Usual Always,
Pay your bills? (hark one) s I
Hardie unexpected expenses:' (Mark one) j ;--_ 74
WORKING, DID YOU EARN AN ADEQUATE AMOUNT OF MONEY LAST MONTH? (Mark one)
1 Earned no money from working last month
2) Earned encuch to take care of my personal needs (spending money)
(2) Earned enough to partially sup ort a family
(4) Earned erough to adequately support a family
;p act[ !-:e1 C'+,'~
answer .no 0 _...__.^_r.s be: to
AGE 9-10
HEIGHT feet in, 11-13
WEIGHT pounds 14-16
WATCH TV?
(1) None or rarely
(2) Less Loan 1 hour per
da y
(3) 1-2 hours per day
75 Subi # 80
THarh UCU Io CUpr02e.t.4ttg the !iara-tcC1:Pad". help of ve of much
app.tect,:ted. P iav :FCr bee to irka i me y iL ~C .~ c ~ u1
iJ.Cet