Never	Occasionally	Half of the time	Most of the time	All of the time
… felt moments of sudden terror, fear or fright	0	1	2	3	4
… felt anxious, worried, or nervous	0	1	2	3	4
… had thoughts of bad things happening	0	1	2	3	4
… felt a racing heart, sweaty, trouble breathing, faint, or shaky	0	1	2	3	4
… felt tense muscles, on edge or restless, or trouble relaxing or sleeping	0	1	2	3	4
… avoided, or did not approach or enter, situations that made me anxious	0	1	2	3	4
… moved away from or left situations early, remained near exits, or participated only minimally because of anxiety	0	1	2	3	4
… spent a lot of time preparing for, or procrastinating about (putting off), things because of anxiety	0	1	2	3	4
… distracted myself to avoid thinking about things that made me anxious	0	1	2	3	4
… needed help to cope with anxiety (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.