1 – Very little
2 – A little
3 – Some
4 – Much
5 – Very much
¹
1
2
3
4
5
1
It is important not to appear nervous.
2
When I cannot keep my mind on a task, I worry that I might be going crazy.
3
It scares me when I feel shaky.
4
It scares me when I feel faint.
5
It is important to me to stay in control of my emotions.
6
It scares me when I my heart beat rapidly.
7
It embarrasses me when my stomach growls.
8
It scares me when I am nauseous (sick stomach).
9
When I notice my heart beating rapidly, I worry that I might be having a heart attack.
10
It scares me when I become short of breath.
11
When my stomach is upset, I worry that I might be seriously ill.
12
It scares me when I am unable to keep my mind on a task.
13
Other people notice when I feel shaky.
14
Unusual body sensations scare me.
15
When I am nervous, I worry that I might be mentally ill.
16
It scares me when I am nervous.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.