Eo
cr
Nome: Estado Civil: dade:
Ocupasao: Escolaridade:
Abaixo esté uma lista de sintomas comuns de ansiedade. Por favor, leia cuidadosamente cada item da lista. Identifique
‘© quanto voeé tem sido incomodado por cada sintoma durante a diltima semana, ineluindo hoje, colocando um “x” no
cespago correspondente, na mesma linha de cada sintoma.
—
ios EEE ker “=
=
a
——e
5. Medo que acontega 0 pior.
6. Atordoado ou tonto.
7.Palpitasio ou aceleracio do coragio.
8, Sem equilibrio.
9. Aterrorizado.
10, Nervoso.
11, Sensagio de sufocagio.
12, Tremores nas mios.
13, Trémulo.
14, Medo de perder 0 controle.
15, Dificuldade de respirar.
16, Medo de morrer,
17. Assustado.
18, Indigestdo ou desconforto no abdémen.
19, Sensagio de desmaio.
20, Rosto afogueado.
21. Suor (do devido ao calor).
rr
“Trauzio adapado por permis de NCS Pearoa, Ine. Diss esrvados “1981 Aaron T. Beck
‘Tradugio prs alinguaporagueen. Dirt reservados °1983 a Aaron T. Back. Todos os dts reservados.”
“Tradugo eadptagio brasileira, 2001, Casa do Psicéloge™. BAL & um logotipo da NCS Parson, Ine. Data:
BRR Rieti
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