IAPT
IAPT Combined Questionnaire This assessment brings together the standard outcome measures used in the Improving Access to Psychological Therapies (IAPT) programme. GPs, Therapists and clients can complete this questionnaire on-line and obtain a printout or electronic copy of their results. You can respond anonymously, and no data will be retained from this assessment. If you choose to include your initials and an email address, your results will be automatically sent to the email address provided. Please check that the email address has been entered correctly before submitting this form. All client information is managed on a strictly confidential basis. Please Note: Whilst every effort is made to ensure that our system is securely encrypted, email is not a completely secure means of communication. Think CBT does not accept liability for loss or theft of personal data where any individual chooses to transmit or receive information via email.
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This questionnaire is not designed to provide a definitive psychological diagnosis or to take the place of a professional consultation. Please answer all questions as accurately and honestly as possible.

PHQ9
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things




2. Feeling down, depressed, or hopeless




3. Trouble falling/staying asleep, sleeping too much




4. Feeling tired or having little energy




5. Poor appetite or overeating




6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down




7. Trouble concentrating on things, such as reading the newspaper or watching television




8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.




9. Thoughts that you would be better off dead or of hurting yourself in some way.




If you have been bothered by any of the 9 questions above, please answer the following

How difficult have these problems made it for you to do your work, take care of things , or get along with other people?






GAD7
Over the last 6 months, how often have you been bothered by the following problems?
1. Feeling nervous, anxious or on edge




2. Not being able to stop or control worrying




3. Worrying too much about different things




4. Trouble relaxing




5. Being so restless that it's hard to sit still




6. Becoming easily annoyed or irritable




7. Feeling afraid as if something awful might happen




If you checked any of the problems, how difficult have these problems made it for you to do your work, take care of things at home or get along with other people?




Phobia Scales

This questionnaire is not designed to provide a definitive psychological diagnosis or to take the place of a professional consultation. Please answer all questions as accurately and honestly as possible.

Please choose an option from the scale below to show how much you would avoid each of the situations or objects listed below.


1. Social situations due to a fear of being embarrassed or making a fool of myself





2. Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness)





3. Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying).





WSAS
1) Because of the way I feel, my ability to work is impaired

0 indicates no impairment at all and 8 indicates severe impairment


                 
2. Because of the way I feel, my home management (cleaning, tidying, shopping, cooking, looking after home or children, paying bills) is impaired

0 indicates no impairment at all and 8 indicates severe impairment


                 
3. Because of the way I feel, my social leisure activities involving other people (such as parties, outings, visits, dating, home entertainment, cinema) are impaired

0 indicates no impairment at all and 8 indicates severe impairment


                 
4. Because of the way I feel, my private leisure activities done alone (such as reading, watching TV, gardening, craft work, walking, sewing) are impaired

0 indicates no impairment at all and 8 indicates severe impairment


                 
5. Because of the way I feel, my ability to form and maintain close relationships with others, including those I live with is impaired

0 indicates no impairment at all and 8 indicates severe impairment