Body Sensations Questionnaire

Below is a list of specific body sensations that may occur when you are nervous or in a feared situation. Please mark down how afraid you are of these feelings. Use the rating scale below:

0. I don’t experience this sensation.
1. Not frightened or worried by this sensation.
2. Somewhat frightened by this sensation.
3. Moderately frightened by this sensation.
4. Very frightened by this sensation.
5. Extremely frightened by this sensation.

_____ Shortness of breath (dyspnea) or smothering sensations.
_____ Dizziness, unsteady feelings or faintness.
_____ Palpitations or accelerated heart rate (tachycardia)
_____ Trembling or shaking
_____ Sweating
_____ Choking
_____ Nausea or abdominal distress
_____ Depersonalization (“I feel like I’m not me anymore”)
_____ Derealization (“I feel like reality isn’t real anymore”)
_____ Numbness or tingling sensations (paresthesias)
_____ Flushes (“hot flashes”) or chills
_____ Chest pain or discomfort
_____ Fear of dying
_____ Fear of going “crazy” or “going out of control”
_____ Fear of being in a terrible accident
_____ Having a dry throat or a “lump” in my throat
_____ Feeling disoriented and confused
_____ Feeling only partly present
_____ Feeling disconnected from my body
_____ Pressure or a heavy feeling in my chest
_____ Blurred or distorted vision
_____ Having “butterflies” or a “knot” in my stomach
_____ Having wobbly or “rubber” legs

_____ Other: ______________________________________
_____ Other: ______________________________________