INSTRUCTIONS: The items below describe the possible ways that a family member (or significant other) might respond to a relative’s anxiety disorder. Please circle the response for each item that best describes your behavior in the past week.
1. I reassured my relative that there were no grounds for his/her worries or fears.
Never
Rarely
Several times week
Daily
Multiple times a day
2. I did things I did not want to do in order to make my relative feel less anxious.
Never
Rarely
Several times week
Daily
Multiple times a day
3. I helped or encouraged my relative to avoid situations that might cause anxiety.
Never
Rarely
Several times week
Daily
Multiple times a day
4. I took on family or household responsibilities that my relative couldn’t adequately perform or did not want to perform due to his/her anxiety.
Never
Rarely
Several times week
Daily
Multiple times a day
5. I avoided talking about things that might have triggered my relative’s anxiety or worry.
Never
Rarely
Several times week
Daily
Multiple times a day
6. I stopped myself from doing things I would
otherwise have done because they would have
caused my relative anxiety
Never
Rarely
Several times week
Daily
Multiple times a day
7. I went along with what my relative wanted even when I disagreed because otherwise he/she would have been upset
Never
Rarely
Several times week
Daily
Multiple times a day
8. I made excuses or covered up for my relative when she/he missed work or a social activity because of her/his anxiety.
Never
Rarely
Several times week
Daily
Multiple times a day
9. I cut back my leisure time activities and my social life because of my relative’s anxiety problems.
Never
Rarely
Several times week
Daily
Multiple times a day
10. I changed my work or school schedule because of my relative’s anxiety problems.
Never
Rarely
Several times week
Daily
Multiple times a day
11. I put off some of my family responsibilities because of my relative’s anxiety problems.
Never
Rarely
Several times week
Daily
Multiple times a day
12. I sought information on behalf of my relative to reduce his/her concerns
Never
Rarely
Several times week
Daily
Multiple times a day
13. I accompanied my relative into situations or remained home with him/her when I did not wish to in order to reduce his/her anxiety.
Never
Rarely
Several times week
Daily
Multiple times a day
14. I tried to distract my relative when he/she talked about his/her anxiety concerns.
Never
Rarely
Several times week
Daily
Multiple times a day
15. I avoided talking about my own feelings and needs for fear that I would upset my relative.
Never
Rarely
Several times week
Daily
Multiple times a day
16. I let my relative decide how we will do things in order to reduce his/her distress
Never
Rarely
Several times week
Daily
Multiple times a day
17. Other: (please describe any other way you have changed your behavior in order to prevent or reduce your relative’s anxiety)