Please read each statement and select a number 0, 1, 2
or 3, which indicates how much the statement applied to you
past week. There are no right or wrong answers. Do not spend too
much time on any statement.
The rating scale is as follows:
0 = Did not apply to me at all.
1 = Applied to me to some degree, or some of the time.
2 = Applied to me a considerable degree, or a good
part of the time.
3 = Applied to me very much, or most of the time.
1. I found it very hard to wind down.
2. I was aware of dryness of my mouth.
3. I couldn’t seem to experience any positive
feeling at all.
5. I found it difficult to work up the initiative to
6. I tended to over-react to situations.
7. I experienced trembling (e.g. in the hands).
8. I felt that I was using a lot of nervous energy.
10. I felt I had nothing to look forward to.
11. I found myself getting agitated.
12. I found it difficult to relax.
13. I felt down-hearted and blue.
15. I felt I was close to panic.
16. I was unable to become enthusiastic about anything.
17. I felt I wasn’t worth much as a person.
18. I felt that I was rather touchy.
20. I felt scared without any good reason.
21. I felt that life was meaningless.
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Tuesday June 19, 2012
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