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How Has Quarantine Affected You?

Is your tendency to have a pessimistic or negative outlook on life?
Yes
Occasionally
No
How often do you feel worried or anxious?
Daily
A few times a week
Hardly ever
How often do you feel self-critical and guilty?
Daily
A few times a week
Hardly ever
Do you feel low self-esteem and lack confidence?
Yes
Occasionally
No
Do you have unexplained muscle pain or pain, tension and grinding associated with your jaw?
Yes, on a regular basis
Yes, but very rarely
No
Is it difficult for you to make transitions or be flexible?
Yes
Occasionally
No
Is it easy for you to become irritated, impatient, edgy, or angry?
Yes
Occasionally
No
Do you find it difficult to fall or stay asleep, even though you want to?
Yes
Occasionally
No
Do substances bring you welcomed relief or comfort which you cannot find elsewhere?
Yes
No
Do you have anxiety attacks or panic attacks (your heart races or it's hard to breathe)?
Yes, on a regular basis
Yes, but very rarely
No
Has a loved one voiced concern regarding your emotional or mental state in the last 6 months?
Yes
No
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