The Spiritual Trauma Assessment Tool (STAT) INSTRUCTIONS: Please read each question completely and carefully before making your selections. Provide a response for each question. OK Question Title * 1. Name OK Question Title * 2. Date Date / Time Date OK Question Title * 3. Gender Male Female OK Question Title * 4. Number of Combat Tours OK Question Title * 5. Branch of Service OK Question Title * 6. Most Recent Combat Tour (Month/Year) Month Year OK Question Title * 7. Please check all the feelings or thoughts that apply to you today. I am experiencing nightmares I feel ashamed I feel guilty I feel unforgiven I am depressed I have fears I feel lost I’ve lost all interest I feel numb I dislike myself I cannot trust anyone I am confused I have intrusive thoughts I feel alone I have questions about my faith I am always angry I have feelings of revenge I cannot sleep I don’t know who I am Life has no meaning for me I am always on edge I have no direction I am grieving I feel disconnected OK Question Title * 8. From your list above, please list the three that affect you most. Choose One Choose One Choose One OK Question Title * 9. How well are you functioning? 0 - Very Poorly 1 2 3 4 5 - Moderately Well 6 7 8 9 10 - Extremely Well 0 - Very Poorly 1 2 3 4 5 - Moderately Well 6 7 8 9 10 - Extremely Well OK Question Title * 10. On a scale of 1-10, how would you rate your traumatic experience(s) during combat? 0 - Minimal Impact 1 2 3 4 5 - Moderate Impact 6 7 8 9 10 - Extreme Impact N/A 0 - Minimal Impact 1 2 3 4 5 - Moderate Impact 6 7 8 9 10 - Extreme Impact N/A OK Question Title * 11. How would you assess your spiritual fitness on a scale of 1-10 (poor to excellent)? Spiritual fitness relates to the extent spirituality [one’s capability to find meaning and purpose in life in ways related to God or to sacred pursuits] affects your life. 0 - Poor 1 2 3 4 5 - Moderate 6 7 8 9 10 - Excellent N/A Prior To Combat Prior To Combat 0 - Poor Prior To Combat 1 Prior To Combat 2 Prior To Combat 3 Prior To Combat 4 Prior To Combat 5 - Moderate Prior To Combat 6 Prior To Combat 7 Prior To Combat 8 Prior To Combat 9 Prior To Combat 10 - Excellent Prior To Combat N/A During Combat During Combat 0 - Poor During Combat 1 During Combat 2 During Combat 3 During Combat 4 During Combat 5 - Moderate During Combat 6 During Combat 7 During Combat 8 During Combat 9 During Combat 10 - Excellent During Combat N/A After Combat After Combat 0 - Poor After Combat 1 After Combat 2 After Combat 3 After Combat 4 After Combat 5 - Moderate After Combat 6 After Combat 7 After Combat 8 After Combat 9 After Combat 10 - Excellent After Combat N/A OK Question Title * 12. What spiritual fitness or religious activities are you doing now? Attending worship services Praying Reading my Bible or other Sacred Scriptures Attending small group religious studies or prayer groups Member of a small fellowship group None Other (please specify) OK Question Title * 13. What spiritual coping mechanisms are you using today to help you with your traumatic symptoms (if any are present)? I am praying I am attending worship services I am meeting with a spiritual counselor I am reading religious literature I am in a spiritually focused support group N/A - Not Applicable Other (please specify) OK Question Title * 14. Do you have difficulty adjusting socially or have difficulty adjusting to work or other areas of your life because of your combat experience? Yes No OK Question Title * 15. Are you having thoughts or concerns you might hurt or lose control with someone or yourself because of your combat experience? Yes No OK Question Title * 16. For the next several questions, I am using the term “resilience.” Resilience is the ability to recover quickly from a traumatic experience or a stressful situation.On a scale of 1 – 10, rate your resilience PRIOR to your deployment to the combat zone: 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent OK Question Title * 17. On a scale of 1 – 10, rate your resilience DURING your deployment to the combat zone: 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent OK Question Title * 18. On a scale of 1 – 10, rate your resilience AFTER your deployment to the combat zone: 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent OK Question Title * 19. To what extent did the following factors support your resilience during combat? 