Anxiety Self-Rating Scale

INSTRUCTIONS:

This scale is designed for your personal use. There are no right or wrong answers. Usually your first response is the best. Please click on the level of extremity on the scale from 0 - 4. When you are finished your score will add up and you will get your TOTAL SCORES.

Make sure you base your answers on how you actually behave in your daily life, not on how you would like to be.

I feel tense, nervous, restless, or agitated	0 1 2 3 4
I feel afraid for no apparent reason	0 1 2 3 4
I worry about bad things that might happen to me or those I care about	0 1 2 3 4
I have difficulty falling asleep, staying asleep or waking up early	0 1 2 3 4
I have difficulty eating too much, too little or digesting my food	0 1 2 3 4
I wish I knew a way to make myself more relaxed	0 1 2 3 4
I have difficulty with my concentration, memory or thinking	0 1 2 3 4
I would say I am anxious much of the time	0 1 2 3 4
From time to time I have experienced a racing heartbeat, cold hands or feet, dry mouth, sweating, tight muscles, difficulty breathing, numbness, frequent urination, or hot/cold flashes	0 1 2 3 4
I wish I could be as relaxed with myself as others seem to be	0 1 2 3 4

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