Anxiety scale
Indicate which answer best describes how much you have experienced each symptom over the last week.
0= Never 1=Sometimes 2=Frequently 3=Most of the time *
0
1
2
3
1. Feeling nervous
2. Frequent worrying
3. Trembling, twitching, feeling shaky
4. Muscle tension, muscle aches, muscle soreness
5. Restlessness
6. Easily tired
7. Shortness of breath
8. Rapid heartbeat
9. Sweating not due to the heat
10. Dry mouth
11. Dizziness or light-headedness
12. Nausea, diarrhea, or stomach problems
13. Frequent urination
14. Flushes (hot flashes) or chills
15. Trouble swallowing or “lump in throat
16. Feeling keyed up or on edge
17. Quick to startle
18. Difficulty concentrating
19. Trouble falling or staying asleep
20. Irritability
21. Avoiding places where I might be anxious
22. Frequent thoughts of danger
23. Seeing myself as unable to cope
24. Frequent thoughts that something terrible will happen
Name *
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