The Crushing Anxiety Questionnaire
1.
Please indicate your gender. You may use any pronoun to identify yourself.
2.
Were you an anxious or nervous child (up until the age of 18 years old)?
Yes
No
3.
Do you believe that there is a Genetic component to your Anxiety? Specifically, are there other family members that also suffer from this or any other emotional issues? Please elaborate, if so.
4.
If YES, was their a trigger, an event, a trauma, a crisis or any reason that you can point to as to why you started suffering from anxiety?
5.
If your anxiety started after 18, than what age did it begin?
6.
Was there a specific event, trauma or crisis that triggered your first panic attack? If YES, please feel free to share that experience, under OTHER.
Yes
No
Other (please specify)
7.
Please list the specific anxiety disorder(s) that you have been diagnosed with.
8.
Do you currently suffer from panic attacks?
Yes
No
9.
If yes, than how often do they occur?
10.
Are you currently on anti-anxiety medication?
Yes
No
Other (please specify)
11.
If YES, please indicate which ones.
12.
If NO, than have you ever been on anti-anxiety meds? Please indicate which meds.
13.
When you experience your anxiety, please explain how it makes you feel, physically and mentally.
14.
How long does the anxiety last for? Hours, days, weeks, months? Please elaborate where possible.
15.
Do you also suffer from depression?
Yes
No
16.
If you suffer from both, which would you say affects you worse, and please explain why?
17.
Do you have substance abuse habits? If YES, please indicate whether it is drugs or alcohol and how often.
18.
If YES, would you say that your substance abuse habits are tied to your anxiety (ie. you "use" to numb the pain) or is your substance abuse completely separate?
19.
Are you currently in a relationship?
Yes
No
Please elaborate here, if it's neither yes or no.
20.
Do you struggle with maintaining healthy relationships? If YES, please explain why?
21.
Have you ever been in Behavioural Modification therapy for your Anxiety? These are treatment methods that teach you how to cope with and manage your anxiety. (This does not include taking medication.)
Yes
No
Other (please specify)
22.
If YES, which behavioural & cognitive treatment methods have worked for you and which ones have not?
23.
If you have never tried behavioural modification therapy, is there a reason why not?
24.
Do you consider yourself a highly sensitive person who is emotionally affected by other people's actions, opinions, moods and lifestyle?
Yes
No
Other (please specify)
25.
How much time do you spend each day scrolling through social media platforms to see what everyone else is doing?
26.
How does that make you feel, seeing how everyone else is thriving, living their "best" lives and seemingly always happy?
27.
Do you feel truly safe only when you are home and/or alone?
Yes
No
Other (please specify)
28.
Would you say that you live in fear of having another anxiety attack?
Yes
No
Other (please specify)
29.
Do you truly believe that you CAN get better and stop suffering from anxiety, panic attacks and any of the other behaviours that prevent you from living your life worry-free?
Yes
No
30.
If you are currently on medication, are you willing (with your doctors help) to begin weaning yourself off, in order to live your life without meds, using only behavioural & cognitive methods to deal with your anxious thoughts? If YES, please feel free to elaborate on your concerns or fears.
31.
Final question; In your own words, can you explain the difference between incessant over-worrying and anxiety?
Current Progress,
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