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Agoraphobic cognitions questionnaire

Below are some thought or ideas that may pass through your mind when you are nervous or frightened. Please indicate how often each thought occurs when you are nervous. Rate from 1-5 using the scale below:

Thought

Never

Occurs

Thought

Rarely

occurs

Thought occurs

During half of the times

Thought

Usually

Occurs

Thought

Always

occurs

When I am nervous ….

1. I am going to throw up	1	2	3	4	5
2. I am going to pass out
3. I must have a brain tumor
4. I will have a heart attack
5. I will chock to death
6. I am going to act foolish
7. I am going blind
8. I will not be able to control my self
9. I will hurt someone
10. I am going to have stroke
11. I am going crazy
12. I am going to scream
13. I am going to babble or talk funny
14. I am going to be paralyzed by fear
15. other ideas not listed (please describe and rate them)
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .

Copy right 1984‚ Dianne L. Chambless

http://www.psych.upenn.edu/~dchamb/questionnaires/ACQ.pdf

Agoraphobic cognitions questionnaire

Thought

Never

Occurs

Thought

Rarely

occurs

Thought occurs

During half of the times

Thought

Usually

Occurs

Thought

Always

occurs

When I am nervous ….

1. I am going to throw up	1	2	3	4	5
2. I am going to pass out
3. I must have a brain tumor
4. I will have a heart attack
5. I will chock to death
6. I am going to act foolish
7. I am going blind
8. I will not be able to control my self
9. I will lose control of my bladder or bowels
10. I will hurt someone
11. I am going to have stroke
12. I am going crazy
13. I am going to scream
14. I am going to babble or talk funny
15. I will be paralysed with fear
16. I am about to die
17. I am seriously ill
18. I am going to suffocate
other ideas not listed (please describe and rate them)
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .

Copy right 1984‚ Dianne L. Chambless

When you have the symptoms of panic‚ how much would you believe each of these thoughts to be true. Go back and rate each thought by choosing a number from the scale below‚ and put the number which applies on the dotted line on the RIGHT hand side of the form.

I do not believe this thought at all

100

I am completely convinced this thought is true

Finally‚ please rate the item below in the way you have done for the individual thoughts above; remember that the harm might include one or more of the thoughts listed above.

19. in panic attack‚ I will suffer serious physical or mental harm

-‎--‎--‎--‎--

http://psychology.iop.kcl.ac.uk/cadat/pdf/Panic/Agoraphobic_Cognitions_ACQ.pdf

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15 مهر 1391

Relative/s Response to the Anxiety Disorder Scale

Adjunctive Couple/Family Therapy for Anxiety Disorders Study

RELATIVE′S RESPONSES TO THE ANXIETY DISORDER SCALE (R-RADS)

Pt’s code: _____ Family member (circle): spouse/partner mother father

Assessment (circle): pretreatment Session 4 Session 8 Posttest Follow-up

INSTRUCTIONS: The items below describe the possible ways that a family member (or significant other) might respond to a relative’s anxiety disorder. Please circle the response for each item that best describes your behavior in the past week.

