Anxiety Self Screen
Answer all the following questions and then push the "result"
button at the end of the questionnaire to get your score.

1. Do you anxiety, nervousness, worry or fear?

Not at all
Sometimes
Very often
All the time

2. Do you fell that things around yu are strange or unreal?

No
Sometimes
Occasionally
All the time.

3. Do you ever feel detached from all or part of your body?

No
Not often
Pretty often
Very often

4. Do you ever have sudden and unexpected panic spells?

No
I've had them
I have them frequently
All the time

5. Do you have a feeling of apprehension or impending doom?

NO
Sometimes
Often
All thetime

6. Do you feel tense, stressed, uptight on on edge?

No
Occasionally
Pretty often
All the time

7. Do you have difficulty concentrating?

No
Sometimes
Often
All the time

8. Does your mind race... jump from one thing to the next ?

No
Sometimes
Very often
All the time

9. Do you have frightening fantasies or daydreams?

No
I have in the past
I often do
All the time

10. Do you feel on the verge of losing control?

No
Occasionally
Often
All the time

11. Do you ever think you are going crazy?

No
Somtimes I think about that
I worry about that often
I am going crazy

12. Do you have fears of feinting or passing out?

No
Sometimes but not often
Frequently
All the time

13. Do you have fears about becoming ill or dying?

No
I worry occasionally
I am afraid of that quite often
No one believes me but I am sick and dying

14. Do you worry about looking foolish or inadequate in front of other people?

No
Sometimes I wonder what people think of me
I occasionally worry that I look fooolish to people
I am concerned about that all the time

15. you have fears of being alone, isolated or abandoned?

No, I can take care of myself
Sometimes I am afraid that will happen to me
I often worry about that
I feel that way right now

16. Do you have fears of criticism or disapproval?

No
Sometimes
Very often
All the time

17. Are you afraid something terrible is about to happen?

No
Occasionally
Very often.
All the time

18. Do you have heart palpitations (skipping beats or racing)?

No
Once in awhile
Quite often
All the time

19. Do you have pain, pressure or tightness in the chest?

No
Occasionally
Often
All the time

20. Do you have tingling or numbness in your toes or fingers?

No
Not often
Occasionally
Very often

21. Do you have "butterflies" or discomfort in your stomach?

No
Seldom
Sometimes
Quite often

22. Do you have constipation, diarrhea or other stomach upsets?

Not often
Once in awhile
Quite often
All the time

23. Do you suffer from restlessness or jumpiness?

No
Once in awhile
Quite often
All the time

24. Do you have tightness ro tenseness in your muscles?

No
Once in awhile
Quite often
All the time

25. Do you have sweating not related to the heat or your exertions?

No
Once in awhile
Quite often
All the time

26. Do you ever feel like you have a "lump in you throat"?

No
Once in awhile
Quite often
All the time

27. Do you feel trembling or shaking?

No
Once in awhile
Quite often
All the time

28. Do you ever have rubbery or "jelly" legs (unsteadiness)?

No
Once in awhile
Quite often
All the time

29. Do you fell dizzy. lightheaded or off balance?

No
Once in awhile
Quite often
All the time

30. Do you have choking or smothering sensations, problems breathing?

No
Once in awhile
Quite often
All the time

31. Do you have headachs or neck or back pains?

No
Once in awhile
Quite often
All the time

32. Do you have hot flashes or cold chills?

No
Once in awhile
Quite often
All the time

33. Do you feel weak or tired or easily exhausted?

No
Once in awhile
Quite often
All the time





FROM: The Feeling Good Handbook, copyright @ 1989 by David D. Burns, M.D.,