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Disturbances experienced across three scales (21 questions)
Please read each statement and select 0, 1, 2, or 3 which indicates how much the statement applied to you
over the past week
. There are no right or wrong answers. Do not spend too much time on any statement.
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
The rating scale is as follows
:
0 = Did not apply to me at all - NEVER
1 = Applied to me to some degree, or some of the time - SOMETIMES
2 = Applied to me to considerable degree, or a good part of the time - OFTEN
3 = Applied to me very much, or most of the time - ALMOST ALWAYS
I found it hard to wind down
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I was aware of dryness of my mouth
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I couldn't seem to experience any positive feeling at all
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I found it difficult to work up the initiative to do things
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I tended to over-react to situations
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I experienced trembling (eg, in the hands)
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt that I was using a lot of nervous energy
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I was worried about situations in which I might panic and make a fool of myself
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt that I had nothing to look forward to
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I found myself getting agitated
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I found it difficult to relax
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt down-hearted and blue
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I was intolerant of anything that kept me from getting on with what I was doing
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt I was close to panic
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I was unable to become enthusiastic about anything
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt I wasn't worth much as a person
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt that I was rather touchy
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt scared without any good reason
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
I felt that life was meaningless
*
0 = Never
1 = Sometimes
2 = Often
3 = Almost always
Submit
Home
About Us
Nancy Bunt
Hours
Directions
Rates
Health Insurance Information
Services
Reiki Treatment
Reiki Training
>
Reiki For The Self
Reiki For Others
Reiki Second Degree
Reiki Master Teacher
Reiki Consulting
iRest® Self-Inquiry Meditation
SoulCollage®
TRE®
Live Workshops
Online Courses
Free Meditation Library
Online Booking
Store
Blog
Contact