Questionnaire (Safety Seeking)

Hello! Please click the button below to complete a short questionnaire. Doing this regularly is one way we can track how therapy is going. Your responses will be emailed directly to Dr Forzisi.

When you are at your most anxious or panicky, how often do you do the following things?:
Try to think about other things
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Hold on to or lean on to something
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Hold on to or lean on someone
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Sit down
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Keep still
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Move very slowly
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Look for an escape route
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Make yourself do more physical exercise
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Focus attention on your body
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Try to keep control of your mind
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Try to keep tight control over behaviour
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Talk more
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Take medication
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Ask people around for help
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Change your breathing
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Please select the word which best describes how often you AVOID the situations listed below because of anxiety. Select the word which best describes the extent to which your anxiety PREVENTS you from actually doing or coming into contact with these things.
Talking
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Being with people
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Sex
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Drinking alcohol
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Injections or minor surgery
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Eating or drinking with other people
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Hospitals
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Travelling alone by bus or coach
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Walking alone in busy streets
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Being watched or stared at
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Going into crowded shops
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Talking to people in authority
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Sight of blood
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Being criticised
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Going alone far from home
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Thought of injury or illness
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Speaking or acting to an audience
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Large open spaces Going to the dentist
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Exercise
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always
Drinking coffee
1 = Never, 2 = Sometimes, 3 = Often, 4 = Always