University of Virginia Division of Perceptual Stud

University of Virginia Division of Perceptual Studies Unusual Experience Study Questionnaire

Informed Consent Agreement

Please read this consent agreement carefully before you decide to participate in the study.

Purpose of the research study: The purpose of the study is to learn more about near-death experiences and their aftereffects.

What you will do in the study: You will be asked to complete questionnaires describing your experience and its effects, if any. These questionnaires will be mailed or e-mailed to you, and you may complete them in your home at your convenience. We may also wish to interview you in person to learn more about your experience and its effects. If that is the case, we will contact you to arrange a time and place that are convenient for you, and, if you agree, we may audiotape the interview.

Time required: The preliminary questionnaire usually takes between 30 and 60 minutes to complete, depending on how extensive your experience was and what you are able to recall of it. Depending on your responses to this questionnaire, we may send you further questionnaires from time to time, which would be of comparable length. If we should decide to interview you in person about your experience, that interview may also take about an hour.

Risks: There are no expected risks to your participation in this study.

Benefits: There are no direct benefits to you for participating in this research study. The study may help us understand near-death experiences and their effects on people’s lives.

Confidentiality: The information that you give in the study will be handled confidentially. Your information will be assigned a code number. The list connecting your name to this code will be kept in a locked file. When the study is completed and the data have been analyzed, this list will be destroyed. Your name will not be used in any report. If we audiotape an interview with you, we will erase the tape as soon as we have used it to make an accurate written account of the interview (usually within a month of the interview).

Voluntary participation: Your participation in the study is completely voluntary.

Right to withdraw from the study: You have the right to withdraw from the study at any time without penalty. If you do withdraw from the study, the information you have given us, including the audiotape if one was made, will be destroyed.

How to withdraw from the study: If you want to withdraw from the study, just tell us you no longer wish to participate. There is no penalty for withdrawing.

Payment: You will receive no payment for participating in the study.

If you have questions about the study, contact: Dr. Bruce Greyson, Division of Perceptual Studies, University of Virginia Health System, P.O. Box 800152, Charlottesville, VA 22908-0152. Phone: (434) 924-2281.

If you have questions about your rights in the study, contact:
Tonya R. Moon, Ph.D., Chair, Institutional Review Board for the Social and Behavioral Sciences, One Morton Drive Suite 500, University of Virginia, P.O. Box 800392, Charlottesville, VA 22908-0392; telephone: (434) 924-5999; e-mail: [email protected]; website: www.virginia.edu/vprgs/irb

I Agree

This is a questionnaire about near-death experiences, which are unusual experiences that may occur during a frightening or dangerous situation, such as being near death. Some of the questions may not apply to your experience. Do not be concerned about that. Just skip those questions.

In many places we ask you to be specific and we hope that you can be, because details are important. However, if you do not remember some item of information exactly, write whatever you do remember.

All information obtained from this questionnaire will remain completely confidential and no publication of the results of this study will contain information that could identify participants in any way.

Please use additional pages if we have not provided enough space for your answer to any question.

Background

* 1. Name:

* 2. Date questionnaire completed:

* 3. Date of birth:

4. Time of birth (and specify am or pm):

5. Place of birth:

* 6. Sex

Male

Female

* 7. Marital status now:

Single

Married or living with partner

Separated or divorced

Widowed

* 8. Marital status at time of NDE:

Single

Married or living with partner

Separated or divorced

Widowed

9. Race:

10. Cultural roots (family origin):

11. What is the highest level of education that you have completed?

12. What was the highest level of education you had completed at the time of your NDE?

13. What was your occupation at the time of your NDE?

14. What is your present occupation?

Circumstances Before and During Your NDE

15 a. What date did your NDE occur on? Please be as specific as possible.

15 b. What time did your NDE occur? Please be as specific as possible.

16. In what state or country did your NDE occur?

17. Where did your NDE occur? Please be as specific as possible (for example, in a hospital, at home, in some other building, outdoors, in a vehicle, etc.):

18. What was your age at the time?

19. How would you describe your health just prior to your NDE?

excellent health

moderately good health, no serious problems

experienced a serious health problem within 1 year before the NDE

seriously ill at the time of the NDE

20 a. Was your NDE associated with an illness?

Yes

20 b. what was your diagnosis?

20 c. How long did this illness last?

20 d. How severe was your illness?

20 e. Please describe any complications:

21 a. Was your NDE associated with a surgical operation?

Yes

21 b. If so, what kind of operation did you have and what was the reason for it?

21 c. How long did the operation last?

21 d. Please describe the type of anesthesia used (for example, gas, spinal, injection, local):

21 e. Please describe any complications:

22 a. Was your NDE associated with childbirth?

Yes

22 b. If so, please describe any anesthesia or pain medication used:

22 c. Please describe any complications that occurred:

23 a. Was your NDE associated with an accident, such as a vehicular accident, a near-drowning, or a fall?

