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Mind Over Matter Questionnaire Study
Information  sheet and consent form

Welcome to our questionnaire study on mind over matter. We are interested in learning more about the types of experiences that people have. The following questionnaire asks a series of questions about your experiences and attitudes toward anomalous physical phenomena or psychokinesis (defined as physical events which appear to result from the influence of a living or deceased organism on a given aspect of the physical world, without any known physical interaction between that organism and the physical world. Such effects may include lights switching on or off, objects falling, breaking or malfunctioning, spoons bending, etc.).


The study is based at the Rhine Research Center, and is part of a larger study on mind over matter effects. You have been invited to complete the questionnaire, as you had previously contacted the Rhine Research Center. If you choose to participate, you would be one of approximately 150 respondents. It is hoped that the results of the study will enable greater understanding of these experiences.

If you choose to take part, you would be asked to fill out an electronic or paper copy of the questionnaire. Please read each of the statements on the questionnaire carefully, and respond to each as honestly as possible, by clicking the response choice that most relates to your own experiences and attitudes. The best way to answer the questions is not to think too long about them and go with your first response (there are no right or wrong answers). We would like to encourage you to complete all the questions. You can, of course, choose to skip any questions that you prefer not to answer.

We would like to assure you that your responses to these questions will be treated with upmost confidentiality and data will be stored in coded form such that your name will not be associated with your responses.  In addition, data will be analyzed based on general patterns rather than individual scoring. Data resulting from this research project will only be used for the purposes of research.

This questionnaire explores subjective experiences and beliefs and as such will not evaluate the extent to which experiences are veridical.

If you choose to take part in the study, you have the right to withdraw your data at any time. You will be offered the opportunity to receive feedback on the overall study results, at the end of the study.

You are encouraged to ask questions about any aspect of this study at any time (before, during or after the study).

If you have any questions about the study, at any time, please feel free to contact Christine Simmonds-Moore at simmonc@hope.ac.uk or Sally Rhine Feather at srfeather@nc.rr.com.

Consent to participate in this study

By clicking the box below and filling out the study questionnaire, you are giving your initial consent to participate in this study. You are free to withdraw your participation at any time without any penalty, even after the study has begun.

The identity of your data will be kept confidential and only group results will be reported.

I have read the above description and agree to begin participation in the study, with the understanding that I may withdraw at any time without penalty.

Participant's Agreement

If you have any questions about the study, at any time, please feel free to contact Christine Simmonds-Moore at simmonc@hope.ac.uk or Sally Rhine Feather at srfeather@nc.rr.com.

A. The Anomalous Physical Experiences Questionnaire (Draft January 2010)

This questionnaire is about your attitudes toward and experiences of anomalous physical events which appear to result from the influence of a living or deceased organism on a given aspect of the physical world, without any known physical interaction between that organism and the physical world. Physical effects may include lights switching on or off, objects falling, breaking or malfunctioning, spoons bending, etc.

On the following questionnaire, you should indicate how much you agree or disagree with each statement by circling one of the options, where 'SA' means you strongly agree, 'A' means you agree, 'D' that you disagree, and 'SD' that you strongly disagree

 Strongly AgreeAgreeNeither Agree Nor DisagreeDisagreeStrongly Disagree
1. I have experienced anomalous physical phenomena.
2. I have never experienced anomalous physical phenomena.
3. I am unable to wear a wrist watch.
4. I feel that I am “wired” differently to other people.
5. Anomalous physical effects are associated with having too much energy in my body/nervous system.
6. Anomalous physical effects have occurred when I am extremely angry, stressed, or upset.
7. Anomalous physical effects have taken place when I am in a relaxed or meditative state.
8. My wrist watch rarely malfunctions.
9. Computers seem to malfunction or “crash” when I am stressed.
10. Human beings cannot affect electronic equipment.
11. Members of my family have experienced problems wearing watches.
12. I am sensitive to electrical or magnetic equipment.
13. I am not overly sensitive to electrical equipment.
14. Other people have noticed that electrical equipment often breaks, switches on or off, or malfunctions in my presence.
15. I frequently experience problems with my cell-phone.
16. When I walk or drive along the street, the street lights go on or off as I pass them.
17. Anomalous physical events can be explained as chance or coincidental events.
18. Anomalous physical events have happened when I have experienced extreme emotions.
19. Anomalous physical experiences frighten me.
20. Anomalous physical experiences indicate that life is more interconnected than it might seem to be.
21. Anomalous physical phenomena are outside of my control.
22. I can affect physical objects at will.
23. I have intentionally affected the movement of a physical object with another person.
24. I can affect the weather at will.
25. I cannot affect physical or external objects at will.
 Strongly AgreeAgreeNeither Agree Nor DisagreeDisagreeStrongly Disagree
26. When a person is suffering, I have experienced the palms of my hands going red and warm.
27. I have successfully undertaken a distant healing practice.
28. I am a healer.
29. I feel that I could become a healer.
30. Electrical equipment has malfunctioned due to a discarnate influence.
31. Anomalous physical events have a normal explanation.
32. An anomalous physical event occurred in response to my desire or question (to the universe/god/a discarnate entity).
33. Anomalous physical events take place due to the intervention of discarnate spirits in the world of the living.
34. An anomalous physical event has conveyed a message to me from a discarnate source.
35. I have observed an object falling or moving strangely at the time as the death of a loved one.
36. I have experienced “apports” (objects have anomalously appeared or disappeared).
37. Anomalous physical phenomena reflect the actions of an external (perhaps discarnate) entity.
38. Anomalous physical phenomena can reflect messages from the universe.
39. An anomalous physical event has conveyed a meaningful message to me.
40. Anomalous physical phenomena have occurred to direct my attention to important things in my life.

