BSTTW Anxiety Questionnaire Survey
Anxiety Questionnaire
1. Are you suffering from nervousness, worry or fear?
No
Yes
2. Do you feel that things around you are strange, unreal or foggy?
No
Yes
3. Do you have sudden and/or unexpected panic attacks?
No
Yes
4. Do you have difficulty concentrating?
No
Yes
5. Do you have racing thoughts?
No
Yes
6. Do you have frightening daydreams?
No
Yes
7. Do you feel that you are on the verge of losing control?
No
Yes
8. Do you have a fear of going crazy?
No
Yes
9. Do you have a fear of fainting or passing out?
No
Yes
10. Do you have a fear of losing control?
No
Yes
11. Do you have a fear of dying?
No
Yes
12. Do you feel you will have a physical illness or heart attack?
No
Yes
13. Do you have a fear of being abandoned?
No
Yes
14. Do you feel you will look foolish or inadequate in front of others?
No
Yes
15. Do you feel tense up tight, or stressed out?
No
Yes
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