Yes

23 b. Please describe the accident and how it happened:

24 a. Was your NDE associated with a suicide attempt?

Yes

24 b. If so, please describe the means (type of drug or weapon) and severity of your attempt:

25 a. Was your NDE associated with intentional wounding by someone else?

Yes

25 b. If so, please describe the means and circumstances, and the severity of your injury:

26 a. Was your NDE associated with an allergic or drug reaction?

Yes

26 b. If so, please describe the allergen or drug involved:

27 a. Was your NDE associated with any circumstances or causes not mentioned above?

Yes

27 b. If so, please describe the circumstances or possible cause:

28 a. Was your NDE associated with no particular illness or injury?

Yes

28 b. If so, please describe the circumstances (for example, sleep, lying in bed awake, unusual stress, ingestion of recreational drugs, etc.):

29. How suddenly did your NDE occur after the onset of the illness, injury, or condition that caused it?

within 5 minutes of the onset of the condition

within 1 hour of the onset of the condition

within 24 hours of the onset of the condition

more than 24 hours after the onset of the condition

no known condition caused my NDE

30. At the present time, how severe do you think your condition was at the time of your NDE?

ill or injured, but not seriously

seriously ill or injured, but not near death

near death, but not in crisis and did not lose vital signs

lost vital signs or considered dead

no illness or injury involved

fear of injury or dying (for example, in near-accident)

31. Did you lose consciousness during your NDE (or did it appear to others that you had)?

Yes

32. If you lost consciousness or appeared to be unconscious, for how long did that last?

up to 10 seconds

longer than 10 seconds, up to 1 hour

longer than 1 hour, up to 6 hours

longer than 6 hours, up to 24 hours

longer than 24 hours

unknown

33. If you lost consciousness or appeared to be unconscious, what was the cause?

34. If you lost consciousness or appeared to be unconscious, how suddenly did that occur?

slowly

moderately suddenly

very suddenly

35. If your loss of consciousness was not distinct (for example, you drifted in and out of consciousness), please describe your experience of loss of consciousness:

36. What was the position of your body at the start of your NDE?

37 a. Were any medical personnel present during your NDE?

Yes

37 b. If so, please list their names:

38 a. Were any other individuals (for example, relatives, friends, clergy) present during your NDE?

Yes

38 b. If so, please list their names:

39 a. Please indicate if you took any of the following substances within 24 hours prior to your experience - alcohol (type and amount):

39 b. Please indicate if you took any of the following substances within 24 hours prior to your experience - hallucinogenic drugs (type and dose):

39 c. Please indicate if you took any of the following substances within 24 hours prior to your experience - prescription drugs (type and dose):

39 d. Please indicate if you took any of the following substances within 24 hours prior to your experience - non-prescription drugs such as cold or allergy medications (type and dose):

39 e. Please indicate if you took any of the following substances within 24 hours prior to your experience - pain-killers (type and dose):

39 f. Please indicate if you took any of the following substances within 24 hours prior to your experience - sedatives or tranquilizers (type and dose):

39 g. Please indicate if you took any of the following substances within 24 hours prior to your experience - stimulants (such as coffee and tea)(type and amount):

39 h. Please indicate if you took any of the following substances within 24 hours prior to your experience - other (please specify type and dose):

40. Please describe any other medical circumstances associated with your NDE that have not already been described above:

Features of the NDE

"Out-of-Body" Experience

41. Did you feel separated from your physical body during your NDE?

Yes

The following 26 questions are about an “out-of-body” experience. If you answered “Yes” to question 41, please answer questions 42 through 67. If you answered “No,” please skip these questions and go on to question 68.

42 a. What was your relationship to your physical body during your NDE?

I saw my body from another position

I felt “out of body” with a sense of being in a nonphysical body, but did not see my physical body

I felt “out of body” with no sense of being in any kind of body, but only a sense of consciousness

Other

42 b. I saw my body from another position (please specify):

43. Did you feel yourself leave your physical body?

Yes

44. How easy was it to leave your physical body?

easy or painless

mildly difficult or uncomfortable

very difficult or painful

I do not remember

Other

45. How rapidly did you leave your physical body?

46. What made you leave your physical body?

wanted to leave

something external pulled me out

someone pulled me out

forced out by a change in my physical body

unknown

Other

47 a. Do you recall a specific exit route by which you left your physical body?

