Never	Occasionally	Half of the time	Most of the time	All of the time
… felt moments of sudden terror, fear or fright in these situations	0	1	2	3	4
… felt anxious, worried, or nervous about these situations	0	1	2	3	4
… had thoughts about panic attacks, uncomfortable physical sensations, getting lost, or being overcome with fear in these situations	0	1	2	3	4
… felt a racing heart, sweaty, trouble breathing, faint, or shaky in these situations	0	1	2	3	4
… felt tense muscles, on edge or restless, or trouble relaxing in these situations	0	1	2	3	4
… avoided, or did not approach or enter, these situations	0	1	2	3	4
… moved away from these situations, left them early, or remained close to the exits	0	1	2	3	4
… spent a lot of time preparing for, or procrastinating about (putting off), these situations	0	1	2	3	4
… distracted myself to avoid thinking about these situations	0	1	2	3	4
… needed help to cope with these situations (e.g. alcohol or medications, superstitious objects, other people)	0	1	2	3	4

Reprinted with permission from American Psychiatric Association. Copyright © 2012, American Psychiatric Association. All rights reserved.