Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by making one choice for each symptom by marking the corresponding box in the column.

Instructions: This questionnaire consists of 21 groups of statements. Please read each group of statements carefully, and then pick out the ONE statement in each group that best describes the way you have been feeling during the past two weeks, including today. If several statements in the group seem to apply equally well, choose the farthest down on the list that applies. Be sure that you do not choose more than one statement for any group, including Item 16 (Changes in Sleeping Pattern) or Item 18 (Changes in Appetite).