Yes

47 b. If so, please describe that exit route:

48. Did you move from place to place without your physical body?

Yes

49. If you did move without your physical body, how fast was that movement?

50. If you did move without your physical body, please describe the type of movement you experienced (for example, floating, drifting, instantaneous, purposeful, etc.):

51. What caused you to move without your physical body?

moved at will

moved by some external force

unknown

Other

52. How far did you seem to travel from your physical body?

stayed within several yards (for example, in the same room)

beyond several yards (for example, into another room)

to a distant location (for example, to another building or town)

to some location that did not seem to be on our familiar Earth

Other

53. What effect (if any) did you exert on physical objects while you were out of your body?

unusual effect (for example, I could pass through walls)

normal effect (for example, I could pick up and move objects)

I don't remember or did not try

Other

54. What effect did you exert on people physically present while you were out of your body?

none (for example, they could not see or hear you)

normal (for example, they saw and heard you as usual)

I don't remember or did not try

Other

55. What effect did others who were physically present have on you while you were out of body?

no effect (for example, I could not see or hear them)

normal (for example, I saw and heard them as usual)

unknown

Other

56. How easy was it to return to your physical body?

easy or painless

mildly difficult or uncomfortable

very difficult or painful

I don’t remember

Other

57. How rapidly did you return to your physical body?

58. Please describe any additional details that you remember about leaving your physical body:

59. Did you seem to have another, nonphysical body while you were out of your physical body?

Yes

60. How was your nonphysical body clothed?

not clothed at all

wearing the same things as my physical body

wearing different, but ordinary, clothing

unknown

wearing unusual clothing (please specify)

61. How heavy did your nonphysical body feel?

heavier than physical body

same weight as physical body

lighter than physical body

unknown

Other

62. How large was your nonphysical body?

larger than physical body

same size as physical body

smaller than physical body

unknown

Other

63. What age did your nonphysical body seem to be?

64. What signs of “life” did your nonphysical body seem to have?

heartbeat or pulse, breathing

none

unknown

Other

65 a. If your physical body has any “defects,” such as scars, deformities, needing eyeglasses, or needing hearing aids, were these “defects” also present in your nonphysical body?

nonphysical body had “defects” that are present in physical body

nonphysical body had “defects” that are not present in physical body

nonphysical body did not have “defects” that are present in physical body

neither physical nor nonphysical body had any “defects”

unknown

65 b. Please describe any “defects” that were present or absent in your nonphysical body:

66 a. Did you notice any other differences between your physical body and your nonphysical body?

Yes

66 b. If so, please describe any other differences you noticed:

67 a. Did you notice any connection or “link” between your physical body and your nonphysical body?

Yes

67 b. If so, please describe that connection or “link”:

Experience of Light

68. During your NDE, did you see a light?

Yes

The following 9 questions are about an experience of light. If you answered “Yes” to question 68, please answer questions 69 through 77. If you answered “No,” please skip these questions and go on to question 78.

69. Which of the following best describes the intensity of the light you experienced?

70. Did the light change in intensity?

lessened in intensity

stayed the same

grew in intensity

other change in intensity (please describe):

71. Was the light that you experienced localized?

the light was not localized; it was everywhere

the light was localized, close

the light was localized, far away

Other

72. Did you experience a movement of the light?

the light moved toward me

the light moved away from me

I felt compelled to move toward the light

I moved toward the light voluntarily

I moved away from the light

no movement experienced

other, or combination of the above (please specify):

73. If you experienced a movement of the light, how would you describe its speed?

74. Did you enter the light, or merge with it, or become one with it?

Yes

75. Which of the following best describes the shape of the light?

76. Please check any of the following that you associate with your experience of the light:

77. Please describe any other details, including your feelings, that you associate with your experience of light:

Tunnel or Darkness

78 a. Did you experience a tunnel or dark void during your NDE?

Yes

78 b. If so, please describe it:

79. If you did experience a tunnel or dark void, did you enter it?

I saw a tunnel or dark void but did not enter it

I saw a tunnel or dark void and entered it voluntarily

I saw a tunnel or dark void and entered it involuntarily

Other

80. If you did experience a tunnel or dark void, please describe any movement you experienced toward, away from, or through it. Include the position of your body, the speed of your movement, and the relationship of the tunnel or dark void to any other feature of your NDE:

Experience of Other Persons or Beings

81. During your NDE, did you meet, see, hear, or become aware of any persons or beings who were not physically present?

Yes

The following 10 questions are about persons or beings you met during your NDE. If you answered “Yes” to question 81, please answer questions 82 through 91. If you answered “No,” please skip these questions and go on to question 92.

82 a. Did you meet or become aware of a deceased person?

Yes

82 b. If so, how many deceased persons did you meet or become aware of?

82 c. If you met or became aware of more than one deceased person, did they all appear together?

Yes

82 d. If you met or became aware of more than one deceased person, did they know each other while they were alive?

they all had known each other while alive

some of them had known each other while alive

they had not known each other while alive

unknown

83. Were there deceased loved ones whom you might have seen, but did not?

Yes

84 a. Did you meet or become aware of a person who was still living?

Yes

84 b. If so, how many living persons did you meet or become aware of?

