Questionnaire for Video Games and Consciousness Study:
Part 1. Demographic Information
Part 2: Video Games Habits/Experiences
Part 3. Dream and Related Phenomena Habits/Experiences
Part 4: Sleep and Waking Experiences
Part 1. Demographic Information
1. Sex:
a. Male
b. Female
2. Age:
a. less than 16 years old
b. 16 to 19 years old
c. 20 to 29 years old
d. 30 to 39 years old
e. 40 to 49 years old
f. 50 to 59 years old
g. 60 to 69 years old
h. 70 to 79 years old
i. 80 or older
3. Primary Relationship Status:
a. Married
b. Divorced/Separated
c. Widow(er)
d. Engaged
e. Living With
f. Have a boy/girl friend but relationship does not fit in one of
above categories
g. Single (currently not in a relationship)
4. Number of children:
a. none
b. one
c. two
d. three
e. four
f. five
g. six or more
5. Education:
a. did not/have not completed high school
b. high school diploma
c. some technical training/two year diploma
d. in first two years of college/university
e. in last two years of college
f. finished a college/university degree
g. some graduate study/currently enrolled
h. craftsman/craftswoman
i. masters degree
j. doctoral degree
k. professional degree
6. Occupation: __________________
7. Primary Ethnic Background: _______________________
Part 2: Video Games Habits/Experiences
1. How many days in a week do you typically play video games?
a. less than once a week
b. one
c. two
d. three
e. four
f. five
g. six
h. seven
2. If you typically play less than once a week, please estimate the frequency of your play per month; otherwise go on to question #4?
a. less than once a month
b. once a month
c. twice a month
d. three times a month
3. If you typically play less than once a month, please estimate the frequency of your play per year, or go on to question #4?
a. less than once a year or never
b. one to three times a year
c. four to six times a year
d. seven to nine times a year
e. ten or 11 times a year
4. How long is your typical playing session?
a. less than 15 minutes
b. greater than 15 minutes but less than an hour
c. one to two hours
d. two to four hours
e. four to six hours
f. six to eight hours
g. eight to 10 hours
h. over 10 hours
5. Please list your five favorite games? _______________________
6. Which setting do you most typically play in?
a. arcade
b. home
c. friends house
d. computers in an internet cafe/gaming store
e. other ______________
7. Who do you typically play with?
a. alone
b. alone but on the net or by modem with others
c. with a friend near by who may or may not be playing but is involved in the activity to some extent
8. How many different video games in any formats have you played to date?
a. none
b. one
c. two - five
d. six to ten
e. ten to 20
f. 20 to 50
g. 50 to 100
h. over 100
9. How old were you when you played your first video game?
a. before kindergarten
b. kindergarten to grade 1
c. grade 2 to grade 4
d. grade 5 to grade 6
e. junior high school
f. high school
g. young adulthood/post secondary school
h. middle adulthood (30 to 50 years old)
i. late adulthood (over 50)
j. never played a video game
10. How old were you when you hit your peak frequency of video game play?
a. before kindergarten
b. kindergarten to grade 1
c. grade 2 to grade 4
d. grade 5 to grade 6
e. junior high school
f. high school
g. young adulthood/post secondary school
h. middle adulthood (30 to 50 years old)
i. late adulthood (over 50)
j. never played a video game
Part 3. Dream and Related Phenomena Habits/Experiences
1. How many dreams do you recall on the average per MONTH?
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70 per month
2. Have you ever kept a dream diary/journal?
a. yes
b. no
3. If yes, for how long?
a. less than a year
b. between 1 and 2 years
c. between 2 and 5 years
d. between 5 and 10 years
e. over 10 years
4. Check one of the following regarding your experience with and interest
in prayer.
a. no experience, no interest
b. no experience, moderate interest
c. no experience, very interested
d. some experience, no interest
e. some experience, moderate interest
f. some experience, very interested
g. currently regularly praying
5. Check one of the following regarding your experience with and interest
in meditation.
a. no experience, no interest
b. no experience, moderate interest
c. no experience, very interested
d. some experience, no interest
e. some experience, moderate interest
f. some experience, very interested
g. currently regularly meditating
6. How important is religion/spirituality in your life?
a. very important
b. moderately important
c. mildly important
d. not at all important
Part 4: Sleep and Waking Experiences
For the remainder of this part of the assignment you will be told about a variety of experiences of consciousness during sleeping and waking. You will be asked to estimate how frequently you have had them, when your first experience occurred and then to give an illustration of each experience. If you are unsure, just give your best estimate.
SLEEP EXPERIENCE 1: Most of us don't realize that we are dreaming until we wake up. Some people, however, do realize that they are dreaming while still in the dream. You might, for example, dream that you are visiting a home of a friend. Suddenly the dream becomes "lucid" and you are aware of the fact that you are dreaming while you are still in the dream. You do not wake up, but attend to your surroundings with curiosity. You may be able to exert some control over what happens in the dream such as changing the setting or deciding to fly or make a scene disappear.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of a lucid dream:
SLEEP EXPERIENCE 2: A nightmare which is bizarre, irrational and disturbing that you can recall clearly and in detail upon awakening. Negative emotions are associated with this experience.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of a nightmare:
SLEEP EXPERIENCE 3: An experience at night where you awake in a state of panic, without recall of a dream or the memory of having awakened. This is most likely to occur in the first hour or two of the night and is called a night terror.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of a night terror:
SLEEP EXPERIENCE 4: Occasionally people have dreams that carry a sense of importance, awe and fascination. They may be reminiscent of mythology, or fairy tales, or be felt to have a religious/spiritual significance. This type of dream may still be remembered years later. Such dreams can carry with them a deep sense of significance to one's life either on a personal level and/or on a broader level.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of this type of dream:
WAKE EXPERIENCE 1: Occasionally people may experience a sense of being above their body and looking down on it from a different vantage point. This experience could be fleeting, or it could continue for some time and has been called an "out-of-body" experience.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of an out-of-body experience:
WAKE EXPERIENCE 2: During waking you may experience a sense of oneness and unity in all things, along with experiences of awe, bliss, and/or wonder. Sometimes this involves a sensation of melting or fusing with one's surroundings, feelings of being overwhelmed by a sense of love or compassion. Some of these experiences can be very hard to put into words.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of this experience:
WAKE EXPERIENCE 3: During waking you may experience knowledge of someone else's thought or actions at a distance. You have no possible rational explanation for how this is possible, or precognition: that is, knowing what will happen in the future but with no possible basis in ordinary anticipating. This might include seeing unusual phenomena, which other people may not be able to see.
Total number of such experiences in the last year:
a. less than 1
b. between 1 and 2
c. between 2 and 4
d. between 4 and 10
e. between 10 and 20
f. between 20 and 35
g. between 35 and 70
h. more than 70
Age of first experience _____ years old.
Please give an example below of this experience:
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