How have you been feeling in the past week? Your Initials * I have felt tense, anxious or nervous Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) I have felt I have someone to turn to for support when needed Not at all (4) Occasionally (3) Sometimes (2) Often (1) Most or all of the time (0) I have felt able to cope when things go wrong Not at all (4) Occasionally (3) Sometimes (2) Often (1) Most or all of the time (0) Talking to people has felt too much for me Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) I have felt panic or terror Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) I made plans to end my life Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) I have had difficulty getting to sleep or staying asleep Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) I have felt despairing or hopeless Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) I have felt unhappy Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) Unwanted images or memories have been distressing me Not at all (0) Occasionally (1) Sometimes (2) Often (3) Most or all of the time (4) Thank you for taking the time to complete this form. The outcome of your therapy is important to me.
