Instruction: Please read each statement and indicate how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement. 1.I was aware of dryness of my mouth Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS 2.I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion) Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS 3.I experienced trembling (e.g. in the hands) Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS 4.I was worried about situations in which I might panic and make a fool of myself Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS 5.I felt I was close to panic Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS 6.I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat) Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS 7.I felt scared without any good reason Did not apply to me at all – NEVER Applied to me to some degree, or some of the time – SOMETIMES Applied to me to a considerable degree, or a good part of time – OFTEN Applied to me very much, or most of the time – ALMOST ALWAYS Comments Leave a reply Cancel replyYou must be logged in to post a comment. This site uses Akismet to reduce spam. Learn how your comment data is processed.
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