Anxiety checklist

For more than TWO WEEKS have you:
1. Felt anxious, tense or nervious most of the time?	Yes No
2. Felt fearful or worried all of the time?	Yes No

If you answered ”YES” to either of those questions, please complete the following sympton checklist:

Behaviours	Thoughts
Avoid the supermarket or cinema	“I’m going crazy”
Constantly check your pulse	“I won’t have anything interesting to say”
Do different things to cope, like having someone with you, or carrying the phone around	“I can’t control my worry”
Avoid eye contact	“I have a serious illness that the doctors can’t detect”
Use alcohol and sedatives to calm down	“What if germs are on my hands and I get sick”
Feelings	Physical
Confused	Blushing
Anxious	Trembling
Tense all the time	Heart racing
Constantly nervous	Numbness, tingling
Panicky	Nausea
Terrified	Sweating
On edge	Shaking
Scared	Pounding heart
	Short of breath
	Dizzy