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Please read each statement and choose the option which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.
Answer according to the rating scale below:
0 = Did not apply to me at all
1 = Applied to me to some degree, or some of the time
2 = Applied to me to a considerable degree, or a good part of time
3 = Applied to me very much, or most of the time
1. I found it hard to wind down
0
1
2
3
Clear selection
2. I was aware of dryness of my mouth
0
1
2
3
Clear selection
3. I couldn't seem to experience any positive feeling at all
0
1
2
3
Clear selection
4. I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)
0
1
2
3
Clear selection
Answer according to the rating scale below:
0 = Did not apply to me at all
1 = Applied to me to some degree, or some of the time
2 = Applied to me to a considerable degree, or a good part of time
3 = Applied to me very much, or most of the time
5. I found it difficult to work up the initiative to do things
0
1
2
3
Clear selection
6. I tended to over-react to situations
0
1
2
3
Clear selection
7. I experienced trembling (eg, in the hands)
0
1
2
3
Clear selection
8. I felt I was using a lot of nervous energy
0
1
2
3
Clear selection
Answer according to the rating scale below:
0 = Did not apply to me at all
1 = Applied to me to some degree, or some of the time
2 = Applied to me to a considerable degree, or a good part of time
3 = Applied to me very much, or most of the time
9. I was worried about situations in which I might panic and make a fool of myself
0
1
2
3
Clear selection
10. I felt that I had nothing to look forward to
0
1
2
3
Clear selection
11. I found myself getting agitated
0
1
2
3
Clear selection
12. I found it difficult to relax
0
1
2
3
Clear selection
Answer according to the rating scale below:
0 = Did not apply to me at all
1 = Applied to me to some degree, or some of the time
2 = Applied to me to a considerable degree, or a good part of time
3 = Applied to me very much, or most of the time
13. I felt down-hearted and blue
0
1
2
3
Clear selection
14. I was intolerant of anything that kept me from getting on with what I was doing
0
1
2
3
Clear selection
15. I felt I was close to panic
0
1
2
3
Clear selection
16. I was unable to become enthusiastic about anything
0
1
2
3
Clear selection
Answer according to the rating scale below:
0 = Did not apply to me at all
1 = Applied to me to some degree, or some of the time
2 = Applied to me to a considerable degree, or a good part of time
3 = Applied to me very much, or most of the time
17. I felt I wasn't worth much as a person
0
1
2
3
Clear selection
18. I felt that I was rather touchy
0
1
2
3
Clear selection
19. I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)
0
1
2
3
Clear selection
20. I felt scared without any good reason
0
1
2
3
Clear selection
21. I felt that life was meaningless
0
1
2
3
Clear selection
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