85. Did you meet or become aware of a “Being of Light”?

Yes

86. Did you meet or become aware of a religious figure, such as God, Jesus, a saint, or a guide?

Yes

87. Did you meet or become aware of someone you could not identify?

Yes

88. Did you sense the presence of someone whom you could not see?

yes, someone I could not identify

yes, someone I could identify (please specify whom):

89. Did any of these persons or beings whom you met communicate with you?

90. Did any of these persons or beings whom you met seem to have some purpose toward you?

to welcome me, or beckon me on, or ask me to join them

to guide or help me

to express love or reassurance

to judge me

to send me back or tell me that my time had not yet come

unknown

Other

91. Please describe in detail who the persons you met were, what they looked like (appearance, clothing), how you recognized them, and what happened when you met:

Other Realms or Visions

92 a. Did you find yourself in any “other realm,” or a place different from the surroundings of your physical body?

Yes

92 b. If so, please describe this other realm or place:

93 a. If so, which of the following best describes that “other realm”?

93 b. other recognizable place (please specify):

94 a. Did you experience any other vision of a different place, realm, or dimension?

Yes

94 b. If so, please describe your vision:

95 a. Did you experience a “border” or “point of no return,” or some barrier that you could not pass?

Yes

95 b. If so, please describe it, including what prevented you from crossing it and what you think would have happened it you had crossed it:

Judgment

96. Did you have some kind of experience of being judged or held accountable for your life?

yes, I judged myself

yes, some deceased person judged me

yes, some unseen presence judged me

yes, the “Being of Light” judged me

yes, some religious figure judged me (such as God or Jesus)

unknown

no experience of being judged or held accountable

yes, some other being judged me (please specify):

97. If you were judged, what was the result of the judgment?

positive or favorable

negative or unfavorable

mixed positive and negative

I was told it was not time to be judged

I was judged but not told the result

no experience of being judged or held accountable

Other

Sensations

98. How clear was your sense of vision during your NDE?

99. How bright did your field of vision seem?

100. Was your perception of color different from the way it usually is?

colors were more vivid than usual

colors were the same as usual

colors were less vivid than usual

unknown

colors were changed in some other way (please describe):

101. Please describe any other changes in your sense of vision, or any unusual visual experiences you had, during your NDE:

102. How clear was your sense of hearing during your NDE?

103. How loud did sounds seems to be in your NDE?

104 a. Did you hear any voices speaking during your NDE?

yes, I heard voices coming from people not physically present

yes, but I could not tell where they were coming from

yes, I heard voices of people physically present or near my body

yes, I heard more than one of the above

no, I did not hear any voices speaking

104 b. If you heard voices speaking, please describe what you heard:

105 a. Did you hear any music or singing during your NDE?

Yes

105 b. If so, please describe what you heard:

106. Please describe any other changes in your sense of hearing, or any unusual sounds, that you recall from your NDE:

107 a. Did you experience any unusual odors or changes in your sense of smell?

Yes

107 b. If so, please describe:

108 a. Did you experience any unusual tastes or changes in your sense of taste?

Yes

108 b. If so, please describe:

109. Did you experience a change in the amount of physical pain you felt during your NDE?

increase in the amount of physical pain

no change in the amount of physical pain

decrease in the amount of physical pain

complete disappearance of physical pain

I don’t remember

I had no pain before or during my NDE

110. If the amount of physical pain you felt changed, how rapid was that change?

gradual

sudden

I don’t remember

111 a. Did you experience any unusual “physical” feelings, or changes in your senses of touch, temperature, or other bodily sensations?

Yes

111 b. If so, please describe:

112 a. Did any of your senses change during the NDE itself, for example, fluctuations in the clarity of your vision?

Yes

112 b. If so, please describe:

113. How rapidly did time seem to pass during your NDE?

faster than usual

the same as usual

slower than usual

I had a feeling of timelessness, or time became meaningless or ceased to exist

Other

114. How long did your NDE seem to you to last?

up to 10 seconds

longer than 10 seconds, up to 1 hour

longer than 1 hour, up to 6 hours

longer than 6 hours, up to 24 hours

longer than 24 hours

it seemed to last forever or was timeless

unknown

Other duration (please specify):

115. How long did your NDE actually last in physical time?

up to 10 seconds

longer than 10 seconds, up to 1 hour

longer than 1 hour, up to 6 hours

longer than 6 hours, up to 24 hours

longer than 24 hours

unknown

Other

Thinking

116. How clear was your thinking during your NDE?

117: How rapid was your thinking during your NDE?

faster than usual

as fast as usual

slower than usual

unknown

118. How would your describe your train of thought during your NDE, the connection between one thought and the next?

sequence of thoughts was more logical than usual

sequence of thoughts was as logical as usual

sequence of thoughts was less logical than usual

unknown

Other (please describe):

