What's My Bad Habit?

What is your single most "bad habit?"

• biting fingernails
• chewing tobacco
• chewing gum
• clearing throat
• complaining/whining
• cracking knuckles
• drinking in excess
• eating
• fidgeting
• gambling
• gossiping
• internet, too much time online
• interrupting
• lateness
• lying
• picking skin
• playing online games
• procrastinating
• pulling hair
• smoking
• spanking the monkey
• speeding (in vehicle)
• spending too much money
• swearing, cursing
• talking too much
• using pornography
• wanking
• watching tv

Has your bad habit negatively effected you?

• Yes
• No

Has your bad habit negatively effected others?

• Yes
• No

In what areas of your life has your bad habit negatively effected you?

Please select all that apply.

• work/job
• relationships
• finances
• health/fitness
• personal

Have your tried changing your bad habit?

• Yes
• No

When you tried breaking your bad habit in the past, did it work?

• Yes
• No

What did you think, or say to yourself, when you went back to your bad habit?

Please select all that apply.

• It's ok.
• There I go again, doing exactly what I didn't want to do.
• I'm a loser!
• I'll never learn.
• I just can't stop myself.
• This will be the last time.
• I just won't overdo this time.
• I'll just put a limit on it this time and it'll be ok.
• It won't make me a bad person.

how did you feel after going back to your bad habit?

Please select all that apply.

• Happy
• Sad
• Excited
• Concerned
• Anxious
• Fearful
• Depressed
• Frustrated
• Annoyed
• Disgusted
• Angry
• Resentful
• Hostile

What did you do as a result of how you felt when you went back to your bad habit? (Pick the answer that best matches what you did).

Please select all that apply.

• I ate.
• I smoked.
• I drank.
• I drugged.
• I slept.
• I stayed up all night.
• I yelled at others.
• I didn't go to work.
• I didn't eat.
• I continued to engage in my bad habit.
• I didn't want to be around other people.

Would you like to break your bad habit forever?

• Yes
• No

How ready are you to change your habit? (on a scale of 7 to 1 where 7 is extremely ready and 1 is not at all ready).

• 7 - I'm extremely ready to change
• 6
• 5
• 4
• 3
• 2
• 1 - I'm not at all ready to change