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Anxiety Questionnaire
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Anxiety Questionnaire
Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by circling the number in the corresponding space in the column next to each symptom.
Numbness or tingling
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Feeling hot
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Wobbliness in legs
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Unable to relax
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Fear of worst happening
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Dizzy or lightheaded
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Heart pounding / racing
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Unsteady
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Terrified or afraid
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Nervous
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Feeling of choking
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Hands trembling
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Shaky / unsteady
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Fear of losing control
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Difficulty in breathing
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Fear of dying
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Scared
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Indigestion
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Faint / lightheaded
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Face flushed
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Hot / cold sweats
Not at all
Mildly, but it didn’t bother me much
Moderately – it wasn’t pleasant at times
Severely – it bothered me a lot
Total Score:
BECK ANXIETY INVENTORY (BAI) The total score is calculated by finding the sum of the 21 items. Score of 0-21 = low anxiety Score of 22-35 = moderate anxiety Score of 36 and above = potentially concerning levels of anxiety
XV. BECK’S DEPRESSION INVENTORY
This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.
Q1
I do not feel sad.
I feel sad
I am sad all the time and I can’t snap out of it.
I am so sad and unhappy that I can’t stand it.
Q2
I am not particularly discouraged about the future.
I feel discouraged about the future.
I feel I have nothing to look forward to.
I feel the future is hopeless and that things cannot improve.
Q3
I do not feel like a failure.
I feel I have failed more than the average person.
As I look back on my life, all I can see is a lot of failures.
I feel I am a complete failure as a person.
Q4
I get as much satisfaction out of things as I used to.
I don’t enjoy things the way I used to.
I don’t get real satisfaction out of anything anymore.
I am dissatisfied or bored with everything.
Q5
I don’t feel particularly guilty.
I feel guilty a good part of the time.
I feel quite guilty most of the time.
I feel guilty all the time.
Q6
I don’t feel I am being punished.
I feel I may be punished.
I expect to be punished.
I feel I am being punished.
Q7
I don’t feel disappointed in myself.
I am disappointed in myself.
I am disgusted with myself.
I hate myself.
Q8
I don’t feel I am any worse than anybody else.
I am critical of myself for my weakness r mistakes.
I blame myself all the time for my faults.
I blame myself for everything bad that happens.
Q9
I don’t have thoughts of killing myself.
I have thoughts of killing myself, but I would not carry them out.
I would like to kill myself.
I would kill myself if I had the chance.
Q10
I don’t cry more than usual.
I cry more now that I used to.
I cry all the time now.
I used to be able to cry, but now I can’t cry even though I want to.
Q11
I am no more irritated by things that I ever was.
I am slightly more irritated now than usual.
I am quite annoyed or irritated a good deal of the time.
I feel irritated all the time.
Q12
I have not lost interest in other people.
I am less interested in other people than I used to be.
I have most of my intertest in other people.
I have lost all of my interest in other people.
Q13
I make decisions about as well as I ever could.
I put off making decisions more than I used to.
I have greater difficulty in making decisions more than I used to.
I can’t make decisions at all anymore.
Q14
I don’t feel that I look any worse than I used to.
I am worried that I am looking old or unattractive.
I feel there are permanent changes in my appearance that make me look unattractive.
I believe that I look ugly.
Q15
I can work about as well as before.
It takes an extra effort to get started doing something.
I have to push myself very hard to do anything.
I can’t do any work at all.
Q16
I can sleep as well as usual.
I don’t sleep as well as I used to.
I wake up 1-2 hour earlier than usual and find it hard to get back to sleep.
I wake up several hours earlier than I used to and cannot ger back to sleep.
Q17
I don’t get tired more than usual.
I get tired more easily than I used to.
I get tired from doing almost anything.
I am too tired to do anything.
Q18
My appetite is no worse than usual.
My appetite is not as good as it used to be.
My appetite is much worse now.
I have no appetite at all anymore.
Q19
I haven’t lost much weight, if any, lately.
I have lost more than five pounds.
I have lost more than ten pounds.
I have lost more than fifteen pounds.
Q20
I am no more worried about my health than usual.
I am worried about my physical problems like aches, pains, upset stomach, or constipation.
I am very worried about physical problems and it’s hard to think of much else.
I am so worried about my physical problems that I cannot think of anything else.
Q21
I have not noticed any recent change in my interest in sex.
I am less interested in sex than I used to be.
I have almost no interest in sex.
I have lost interest in sex completely.
Total Score:
BECK DEPRESSION INVENTORY (BDI) Add up the score for each of the twenty-one questions by counting the number to the right of each question you marked. The highest possible total for the whole test would be sixty-three. This would mean you circled number three on all twenty-one questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circles zero on each question. You can evaluate your depression according to the Table below.
Levels of Depression:
1-10 These ups and downs are considered normal 11-16 Mild mood disturbance 17-20 Borderline clinical depression 21-30 Moderate depression 31-40 Severe depression over 40 Extreme depression
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