119. How much control did you seem to have over your thoughts?

more control than usual

as much control as usual

less control than usual

no control at all over my thoughts

unknown

Other (please decribe):

120. Did your thoughts contain

a mixture of words and images more or less as usual

much more words and much fewer images than usual

much more images and much fewer words than usual

no words, but only images, impressions, and feelings

any other difference from my usual thoughts (please describe):

121. Did you suddenly seem to understand things, for example, about the universe?

Yes

122 a. Where did your center of consciousness - that is, the place where your thinking was going on - seem to be during your NDE?

in my physical body

in a nonphysical body

in some other particular place

traveling around

everywhere at once

unknown

Other (please describe):

122 b. in some other particular place (please specify):

123. What were you thinking about most during your NDE?

124 a. During your NDE, did you have any apparent extrasensory perception (ESP), for example, hearing a conversation or seeing events going on at some place far from your physical body?

Yes

124 b. If so, please describe what you perceived:

124 c. Did you later learn than those events really had happened just as you perceived them?

Yes

124 d. Did you tell anyone else about this ESP experience soon after you had it?

Yes

124 e. If so, whom did you tell?

125 a. During your NDE, did you become aware of events that would occur in the future?

Yes

125 b. If so, please describe what you became aware of:

126 a. Did anyone else tell you that they had an ESP experience about you during your NDE?

Yes

126 b. If so, please describe who, and what he or she experienced:

127. Did any memories of your life come back to you during your NDE?

yes, one memory or a few memories

yes, many memories

yes, my whole life came back to me

128 a. Did you experience any memories that seemed to be from a previous lifetime?

Yes

128 b. If so, please describe them:

Emotions

129. Please choose on each line whether you felt the following ways during your NDE:

extremely

somewhat

not at all

happy

sad

one with everything

lonely or isolated

free or unburdened

guilty or burdened

joyful

depressed

excited or energetic

tired or lethargic

extremely

somewhat

not at all

curious or interested

indifferent or detached

pleased or content

angry or irritated

peaceful, calm, or relaxed

anxious or tense

hopeful or optimistic

despairing or pessimistic

confident or assured

afraid or uncertain

extremely

somewhat

not at all

proud

ashamed

loving or caring

hateful or uncaring

any other positive emotion

any other negative emotion

130. What was the overall emotional tone of your NDE?

131. Did your NDE change in emotional tone?

yes, from negative or frightening to positive

yes, from positive to negative or frightening

mixed, back and forth

132. Please describe any other emotions you felt during your NDE:

Ending of NDE

133. During your NDE, what did you think was gong to happen to you?

I knew I would return to life

I thought I would return to life

I thought I would go into some other realm, dimension, or condition

I thought I would simply stop existing

I had no ideas about my future

I don’t remember now what I thought at the time

other thoughts about your future (please describe):

134. Why did it seem to you at the time that your NDE ended?

I wanted to return

I did not want to return, but nevertheless made the choice to do so

I was sent back by a deceased person

I was sent back by a religious figure or Being of Light

I was sent back by an unknown person

I was sent back by an unknown force

unknown

other (please specify):

135. Did you think about loved ones just prior to returning?

Yes

136. So far as you know, how did your NDE end?

spontaneously

as a result of medical intervention

unknown

Other (please specify):

137. Did you feel fear just prior to returning?

very afraid

somewhat afraid

no fear

138. Please describe any other aspects you can recall about the ending of your NDE, including any feature of your NDE that seemed to bring it to an end:

139. Please describe any other features of your NDE not mentioned above:

Memory of Your NDE

140. Did you remember your NDE immediately upon regaining normal consciousness?

Yes

141. If you did not remember your NDE immediately upon regaining consciousness, when did you first remember it?

142. If you did not remember your NDE immediately upon regaining consciousness, how did the memory of your NDE return?

spontaneously and suddenly

spontaneously and gradually

after deliberate attempt to remember it, and suddenly

after deliberate attempt to remember it, and gradually

143. If you did not remember your NDE immediately upon regaining consciousness, how much time elapsed between your NDE and your first memory of it?

144. If you did not remember your NDE immediately upon regaining consciousness, please describe the circumstances that led to your first memory of your NDE:

145. How does the memory of your NDE compare to memories of other events in your life?

memory of NDE is clearer or more vivid than memories of other events

memory of NDE is just as clear and vivid as memories of other events

memory of NDE is not as clear or vivid as memories of other events

146. Do you often think about your NDE?

yes, often

yes, occasionally

only rarely or not at all

147. Please describe any other aspects of your memory of your NDE that are not mentioned above:

Psychological Factors Prior to NDE

148. Overall, would you say that you had a happy childhood?

Yes

149. Had you ever abused alcohol or drugs before your NDE?

Yes

150. Had you ever had psychiatric or psychological counseling before your NDE?

Yes

151. In what religious tradition were you raised?

152. What was your religious preference at the time of your experience?

153. Just prior to your NDE, how often were you attending religious services?

154 a. Were you under any unusual stress, or undergoing significant life changes, at the time of your NDE?

