mind alive David - PERSONAL PROFILE QUESTIONNAIRE; III. ANXIETY

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PERSONAL PROFILE QUESTIONNAIRE
III. ANXIETY
Read carefully and identify the symptom(s) that you have experienced
during the last month. For each symptom, circle the number which indicates
the frequency at which you perceive that symptom.
0: Never
3: Most of the time
1: Rarely
4: Constant/Overwhelming
2: Some of the time
Symptoms
Frequency
Nagging thoughts
0
1
2
3
4
Negative thoughts or feelings about yourself
0
1
2
3
4
Feeling insecure
0
1
2
3
4
Fear that someone will notice your anxiety and what
might happen if it is noticed
0
1
2
3
4
Upset stomach
0
1
2
3
4
Sweating / Perspiration
0
1
2
3
4
Tremors or shakiness
0
1
2
3
4
Muscle Tension and discomfort
0
1
2
3
4
Palpitating or racy heart
0
1
2
3
4
Constant squirming (feet, hands, scratching, etc.)
0
1
2
3
4
Smoking, eating or drinking in excess
0
1
2
3
4
Avoiding social situations
0
1
2
3
4
Sensation of breathlessness
0
1
2
3
4
Feeling annoyed
0
1
2
3
4
Feeling irritable
0
1
2
3
4
Difficulty concentrating or maintaining focus
0
1
2
3
4