1. I reassured my relative that there were no grounds for his/her worries or fears.	Never	Rarely	Several times week	Daily	Multiple times a day
2. I did things I did not want to do in order to make my relative feel less anxious.	Never	Rarely	Several times week	Daily	Multiple times a day
3. I helped or encouraged my relative to avoid situations that might cause anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
4. I took on family or household responsibilities that my relative couldn’t adequately perform or did not want to perform due to his/her anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
5. I avoided talking about things that might have triggered my relative’s anxiety or worry.	Never	Rarely	Several times week	Daily	Multiple times a day
6. I stopped myself from doing things I would otherwise have done because they would have caused my relative anxiety	Never	Rarely	Several times week	Daily	Multiple times a day
7. I went along with what my relative wanted even when I disagreed because otherwise he/she would have been upset	Never	Rarely	Several times week	Daily	Multiple times a day
8. I made excuses or covered up for my relative when she/he missed work or a social activity because of her/his anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
9. I cut back my leisure time activities and my social life because of my relative’s anxiety problems.	Never	Rarely	Several times week	Daily	Multiple times a day
10. I changed my work or school schedule because of my relative’s anxiety problems.	Never	Rarely	Several times week	Daily	Multiple times a day
11. I put off some of my family responsibilities because of my relative’s anxiety problems.	Never	Rarely	Several times week	Daily	Multiple times a day
12. I sought information on behalf of my relative to reduce his/her concerns	Never	Rarely	Several times week	Daily	Multiple times a day
13. I accompanied my relative into situations or remained home with him/her when I did not wish to in order to reduce his/her anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
14. I tried to distract my relative when he/she talked about his/her anxiety concerns.	Never	Rarely	Several times week	Daily	Multiple times a day
15. I avoided talking about my own feelings and needs for fear that I would upset my relative.	Never	Rarely	Several times week	Daily	Multiple times a day
16. I let my relative decide how we will do things in order to reduce his/her distress	Never	Rarely	Several times week	Daily	Multiple times a day
17. Other: (please describe any other way you have changed your behavior in order to prevent or reduce your relative’s anxiety)	Never	Rarely	Several times week	Daily	Multiple times a day

http://www.psych.upenn.edu/~dchamb/questionnaires/R-RADS%20for%20web.pdf

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15 مهر 1391

PERCEIVED STRESS SCALE -4

PERCEIVED STRESS SCALE (PSS4)

INSTRUCTIONS:

The questions in this scale ask you about your feelings and thoughts during the last month. In each case‚ please indicate your response by placing an “X” over the circle representing HOW OFTEN you felt or thought a certain way.

	Never	Almost Never	Sometime	Fairly Often	Very Often
1. In the last month‚ how often have you felt that you were unable to control the important things in your life?
2. In the last month‚ how often have you felt that things were going your way?
3. In the last month‚ how often have you felt confident about your ability to handle your personal problems?
4. In the last month‚ how often have you felt difficulties were piling up so high that you could not overcome them?

http://www.psy.cmu.edu/~scohen/scales.html

This scale can be found in:

Cohen‚ S.‚ Kamarck‚ T.‚ Mermelstein‚ R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior‚ 24‚ 385-396. Link to full-text (pdf)

Cohen‚ S.‚ & Williamson‚ G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.)‚ The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park‚ CA: Sage. Link to full-text (pdf)

up‎dated July 8‚ 2008

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15 مهر 1391

Relative/s Response to the Anxiety Disorder Scale

Adjunctive Couple/Family Therapy for Anxiety Disorders Study

RELATIVE′S RESPONSES TO THE ANXIETY DISORDER SCALE (R-RADS)

