Directions: Tick the box beside the reply that is closest to how you have been feeling in the past week. Don’t take too long over your replies: your immediate answer is best.

D

A

D

A

I feel tense or ‘wound up:’

I feel as if I am slowed down:

3

Most of the time

3

Nearly all the time

2

A lot of the time

2

Very often

1

From time to time, occasionally

1

Sometimes

0

Not at all

0

Not at all

I still enjoy the things I used to enjoy:

I get a sort of frightened feeling like ‘butterflies’ in the stomach:

0

Definitely as much

0

Not at all

1

Not quite so much

1

Occasionally

2

Only a little

2

Quite often

3

Hardly at all

3

Very often

I get a sort of frightened feeling as if something awful is about to happen:

I have lost interest in my appearance:

3

Very definitely and quite badly

3

Definitely

2

Yes, but not too badly

2

I don’t take as much care as I should

1

A little, but it doesn’t worry me

1

I may not take quite as much care

0

Not at all

0

I take just as much care as ever

I can laugh and see the funny side of things:

I feel restless as if I have to be on the move:

0

As much as I always could

3

Very much indeed

1

Not quite so much now

2

Quite a lot

2

Definitely not quite so much now

1

Not very much

3

Not at all

0

Not at all

Worrying thoughts go through my mind:

I look forward with enjoyment to things:

3

A great deal of the time

0

As much as I ever did

2

A lot of the time

1

Rather less than I used to

1

From time to time, but not too often

2

Definitely less than I used to

0

Only occasionally

3

Hardly at all

I feel cheerful:

I get sudden feelings of panic:

3

Not at all

3

Very often indeed

2

Not often

2

Quite often

1

Sometimes

1

Not very often

0

Most of the time

0

Not at all

I can sit at ease and feel relaxed:

I can enjoy a good book or radio or TV program:

0

Definitely

0

Often

1

Usually

1

Sometimes

2

Not often

2

Not often

3

Not at all

3

Very seldom