Choose one answer for each item that best describes how much you have experienced each symptom over the past week.

  Not at all Sometimes Frequently Most of the time
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


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