Weekly Record of Anxiety and Depression

Name:
Each evening before you go to bed, please make the following ratings, using the scale
below:
1. Your AVERAGE level of anxiety (taking all things into consideration);
2. Your MAXIMUM level of anxiety which you experienced that day;
3. Your AVERAGE level of depression;
4. Your AVERAGE level of pleasantness;
5. The percentage of the day that you felt worried, using a 0-100% scale where 0
means no worry at all and 100 means worried all the waking day.

Level of Anxiety/Depression/Pleasantness feelings

0
None

Date

Average
anxiety

2
Slight

Maximum
anxiety

4
Moderate

Average
depression

6
A lot

Average
pleasantness

8
As much as
you can
imagine

Percentage of
day worried