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Checking in with yourself takes courage. Take your time with each question — there's no rush.
Over the last 2 weeks, how often have you been bothered by the following problems?
Question 1
Feeling nervous, anxious, or on edge
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
Question 2
Not being able to stop or control worrying
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
Question 3
Worrying too much about different things
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
Question 4
Trouble Relaxing
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
Question 5
Being so restless that it is hard to sit still
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
Question 6
Becoming easily annoyed or irritable
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
Question 7
Feeling afraid as if something awful might happen
0
Not at all
1
Several days
2
More than half the days
3
Nearly every day
If you checked any problems above, how difficult have these
made it to work, manage home life, or get along with others?