Anxiety Screener

Please correct the errors described below.

Name:

Pronouns:

Date:

Over the last 2 weeks, how often have you been bothered by the following problems?

1. Feeling nervous, anxious, or on edge

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

2. Not being able to stop, or control worrying

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

3. Worrying too much about different things

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

4. Trouble relaxing

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

5. Being so restless that it’s hard to sit still

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

6. Becoming easily annoyed or irritable

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

7. Feeling afraid, as if something awful might happen

0 = Not at all 1 = Several days 2 = Over half the days 3 = Nearly every day

If you checked off any problems, how difficult have these made if for you to do your work, take care of things at home, or get along with other people?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

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