Name (Optional) _____________

Gender
M/F
Age _____

Participant Instructions
Below is a collection of statements about your everyday experience. Using the scale provided, please indicate how true each statement is of your
general experiences. Please answer according to what really reflects your experiences rather than what you think your experiences should be.
Please treat each item separately from every other item.
Rating Scale
Not at all true of me
Slightly true of me
Moderately true of me
Very true of me
Extremely true of me

1
2
3
4
5
6
7
8
9
10

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1
2
3
4
5

I get worried when I find out my friends are having fun without me.
When I have a good time it is important for me to share the details online (e.g. updating status)
It is important that I understand my friends inside jokes.
When I go on vacation, I continue to keep tabs on what my friends are doing.
I fear others have more rewarding experiences than me.
When I miss out on a planned get-together, it bothers me.
Sometimes, I wonder if I spend too much time keeping up with what is going on.
I fear my friends have more rewarding experiences than me.
I get anxious when I dont know what my friends are up to.
It bothers me when I miss an opportunity to meet up with friends.

1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2

3
3
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3
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3
3
3
3
3

4
4
4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5
5
5

Please read each statement and circle a number (0, 1, 2 or 3) that indicates how much the statement applied to you over the week. There are no
right or wrong answers. Do not spend too much time on any statement.
Rating Scale
Did not apply to me at all
Applied to me to some degree, or some of the time
Applied to me to a considerable degree, or a good part of time
Applied to me very much, or most of the time

1
2
3
4
5
6
7
8
9
10
11
12
13
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15
16
17
18
19
20
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23
24
25
26
27
28
29

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0
1
2
3

I found myself getting upset by quite trivial things

I was aware of dryness of my mouth
I couldnt seem to experience any positive feeling at all
I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)

I couldnt seem to get going

I tended to over-react to situations
I had a feeling of shakiness (e.g. legs going to give way)
I found it difficult to relax
I found myself in situations that made me so anxious I was most relieved when they ended
I felt that I had nothing to look forward to
I found myself getting upset rather easily
I felt that I was using a lot of nervous energy
I felt sad and depressed
I found myself getting impatient when I was delayed in any way (e.g. elevators, traffic lights, being kept waiting)
I had a feeling of faintness
I felt that I had lost interest in just about everything
I felt I wasnt worth much as a person
I felt that I was rather touchy
I perspired noticeably (e.g. hands sweaty) in the absence of high temperatures or physical exertion
I felt scared without any good reason
I felt that life wasnt worthwhile
I found it hard to wind down
I had difficulty in swallowing
I couldnt seem to get any enjoyment out of the things I did
I was aware of the action of my heart in the absence of a physical exertion (e.g. sense of heart rate increase, heart missing a beat

I felt down-hearted and blue

I found that I was very irritable
I felt I was close to panic
I found it hard to calm down after something upset me

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
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2
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2
2
2
2
2
2

3
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3
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3
3
3
3
3

30
31
32
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34
35
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38
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40
41
42

I feared that I would be thrown by some trivial but unfamiliar task

I was unable to become enthusiastic about anything
I found it difficult to tolerate interruptions to what I was doing
I was in a state of nervous tension
I felt I was pretty worthless
I was intolerant of anything that kept me from getting on with what I was doing
I felt terrified
I could see nothing in the future to be hopeful about
I felt that life was meaningless
I found myself getting agitated
I was worried about situations in which I might panic and make a fool of myself
I experienced trembling (e.g. in the hands)
I found it difficult to work up the initiative to do things

0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3