Language
English (US)
Hindi
How I'm Feeling
Name
First Name
Last Name
INSTRUCTIONS: Read the options carefully. Select the option which indicates 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 found it hard to wind down
*
0 = Did not apply to me at all
2 = Applied to me very much or most of the time
1 = Applied to me to some degree, or some of the time
3 = Applied to me to a considerable degree or a good part of time
2. I was aware of dryness of my mouth
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
3. I couldn’t seem to experience any positive feeling at all
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
4. I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
5. I found it difficult to work up the initiative to do things
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
6. I experienced trembling (e.g. in the hands)
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
7. I tended to over-react to situations
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
8. I felt that I was using a lot of nervous energy
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
9. I was worried about situations in which I might panic and make a fool of myself
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
10. I felt that I had nothing to look forward to
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
11. I found myself getting agitated
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
12. I found it difficult to relax
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
13. I felt down-hearted and blue
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
14. I was intolerant of anything that kept me from getting on with what I was doing
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
15. I felt I was close to panic
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
16. I was unable to become enthusiastic about anything
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
17. I felt I wasn’t worth much as a person
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
18. I felt that I was rather touchy
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
19. 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
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
20. I felt scared without any good reason
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
21. I felt that life was meaningless
*
Did not apply to me at all
Applied to me very much or most of the time
Applied to me to some degree, or some of the time
Applied to me to a considerable degree or a good part of time
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