Are You Relaxed As Rain OR Crippled With Anxiety?


Your Age:
Your Gender (M or F):

I am unable to relax and worry a lot.
Never
Seldom
Sometimes
Often
Always

I find it hard to concentrate.
Never
Seldom
Sometimes
Often
Always

I cannot get my mind off my problems, no matter what I try.
Never
Seldom
Sometimes
Often
Always

I focus the most on events in my life that upset me.
Never
Seldom
Sometimes
Often
Always

I feel like crying for no apparent reason.
Never
Seldom
Sometimes
Often
Always

I feel like I am under pressure, overwhelmed, or that there is just too much to handle or do.
Never
Seldom
Sometimes
Often
Always

I have trouble falling asleep, staying asleep, have nightmares or wake up in a panic.
Never
Seldom
Sometimes
Often
Always

I get irritated or annoyed easily.
Never
Seldom
Sometimes
Often
Always

I feel on edge, tense or grouchy.
Never
Seldom
Sometimes
Often
Always

I feel tired, sluggish, lethargic or worn out.
Never
Seldom
Sometimes
Often
Always

I have digestive problems like diarrhea, constipation, or upset stomach.
Never
Seldom
Sometimes
Often
Always

My muscles feel sore, tense, or just plain ache.
Never
Seldom
Sometimes
Often
Always

I get cold, clammy or sweaty hands.
Never
Seldom
Sometimes
Often
Always

I feel hot then cold then hot then cold (flashes).
Never
Seldom
Sometimes
Often
Always

I have difficulty swallowing or feel that lump in my throat.
Never
Seldom
Sometimes
Often
Always

I experience twitching, trembling or shaking.
Never
Seldom
Sometimes
Often
Always

I get headaches, neck pain or stiffness.
Never
Seldom
Sometimes
Often
Always

I feel a numbness or tingling sensation in my extremities (anywhere on the body, including the hands, feet, legs, arms, head, mouth, chest, groin area).
Never
Seldom
Sometimes
Often
Always

I faint, feel like fainting, feel dizzy or light-headed.
Never
Seldom
Sometimes
Often
Always

I feel my heart pounding like its going to burst out of my chest.
Never
Seldom
Sometimes
Often
Always

I get chest pains, chest tightness or find it hard to breathe.
Never
Seldom
Sometimes
Often
Always

I have to pee often.
Never
Seldom
Sometimes
Often
Always

I am easily alarmed, scared, fearful or anxious for no reason at all.
Never
Seldom
Sometimes
Often
Always

I am afraid of strangers, public places or being trapped in a place with no exits.
Never
Seldom
Sometimes
Often
Always

I fear being embarrassed or making a fool out of myself.
Never
Seldom
Sometimes
Often
Always

I am afraid to make a mistake.
Never
Seldom
Sometimes
Often
Always

I over think about the reasons why I do many of the things I do.
Never
Seldom
Sometimes
Often
Always

I spend my time wondering why I feel the way I do.
Never
Seldom
Sometimes
Often
Always

I am indecisive.
Never
Seldom
Sometimes
Often
Always

I have difficulty resolving issues or problems no matter how long I spend thinking about them.
Never
Seldom
Sometimes
Often
Always

I think about all the things I have yet to accomplish.
Never
Seldom
Sometimes
Often
Always

I am afraid of the future that awaits me.
Never
Seldom
Sometimes
Often
Always

I feel unsatisfied with my life.
Never
Seldom
Sometimes
Often
Always

I feel down in the dumps.
Never
Seldom
Sometimes
Often
Always

I feel I have lost control of my life, my mind or of reality itself.
Never
Seldom
Sometimes
Often
Always

I do not have as much interest in activities I used to enjoy.
Never
Seldom
Sometimes
Often
Always

I don't feel like myself. I feel detached from loved ones and emotionally numb.
Never
Seldom
Sometimes
Often
Always

The world is a very scary place to me.
Never
Seldom
Sometimes
Often
Always

I worry about dying or impending doom.
Never
Seldom
Sometimes
Often
Always

I am very happy and feel great about myself.
Never
Seldom
Sometimes
Often
Always





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