Choosing Memento Vivere

Beck Anxiety Inventory (BAI)

Your Name Client Code (provided by your therapist)

Question 1 of 21

Numbness or tingling

Not at all Mildly Moderately Severely

Question 2 of 21

Feeling hot

Not at all Mildly Moderately Severely

Question 3 of 21

Wobbliness in legs

Not at all Mildly Moderately Severely

Question 4 of 21

Unable to relax

Not at all Mildly Moderately Severely

Question 5 of 21

Fear of worst happening

Not at all Mildly Moderately Severely

Question 6 of 21

Dizzy or lightheaded

Not at all Mildly Moderately Severely

Question 7 of 21

Heart pounding/racing

Not at all Mildly Moderately Severely

Question 8 of 21

Unsteady

Not at all Mildly Moderately Severely

Question 9 of 21

Terrified or afraid

Not at all Mildly Moderately Severely

Question 10 of 21

Nervous

Not at all Mildly Moderately Severely

Question 11 of 21

Feeling of choking

Not at all Mildly Moderately Severely

Question 12 of 21

Hands trembling

Not at all Mildly Moderately Severely

Question 13 of 21

Shaky/unsteady

Not at all Mildly Moderately Severely

Question 14 of 21

Fear of losing control

Not at all Mildly Moderately Severely

Question 15 of 21

Difficulty in breathing

Not at all Mildly Moderately Severely

Question 16 of 21

Fear of dying

Not at all Mildly Moderately Severely

Question 17 of 21

Scared

Not at all Mildly Moderately Severely

Question 18 of 21

Indigestion

Not at all Mildly Moderately Severely

Question 19 of 21

Faint/lightheaded

Not at all Mildly Moderately Severely

Question 20 of 21

Face flushed

Not at all Mildly Moderately Severely

Question 21 of 21

Hot/cold sweats

Not at all Mildly Moderately Severely

Your responses are confidential.

Thank you

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© 2026 Jonathan Procter, Ph.D., LMHC — Choosing Memento Vivere

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