Please circle a number by each statement to indicate how much the statement has applied to you over the last week.
  • Name*full name
  • Email*a valid email address
  • 0 – did not apply to me at all 2 – applied to me to some degree, or some of the time 4 – applied to me to a considerable degree, or a good part of the time 6 – applied to me very much, or most of the time
  • N*0246
    1. I found it hard to wind down
    6. I tended to over-react to situations
    8. I felt I was using a lot of nervous energy
    11. I found myself getting agitated
    12. I found it difficult to relax
    14. I was intolerant of anything that kept me from getting on with what I was doing
    18. I felt that I was rather touchy
  • N*0246
    2. I was aware of dryness in my mouth
    4. I experienced breathing difficulty – rapid breathing, breathlessness in absence of physical exertion
    7. I experienced trembling (especially in the hands)
    9. I was worried about situations where I might panic and make a fool of myself
    15. I felt I was close to panic
    19. I was aware of the action of my heart in the absence of physical exertion (sense of heart rate increase, miss a beat)
    20. I felt scared without good reason
  • N*0246
    3. I couldn’t seem to experience any positive feelings at all
    5. I found it difficult to work up the initiative to do things
    10. I felt that I had nothing to look forward to
    13. I felt down-hearted and blue
    16. I was unable to become enthusiastic about anything
    17. I felt I was not worth much as a person
    21. I felt that life was meaningless
  • 6