Yes

154 b. If so, please describe:

155. Just before your NDE, did you think or fear that you might die?

Yes

156. Just before your NDE, how serious did you think your medical condition was?

I was not aware of any illness or injury

I thought I had a mild illness or injury

I thought I faced the threat of illness or injury

I thought I had a serious illness or injury

I thought I was on the brink of death

I thought or feared I was dead

unknown

157. Just before your NDE, how well did you understand your medical condition?

I had no idea what was happening

I knew something was wrong, or about to go wrong, but was not sure what

I understood fairly well what was happening

I understood very well what was happening

158. Just before your NDE, how confused did you feel about your medical condition?

I was not at all confused about what was happening

I was mildly confused about what was happening

I was moderately confused about what was happening

I was very confused about what was happening

I did not think about what was happening to me

159. When did you become aware of the seriousness of your medical condition?

before the NDE began

during the NDE

after the NDE

my condition was not serious

160 a. How did you become aware of the seriousness of your medical condition?

I was told

something I overheard made me think my condition was serious

Some other way (please specify):

160 b. something I overheard made me think my condition was serious (please specify what you heard):

161. Just before your NDE, what was your attitude toward living or dying?

I was trying to die

I wanted to die, but was not actively trying to do so

I did not care whether I lived or died

I did not want to die, but I was not actively fighting to live

I wanted to live, and was actively fighting to do so

Other (please specify):

162. Just before your NDE, did you let go or try to remain in control?

I struggled to remain in control or fought to stay alive

I let go or gave in to what was happening

Other (please specify):

163. What was your mood just before your NDE began?

more positive than usual

more negative than usual

my usual mood

I don’t remember

Other (please specify):

164. How mentally alert were you just before your NDE began?

more alert than usual

less alert than usual

as alert as usual

I don’t remember

Other (please specify):

165 a. Are you aware of any event that seemed to trigger your NDE?

Yes

165 b. If so, please describe that event:

Unusual Experiences Prior to Your NDE

We are interested in learning whether you had ever had any of the following unusual experiences before your NDE. Please check any of the following that apply to you. You may check more than one category. A space will be provided at the end for you to include any more detailed description of your prior unusual experiences. If you can, please note at what age and how often you had the experience:

166 - 187. Check the following that apply to you.

188. Please add any additional comments about any of the above experiences that you had before your NDE, including your age at the time and how often it occurred:

189 a. Before your NDE, had you known anyone else who had had any of the unusual experiences described above?

Yes

189 b. If so, please describe who and what:

190. Before your NDE, how much had you read or heard about NDEs?

a lot

some

very little

none at all

191. Before your NDE, how much had you read or heard about psychical research or parapsychology?

a lot

some

very little

none at all

192. Before your NDE, how much had you read or heard about religious miracles?

a lot

some

very little

none at all

193. Please describe any other psychological factors from the period prior to your NDE that you think might be relevant in any way to your NDE:

Aftereffects of Your NDE

194. Do you believe that your NDE affected how quickly or how fully you recovered from the illness or injury that led to your NDE?

I believe I was completely healed by my NDE

I believe I recovered more quickly or more fully that normal because of my NDE

I believe I recovered more slowly or less fully than normal because of my NDE

I don=t believe my NDE affected my recovery

195 a. Did any medical professionals ever comment on how quickly or slowly you recovered?

Yes

195 b. If so, who commented and what did they say?

196. How would you describe your general state of health at the present time?

excellent

moderately good, with no serious health problem

I experienced a serious health problem within the past year

I have at this time a serious health problem

197. Do you think that your general state of health changed as a result of your NDE?

I think my health has improved because of my NDE

I think my health has deteriorated because of my NDE

198. Do you think that your health habits changed as a result of your NDE?

I think my health habits have improved because of my NDE

I think my health habits have deteriorated because of my NDE

199. What is your present religious preference?

200. Did your religious or spiritual beliefs change as a result of your NDE?

Yes

201. How often do you attend religious services now?

202. Did your private religious or spiritual practices change as a result of your NDE?

Yes

203. How often did you remember your dreams before your NDE?

204. How often do you remember your dreams now?

205. Has your ability to recall dreams changed since your NDE?

I remember more dreams now

I remember fewer dreams now

no change

206. Please describe any other changes in your dreams since your NDE:

207 a. Have you ever had a dream in which you knew, during the dream, that you were dreaming?

Yes

207 b. If so, how often did this occur?

208 a. Have you ever been able to control your dream, or determine your actions in the dream?

Yes

208 b. If so, how often did this occur?

209 a. Have your attitudes or beliefs changed as a result of your NDE?

