The following questions ask about thoughts, feelings, and behaviors that you may have had in a variety of situations. Please select the item below that makes you most anxious. Select the specific phobia category that applies to you: a. Driving, flying, tunnels, bridges, or enclosed spaces b. Animals or insects c. Heights, storms, or water d. Blood, needles, or injections e. Choking or vomiting
During the past month, I have... 1. Felt moments of sudden terror, fear, or fright in these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
2. Felt anxious, worried, or nervous about these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
3. Had thoughts of being injured, overcome with fear, or other bad things happening in these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
4. Felt a racing heart, sweaty, trouble breathing, faint, or shaky in these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
5. Felt tense muscles, on edge or restless, or had trouble relaxing in these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
6. Avoided, or did not approach or enter, these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
7. Moved away from these situations or left them early. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
8. Spent a lot of time preparing for, or procrastinating about (putting off) these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
9. Distracted myself to avoid thinking about these situations. 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
10. Needed help to cope with these situations (e.g., alcohol or medications, superstitious objects, other people). 0 - Never 1 - Occasionally 2 - Half of the time 3 - Most of the time 4 - All of the time
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