[form] Name: [text,name,40] Email: [text,email,30] Anxiety profile for this past week Dates from: [text,datefrom,20] To: [text,dateto,20]

SITUATIONAL Experiences I am facing a threat [list,anxiety01] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I am facing a danger [list,anxiety02] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I am facing a challenge [list,anxiety03] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] Those I have a close relationship with are under threat of some kind [list,anxiety04] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I have had unhelpful Memories and Images in my mind [list,anxiety05] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] Situational Score: [text,sitAgscore,10] Add up the scores (your evaluative figures) for your situations

THINKING PROCESS I overestimate the negative features of the (event) [list,anxiety06] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I underestimate my ability to cope with the threat [list,anxiety07] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I create an even more negative threat in my mind [list,anxiety08] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I have more task irrelevant thoughts than mere concern [list,anxiety09] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I withdraw mentally from the [event] [list,anxiety10] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I withdraw physically from the [event] [list,anxiety11] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] Thinking Score: [text,thinkAgscore,10] Add up the scores for your thinking

THINKING PROCESS I view the event/experience realistically [list,anxiety16] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I realistically appraise my ability to cope with the event/experience [list,anxiety17] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I do not create an even more negative threat in my mind [list,anxiety18] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I have more task relevant thoughts than in anxiety [list,anxiety19] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I do not withdraw physically from the [event], I fact it [list,anxiety20] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I do not withdraw mentally from the [event], I deal with it constructively [list,anxiety21] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] I don't wish the event away. [list,anxiety22] [option,choose,Choose the frequency of occurence,selected] [option,0,0 Not at all] [option,1,1 Some occurences] [option,2,2 Frequently] [option,3,3 Most of the time] [/list] Alternative Thinking Score: [text,thinkANscore,10] Add up the scores for your thinking