www.calpsy.net
Confidential Online Anxiety Screening

Choose one of the following statements

For a long time, probably more than six months, I have felt worried and anxious, more days than not.

For the last few months or so, I have quite often been worried and felt anxious, more often than before.

I have been feeling more worried and anxious lately, maybe for as long as a few weeks.

I tend to worry and become anxious every now and then, just like everyone else.

I almost never feel worried or anxious.

Choose one of the following statements

I tend to worry and feel anxious about a number of different things.

 

I usually worry about one thing, or a few things, or something very specific.

 

Choose one of the following statements

When I feel anxious or start worrying, it is really difficult for me to stop it or to control it.

 

Although it may take some effort, I can usually stop my worrying or control it.

 

Choose one of the following statements

I am having problems in life because I am worrying so much. My feelings of anxiety are causing me
to have troubles at school, or at work, or at home, or in relationships, etc.

 

I am usually able to cope with my feelings of anxiety, and to prevent them from interfering with my life.

 

Choose one of the following statements

I sometimes think that it's not really worth it, that things are not going to get better,
and that maybe there is no good reason to care about what happens.

 

I usually think that things will get better, and that there is always good reason
to care about what happens, and how I am feeling.

 

Select as many as the following that apply:
True
False

I have been feeling restless, or "keyed up" or "on edge"

 

 

I find that I am easily tired or fatigued.

 

 

I have been having troubles concentrating, my mind sometimes goes blank.

 

 

I have been unusually irritable.

 

 

I have been experiencing a lot of muscle tension or muscle pain.

 

 

My sleep is often disturbed (difficulty falling asleep, or staying asleep, or restless, unsatisfying sleep).

 

 

I seem to have a lot of medical problems, or I often feel that I am generally not in good health.

 

 

I have been suffering from a significant and specific medical problem,
or I have a significant medical condition.

 

 

Choose one of the following statements

I have been using drugs, or a lot of alcohol.

 

Sometimes I will have a drink to stop myself from worrying.

 

Sometimes I will have a drink to relax.

 

I only drink in social situations, or with a meal, and always in moderation.

 

I don't drink at all.

 

Please answer true or false to each of the following:
True
False

There is a specific thing or activity that I have a strong fear about. When I get close to it, I become very nervous or distressed, and I know it's a problem for me.

 

 

There are social situations (it may be one, or a number of them) that I greatly fear. I try to avoid the situation, but if I can't, I become very nervous or distressed, and I know it's a problem for me.

 

 

I have thoughts, or images, or impulses that keep coming back to my mind,
over and over, and it really bothers me.

 

 

There is a behavior, or a mental routine that I feel like I have to go through
over and over again, and it really bothers me.

 

 

A number of times, I have had attacks, where in just a matter of ten or fifteen minutes, I become completely unsettled, and I feel like maybe I'm having a heart attack or a nervous breakdown.

 

 

Last two questions:
You are:       Male     Female 
Your age is:      

Never mind, I've changed my mind, please do not process

Copyright 2001, Paul G. Mattiuzzi, Ph.D.