Weekly Anxiety Survey

1.	Do you feel anxiety, nervousness, worry, or fear?	Not At All	Rare	Somewhat	Often
2.	Do you have moments where things around you are strange, unreal, or foggy?	Not At All	Rare	Somewhat	Often
3.	Do you have moments where you feel detached from all or parts of your body?	Not At All	Rare	Somewhat	Often
4.	Do you experience sudden unexpected panic spells?	Not At All	Rare	Somewhat	Often
5.	Do you experience apprehension or a sense of impending doom?	Not At All	Rare	Somewhat	Often
6.	Do you have moments of feeling tense, stressed, or on edge?	Not At All	Rare	Somewhat	Often
7.	Do you have difficulty concentrating?	Not At All	Rare	Somewhat	Often
8.	Do you have racing thoughts?	Not At All	Rare	Somewhat	Often
9.	Do you have frightening fantasies or daydreams?	Not At All	Rare	Somewhat	Often
10.	Do you feel like you are on the verge of losing control?	Not At All	Rare	Somewhat	Often
11.	Do you have fears of going crazy?	Not At All	Rare	Somewhat	Often
12.	Do you have fears of fainting or passing out?	Not At All	Rare	Somewhat	Often
13.	Do you have fears of physical illnesses or heart attacks or dying?	Not At All	Rare	Somewhat	Often
14.	Do you have worries about looking foolish or inadequate in front of others?	Not At All	Rare	Somewhat	Often
15.	Do you have fears of being alone, isolated, or abandoned?	Not At All	Rare	Somewhat	Often
16.	Are you afraid of disapproval from others or being criticized?	Not At All	Rare	Somewhat	Often
17.	Do you have fears that something terrible is about to happen?	Not At All	Rare	Somewhat	Often
18.	Do you experience skipping, racing, or pounding of the heart?	Not At All	Rare	Somewhat	Often
19.	Do you experience pain, pressure, or tightness in the chest?	Not At All	Rare	Somewhat	Often
20.	Do you experience tingling or numbness in your fingers or toes?	Not At All	Rare	Somewhat	Often
21.	Do you experience butterflies or discomfort in the stomach?	Not At All	Rare	Somewhat	Often
22.	Do you experience constipation or diarrhea?	Not At All	Rare	Somewhat	Often
23.	Do you experience restlessness or jumpiness?	Not At All	Rare	Somewhat	Often
24.	Do you experience tight, tense muscles?	Not At All	Rare	Somewhat	Often
25.	Do you experience cold sweats?	Not At All	Rare	Somewhat	Often
26.	Do you experience a lump in the throat?	Not At All	Rare	Somewhat	Often
27.	Do you experience trembling or shaking?	Not At All	Rare	Somewhat	Often
28.	Do you experience a feeling of rubbery or jelly-like legs?	Not At All	Rare	Somewhat	Often
29.	Do you have spells of dizziness, lightheadedness, or feeling off-balance?	Not At All	Rare	Somewhat	Often
30.	Do you experience choking or smothering sensations? Difficulty breathing?	Not At All	Rare	Somewhat	Often
31.	Do you experience headaches? Pain in the neck or back?	Not At All	Rare	Somewhat	Often
32.	Do you experience either hot flashes or cold chills?	Not At All	Rare	Somewhat	Often
33.	Do you feel tired or weak? Are you easily exhausted?	Not At All	Rare	Somewhat	Often