Pt’s code: _____ Family member (circle): spouse/partner mother father

Assessment (circle): pretreatment Session 4 Session 8 Posttest Follow-up

1. I reassured my relative that there were no grounds for his/her worries or fears.	Never	Rarely	Several times week	Daily	Multiple times a day
2. I did things I did not want to do in order to make my relative feel less anxious.	Never	Rarely	Several times week	Daily	Multiple times a day
3. I helped or encouraged my relative to avoid situations that might cause anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
4. I took on family or household responsibilities that my relative couldn’t adequately perform or did not want to perform due to his/her anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
5. I avoided talking about things that might have triggered my relative’s anxiety or worry.	Never	Rarely	Several times week	Daily	Multiple times a day
6. I stopped myself from doing things I would otherwise have done because they would have caused my relative anxiety	Never	Rarely	Several times week	Daily	Multiple times a day
7. I went along with what my relative wanted even when I disagreed because otherwise he/she would have been upset	Never	Rarely	Several times week	Daily	Multiple times a day
8. I made excuses or covered up for my relative when she/he missed work or a social activity because of her/his anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
9. I cut back my leisure time activities and my social life because of my relative’s anxiety problems.	Never	Rarely	Several times week	Daily	Multiple times a day
10. I changed my work or school schedule because of my relative’s anxiety problems.	Never	Rarely	Several times week	Daily	Multiple times a day
11. I put off some of my family responsibilities because of my relative’s anxiety problems.	Never	Rarely	Several times week	Daily	Multiple times a day
12. I sought information on behalf of my relative to reduce his/her concerns	Never	Rarely	Several times week	Daily	Multiple times a day
13. I accompanied my relative into situations or remained home with him/her when I did not wish to in order to reduce his/her anxiety.	Never	Rarely	Several times week	Daily	Multiple times a day
14. I tried to distract my relative when he/she talked about his/her anxiety concerns.	Never	Rarely	Several times week	Daily	Multiple times a day
15. I avoided talking about my own feelings and needs for fear that I would upset my relative.	Never	Rarely	Several times week	Daily	Multiple times a day
16. I let my relative decide how we will do things in order to reduce his/her distress	Never	Rarely	Several times week	Daily	Multiple times a day
17. Other: (please describe any other way you have changed your behavior in order to prevent or reduce your relative’s anxiety)	Never	Rarely	Several times week	Daily	Multiple times a day

http://www.psych.upenn.edu/~dchamb/questionnaires/R-RADS%20for%20web.pdf

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15 مهر 1391

Depression‚ Anxiety and Stress Scales 42

Depression‚ Anxiety and Stress Scales DASS- 42

Please read each statement and circle a number 0‚ 1‚ 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers.

Do not spend too much time on any statement.

0= Did not apply to me at all

1= Applied to me to some degree or for some of time

2= Applied to me to consider degree or for a good part of time

3= Applied to me very much or most of the time

1. I found myself getting upset by quite trivial things

2. I was aware of dryness of my mouth.

3. I couldn't seem to experience any positive feeling at all.

4. I experience breathing difficulty (e.g. breathlessness or excessively rapid breathing in the absence of physical exertion).

5. I just couldn't seem to get going

6. I tended to over-react to situations.

7. I had a feeling of shakiness (e.g. legs going to give way)

8. I found it difficult to relax.

9. I found myself in situations that made me so anxious I was most relieved when they ended

10.I felt that I had nothing to look forward to.

11.I found myself getting upset rather easily

12.I felt that I was using a lot of nervous energy.

13.I felt sad and depressed

14. I found myself getting impatient when I was delayed in any way (eg‚ lifts‚ traffic lights‚ being kept waiting)

15.I had a feeling of faintness

16.I felt that I had lost interest in just about everything

17.I felt I wasn't worth much as a person.

18.I felt that I was rather touchy.

19. I perspired noticeably (e.g. hands sweaty) in the absence of high temperatures or physical exertion

20.I felt scared without any good reason.

21.I felt that life wasn't worthwhile

22.I found it hard to "wind down".

23.I had difficulty in swallowing

24.I couldn't seem to get any enjoyment out of the things I did

25. I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart 'missing a beat').

26.I felt down hearted and blue.

27.I found that I was very irritable

28.I felt I was close to panic.

29.I found it hard to calm down after something upset me

30.I feared that I would be "thrown" by some trivial but unfamiliar task

31.I was unable to become enthusiastic about anything.

32.I found it difficult to tolerate interruptions to what I was doing

33.I was in a state of nervous tension

34.I felt I was pretty worthless

35.I was intolerant of anything that kept me from getting on with what I was doing.

36.I felt terrified

37.I could see nothing in the future to be hopeful about

38.I felt that life was meaningless.

39.I found myself getting agitated.

40.I was worried about situations in which I might panic and make a fool of myself

41.I experienced trembling (e.g. in the hands).