Yes

209 b. If so, how quickly did those changes occur?

suddenly

gradually

210. Did the NDE change your general disposition (mood, spirits, sense of well-being)?

mood improved

mood deteriorated

no change

mood changed in some other way (please describe):

211. Did your NDE change the way you felt about yourself?

I feel better about myself

I feel worse about myself

no change

other change (please specify):

212. Did your NDE change your relationships with close family and friends?

relationships improved

relationships deteriorated

no change

other change (please specify):

213. Did your NDE change your relationships with people in general (acquaintances, co-workers, strangers)?

relationships improved

relationships deteriorated

no change

other change (please specify):

214. Did your NDE change your substance abuse behavior?

I started or increased substance abuse after my NDE

I stopped or decreased substance abuse after my NDE

no change

other change (please specify):

215. Did your NDE change your general level of serenity (sense of peacefulness, acceptance of the ups and downs of life)?

increased serenity

decreased serenity

no change

216. Did your NDE change your altruistic behavior (for example, giving up your place in line to someone else who seems to be in a hurry, helping those in need, working as a volunteer, or contributing to charitable causes)?

increase in altruistic behavior

decrease in altruistic behavior

no change

217. Did your NDE change your fear of death?

increased fear of death

decreased fear of death

no change

218 a. Did the NDE change your beliefs about survival after death?

Yes

218 b. If so, please specify:

219 a. Did you change your lifestyle or activities as a result of your NDE?

Yes

219 b. If so, please specify:

220 a. Did your NDE play a significant role in a divorce or break-up of a relationship?

Yes

220 b. If so, please specify:

221 a. Did your NDE play a significant role in a change in your job or occupation?

Yes

221 b. If so, please specify:

222. Did you seek counseling after your NDE?

yes, to talk about my NDE

yes, because of changes resulting from my NDE

yes, for reasons not related to my NDE

I was already in counseling at the time of my NDE

223. Has the impact of your NDE on your life changed over time?

impact has increased over time

impact has diminished over time

impact has remained the same over time

If the impact of your NDE has changed over time, how many months or years was it at full strength?

Did your near-death experience change . . .

Questions 224 - 267

Unusual Experiences After Your NDE

We are interested in learning whether you had ever had any of the following unusual experiences after your NDE. Please check any of the following that apply to you. You may check more than one category. A space will be provided at the end for you to include any more detailed description of your prior unusual experiences. If you can, please note at what age and how often you had the experience:

268 - 289. Please check any of the following that apply to you.

290. Please add any additional comments about any of the above experiences that you had after your NDE, including your age at the time and how often it occurred:

291. Has there been a change in the amount of unusual experiences you have had since your NDE?

increase in unusual experiences

decrease in unusual experiences

no change

292. Since your NDE, how much have you read or heard about NDEs, “New Age” thinking, parapsychology, psychical research, or religious miracles?

a lot

some

very little

none at all

293. Please describe any other after-effects of your NDE not mentioned above:

Communication to Others About Your NDE

294. Have you told other people about your NDE (besides us)?

yes, more than 4 people

yes, 1 to 3 people

295. Whom have you told about your NDE? (Check all that apply)

296 a. Who was the first person you told about your NDE?

family member or friend

medical personnel

our staff

Other (please specify):

296 b. family member or friend (please specify):

296 c. medical personnel (please specify):

297. How much time elapsed between your NDE and the first time you told someone else about it?

less than 24 hours

less than 1 month

less than 1 year

longer (please specify):

298. What was the reaction of the first person you told about your NDE?

positive, supportive, or interested

negative, dismissing it as a hallucination, dream, or drug effect

neutral, ignored it

Other (please specify):

299. What has been the reaction of most people with whom you have talked about your NDE?

mostly positive

mostly negative

mixed positive and negative

Other (please specify):

300. Have you felt a need to talk about your NDE?

Yes

301. Have you been afraid to talk about your NDE?

Yes

302. How did you learn about our interest in NDEs?

newspaper, magazine, or popular book

TV or radio

professional book or journal

303. Please describe why you contacted us to share your NDE:

304. Please add any additional comments about your communications with others about your NDE:

305 a. Have you been exposed to scholarly sources of information about psychical, paranormal, or unusual phenomena, such as professional or scientific journals or books?

yes, but only before my NDE

yes, but only after my NDE

yes, both before and after my NDE

305 b. If so, please describe:

306 a. Have you been exposed to popular sources of information about psychical, paranormal, or unusual phenomena, such as television, popular magazines, religious tracts, or “New Age” literature?

yes, but only before my NDE

yes, but only after my NDE

yes, both before and after my NDE

306 b. If so, please describe:

Is there anything else you think we should know about your NDE or its effects on you, or anything you would like to ask us?

