| How do you feel? | Not at all | Somewhat | Moderately so | Much so | |
| 1. | I feel calm | ||||
| 2. | I feel safe | ||||
| 3. | I feel tense | ||||
| 4. | I feel strained | ||||
| 5. | I feel at ease | ||||
| 6. | I feel angry | ||||
| 7. | I am worried about possible problems | ||||
| 8. | I feel satisfied | ||||
| 9. | I feel jittery | ||||
| 10. | I feel good | ||||
| 11. | I feel self-confident | ||||
| 12. | I feel nervous | ||||
| 13. | I feel frightened | ||||
| 14. | I feel indecisive | ||||
| 15. | I feel relaxed | ||||
| 16. | I feel content | ||||
| 17. | I feel worried | ||||
| 18. | I feel confused | ||||
| 19. | I feel determined | ||||
| 20. | I am pleasant | ||||