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Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully, and select the response that accurately indicates how much you have been bothered by that problem in the past month.
Answer according to the scale below:
1= Not at all
2 = A little bit
3 = Moderately
4 = Quite a bit
5 = Extremely
1. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?
Not at all
1
2
3
4
5
Extremely
Clear selection
2. Repeated, disturbing dreams of a stressful experience from the past?
Not at all
1
2
3
4
5
Extremely
Clear selection
3. Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it)?
Not at all
1
2
3
4
5
Extremely
Clear selection
4. Feeling very upset when something reminded you of a stressful experience from the past?
Not at all
1
2
3
4
5
Extremely
Clear selection
Answer according to the scale below:
1= Not at all
2 = A little bit
3 = Moderately
4 = Quite a bit
5 = Extremely
5. Having physical reactions (e.g., heart pounding, trouble breathing, or sweating) when something reminded you of a stressful experience from the past?
Not at all
1
2
3
4
5
Extremely
Clear selection
6. Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?
Not at all
1
2
3
4
5
Extremely
Clear selection
7. Avoid activities or situations because they remind you of a stressful experience from the past?
Not at all
1
2
3
4
5
Extremely
Clear selection
8. Trouble remembering important parts of a stressful experience from the past?
Not at all
1
2
3
4
5
Extremely
Clear selection
Answer according to the scale below:
1= Not at all
2 = A little bit
3 = Moderately
4 = Quite a bit
5 = Extremely
9. Loss of interest in things that you used to enjoy?
Not at all
1
2
3
4
5
Extremely
Clear selection
10. Feeling distant or cut off from other people?
Not at all
1
2
3
4
5
Extremely
Clear selection
11. Feeling emotionally numb or being unable to have loving feelings for those close to you?
Not at all
1
2
3
4
5
Extremely
Clear selection
12. Feeling as if your future will somehow be cut short?
Not at all
1
2
3
4
5
Extremely
Clear selection
Answer according to the scale below:
1= Not at all
2 = A little bit
3 = Moderately
4 = Quite a bit
5 = Extremely
13. Trouble falling or staying asleep?
Not at all
1
2
3
4
5
Extremely
Clear selection
14. Feeling irritable or having angry outbursts?
Not at all
1
2
3
4
5
Extremely
Clear selection
15. Having difficulty concentrating?
Not at all
1
2
3
4
5
Extremely
Clear selection
16. Being “super alert” or watchful on guard?
Not at all
1
2
3
4
5
Extremely
Clear selection
17. Feeling jumpy or easily startled?
Not at all
1
2
3
4
5
Extremely
Clear selection
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