Consciousness Integration Questionnaire

Norman E. Rosenthal, M.D., Fred Travis, Ph.D., Gerry Geer

Consciousness Integration Questionnaire (CIQ) Introduction
Thanks for being willing to take a look at the Consciousness Integration Questionnaire
(CIQ). The purpose of this questionnaire is to obtain information about experiences that
some people have after they start to meditate. Almost all the questions refer to the period of time since you started to meditate.
Although almost all the questions refer to the period of time since you started to meditate, this questionnaire is also useful as a baseline measure. If you have not yet started to
meditate, simply ignore that opening clause to most of the questions, and answer them
to reflect how you have been in the past year.That way you will be able to evaluate how
your scores vary over time, including what impact, if any, meditation may have on them.
Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

Instructions for scoring Consciousness Integration Questionnaire

1. Answer all questions 4 through 31 by noting Yes or No
2. All No responses are scored as zero for the purpose of determining your
final score. Items numbers 17, 18, 29, 30, and 31 do not count towards your final
score and are included only for the sake Frequency Scale | please rate the average frequency over the past year
1. Rarely (less than once a year)
5. Regularly (+/- once a week)
7. Very often (at least once a day)
of completeness and for your interest.
2. Infrequently (+/- once a year)
6. Often (> once a week, <daily)
8. Almost continuously (most of the day)
9. Continuously
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)
3. For those items that you scored Yes,
COLUMN 1
COLUMN 2
COLUMN 3
give yourself a score of one point,
two points, or three points corresponding to how frequently it applies to you,
using COLUMNS 1, 2, or 3 in the Frequency Scale key at the top of each page.
4. Add up your scores for items 4 through 9 to arrive at your total state of
consciousness score.
5. Add up your score for items 10 through 28 to arrive at your total life impact score.

one point

two points

three points

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

Consciousness Integration Questionnaire (CIQ)

Norman E. Rosenthal, M.D., Fred Travis, Ph.D., and Gerald Geer
Name (Optional):
Todays date: Day Month Year
If we have follow up questions, may we be in touch?
Yes
No
If it is okay to be in touch, please provide email address:
What city and country do you live in?
Gender:
Male
Female
Age:
Highest Educational Level:

High School

Partial College

Graduated College

Graduate Degree
What is your current occupation?
Code (if this has been provided to you)
1. How long have you been doing TM?

Years Months

2. On average, how often do you meditate?times per week

3. On average, how long do you meditate for each session?

Minutes

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

Experiences related to your state of consciousness

4. While meditating, have you experienced periods of time which are different from ordinary waking
experience often silent and calm without thoughts?
Yes
No
If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

5. Since starting to meditate, have you felt a sense of inner stillness even during times of activity?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously

two points

three points

Experiences related to your state of consciousness

6. Since starting to meditate, have you felt that the real you is somewhat separate from the ups and
downs of your daily life?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

7. Since starting to meditate, have there been times in which you have experienced the world around
you in more vivid, richly colorful, or fine-grained detail?

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Yes
No

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

8. Have you noticed any continuing influence of such vivid experiences in your daily life?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

9. Since starting to meditate, have you noticed any changes in the quality of your sleep or in your
experiences during sleep?
Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

10. Since starting to meditate, do you feel you have become more mindful of your own inner
experiences or of the world around you?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

11. Since starting to meditate, have you noticed any change in your level of well-being?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

12. Since starting to meditate, have you noticed that you feel less upset by, or recover faster from,
unpleasant or negative experiences?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

13. Since starting to meditate, have you noticed any change in your reactions to pleasant or positive
experiences?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

14. Since starting to meditate, have you noticed that you dont get as overly attached to things -- or
emotionally overinvolved in things as you did before?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

15. Since starting to meditate, do you feel you are more fully present in your day-to-day life, more in
the moment, or more engaged?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

16. Since starting to meditate, when you have been involved in specific activities, have you felt more
completely engaged and focused, in the zone or in a state of flow?
Yes
No
If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

17. Since starting to meditate, have you been less afraid of death?

Yes
No
Please feel free to describe.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

18. Since starting to meditate, have your ideas about the possibility of life after death
changed in any way?

Yes
No

Please feel free to describe.

19. Since starting to meditate, do you feel more content with who you are and what you have?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

20. Since starting to meditate, do you feel more empowered to be your authentic self?

Yes
No
If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

21. Since starting to meditate, have you noticed any improvement in your work or other endeavors?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

22. Since starting to meditate, is it easier to get things done?

Yes
No
If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

23. Since starting to meditate, have you noticed changes in your productivity or creativity?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

24. Since starting to meditate, have you made healthier choices in your daily life, e.g., discontinued
bad habits or initiated good habits?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

25. Since starting to meditate, have you noticed changes in your relationships with others?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

26. Since you started to meditate has anyone commented on changes in you?

Yes
No
If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

27. Since starting to meditate, have you noticed any changes in your financial circumstances?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

28. Since starting to meditate, do you feel you have been luckier or that things have gone your way
more than before without your having to put any extra effort into them?

Yes
No

If yes, how frequently? (Please refer to above frequency scale)

Please feel free to describe these experiences.

29. Since starting to meditate, have you felt a greater connection with your community, the world or
even the universe?

Yes
No

If yes, please feel free to describe.

Frequency Scale | please rate the average frequency over the past year

1. Rarely (less than once a year)

2. Infrequently (+/- once a year)
3. Occasionally (few times a year)
4. Sometimes (+/- once a month)

5. Regularly (+/- once a week)

6. Often (> once a week, <daily)

one point

two points

7. Very often (at least once a day)

8. Almost continuously (most of the day)
9. Continuously
three points

30. Since starting to meditate, if you have noticed positive changes in yourself or your life, have these
changes continued to grow over time? For example, have they become more frequent or continuous the longer you have meditated?

Yes
No

If yes, please feel free to describe.

31. Since starting to meditate, have you had any kind of peak or heightened experience of consciousness not covered in the rest of the questionnaire?

If you have, please share it here:

Yes
No