Following is a list of symptoms, which usually are experienced when one is stressed or anxious.
Please print this page and circle the
number from 0 to 6 which reflects the intensity of your feelings lately.
When you feel less stress and more happy, do it again. |
| Rapid Heartbeat | very much 6 5
4 3 2 1 0 not at all |
| Muscle Tension | very much 6 5
4 3 2 1 0 not at all |
| Trembling | very much 6 5 4
3 2 1 0 not at all |
| Lump in the Throat | very much 6 5
4 3 2 1 0 not at all |
| Chest Pain | very much 6 5
4 3 2 1 0 not at all |
| Heavy Perspiration | very much 6 5
4 3 2 1 0 not at all |
| Dry Mouth | very much 6 5
4 3 2 1 0 not at all |
| Loosing Weight | very much 6 5
4 3 2 1 0 not at all |
| Gaining Weight | very much 6 5
4 3 2 1 0 not at all |
| Feeling Tired | very much 6 5
4 3 2 1 0 not at all |
| Shortness of Breath | very much 6 5
4 3 2 1 0 not at all |
| Hyperventilation | very much 6 5
4 3 2 1 0 not at all |
| Digestive Discomfort | very much 6 5
4 3 2 1 0 not at all |
| Diarrhea | very much 6 5 4
3 2 1 0 not at all |
| Frequent Urination | very much 6 5
4 3 2 1 0 not at all |
| Panic Attacks | very much 6 5
4 3 2 1 0 not at all |
| Fear of Loosing Control | very much 6 5
4 3 2 1 0 not at all |
| Irritability | very much 6 5 4
3 2 1 0 not at all |
| Difficulty Concentrating | very much 6 5
4 3 2 1 0 not at all |
| Sleep Disturbance | very much 6 5
4 3 2 1 0 not at all |
| Sensitivity to Noise | very much 6 5
4 3 2 1 0 not at all |
| Excessive Worry | very much 6 5
4 3 2 1 0 not at all |
| Intrusive Thoughts | very much 6 5
4 3 2 1 0 not at all |
| If the totals are very high, (110 Points and above), it would be adviseable to discuss this with your
doctor. |
