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Anxiety Assessment Quiz
1) I worry about the future all the time
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
2) I have some unresolved past traumas and negative experiences
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
3) I love being on stage or presenting to other people
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
4) I struggle to go to sleep at night and sometimes wake up in the middle of the night and cannot go back to sleep
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
5) I have a hard time trusting people easily
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
6) I spend a lot of time thinking about negative things in my life
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
7) I don't like big crowds of people
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
8) It puts me on edge if I have to interact with people where I may have to make small talk
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
9) I can easily relax into the present moment
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
10) I feel uncomfortable in my physical body
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
11) I have digestive problems such as indigestion, diarrhea or constipation
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
12) I am easily scared or shocked
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
13) I frequently experience shortness of breath or shallow breathing
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
14) I sometimes feel dizzy, faint or nauseous
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
15) I trust that life is good to me
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
16) Procrastination is my middle name
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
17) I often either feel too hot or too cold
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
18) I sometimes find myself shaking or twitching
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
19) I worry about being left alone
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
20) I sometimes have bad dreams or nightmares
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
21) My body is always tired or achy
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
22) My hands are always cold and sweaty
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
23) I am good at disconnecting from my emotions
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
24) My mind is always racing a hundred miles an hour
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
25) I am fearful about many things
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
26) I practice lots of self care such as meditation, energy work, essential oils etc, to stay out of overwhelm
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
27) The muscles in my neck and shoulders are always tight
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
28) I struggle with headaches
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
29) There is always something fun going on that I can be a part of
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
30) I feel wonderful about myself
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
31) Life seems to get harder the older I am getting
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
32) My childhood was very difficult
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
33) I believe I am the master of my own destiny
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
34) I am able to manifest my desires easily and effortlessly
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
35) I am surrounded by wonderful supportive relationships
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
36) I have lots of family and friends who love and care about me
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
37) I have a hard time focusing properly on things
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
38) I need to empty my bladder frequently
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
39) I sometimes have out of body experiences
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
40) My heart is always pounding and beating fast
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
41) I often feel hopeless and powerless about my life and the future
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
42) I feel emotionally numb in some relationships
*
Strongly Agree
Agree
Neither Agree / Disagree
Disagree
Strongly Disagree
Name
*
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Last
Email
*
Total Score
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Home
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Breakthrough Anxiety Retreat – Reclaim Your Life
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