First name:
Last name:

Rater's Name:

Please read each statement and select the number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:
0. Did not apply to me at all
1. Applied to me to some degree, or some of the time
2. Applied to me to a considerable degree, or a good part of time
3. Applied to me very much, or most of the time

Statements
0
1
2
3
1. I found myself getting upset by quite trivial things
2. I was aware of dryness of my mouth
3. I couldn't seem to experience any positive feeling at all
4. I experienced breathing difficulty (eg. excessively rapid breathing, breathlessness in the absence of physical exertion)
5. I just couldn't seem to get going
6. I tended to over react to situations
7. I had a feeling of shakiness (e.g. legs going to give way)
8. I found it difficult to relax
9. I found myself in situations that made me so anxious I was most relieved when they ended
10. I felt that I had nothing to look forward to
11. I found myself getting upset rather easily
12. I felt I was using a lot of nervous energy
13. I felt sad and depressed
14. I found myself getting impatient when I was delayed in any way
(e.g. lifts, traffic lights, being kept waiting)
15. I had a feeling of faintness
16. I felt that I had lost interest in just about everything
17. I felt I wasn't worth much as a person
18. I felt that I was rather touchy
19. I perspired noticeably (e.g. hands sweaty) in the absence of high temperatures or physical exertion
20. I felt scared without any good reason
21. I felt that life wasn't worthwhile
22. I found it hard to wind down
23. I had difficulty in swallowing
24. I couldn't seem to get any enjoyment out of the things I did
25. I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase or missing a beat)
26. I felt down-hearted and blue
27. I found that I was very irritable
28. I felt I was close to panic
29. I found it hard to calm down after something upset me
30. I feared I would be "thrown" by some trivial but unfamiliar task
31. I was unable to become enthusiastic about anything
32. I found it difficult to tolerate interruptions to what I was doing
33. I was in a state of nervous tension
34. I felt I was pretty worthless
35. I was intolerant of anything that kept me from getting on with what I was doing
36. I felt terrified
37. I could see nothing in the future to be hopeful about
38. I felt that life was meaningless
39. I found myself getting agitated
40. I was worried about situations in which I might panic and make a fool of myself
41. I experienced trembling (e.g. in the hands)
42. I found it difficult to work up the initiative to do things