Anxiety Screening

Please rate yourself and ask one other person who knows you well to rate you using the following scale:

0	1	2	3	4
Never	Rarely	Occasionally	Frequently	Very Frequently

Self	Other
		Do you find difficulty in controlling worry?
		Do you have aches or pains?
		Do you feel restless and/or tired?
		Is it hard to concentrate or complete daily tasks?
		Are you irritable?
		Do you have sleep disruption, or is it difficult to fall asleep?
		Do you have distinct episodes of feeling on edge, shaky, or a pounding heart, shortness of breath, or tightness in your chest?
		Do your hands feel cold or clammy, or your mouth dry, stomach upset, urinary frequency, or trouble swallowing?

Consider a professional assessment if any of the following are answered yes:

	You have distinct episodes of feeling on edge, shaky, or a pounding heart, shortness of breath, or tightness in your chest.
	You are concerned about the checked symptoms.
	You checked “3’s” and “4’s” and have felt this way for at least two weeks.
	You have difficulty accomplishing daily tasks.

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For any diagnosis, participants should seek a professional evaluation from a physician or qualified healthcare professional. Blair Counseling and Mediation shall not be liable for any claims or damages, and expressly disclaim all liability of any nature for any action or non-action taken as a result of the information on the Blair Counseling and Mediation websites, blogs, or any of its programs. The screens on this site are not appropriate for completion by persons under age 18.

Often Anxious?

Fueled by stress hormones, anxiety combines worry with uncomfortable and at times intolerable physical sensations. On top of feeling stressed, you may find shortness of breath, a racing heart, chest or stomach pain, and possibly dizziness. Goals at Blair Counseling include increasing an ability to relax and get the information you need to be more confident in dealing with a situation.

Anxiety combines worry with cardiopulmonary symptoms. You may feel that you cannot stop dwelling on disturbing situations. Even without one’s awareness, hyperventilation leads to increased alkalinity of nerve cells leaving one feeling nervous or excitable. It also decreases the availability of carbon dioxide leading to increased heart palpitations, blood flow, increased muscle tension and unusual sensations. Constriction of blood vessels to the brain or extremities can lead to dizziness, or coldness in one’s hands or feet. Tense chest wall muscles can make it difficult to breathe. Decreased blood flow to the stomach increases acidity. Treatment at Blair Counseling includes relaxation techniques, stress management, and altering thought processes.

Blair Counseling with offices located in McHenry County, Illinois 7115 Virginia Road, Suite 109 Crystal Lake, IL 60014
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