Penn State Worry Questionnaire
Please take a moment to complete this questionnaire.
I prefer to respond anonymously:

1. Trigger: What was the situation, image, feeling or intrusive thought that triggered the health worry?
2. Initial Reaction: What feelings and reactions did you notice?
3. Intensity of Reaction: How strong was the initial reaction?

4. Health Worry: What obsessional thoughts and worries went through your mind?
5. Which of the following health anxiety patterns are maintaining the problem?

6. Checking / Reassurance Seeking Behaviours: What did you do to deal with the health worry?
7. Effectiveness of Response: How effective is the checking / reassurance seeking behaviour?

8. Alternative Response: What helpful, workable and sustainable action can you take in response to the health worry? E.g. Mindfulness, Rationalising, Acceptance / Willingness, Defusion, Competing Response, Slow Motion Focus, Committed Action.
9. Making Room: What uncomfortable thoughts and feelings will you need to make room for to take the alternative response?
10. Values and Goals: How will this move you closer to your values and goals?