Never	Almost never	Some‐times	Often	Always
1	I suddenly felt panicky, fearful or frightened	0	1	2	3	4
2	I felt anxious, worried, or nervous	0	1	2	3	4
3	I thought that bad things would happen, such as to my family, my health, or that accidents would happen	0	1	2	3	4
4	I felt my heart beating fast, felt sweaty, had trouble breathing, passed out, or felt shaky	0	1	2	3	4
5	I felt tense muscles, was unable to sit still, or had trouble relaxing or sleeping	0	1	2	3	4
6	I stayed away from situations that I worried about	0	1	2	3	4
7	I left situations early or I did not participate much because I worried so much	0	1	2	3	4
8	I spent a lot of time making decisions, getting ready for, or putting off situations, because I worried so much	0	1	2	3	4
9	I needed others to calm me down because I worried so much	0	1	2	3	4
10	I needed help to deal with anxiety (for example, medicines, lucky charms, other people)	0	1	2	3	4

Reprinted with permission from American Psychiatric Association. Copyright © 2014, American Psychiatric Association. All rights reserved.