Form: Body Vigilance Scale, BVS

1. I am the kind of person who pays close attention to internal bodily sensations.
0 : Not at all like me
1
2
3
4
5 : Moderately like me
6
7
8
9
10 Extremely like me
2. I am very sensitive to changes in my internal bodily sensations.
0 : Not at all like me
1
2
3
4
5 : Moderately like me
6
7
8
9
10 Extremely like me
3. On average, how much time do you spend each day “scanning” your body for sensations (e.g., sweating, heart palpitations, dizziness)?
0 : No time
1
2
3
4
5 : Half of the time
6
7
8
9
10 : All of the time
4.

Rate how much attention you pay to each of the following sensations

Heart palpitations
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
5. Chest pain / discomfort
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
6. Numbness
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
7. Tingling
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
8. Short of breath / smothering
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
9. Faintness
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
10. Vision changes
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
11. Feelings of unreality
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
12. Feeling detached from self
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
13. Dizziness
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
14. Hot flash
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
15. Sweating / clammy hands
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
16. Stomach upset
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
17. Nausea
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme
18. Choking / throat closing
0 : None
10
20 : Slight
30
40
50 : Moderate
60
70
80 : Substantial
90
100 : Extreme

The presented answer sheet is not an original form and is not intended for printing or use as a handout.