1 - Poor 2 3 4 5 - Average 6 7 8 9 10 - Excellent Realistic military training Realistic military training 1 - Poor Realistic military training 2 Realistic military training 3 Realistic military training 4 Realistic military training 5 - Average Realistic military training 6 Realistic military training 7 Realistic military training 8 Realistic military training 9 Realistic military training 10 - Excellent Support of comrades Support of comrades 1 - Poor Support of comrades 2 Support of comrades 3 Support of comrades 4 Support of comrades 5 - Average Support of comrades 6 Support of comrades 7 Support of comrades 8 Support of comrades 9 Support of comrades 10 - Excellent Physical fitness Physical fitness 1 - Poor Physical fitness 2 Physical fitness 3 Physical fitness 4 Physical fitness 5 - Average Physical fitness 6 Physical fitness 7 Physical fitness 8 Physical fitness 9 Physical fitness 10 - Excellent Example of leaders Example of leaders 1 - Poor Example of leaders 2 Example of leaders 3 Example of leaders 4 Example of leaders 5 - Average Example of leaders 6 Example of leaders 7 Example of leaders 8 Example of leaders 9 Example of leaders 10 - Excellent Warrior Ethos Warrior Ethos 1 - Poor Warrior Ethos 2 Warrior Ethos 3 Warrior Ethos 4 Warrior Ethos 5 - Average Warrior Ethos 6 Warrior Ethos 7 Warrior Ethos 8 Warrior Ethos 9 Warrior Ethos 10 - Excellent Home front support Home front support 1 - Poor Home front support 2 Home front support 3 Home front support 4 Home front support 5 - Average Home front support 6 Home front support 7 Home front support 8 Home front support 9 Home front support 10 - Excellent Spirituality (Can include or exclude religious beliefs) Spirituality (Can include or exclude religious beliefs) 1 - Poor Spirituality (Can include or exclude religious beliefs) 2 Spirituality (Can include or exclude religious beliefs) 3 Spirituality (Can include or exclude religious beliefs) 4 Spirituality (Can include or exclude religious beliefs) 5 - Average Spirituality (Can include or exclude religious beliefs) 6 Spirituality (Can include or exclude religious beliefs) 7 Spirituality (Can include or exclude religious beliefs) 8 Spirituality (Can include or exclude religious beliefs) 9 Spirituality (Can include or exclude religious beliefs) 10 - Excellent Teamwork Teamwork 1 - Poor Teamwork 2 Teamwork 3 Teamwork 4 Teamwork 5 - Average Teamwork 6 Teamwork 7 Teamwork 8 Teamwork 9 Teamwork 10 - Excellent Mission focus Mission focus 1 - Poor Mission focus 2 Mission focus 3 Mission focus 4 Mission focus 5 - Average Mission focus 6 Mission focus 7 Mission focus 8 Mission focus 9 Mission focus 10 - Excellent Military Values Military Values 1 - Poor Military Values 2 Military Values 3 Military Values 4 Military Values 5 - Average Military Values 6 Military Values 7 Military Values 8 Military Values 9 Military Values 10 - Excellent OK Question Title * 20. As you reflect on your faith in God, indicate your present level of faith in God as it is today. 1 - I have deep problems in my faith 2 3 4 5 - I am struggling with my faith 6 7 8 9 10 - I am growing in my faith 1 - I have deep problems in my faith 2 3 4 5 - I am struggling with my faith 6 7 8 9 10 - I am growing in my faith OK Question Title * 21. If your spiritual fitness improved after combat, what resiliency factors contributed to this improvement? Realistic military training Support of comrades Physical fitness Example of leaders Warrior Ethos Home front support Spirituality (Can include or exclude religious beliefs) Teamwork Mission focus Military Values N/A OK Question Title * 22. What other factors contributed to this improvement? OK Question Title * 23. If your spiritual fitness declined after combat, what factors contributed to this decline? Realistic military training Support of comrades Physical fitness Example of leaders Warrior Ethos Home front support Spirituality (Can include or exclude religious beliefs) Teamwork Mission focus Military Values N/A OK Question Title * 24. What other factors contributed to this decline? OK Question Title * 25. To what extent did your combat exposure and subsequent trauma contribute to a decline in your spirituality? 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much OK Question Title * 26. To what extent did your combat exposure and subsequent trauma contribute to an improvement in your spirituality? 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much OK Question Title * 27. If you experienced combat trauma, to what extent did your spirituality lessen the effects [less symptoms] of your trauma? 