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| Not at all | A Little | Moderately | Pretty | Extremely | |
|---|---|---|---|---|---|
| Nervousness or shakiness inside | 1 | 2 | 3 | 4 | 5 |
| Suddenly scared for no reason | 1 | 2 | 3 | 4 | 5 |
| Feeling fearful | 1 | 2 | 3 | 4 | 5 |
| Feeling tense or keyed up | 1 | 2 | 3 | 4 | 5 |
| Spells of terror or panic | 1 | 2 | 3 | 4 | 5 |
| Feeling so restless you couldn't sit still | 1 | 2 | 3 | 4 | 5 |
