Burns Anxiety Inventory

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Instructions: Choose the best answer for how you have felt over the past week, including today. Mark the answer that best describes how much that symptom or problem has bothered you.
0 = Not at all 1 = Somewhat 2 = Moderate 3 = A lot

Name

Category I: Anxious Feelings

Anxiety, nervousness, worry, or fear *

0

1

2

3

Feeling that things around you are strange, unreal, or foggy *

0

1

2

3

Feeling detached from all or part of your body *

0

1

2

3

Sudden unexpected panic spells *

0

1

2

3

Apprehension or sense of impending doom *

0

1

2

3

Feeling tense, stressed, “uptight”, or on edge *

0

1

2

3

Difficulty concentrating *

0

1

2

3

Racing thoughts or having your mind jump from one thing to the next *

0

1

2

3

Frightening fantasies or daydreams *

0

1

2

3

Feeling that you’re on the verge of losing control *

0

1

2

3

Fears of losing your mind (cracking up or going crazy) *

0

1

2

3

Fears of fainting or passing out *

0

1

2

3

Fears of physical illnesses or heart attacks or dying *

0

1

2

3

Concerns about looking foolish or inadequate in front of others *

0

1

2

3

Fears of being alone, isolated, or abandoned *

0

1

2

3

Fears of criticism or disapproval *

0

1

2

3

Fears that something terrible is about to happen *

0

1

2

3

Category III: Physical Symptoms

Skipping or racing or pounding of the heart (sometimes called palpitations) *

0

1

2

3

Pain, pressure, or tightness in the chest *

0

1

2

3

Tingling or numbness in the toes or fingers *

0

1

2

3

Butterflies or discomfort in the stomach *

0

1

2

3

Constipation or diarrhea *

0

1

2

3

Restlessness or jumpiness *

0

1

2

3

Tight, tense muscles *

0

1

2

3

Sweating not brought on by heat *

0

1

2

3

A lump in the throat *

0

1

2

3

Trembling or shaking *

0

1

2

3

Rubbery or “jelly” legs *

0

1

2

3

Feeling dizzy, lightheaded, or off balance *

0

1

2

3

Choking or smothering sensations or difficulty breathing *

0

1

2

3

Headaches or pains in the neck or back *

0

1

2

3

Hot flashes or cold chills *

0

1

2

3

Feeling tired, weak, or easily exhausted *

0

1

2

3

0-4 Minimal or no anxiety 21-30 Moderate anxiety

5-10 Borderline anxiety 31-50 Severe Anxiety

11-20 Mild Anxiety 51-99 Extreme anxiety or panic

BAI Score

Thanks for submitting!

Category II: Anxious Thoughts

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Mississauga, Ontario

416-550-1072

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