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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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