ANXIETY SCALE by David Sheehan, MD 1983

Dr. Reneé Roberts, Psychologist

1405 W. 16th ST, STE C Yuma, AZ 85364-4589 Office: 928-783-4859 FAX: 928-782-3239

Email: Website:

Psychiatric Emergencies: Nursewise, 866-495-6735

Name: ______Date: ______

PART ONE

Instructions: This is a list of problems and complaints that people sometimes have. Circle the number on the right that best describes how much that problem bothered or distressed you. Mark only 1 number for each item, please don’t skip any items.

AMOUNT OF DISTRESS:

0 = Not at all 1 = A little bit 2 = Moderately 3 = Markedly 4 = Extremely

1. Lightheadedness, faintness or dizzy spells 0 1 2 3 4

2. Sensation of rubbery, weak or “jelly legs” 0 1 2 3 4

3. Feeling off-balance or unsteady, as if about to fall 0 1 2 3 4

4. Difficulty in getting breath, smothering sensation 0 1 2 3 4

5. Skipping or racing heart 0 1 2 3 4

6. Chest pain or pressure 0 1 2 3 4

7. Choking sensation, as if there was a lump in your throat 0 1 2 3 4

8. Tingling or numbness in parts of the body 0 1 2 3 4

9. Hot flashes or cold chills 0 1 2 3 4

10. Nausea, stomach problems 0 1 2 3 4

11. Episodes of diarrhea 0 1 2 3 4

12. Headaches or pains in neck or head 0 1 2 3 4

13. Feeling tired, weak, or easily exhausted 0 1 2 3 4

14. Spells of increased sensitivity to sound, light or touch 0 1 2 3 4

15. Bouts of excessive sweating while awake 0 1 2 3 4

16. Feeling that surroundings are strange, unreal, foggy, or that 0 1 2 3 4
you are detached from the world

17. Feeling as if you are outside or detached from part or all of 0 1 2 3 4
your body; or floating outside of your body (not in bed)

18. Worrying about your health too much 0 1 2 3 4

19. Feeling you are losing control or going insane 0 1 2 3 4

20. Something BAD is about to happen0 1 2 3 4

21. Shaking or trembling 0 1 2 3 4

22. Unexpected waves of depression occurring with little or 0 1 2 3 4
no reason

23. Emotions and moods going up and down a lot in response 0 1 2 3 4
to what’s happening around you

24. Being dependent on others because of your fears 0 1 2 3 4

25. Having to repeat the same action in a ritual way (e.g. checking 0 1 2 3 4
things, washing, counting things) when you know it’s not
necessary

26. Recurrent words or thoughts that keep intruding on your mind 0 1 2 3 4
and are hard to get rid of (e.g. unwanted aggressive, sexual,
or impulsive thoughts)

27. Difficulty falling asleep, esp. because of worrying, ruminating0 1 2 3 4

28. Waking up in the middle of the night or restless sleep0 1 2 3 4

29. Avoiding situations because of fear 0 1 2 3 4

30. Tense, unable to relax0 1 2 3 4

31. Anxiety, dread, nervous, restless 0 1 2 3 4

32. Anxiety attacks (3 or more symptoms) that occur when you are 0 1 2 3 4
in, or about to go in to a situation that in the past has brought

on an attack

33. Sudden UNEXPECTED anxiety attacks (3 or more symptoms) 0 1 2 3 4
that occur without any warning or cause

34. Sudden UNEXPECTED spells (1 or 2 symptoms) that occur 0 1 2 3 4
without a trigger

35. Anxiety episodes that build up as you anticipate doing some-0 1 2 3 4
thing that could bring on anxiety attacks

SCORING OF PART ONE: Add up all the numbers you’ve circled.

Score of 6 - 30Mild anxiety

Score of 31 - 50Moderate anxiety

Score of 51 - 80Marked anxiety

Score of 81 - 134Severe anxiety

This kind of anxiety is not related to what is actually going on outside you, in the environment. It is a physical, biological process that occurs randomly.

PART TWO

Instructions: Circle one number that describes how you feel during a phobic or stressful situation.

0 = Not at all 1 = A little bit 2 = Moderately 3 = Markedly 4 = Extremely

1. Mouth drier than usual 0 1 2 3 4

2. Worried, preoccupied 0 1 2 3 4

3. Nervous, jittery, anxious, restless 0 1 2 3 4

4. Afraid, fearful 0 1 2 3 4

5. Tense, uptight 0 1 2 3 4

6. Shaky (inside or out) 0 1 2 3 4

7. Fluttery stomach 0 1 2 3 4

8. Warm all over 0 1 2 3 4

9. Sweaty palms 0 1 2 3 4

10. Rapid or heavy heartbeat 0 1 2 3 4

11. Tremor of hands or legs 0 1 2 3 4

List events/things that can make you feel this way (e.g. phobia of heights, spiders):

______

SCORING OF PART TWO:

Score of 4 - 11Mild anxiety or phobia

Score of 12 - 22Moderate anxiety or phobia

Score of 23 - 33Marked anxiety or phobia

Score of 34 - 44 Severe anxiety or phobia

This kind of anxiety is how you are reacting to outside events in the environment. It has to do with how effective your coping skills are.