Performance Blocking Beliefs Questionnaire Name* First Last Performance Problem I want to solve:*INSTRUCTIONS: Please give each belief a number from 1 (feels completely untrue) to 7 (feels completely true) for each statement.I will never get over this problem.*Completely untrue1234567Completely trueI am not sure I want to get over this problem.*Completely untrue1234567Completely trueI don’t have the strength, ability or will power to get over this problem.*Completely untrue1234567Completely trueIf I talk about or try to get help for this problem, something bad will happen.*Completely untrue1234567Completely trueThis problem can only be solved by someone else.*Completely untrue1234567Completely trueI should solve this problem, but I don’t always do what I know I need to do.*Completely untrue1234567Completely trueIf I get over this problem, the outcome will be negative or bad.*Completely untrue1234567Completely trueI say I want to solve this problem, but I never do.*Completely untrue1234567Completely trueI don’t deserve to get over this problem.*Completely untrue1234567Completely trueThis problem is bigger than I am.*Completely untrue1234567Completely trueSomeone in my life is upset with me because I have this problem.*Completely untrue1234567Completely trueThere are some good things about having this problem.*Completely untrue1234567Completely trueI don’t have a problem.*Completely untrue1234567Completely trueI have had this problem for so long, I could never completely solve it.*Completely untrue1234567Completely trueI have to wait to solve this problem.*Completely untrue1234567Completely trueIf I solve this problem, I could lose a lot.*Completely untrue1234567Completely trueIf I solve this problem completely, it will be mainly for someone else – not for me.*Completely untrue1234567Completely trueI should not have to deal with this problem.*Completely untrue1234567Completely trueThis problem is not my responsibility.*Completely untrue1234567Completely trueWRITE A LIST OF SOME OF YOUR OWN BLOCKING BELIEFS THAT DETRACT YOU FROM SETTING AND REACHING YOUR PERFORMANCE GOALS.*PhoneThis field is for validation purposes and should be left unchanged.
