Questionnaire for Assessing Therapeutic Dynamics of PTSD Test - the question form
Questions: 8 · 2 minutes
1. Have you had distressing images, thoughts, or memories of the trauma that you could not get rid of even if you wanted to? Did they occur repeatedly?
0 – never
1 – mild: infrequent and not upsetting
2 – moderate: at least once a week and/or causing slight distress
3 – severe: at least 4 times a week or causing moderate distress
4 – very severe: daily, or causing distress to the extent that the patient cannot work or function socially
2. Do reminders of the traumatic event (or events similar to it) cause any physical reactions (e.g., sweating, trembling, pounding heart, nausea, rapid breathing, chills)?
0 – never
1 – slight: infrequent or questionable
2 – moderate: causing mild distress
3 – severe: causing marked distress
4 – extreme: causing marked distress or requiring medical attention for the physical reactions (e.g., chest pain so intense that the person was convinced they were having a heart attack)
3. Do you persistently avoid places, people, or situations that remind you of the event (e.g., films, television programs, noisy places, veterans’ reunions, or funerals)?
0 – No avoidance
1 – Mild: of questionable significance (uncomfortable, but does not avoid)
2 – Moderate: definitely avoids situations
3 – Severe: very uncomfortable, and avoidance affects life to some extent
4 – Very severe: housebound; cannot go out to shops and restaurants
4. Have you had less interest or pleasure in things you previously enjoyed?
0 – No loss of interest
1 – One or two activities give less pleasure
2 – Several activities give less pleasure
3 – Most activities give less pleasure
4 – Almost all activities give less pleasure
5. Have you been in contact with other people less than usual? Have you felt detached or estranged from other people?
0 – no problems
1 – mild: feels distant or detached, but still has a normal level of contact with other people
2 – moderate: sometimes avoids contact that he or she would usually have had before
3 – severe: clearly and usually avoids people he or she previously had contact with
4 – very severe: completely refuses or actively avoids all social contact since the trauma
6. Have you had warm feelings or felt close to other people? Have you felt emotionally numb?
0 – no problems
1 – mild: of doubtful significance
2 – moderate: some difficulty expressing feelings
3 – severe: definite problems expressing feelings
4 – very severe: no feelings; feels emotionally numb most of the time.
7. Have you been on guard, easily distracted, or felt on edge?
0 – no problems
1 – mild: occasional / does not interfere
2 – moderate: causes discomfort; feels on edge or hypervigilant in some situations
3 – severe: causes discomfort; feels on edge or hypervigilant in most situations
4 – very severe: causes marked distress and is life-changing (constantly on guard; needs to keep distance from others; socially devalued due to feeling on edge)
8. Are you easily startled? Do you tend to startle suddenly—for example after an unexpected noise, or when you hear or see something that reminds you of the trauma?
0 – no problems
1 – mild: occasionally / does not interfere
2 – moderate: clearly causes distress or excessive startle at least once every two weeks
3 – severe: occurs more than once a week
4 – very severe: so bad that the patient cannot function at work or socially