Survey: BAI

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Instructions

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 each symptom during the PAST WEEK, INCLUDING TODAY, by selecting the corresponding column for each symptom.

SEVERELYI could barelystand it

MODERATELYVery unpleasant,but I could stand it

MILDLYIt did notbother me much

NOT AT ALL

1. Numbness or tingling. *

Not at all

Mildly

Moderately

Severely

2. Feeling hot. *

Not at all

Mildly

Moderately

Severely

3. Wobbliness in legs. *

Not at all

Mildly

Moderately

Severely

4. Unable to relax. *

Not at all

Mildly

Moderately

Severely

5. Fear of the worst happening. *

Not at all

Mildly

Moderately

Severely

6. Dizzy or lightheaded. *

Not at all

Mildly

Moderately

Severely

7. Heart pounding or racing. *

Not at all

Mildly

Moderately

Severely

8. Unsteady. *

Not at all

Mildly

Moderately

Severely

9. Terrified. *

Not at all

Mildly

Moderately

Severely

10. Nervous. *

Not at all

Mildly

Moderately

Severely

11. Feelings of choking. *

Not at all

Mildly

Moderately

Severely

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