CBT standard questionnaires
Name/initials: Date:
PHQ-9
Over the last 2 weeks, how often have you been More than
bothered by any of the following problems? Several Nearly
Not at all half the
days every day
(circle one number for each question) days
1. Little interest or pleasure in doing things? 0 1 2 3
2. Feeling down, depressed, or hopeless? 0 1 2 3
3. Trouble falling or staying asleep, or sleeping too
0 1 2 3
much?
4. Feeling tired or having little energy? 0 1 2 3
5. Poor appetite or overeating? 0 1 2 3
6. Feeling bad about yourself - or that you are a
0 1 2 3
failure or have let yourself or your family down?
7. Trouble concentrating on things, such as reading
0 1 2 3
the newspaper or watching television?
8. Moving or speaking so slowly that other people
could have noticed? Or the opposite - being so fidgety
0 1 2 3
or restless that you have been moving around a lot
more than usual?
9. Thoughts that you would be better off dead or of
0 1 2 3
hurting yourself in some way?
Total
GAD-7
Over the last 2 weeks, how often have you been Not at all Several More than Nearly
bothered by any of the following problems? days half the every day
(circle one number for each question) days
1. Feeling nervous, anxious or on edge? 0 1 2 3
2. Not being able to stop or control worrying? 0 1 2 3
3. Worrying too much about different things? 0 1 2 3
4. Trouble relaxing? 0 1 2 3
5. Being so restless that it is hard to sit still? 0 1 2 3
6. Becoming easily annoyed or irritable? 0 1 2 3
7. Feeling afraid as if something awful might happen? 0 1 2 3
Total
All questionnaires in public domain. This version © Online CBT Resources: [Link]
CBT standard questionnaires
Phobia scales
0 1 2 3 4 5 6 7 8
Would --- Slightly --- Definitely --- Markedly --- Always
not avoid avoid it avoid it avoid it avoid it
it
Your
Choose a number from the scale above to show how much you would avoid each of the situations or score
objects listed below. Then select the number in the box opposite the situation.
(0-8)
Social situations due to fear of being embarrassed or making a fool of myself
Certain situations because of fear of having a panic attack or other distressing symptoms (such as
loss of bladder control, vomiting or dizziness)
Certain situations because of a fear of particular objects (such as animals, heights, seeing blood,
being in confined spaces, driving or flying)
Work and social adjustment scale (adapted)
0 1 2 3 4 5 6 7 8
Not at all --- Slightly --- Definitely --- Markedly --- Very
severely
People's problems sometimes affect their ability to do certain day-to-day tasks in their lives. To rate Your
your problems, look at each section and determine on the scale above how much your problem score
impairs your ability to carry out the activity. (0-8)
WORK/STUDY - if you are retired or choose not to have a job or to study for reasons unrelated to your
problems please put N/A
HOME MANAGEMENT/SELF-CARE - cleaning, tidying, shopping, cooking, looking after home/children,
paying bills, exercising, eating healthily, consuming alcohol within government guidelines etc.
SOCIAL LEISURE ACTIVITIES - with other people, e.g. parties, pubs, outings, entertaining etc.
PRIVATE LEISURE ACTIVITIES - done alone, e.g. reading, gardening, sewing, hobbies, walking etc.
FAMILY AND RELATIONSHIPS - form and maintain close relationships with others including the
people that I live with
Total
All questionnaires in public domain. This version © Online CBT Resources: [Link]