Weekly Record of Anxiety and Depression

Name:

Each evening before you go to bed, please make the following ratings, using the scale
below:
1. Your AVERAGE level of anxiety (taking all things into consideration);
2. Your MAXIMUM level of anxiety which you experienced that day;
3. Your AVERAGE level of depression;
4. Your AVERAGE level of pleasantness;
5. The percentage of the day that you felt worried, using a 0-100% scale where 0
means no worry at all and 100 means worried all the waking day.

Level of Anxiety/Depression/Pleasantness feelings

0 1 2 3 4 5 6 7 8
None Slight Moderate A lot As much as
you can
imagine

Average Maximum Average Average Percentage of

Date
anxiety anxiety depression pleasantness day worried