42.I found it difficult to work up the initiative to do things

http://www2.psy.unsw.edu.au/groups/dass/Persian/Persian.htm

Reference: Lovibond‚ S.H. & Lovibond‚ P.f. (1995). Manual for the Depression anxiety

Stress Scales. (2nd Ed) Sydney: Psychology Foundation.

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15 مهر 1391

Perceived Stress Scale 14 item

PERCEIVED STRESS SCALE (PSS- 14)

INSTRUCTIONS:

The questions in this scale ask you about your feelings and thoughts during the last month. In each case‚ you will be asked to indicate your response by placing an “X” over the circle representing HOW OFTEN you felt or thought a certain way. Although some of the questions are similar‚ there are differences between them and you should treat each one as a separate question. The best approach is to answer fairly quickly. That is‚ don’t try to count up the number of times you felt a particular way‚ but rather indicate the alternative that seems like a reasonable estimate.

	Never	Almost Never	Sometime	Fairly Often	Very Often
1. In the last month‚ how often have you been upset because of something that happened unexpectedly?
2. In the last month‚ how often have you felt that you were unable to control the important things in your life?
3. In the last month‚ how often have you felt nervous and “stressed”?
4. In the last month‚ how often have you dealt successfully with day to day problems and annoyances
5. In the last month‚ how often have you felt that you were effectively coping with important changes that were occurring in your life?
6. In the last month‚ how often have you felt confident about your ability to handle your personal problems?
7. In the last month‚ how often have you felt that things were going your way?
8. In the last month‚ how often have you found that you could not cope with all the things that you had to do?
9. In the last month‚ how often have you been able to control irritations in your life?
10. In the last month‚ how often have you felt that you were on top of things?
11. In the last month‚ how often have you been angered because of things that were outside your control?
12. In the last month‚ how often have you found yourself thinking about things that you have to accomplish
13. In the last month‚ how often have you been able to control the way you spend your time
14. In the last month‚ how often have you felt difficulties were piling up so high that you could not overcome them?

http://www.psy.cmu.edu/~scohen/scales.html

This scale can be found in:

Cohen‚ S.‚ Kamarck‚ T.‚ Mermelstein‚ R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior‚ 24‚ 385-396. Link to full-text (pdf)

up‎dated July 8‚ 2008

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15 مهر 1391

Perceived Stress Scale- 10 Item

Perceived Stress Scale- 10 Item
The questions in this scale ask you about your feelings and thoughts during the last month. In each case‚ please indicate with a check how often you felt or thought a certain way.
1. In the last month‚ how often have you been upset because of something that happened unexpectedly?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
2. In the last month‚ how often have you felt that you were unable to control the important things in your life?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
3. In the last month‚ how often have you felt nervous and "stressed"?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
4. In the last month‚ how often have you felt confident about your ability to handle your personal problems?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
5. In the last month‚ how often have you felt that things were going your way?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
6. In the last month‚ how often have you found that you could not cope with all the things that you had to do?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
7. In the last month‚ how often have you been able to control irritations in your life?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
8. In the last month‚ how often have you felt that you were on top of things?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
9. In the last month‚ how often have you been angered because of things that were outside of your control?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often
10. In the last month‚ how often have you felt difficulties were piling up so high that you could not overcome them?
___0=never	___1=almost never	___2=sometimes	___3=fairly often	___4=very often

This scale can be found in:

Cohen‚ S.‚ Kamarck‚ T.‚ Mermelstein‚ R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior‚ 24‚ 385-396. Link to full-text (pdf)

up‎dated July 8‚ 2008

http://www.psy.cmu.edu/up‎datescohen/PSS.html

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15 مهر 1391

Depression‚ Anxiety and Stress Scales21

Depression‚ Anxiety and Stress Scales DASS- 21

0= Did not apply to me at all

1= Applied to me to some degree or for some of time

2= Applied to me to consider degree or for a good part of time

3= Applied to me very much or most of the time

1. I found it hard to "wind down".

2. I was aware of dryness of my mouth.

3. I couldn't seem to experience any positive feeling at all.

4. I experience breathing difficulty (e.g. breathlessness or excessively rapid breathing in the absence of physical exertion).

