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Beck’s Anxiety Inventory
Name
First
Last
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 circling the number in the corresponding space in the column next to each symptom.
Numbness or tingling
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Feeling Hot
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Wobbliness in legs
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Unable to relax
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Fear of worst happening
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Dizzy or lightheaded
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Heart pounding / racing
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Unsteady
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Terrified or afraid
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Nervous
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Feeling of choking
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Hands trembling
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Shaky / unsteady
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Fear of losing control
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Difficulty in breathing
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Fear of dying
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Scared
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Indigestion
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Faint / lightheaded
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Face flushed
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
Hot / cold sweats
Not at all
Mildly, but it didn't bother me much
Moderately – it wasn't pleasant at times
Severely – it bothered me a lot
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