A. The Australian Sheep-Goat Scale

This section presents a set of statements, each expressing an attitude about some aspect of ESP. For each of these, you should indicate how much you agree or disagree with the statement by circling one of the options, where 'SA' means you strongly agree, 'A' means you agree, 'D' that you disagree, and 'SD' that you strongly disagree. You may find the following definitions helpful when completing this section:

ESP: psychic reception of information without the use of the senses or reasoned guesses

PK: psychic influence on physical objects by the force of mental will power alone

 Strongly AgreeAgreeNeither Agree Nor DisagreeDisagreeStrongly Disagree
1. I am convinced that ESP exists.
2. I am convinced that I have had personal experience of ESP.
3. I am convinced that I am psychic.
4. I am convinced that it is possible to gain information about the future before it happens in ways that do not depend on common sense or the "normal" senses (sight, hearing, etc).
5. I am convinced that I have had at least one hunch that turned out to be correct and which (I believe) was not just a coincidence.
6. I am convinced that I have had at least one premonition about the future that came true and which (I believe) was not just a coincidence.
7. I am convinced that I have had at least one dream that came true and which (I believe) was not just a coincidence.
8. I am convinced that I have had at least one waking vision that was not an hallucination and from which I received information that I could not have otherwise gained at that time and place.
9. I am convinced that there is a life after death.
10. I am convinced that it is possible to contact spirits of the dead.
11. I am convinced that it is possible to gain information about the thoughts, feelings or circumstances of another person, in a way that does not depend on common sense or the "normal" senses (sight, hearing, etc).
12. I am convinced that it is possible to send a "mental message" to another person, or in some way influence them at a distance, by means other than the normal channels of communication.
13. I am convinced that I have had at least one experience of telepathy (where I became aware of another person's thoughts or sensations in a way that was not due to common sense or the "normal" senses of vision, hearing etc.) between myself and another person.
14. I am convinced that psychokinesis (PK) exists; that is, the direct influence of mind on a physical system, without the use of any known physical energy (as in, for example, psychic healing, affecting the roll of dice, bending spoons or moving objects).
15. I am convinced that on at least one occasion I have personally exerted PK, where my mind apparently directly influenced the physical world in some way, without the use of any known physical means.
16. I am convinced that I have strong or reliable PK ability.
17. I am convinced that, on at least one occasion, I have witnessed an apparently psychokinetic effect on physical objects which I cannot explain in terms of a normal physical effect.
18. I am convinced that I have witnessed - in the past or at present - persistent physical disturbances, that seemed to be caused by PK (as for example a "poltergeist").
19. While experiencing something for the first time in my life, I had the feeling of having lived through this situation before.
20. Sometimes I see something for the first time and although I do not know anything about it, it still appears completely familiar to me.
21. I have dreamt about something which really came true at a later date.
22. I have been successful in influencing a person to do something or in preventing him/her from doing something, exactly as I wanted, just by concentrating on this person intensely.
23. Sometimes I feel a strange tension in my body, which serves as a kind of warning signal for a dangerous situation.
24. I have experienced the ability to transmit thoughts, feelings or certain symbols across a great distance to a person close to me by the power of thought alone.


None of the questions in this survey are mandatory. 
Please review and make sure you’ve answered all of the questions that you want to answer.

* Indicates Response Required