Aiding Minds

Understanding minds & making a difference.

Please be honest and answer all questions, there are no right or wrong answers.

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* 1. Please state your schools name

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* 2. Form or class name

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* 3. What year group are you in

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* 4. Insert your full name

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* 5. Please state whether your

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* 6. Select one from each of the following question

I worry about things

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* 7. I feel sad or empty

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* 8. When I have a problem, I get a funny feeling in my stomach

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* 9. I worry when I think I have done poorly at something

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* 10. I would feel afraid of being on my own at home

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* 11. I like to be in control?

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* 12. Nothing is much fun anymore

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* 13. I feel scared when I have to take a test

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* 14. I feel worried when I think someone is angry with me

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* 15. I worry about being away from my parents

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* 16. I get bothered by bad or silly thoughts or pictures in my mind

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* 17. I have trouble sleeping

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* 18. I worry that I will do badly at my school work

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* 19. I worry that something awful will happen to someone in my family

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* 20. I suddenly feel as if I can't breathe when there is no reason for this

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* 21. I have problems with my appetite (eating habits)

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* 22. I have to keep checking that I have done things right (like checking if the switch is off, or the door is locked)

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* 23. I feel scared if I have to sleep on my own

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* 24. I have trouble going to school in the mornings because I feel nervous or afraid

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* 25. I have no energy for things

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* 26. I worry I might look foolish

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* 27. I am tired a lot

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* 28. I worry that bad things will happen to me

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* 29. I can't get bad or silly thoughts out of my head

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* 30. When I have a problem, my heart beats really fast

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* 31. I can not think clearly

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* 32. I suddenly start to tremble or shake when there is no reason for this

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* 33. I worry that something bad will happen to me

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* 34. When I have a problem, I feel shaky

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* 35. I feel worthless

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* 36. I worry about making mistakes

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* 37. I have to think of special thoughts (like numbers or words) to stop bad things from happening

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* 38. I worry what other people think of me

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* 39. I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds)

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* 40. All of a sudden I feel really scared for no reason at all

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* 41. I worry aboutwhat is going to happen

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* 42. I suddenly become dizzy or faint when there is no reason for this

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* 43. I think about death

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* 44. I feel afraid if I have to talk in front of my class

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* 45. My heart suddenly starts to beat too quickly for no reason

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* 46. I feel like I don’t want to move

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* 47. I worry that I will suddenly get a scared feeling when there is nothing to be afraid of

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* 48. I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order)

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* 49. I am afraid of looking foolish in front of people

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* 50. I have to do things just right to stop bad events

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* 51. I worry in bed at night

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* 52. I feel scared if I have to sleep away from home

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* 53. I feel restless

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* 54. Do you help or support an adult in your household, whether thats physical support, emotional support or in any other way ?

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