Bhati Mind Care

Self-Assessment Scale

Beck Anxiety Inventory (BAI)

Below is a list of common symptoms of anxiety. Please read each item carefully. Indicate how much you have been bothered by that symptom during the past month, including today, by selecting the corresponding option.

Item 1 Numbness or tingling

Not At All Mildly Moderately Severely

Item 2 Feeling hot

Not At All Mildly Moderately Severely

Item 3 Wobbliness in legs

Not At All Mildly Moderately Severely

Item 4 Unable to relax

Not At All Mildly Moderately Severely

Item 5 Fear of worst happening

Not At All Mildly Moderately Severely

Item 6 Dizzy or lightheaded

Not At All Mildly Moderately Severely

Item 7 Heart pounding / racing

Not At All Mildly Moderately Severely

Item 8 Unsteady

Not At All Mildly Moderately Severely

Item 9 Terrified or afraid

Not At All Mildly Moderately Severely

Item 10 Nervous

Not At All Mildly Moderately Severely

Item 11 Feeling of choking

Not At All Mildly Moderately Severely

Item 12 Hands trembling

Not At All Mildly Moderately Severely

Item 13 Shaky / unsteady

Not At All Mildly Moderately Severely

Item 14 Fear of losing control

Not At All Mildly Moderately Severely

Item 15 Difficulty in breathing

Not At All Mildly Moderately Severely

Item 16 Fear of dying

Not At All Mildly Moderately Severely

Item 17 Scared

Not At All Mildly Moderately Severely

Item 18 Indigestion

Not At All Mildly Moderately Severely

Item 19 Faint / lightheaded

Not At All Mildly Moderately Severely

Item 20 Face flushed

Not At All Mildly Moderately Severely

Item 21 Hot/cold sweats

Not At All Mildly Moderately Severely

Patient Clinical Record Details

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