I find myself listening to someone with one ear, doing something else at the same time. 1 2 3 4 5 6 1 2 3 4 5 6 Almost Always Very Frequently Somewhat Frequently. Somewhat Infrequently Very Infrequently Almost Never I drive places on 'automatic pilot' and then wonder why I went there. I find myself preoccupied with the future or the past. I find myself doing things without paying attention. I snack without being aware that I'm eating. 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 Instructions: Below is a collection of statements about your everyday experience. Using the 1-6 scale below, please indicate how frequently or infrequently you currently have each experience. Please answer according to what really reflects your experience rather than what you think your experience should be. Please treat each item separately from every other item. | 1 2 3 5 6 Almost Always Very Frequently Somewhat Exequently. Somewhat Infrequently Very Almost Infrequently Never I could be experiencing some emotion and not be conscious of it until some time later. I break or spill things because of carelessness, not paying attention, or thinking of something else. I find it difficult to stay focused on what's happening in the present 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 I tend to walk quickly to get where I'm going without paying attention to what I experience along the way. 1 2 3 4 5 I tend not to notice feelings of physical tension or discomfort until they really grab my attention. 1 2 3 4 5 I forget a person's name almost as soon as I've been told it for the first time. 1 2 3 4 5 19 6 It seems I am "running on automatic," without much awareness of what I'm doing. 1 2 3 4 5 6 I rush through activities without being really attentive to them. 1 2 3 4 10 5 6 I get so focused on the goal I want to achieve that I lose touch with what I'm doing right now to get there. 1 2 3 4 5 I do jobs or tasks automatically, without being aware of what I'm doing. 1 2 3 4 5 6 (modified) Mindfulness Adherence Questionnaire (MAO) Directions: Please give the response that best answers each of the following questions. 1. Over the past 7 days, how often have you performed a body scan? 2. 3. 4. 5. 6. 7. 8. Over the past 7 days, how often have you practiced sitting or lying meditation? Over the past 7 days, how often do you feel you have "lived in the moment" or been focused on the present? Over the past 7 days, how often have you been mindful in your interactions with other people? Over the past 7 days, how often have you practiced a mindful exercise, such as yoga, mindful walking, or chi- gong? Over the past 7 days, how often have you been aware of your breathing? Over the past 7 days, how often have you been mindful during routine activities, such as walking, driving, or eating? Over the past 7 days, how often have you given yourself or others "loving kindness?" Never About once per week 2 or 3 times per week 4 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 2 or 3 times per week 14 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 2 or 3 times per week 4 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 12 or 3 times per week 14 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 2 or 3 times per week 4 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 2 or 3 times per week 4 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 2 or 3 times per week 4 or 5 times per week 16 or 7 times per week More than 7 times per week Never About once per week 2 or 3 times per week 4 or 5 times per week 6 or 7 times per week More than 7 times per week CONTINUE ON THE NEXT PAGE!! When meditating, how much of the time was your attention focused on what you intended to focus on (body, breath, sounds, etc.)? (never)[ 1 2 3 4 5 6 7 (always) When meditating, how much of the time were you noticing when you were getting distracted? When meditating, how much of the time were you practicing an accepting attitude toward what you were experiencing? (never)| 2 3 4 5 6 7 (always) (never) 2 3 4 5 6 7 (always) (never) [ When meditating, how much of the time were you practicing being gentle and compassionate toward yourself? In your daily life, how much of the time were you practicing paying attention to everyday activities (e.g., eating, walking, chores, communicating etc.)? In your daily life, how much of the time were you practicing paying attention while working or studying? 34567 (always) | (never) 1 2 3 4 5 6 7 (always) (never) 2 3 4.5 67 (always) In your daily life, how much of the time were you practicing bringing your attention back to what you were doing when it wandered off? (never) 2 3 4 5 6 7 (always) In your daily life, how much of the time were you practicing being aware of your thoughts, emotions and reactions? (never) [ 3 4 5 657 (always) In your daily life, how much of the time were you practicing bringing an accepting attitude towards what you were experience? (never) 2 3 4 5 6 7 (always) In your daily life, how much of the time were you practicing being gentle and compassionate toward yourself? On a scale from 0 to10, with zero being not important at all and ten being most important, how important is it for you to engage in mindfulness meditation practices for at least 4.5 hours per week? (never) 1 2 3 4 5 6 7 (always) 4 5 89 10 On a scale from 0 to10, with zero being not confident at all and ten being most confident, how confident are you that you will engage in mindfulness meditation practices for at least 4.5 hours per week? 12 45 9 10 Adapted from: XanWormer, J.J., & Pronk, N.P. (2009). Rewarding change: principles for implementing worksite-level incentive programs. In N.P. Pronk NP (Ed), ACSM'S worksite heath handbook: Healthy worker, healthy company (2nd ed.). Champaign, IL: Human Kinetics.