Psychotherapy in English ... in Rome 

"Man is disturbed not by things, but by the views he takes of them."    Epictetus     

Anxiety Evaluation

***Using the indicators below, rate each of the 23 statements as they pertain to symptoms you've experienced during the past week to ten days  0 = never               1= rarely               2= sometimes/occasionally              3= often


1.  Worry, fear, nervousness.

2.  Things around you feel strange or unreal.

3.  Feeling detatched from your body.

4.  Sudden feelings of panic.

5.  A sense of impending doom.

6.  Feeling on edge, tense or stressed out.


1.  Difficulty focusing/concentrating on tasks.

2.  Racing thoughts.

3.  Fears of being alone/isolated.

4.  Fear of losing control.

5.  Fear of going crazy.

6.  Fear of passing out, having a heart attack, or dying.

7.  Fears of criticism or disapproval.

8.  Fear that something terrible is about to happen.


1.  Pounding, racing or skipping of heart.

2.  Pain, pressure, and/or tightness in chest.

3.  Muscle tension, head/neck/back pain.

4.  Easily startled, restlessness.

5.  Weakness in legs, trembling or shaking.

6.  Constipation or diarrhea

7.  Feeling tired or weak for no apparent reason.

8.  A choking sensation or feeling like you can't catch your breath

9.  Stomach discomfort/nervousness. 

KEY:  3- 5  =  borderline anxiety

           6-15  = mild anxiety

          16-25 = moderate anxiety

          26-39 = high anxiety

          40- ^  = severe anxiety

*** It is  important to consult your physician to rule out the possibility that the symptoms you are experiencing are not caused by or related to a medical condition.