5. I found it difficult to work up the initiative to do things.

6. I tended to over-react to situations.

7. I experienced trembling (e.g. in the hands).

8. I felt that I was using a lot of nervous energy.

9. I was worried about situation in which I might panic and make a fool of myself.

10.I felt that I had nothing to look forward to.

11.I found myself getting agitated.

12.I found it difficult to relax.

13.I felt down hearted and blue.

14.I was intolerant of anything that kept me from getting on with what I was doing.

15.I felt I was close to panic.

16.I was unable to become enthusiastic about anything.

17.I felt I wasn't worth much as a person.

18.I felt that I was rather touchy.

19.I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart 'missing a beat').

20.I felt scared without any good reason.

21.I felt that life was meaningless.

www.serene.me.uk

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15 مهر 1391

Generalized anxiety disorder

GAD-7 Anxiety Severity

Generalized anxiety disorder

GAD-7 Over the last 2 weeks‚ how often have you been bothered by the following problems?

Use “✔” to indicate your answer	Not at all	Several days	More than half the days	Nearly every day
1. Feeling nervous‚ anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen

This is calculated by assigning scores of 0‚ 1‚ 2‚ and 3‚ to the response categories of “not at all‚” “several days‚” “more than half the days‚” and “nearly every day‚” respectively. GAD-7 total score for the seven items ranges from 0 to 21. Scores of 5‚ 10‚ and 15 represent cut points for mild‚ moderate‚ and severe anxiety‚ respectively. Though designed primarily as a screening and severity measure for generalized anxiety disorder‚ the GAD-7 also has moderately good operating ch‎aracteristics for three other common anxiety disorders – panic disorder‚ social anxiety disorder‚ and post-traumatic stress disorder. When screening for individual or any anxiety disorder‚ a recommended cutpoint for further evaluation is a score of 10 or greater.

References

Spitzer RL‚ Kroenke K‚ Williams JBW‚ for the Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA 1999;282:1737-1744.

Spitzer RL‚ Williams JBW‚ Kroenke K‚ et al. Validity and utility of the Patient Health Questionnaire in assessment of 3000 obstetrics-gynecologic patients. Am J Obstet Gynecol 2000; 183:759-769

Spitzer RL‚ Kroenke K‚ Williams JBW‚ Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-1097.

Kroenke K‚ Spitzer RL‚ Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-613.

Kroenke K‚ Spitzer RL‚ Williams JBW. The PHQ-15: Validity of a new measure for evaluating somatic symptom severity. Psychosom Med 2002;64:258-266.

Kroenke K‚ Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals 2002;32:509-521. [also includes validation data on PHQ-8]

Kroenke K‚ Spitzer RL‚ Williams JBW. The Patient Health Questionnaire-2 : validity of a two-item depression screener. Med Care 2003; 41:1284-1292.

Kroenke K‚ Spitzer RL‚ Williams JBW‚ Monahan PO‚ Löwe B. Anxiety disorders in primary care: prevalence‚ impairment‚ comorbidity‚ and detection. Ann Intern Med 2007 (in press). [also includes additional validation data on GAD-7 and GAD-2]

Kroenke K‚ Spitzer RL‚ Williams JBW‚ Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Under review.

Löwe B‚ Kroenke K‚ Herzog W‚ Gräfe K. Measuring depression outcome with a short self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affective Disorders 2004;78:131-140.

Löwe B‚ Unutzer J‚ Callahan CM‚ Perkins AJ‚ Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care 2004;42:1194-1201.

http://www.goodmedicine.org.uk/files/assessment‚%20phq9‚%20gad7‚%20etc.pdf

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15 مهر 1391