
| 1. I feel overwhelmed by my worries. | Y | N |
| 2. Other people tell me to stop worrying so much, but I just can’t help it. | Y | N |
| 3. I always seem to find something to worry about. | Y | N |
| 4. I worry because I am trying to get better control over my life. | Y | N |
| 5. I am anxious and uncertain about the future. | Y | N |
| 6. I worry that I will make mistakes or fail at the things I attempt. | Y | N |
| 7. When I worry, I am bothered by symptoms such as muscle tension, fatigue, headaches, sleep disturbance, or stomach problems. | Y | N |
| 8. I feel tense most of the time and have difficulty relaxing. | Y | N |
| 9. I have always tended to be a worrier. | Y | N |
| 10. Once I start worrying, it is difficult for me to stop. | Y | N |
| 11. Worries come to my mind when I am trying to focus on other things. | Y | N |