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BAI

Below is a list of common symptoms of anxiety. Indicate how much each symptom has bothered you during the past week, including today.

  1. 1.Numbness or tingling

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  2. 2.Feeling hot

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  3. 3.Wobbliness in legs

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  4. 4.Unable to relax

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  5. 5.Fear of the worst happening

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  6. 6.Dizzy or lightheaded

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  7. 7.Heart pounding or racing

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  8. 8.Unsteady

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  9. 9.Terrified or afraid

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  10. 10.Nervous

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  11. 11.Feeling of choking

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  12. 12.Hands trembling

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  13. 13.Shaky / unsteady

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  14. 14.Fear of losing control

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  15. 15.Difficulty breathing

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  16. 16.Fear of dying

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  17. 17.Scared

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  18. 18.Indigestion

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  19. 19.Faint / lightheaded

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  20. 20.Face flushed

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

  21. 21.Hot or cold sweats

    • [0]Not at all
    • [1]Mildly — it did not bother me much
    • [2]Moderately — it was very unpleasant but I could stand it
    • [3]Severely — I could barely stand it

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