The Burns Anxiety Inventory

Instructions: The following is a list of symptoms that people sometimes have. Select the choice that best describes how much that symptom or problem has bothered you in the past week.

Patient name:

Symptom List

Category I: Anxious Feelings 0 - No at all 1 - Somewhat 2 - Moderately 3 - A lot
1. Anxiety, nervousness, worry or fear
2. Feeling that things around you are strange, unreal or foggy
3. Feeling detached from all or part of your body
4. Sudden unexpected panic spells
5. Apprehension or a sense of impending doom
6. Feeling tense, stressed, "Uptight", or on edge

Category II: Anxious Thoughts 0 - No at all 1 - Somewhat 2 - Moderately 3 - A lot
7. Difficulty concentrating
8. Racing thoughts or having your mind jump from one thing to the next
9. Frightening fantasies or daydreams
10. Feeling that you're on the verge of losing control
11. Fears of cracking up or going crazy
12. Fears of fainting or passing out
13. Fears of physical illnesses or heart attacks or dying
14. Concerns about looking foolish or inadequate in front of others
15. Fears of being alone, isolated or abandoned
16. Fears of criticism or disapproval
17. Fears that something terrible is about to happen

Category III: Physical Symptoms 0 - No at all 1 - Somewhat 2 - Moderately 3 - A lot
18. Skipping or racing or pounding of the heart (sometimes called "palpitations")
19. Pain, pressure or tightness in the chest
20. Tingling or numbness in the toes or fingers
21. Butterflies or discomfort in the stomach
22. Constipation or diarrhea
23. Restlessness or jumpiness
24. Tight, tense muscles
25. Sweating not brought on by heat
26. A lump in the throat
27. Trembling or shaking
28. Rubbery or "jelly" legs
29. Feeling dizzy, lightheader or off balance
30. Choking or smothering sensations or difficulty breathing
31. Headaches or pains in the nexk or back
32. Hot flashes or cold chills
33. Feeling tired, weak or easily exhausted

Total score Degree of anxiety
0-4 Minimal or no anxiety
5-10 Borderline anxiety
11-20 Mild anxiety
21-30 Moderate anxiety
31-50 Severe anxiety
51-99 Extreme anxiety