***QUESTIONNAIRE***
Non-Ordinary Forms of Mental Time


After you have completed the questionnaire, please double check each entry and then press the SUBMIT button.

Question 1: Basic Demographic Data
Age:
Gender:
Education:
Religious Beliefs:

Question 2: Have you ever experienced an "altered" state of consciousness, e.g. a psychosis, a trance, a mystical/religious vision, a loss of sense of self/ego, etc.?
Never
Once
Twice
More than twice
Regularly

Question 3a: Please specify the context and/or (likely) trigger of your experience.
Spontaneous Experience
Meditation
Drug-Induced
Accident/Emergency
Near-Death Experience
Mental/Psychological Crisis, or Psychotic Episode
Cause/Trigger Unknown
Other (please specify): 

Question 3b: If you have any further comments/specifications on the trigger and/or context of your experience, please specify. For example, if you took a drug, you may want to specify which drug you used.

Question 4: During your experience, did you experience an altered/distorted structure of time?
YES, a remarkable/pronounced change in the perception of time
YES, a slight change in the perception of time
NO. (If you marked "NO", go directly to Question 8.)

Question 5: If your answer to the previous question was "YES", please select from the list below the type of "anomalous/peculiar" sense of time that most closely matches the one you experienced. You can check more than one item, but please try to be as specific as possible. Using a number from 1 to 9, please specify the degree/level of intensity or prominence of the corresponding change of your experience of time within the overall context ("9" means the highest level).
A. Everlasting Now:
B. Timelessness:
C. Eternity:
D. Time Standing Still / Arrested, Suspended Time:
E. Awareness of Future Events:
F. Time Flowing Backward / Reverse Flow of Time:
G. Fragmented/Disordered (Flow of) Time:
H. Complete Loss of the Sense of Time:
I. Beyond Any Concept of Time:
J. Other (please specify): 
Alternating Different Time Modes (please specify):

Question 6: If you experienced more than one of the above listed patterns of time, and these seemed to occur in a certain sequence or order, please try to approximately describe this sequence/order. When doing so, please use the above-given letters and the "=>" sign, e.g. E=>C=>G.


Question 7: Recalling the answer you gave to Question 4 above, please state in some detail how prominent was the altered perception of time during your experience?


Question 8: Besides the altered time perspective, which of the following were the most pronounced features of your experience? (You can mark more than one item)
Altered sense of space
Altered sense of personality/ego
Feeling of being one with space/universe ("Cosmic Consciousness")
Perception of the absolute void/emptiness/nothingness
Other (please specify): 

Question 9: During your experience, did you have
a sense of recognition (i.e. a sense of having already been there before)?
a sense of knowledge you had not had before?
both of the above?
neither of the above?

Question 10: If you acquired new and unusual knowledge during your experience, did you take it with you, or how much of it were you able to take with you, upon returning to your "ordinary/normal" state?


Question 11: During your extraordinary experience, how much control did you have over its contents and development?


Question 12: Are there any other features of your experience that you think stand out as particularly striking? If yes, please describe them (feel free to use as much space as you like).


Question 13: Looking back at your experience, you regard it as (mark more than one field if appropriate):
A truly life-changing event
A very pleasant experience
A very unpleasant/terrifying experience
An experience of great beauty
Awareness of primordial/absolute reality
Being of enormous and lasting benefit to me
The greatest thing that ever happened to me
A profound religious/mystical experience
An experience of mere insanity and/or illusion

Question 14: If there is anything else you'd like to share with us - be it about the experience itself, or about this questionnaire, or whatever related to the topic, please use the following space for that.


If you wish to be informed about the final results of our research, you can leave us your e-mail address: We shall take the utmost care in keeping the privacy and security of the information provided.

Thank you. Your assistance is very much appreciated, indeed. The information you provided us will be used solely for scientific purposes.



                   




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Last update: May 21, 2004