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much N/A 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much N/A OK Question Title * 28. If you experienced combat trauma, to what extent did your spirituality increase the effects [more symptoms] of your trauma? 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much N/A 0 - Very Little 1 2 3 4 5 - Some 6 7 8 9 10 - Very Much N/A OK Question Title * 29. If your spirituality increased the effects of your trauma, what factors contributed to this increase in symptoms? OK Question Title * 30. If the presence of spirituality in your life contributed significantly to your resilience during combat and after combat, what actions did you take or what attitudes did you adopt during and after combat? OK Question Title * 31. To what extent did your combat experience contribute to the following factors? 1 - Little 2 3 4 5 - Average 6 7 8 9 10 - Much Greater Appreciation for Life Greater Appreciation for Life 1 - Little Greater Appreciation for Life 2 Greater Appreciation for Life 3 Greater Appreciation for Life 4 Greater Appreciation for Life 5 - Average Greater Appreciation for Life 6 Greater Appreciation for Life 7 Greater Appreciation for Life 8 Greater Appreciation for Life 9 Greater Appreciation for Life 10 - Much Changed Sense of Priorities Changed Sense of Priorities 1 - Little Changed Sense of Priorities 2 Changed Sense of Priorities 3 Changed Sense of Priorities 4 Changed Sense of Priorities 5 - Average Changed Sense of Priorities 6 Changed Sense of Priorities 7 Changed Sense of Priorities 8 Changed Sense of Priorities 9 Changed Sense of Priorities 10 - Much Warmer, More Intimate Relationships with Others Warmer, More Intimate Relationships with Others 1 - Little Warmer, More Intimate Relationships with Others 2 Warmer, More Intimate Relationships with Others 3 Warmer, More Intimate Relationships with Others 4 Warmer, More Intimate Relationships with Others 5 - Average Warmer, More Intimate Relationships with Others 6 Warmer, More Intimate Relationships with Others 7 Warmer, More Intimate Relationships with Others 8 Warmer, More Intimate Relationships with Others 9 Warmer, More Intimate Relationships with Others 10 - Much A Greater Sense of Personal Strength A Greater Sense of Personal Strength 1 - Little A Greater Sense of Personal Strength 2 A Greater Sense of Personal Strength 3 A Greater Sense of Personal Strength 4 A Greater Sense of Personal Strength 5 - Average A Greater Sense of Personal Strength 6 A Greater Sense of Personal Strength 7 A Greater Sense of Personal Strength 8 A Greater Sense of Personal Strength 9 A Greater Sense of Personal Strength 10 - Much Recognition of New Possibilities or Paths of One’s Life Recognition of New Possibilities or Paths of One’s Life 1 - Little Recognition of New Possibilities or Paths of One’s Life 2 Recognition of New Possibilities or Paths of One’s Life 3 Recognition of New Possibilities or Paths of One’s Life 4 Recognition of New Possibilities or Paths of One’s Life 5 - Average Recognition of New Possibilities or Paths of One’s Life 6 Recognition of New Possibilities or Paths of One’s Life 7 Recognition of New Possibilities or Paths of One’s Life 8 Recognition of New Possibilities or Paths of One’s Life 9 Recognition of New Possibilities or Paths of One’s Life 10 - Much Spiritual Development Spiritual Development 1 - Little Spiritual Development 2 Spiritual Development 3 Spiritual Development 4 Spiritual Development 5 - Average Spiritual Development 6 Spiritual Development 7 Spiritual Development 8 Spiritual Development 9 Spiritual Development 10 - Much OK Question Title * 32. To what extent did your combat experience contribute to the following factors? 1 - Little 2 3 4 5 - Average 6 7 8 9 10 - Much Stronger Faith Stronger Faith 1 - Little Stronger Faith 2 Stronger Faith 3 Stronger Faith 4 Stronger Faith 5 - Average Stronger Faith 6 Stronger Faith 7 Stronger Faith 8 Stronger Faith 9 Stronger Faith 10 - Much Greater Insight Greater Insight 1 - Little Greater Insight 2 Greater Insight 3 Greater Insight 4 Greater Insight 5 - Average Greater Insight 6 Greater Insight 7 Greater Insight 8 Greater Insight 9 Greater Insight 10 - Much Less Attachment to Material Things Less Attachment to Material Things 1 - Little Less Attachment to Material Things 2 Less Attachment to Material Things 3 Less Attachment to Material Things 4 Less Attachment to Material Things 5 - Average Less Attachment to Material Things 6 Less Attachment to Material Things 7 Less Attachment to Material Things 8 Less Attachment to Material Things 9 Less Attachment to Material Things 10 - Much OK DONE