Please select the situation that makes you MOST anxious (choose only one):
Please select the situation that makes you most anxious.
During the PAST 7 DAYS, I have...
1. felt moments of sudden terror, fear, or fright in these situations
Please select a response for question 1.
2. felt anxious, worried, or nervous about these situations
Please select a response for question 2.
3. had thoughts of being injured, overcome with fear, or other bad things happening in these situations
Please select a response for question 3.
4. felt a racing heart, sweaty, trouble breathing, faint, or shaky in these situations
Please select a response for question 4.
5. felt tense muscles, felt on edge or restless, or had trouble relaxing in these situations
Please select a response for question 5.
6. avoided, or did not approach or enter, these situations
Please select a response for question 6.
7. moved away from these situations or left them early
Please select a response for question 7.
8. spent a lot of time preparing for, or procrastinating about (i.e., putting off), these situations
Please select a response for question 8.
9. distracted myself to avoid thinking about these situations
Please select a response for question 9.
10. needed help to cope with these situations (e.g., alcohol or medications, superstitious objects, other people)
Please select a response for question 10.