Anxiety Assessment

Instructions

Circle one number for each item that best describes how much you have experienced each symptom over the last week.

Begin Assessment Below

  1. Feeling nervous:


    Not at all
    Sometimes
    Often
    Most of the time
  2. Frequent Worrying:

    Not at all
    Sometimes
    Often
    Most of the time

  3. Trembling, twitching, feeling shaky:

    Not at all
    Sometimes
    Often
    Most of the time

  4. Muscle tension, muscle aches, muscle soreness:
    Not at all
    Sometimes
    Often
    Most of the time
  5. Restlessness

    Not at all
    Sometimes
    Often
    Most of the time

  6. Easily tired:

    Not at all
    Sometimes
    Often
    Most of the time

  7. Shortness of breath:

    Not at all
    Sometimes
    Often
    Most of the time

  8. Rapid heartbeat

    Not at all
    Sometimes
    Often
    Most of the time

  9. Sweating – not due to the heat:

    Not at all
    Sometimes
    Often
    Most of the time

  10. Dry mouth:

    Not at all
    Sometimes
    Often
    Most of the time

  11. Dizziness or light-headedness:

    Not at all
    Sometimes
    Often
    Most of the time

  12. Nausea, diarrhea, or stomach problems:

    Not at all
    Sometimes
    Often
    Most of the time

  13. Frequent urination

    Not at all
    Sometimes
    Often
    Most of the time

  14. Flushes (hot flashes) or chills:

    Not at all
    Sometimes
    Often
    Most of the time

  15. Trouble swallowing or “lump in throat”:

    Not at all
    Sometimes
    Often
    Most of the time

  16. Feeling keyed up or on edge:

    Not at all
    Sometimes
    Often
    Most of the time

  17. Quick to startle:

    Not at all
    Sometimes
    Often
    Most of the time

  18. Difficulty concentrating

    Not at all
    Sometimes
    Often
    Most of the time

  19. Trouble falling asleep or stying asleep:

    Not at all
    Sometimes
    Often
    Most of the time

  20. Irritablility:

    Not at all
    Sometimes
    Often
    Most of the time

  21. Avoiding places where I might be anxious:

    Not at all
    Sometimes
    Often
    Most of the time

  22. Frequent thoughts of danger:

    Not at all
    Sometimes
    Often
    Most of the time

  23. Seeing myself as unable to cope:

    Not at all
    Sometimes
    Often
    Most of the time

  24. Frequent thoughts that something terrible will happen

    Not at all
    Sometimes
    Often
    Most of the time