3 g i 5 1968, 1977 by Chars 0 Cony State-Trait Anxiety Inventory for Adults Self-Evaluation Questionnaire STAI Form Y-1 and Form Y-2 Developed by Charles D. Spielberger in collaboration with RL. Gorsuch, R. Lushene, PR. Vagg, and G.A. Jacobs Copyright Permission You have purchased permission to reproduce this document up to the maximum number that Is shown on the leftmost column of this page. You may not reproduce more than this allotted amount. if you wish to reproduce more than this amount, you are required to purchase bulk permission for each additional copy over the amount that is shown in the leftmost column on this page. Copyright Policy Its your legal responsibil to compensate the copyright holder of this work for any reproduction in any medium, If any part of this Work (@.g,, scoring, items, etc.) is put on an electronic or other media, you agree to remove this Work from that media at the end of this license. The copyright holder has agreed to grant one person permission to reproduce this work for one year from the date of purchase for non-commercial and personal use only. Non- ‘commercial use means that you will not receive payment for distributing this document and personal use means that you wll only reproduce this work for your own research or for cients. This permission is granted to one: person only. Each person who administers the test must purchase permission separately. Any organization purchasing permissions must purchase separate permissions for each individual who will be using or administering the test Published by Mind Garden 1690 Woodside Road Suite 202, Redwood City, CA 94061 USA 650-261-3500 ‘www.mindgarden.com Copyright © 1968, 1977 by Charles D. Spielberger. All rights reserved.Copytigh 1368, 1977 by ChallesD. Spier. Al rights served \© Copyright 1986,1977 by Charles 0. Spieberger. All rights reserved. Published by Mind Garden, Inc., 1690 Woodside Re, Suite 202, Redwood City. CA 94081 STAIP-AD Test Form ¥ \waw.mindgarden.comCCopytigh 1868, 1877 by Charis D. Speiberger. Al gts roroned. SELF-EVALUATION QUESTIONNAIRESTAI Form Y-1 Please provide the following information: Name_ Date. S. Age. Gender (Circle) MF TL DIRECTIONS: ey, cn ‘A numberof statements which people have used to describe themselves are gven below — 4. dy %, v7 Read each statement and then circie the appropriate number to the right of the statement = hy, Mm to indicate how you fee ight no, thai, a his moment. There ae no right oF wrong ho, answers. Do not spend too much time on any one statement but lve the answer which & seems to describe your present feelings best 1. | feel calm. 234 2.1 feel secure -12 3 4 3.1.am tense 23 4 4. | feel strained .. i i 23 4 5. | feel at ease ales a 123 4 6.1 feel upset — a seven 123 4 7.1 am presently worrying over possible misfortunes 123 4 8. | feel satisfied... oe 123 4 9. | feel frightened ...... 203 4 10. | feel comfortable ... 23 4 11. | feel self-confident... 123 4 12. | feel nervous tens nveces es sensnaee 1°23 4 13.1. am jittery eemeeesitsu secnetsstneineeseense women 1 2 BF 14. | feel indecisive. we 12 3 4 15, 1am relaxed Sarmaneain suv ioceeaoepie este ie 123 4 16. | feel content ........ 23 4 17.1 am worried ........ 23 4 18. | feel confused.. 23 4 19. | feel steady.....-...s.ssssersse men ws 123 4 20. feel pleasant 234 Pubtahed by ind Garde, ie. 1860 Woda Rd Sue 208 Rodwood iy, CA 94061 Sv magerden comSELF-EVALUATION QUESTIONNAIRE STAI Form ¥-2 Name. Date. DIRECTIONS % % Anmburtesonete vero ive sti rte encesaeanenseew 5, y ac eac statement and then cic th appropriate number oth right ofthe satement % spines a epvaryalTropeare oo oh reno spain, Oot weet i 4% % ai Gig ond latrnam te Is ghenor len poeta ES CEO hw %, ‘genoraly feel 24. feel pleasant. ...jcccnnnnemisennnnene ss 22. | feel nervous and restless 23. | feel satisfied with myselt.. 24. | wish | could be as happy as others seem to be... 28. | feel like a failure... 2B: ETRGH FOB1OK sciccsonzsnwssninisnsninnsetinitecestne ee 27.1am “calm, cool, and collected" . 28. | feel that difficulties are piling up so that | cannot overcome them 29. | worry too much over something that really doesn't matter... 30. | am happy... 31. | have disturbing thoughts ...sscsssssusenesenstnsit ie . | lack self-confidence. TERR SOCUE scsssseninstntncsnoesi a 32, 33, 34. [make decisions easily... 35, [feel inadequate....c.cnme Se 36. lam content... 37. Some unimportant thought runs through my mind and bothers me... 38. | take disappointments so keenly that | can't put them out of my mind.. aR RR hh hh hh hhh hh RR 39. lam a steady person. 40. | get in a state of tension or turmoil as | think over my recent concerns and interests soa sci 1968, 1977 by Chatles D. Speiberger. Al rights reserved > Copyright 1968,1977 by Charlas 0. Spielberger. Allrighis reserved, STAIP-AD Test Form ¥ Published by Mind Garden, inc,, 1690 Woodside Rd, Suite 202, Redwood City, CA $4061 ‘www mindgarden.com(Copyigh 1968, 1977 by Chavos ©. Spoloerger. Al ghts reserved State-Trait Anxiety Inventory for Adults Scoring Key (Form Y-1, ¥-2) Developed by Charles D. Splelborger in calaboraton wth RL. Gorsuch, R: Lushane, PI: Vagg. and GA. Jaco0s ‘To Use this stencil, fold this chect in haif and line up with the appropriato tost side, either Form ¥-1 of Form ¥-2 ‘Simply total the scoring weights shown on the stencil for each response category. For example, for question # 1, if the respondent marked 3, then the weight would be 2. Refer to the manual for appropriate normative data. toy % 4 & % % 2 ey Me, My % ty Be, *, Form Y-1 ue oo Form Y-2 1. 43 2 4, 21, 4321 2. 43 2 * 22. 123 4 3. 123 4 23. 43 21 4. 123 4 24. 123 4 5. 43 2 4 25. 4123 4 6. 41°23 4 26. 43 2 1 7. 423 4 27. 43214 8. 43 2 1 28. 123 4 9. 123 4 29. 4123 4 10. 43 2 1 30. 4321 11. 43 2 4 31. 123 4 12. 123 4 32. 1623 4 13. 412 3 4 33. 43 2 1 14, 4123 4 34. 4321 15. 43 2 1 35. 1423 4 16. 43 2 1 36. 4321 17. 1623 4 37. 123 4 18. 123 4 38. 123 4 19. 43 2 4 39. 4321 20. 43 2 + 40. 423 4 Pupil by Mind Garden na 1090 WoedeGe Rd. Sue 208 Redwood Giy, CA 4061 “mcnndgerden on