NDE Scale

Please choose one number (0, 1, or 2) for each question to indicate which answer comes closest to what you experienced during your NDE:

1. Did time seem to speed up or slow down?

0 = No

1 = Time seemed to go faster or slower than usual

2 = Everything seemed to be happening at once; or time stopped or lost all meaning

2. Were your thoughts speeded up?

0 = No

1 = Faster than usual

2 = Incredibly fast

3. Did scenes from your past come back to you?

0 = No

1 = I remembered many past events

2 = My past flashed before me, out of my control

4. Did you suddenly seem to understand everything?

0 = No

1 = Everything about myself or others

2 = Everything about the universe

5. Did you have a feeling of peace or pleasantness?

0 = No

1 = Relief or calmness

2 = Incredible peace or pleasantness

6. Did you have a feeling of joy?

0 = No

1 = Happiness

2 = Incredible joy

7. Did you feel a sense of harmony or unity with the universe?

0 = No

1 = I felt no longer in conflict with nature

2 = I felt united or one with the world

8. Did you see, or feel surrounded by, a brilliant light?

0 = No

1 = An unusually bright light

2 = A light clearly of mystical or other-worldly origin

9. Were your senses more vivid than usual?

0 = No

1 = More vivid than usual

2 = Incredibly more vivid

10. Did you seem to be aware of things going on elsewhere, as if by ESP?

0 = No

1 = Yes, but the facts have not been checked out

2 = Yes, and the facts have been checked out

11. Did scenes from the future come to you?

0 = No

1 = Scenes from my personal future

2 = Scenes from the world's future

12. Did you feel separated from your body?

0 = No

1 = I lost awareness of my body

2 = I clearly left my body and existed outside it

13. Did you seem to enter some other, unearthly world?

0 = No

1 = Some unfamiliar and strange place

2 = A clearly mystical or unearthly realm

14. Did you seem to encounter a mystical being or presence, or hear an unidentifiable voice?

0 = No

1 = I heard a voice I could not identify

2 = I encountered a definite being, or a voice clearly of mystical or unearthly origin

15. Did you see deceased or religious spirits?

0 = No

1 = I sensed their presence

2 = I actually saw them

16. Did you come to a border or point of no return?

0 = No

1 = I came to a definite conscious decision to "return" to life

2 = I came to a barrier that I was not permitted to cross; or "sent back" against my will.

Please choose the one phrase that most closely describes that part of your NDE:

First part of experience:

totally pleasant

mostly pleasant, partly unpleasant

neither pleasant nor unpleasant

mostly unpleasant, partly pleasant

totally unpleasant

no recollection

Middle part of experience:

totally pleasant

mostly pleasant, partly unpleasant

neither pleasant nor unpleasant

mostly unpleasant, partly pleasant

totally unpleasant

no recollection

Last part of experience:

totally pleasant

mostly pleasant, partly unpleasant

neither pleasant nor unpleasant

mostly unpleasant, partly pleasant

totally unpleasant

no recollection

Entire experience:

totally pleasant

mostly pleasant, partly unpleasant

neither pleasant nor unpleasant

mostly unpleasant, partly pleasant

totally unpleasant

no recollection

Regardless of whether you had a pleasant experience or a frightening one, please check if you sensed at any time during your experience any of the following things. You may check as many items in each section as apply to your experience:

being in a void or empty space

being in outer space, or in the heavens, or in the sky

being in hell or a place of torment

being just outside the entrance to hell or a place of torment (but never going in)

heading toward hell or a place of torment (but never reaching it)

observing others in hell or a place of torment

hearing wails, moans, gnashing of teeth, or sounds of torment

If you checked any of the above, do you think that place was Hell?

Yes

Did you experience:

a terrifying, horrible, or painful separation from your body, or from "normal consciousness"

a terrifying, horrible, or painful return to your body, or to "normal consciousness"

any other terrifying, horrible, or painful incident at any time

Please check as many of the following items that apply to your experience. You may check as many items in each category as apply to your experience. Do you recall, at any time during your experience:

Did you feel that what you were experiencing:

would never end, or would repeat itself forever

was eternity or was forever

Did you try to escape from your situation by any of the following:

fighting, running, or climbing out

trying to get back in control of your situation yourself

arguing, or pleading your case

begging for mercy

praying for help

Were you told during your experience, or have a sense, that:

life was just a game or a joke

you had lost, or were about to lose, all sense of personal identity

you would be completely annihilated or cease to exist

nothing earthly ever existed or was real

you had imagined or hallucinated your entire earthly life

Did you feel the particular kind of experience you had was related to:

your actions or lifestyle up to that time

your religious faith up to that time

your overall set of beliefs and attitudes

a physiological accident

something else about you or your situation

some universal truth not specific to you

chance

Please think back upon your near-death experience and answer the following questions in an honest and sincere way, by marking a number between 1 (totally disagree) and 5 (totally agree).

Please think back upon your near-death experience and answer the following questions in an honest and sincere way, by marking a number between 1 and 7.