Anxiety questionnaire.

1. Feeling nervous, anxious, or on edge

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

o NOT AT ALL

o SEVERAL DAYS

o MORE THAN HALF THE DAYS

o NEARLY EVERY DAY

 Never

 Rarely

 Sometimes

 Often
 Do you have trouble controlling your worries?

 Never

 Rarely

 Sometimes
 Often
 Do you get irritable and/or easily annoyed when anxious?

 Never

 Rarely

 Sometimes

 Often
 Does worry or anxiety make you feel fatigued or worn out?

 Never

 Rarely

 Sometimes

 Often
 Does worry or anxiety interfere with falling and/or staying asleep?

 Never

 Rarely

 Sometimes

 Often
 Does worry or anxiety make it hard to concentrate?

 Never

 Rarely

 Sometimes

 Often
 Do you feel jumpy?

 Never

 Rarely

 Sometimes

 Often
 Do you worry about how well you do things?

 Never

 Rarely

 Sometimes
 Often
 Do you worry about things working out in the future?

 Never

 Rarely

 Sometimes

 Often
 Do you worry about things that have already happened in the past?

 Never

 Rarely

 Sometimes

 Often
 Do your muscles get tense when you are worried or anxious?

 Never

 Rarely

 Sometimes

 Often
 Do you experience repetitive and persistent thoughts that are upsetting and unwanted?

 Never

 Rarely

 Sometimes

 Often
 Do you experience strong fear that causes panic, shortness of breath, chest pains, a pounding heart,
sweating, shaking, nausea, dizziness and/or fear of dying?

 Never

 Rarely

 Sometimes

 Often
 Do you ever avoid places or social situation for fear of this panic?

 Never

 Rarely

 Sometimes
 Often
 Do you ever engage in repetitive behaviors to manage your worry? (For example, checking that the
oven is off, locking doors, washing hands, counting, repeating words.)

 Never

 Rarely

 Sometimes

 Often
Not being able to stop or control worrying

Not at all Several days More than half the days Nearly every day

Worrying too much about different things

Not at all Several days More than half the days Nearly every day

Trouble relaxing

Not at all Several days More than half the days Nearly every day

Feeling afraid as if something awful might happen

Not at all Several days More than half the days Nearly every day

I  find it very hard to unwind, relax or sit still

Never Rarely Sometimes Often

I have had stomach problems, such as feeling sick or stomach cramps

I have been irritable and easily become annoyed

I have experienced shortness of breath

I have felt dizzy and unsteady at times

I have had difficulties with sleep (including waking early, finding it hard to go to sleep)

I have felt panicked and overwhelmed by things in my life

I have felt nervous and on edge

I have had trembling hands

I seem to be constantly worrying about things

1. Pounding heart
Not at all Just a little Sometimes OftenUsually

Sweating

Not at all Just a little Sometimes OftenUsually

Trembling or shaking

Not at all Just a little Sometimes OftenUsually

Shortness of breath

Not at all Just a little Sometimes OftenUsually

Afraid or scared

Not at all Just a little Sometimes OftenUsually

Chest pain or discomfort

Not at all Just a little Sometimes OftenUsually

Nausea or abdominal distress

Not at all Just a little Sometimes OftenUsually

Feeling dizzy or unsteady

Not at all Just a little Sometimes OftenUsually

Fear of losing control or going crazy

Not at all Just a little Sometimes OftenUsually

Numbness or tingling sensations

Not at all Just a little Sometimes OftenUsually

Chills or hot flashes

Not at all Just a little Sometimes OftenUsually

Fear of dying

Not at all Just a little Sometimes OftenUsually

Constant or persistent worry

Not at all Just a little Sometimes OftenUsually

Feeling of choking

Not at all Just a little Sometimes OftenUsuall

Unable to relax

Not at all Just a little Sometimes OftenUsually

Not at all Just a little Sometimes OftenUsually

Nervous

Not at all Just a little Sometimes OftenUsually

Feeling shaky or wobbly

Not at all Just a little Sometimes OftenUsually

Irritable or difficulty sleeping

Not at all Just a little Sometimes OftenUsually

Trembling hands

Not at all Just a little Sometimes OftenUsually

I avoid situations because of anxiety

Not at all Just a little Sometimes OftenUsually

Feeling lightheaded or faint

Not at all Just a little Sometimes OftenUsually