On the following levels you will find descriptive terms for 5 levels of Negative Affective states of increasing intensity and/or severity. Descriptors within each set are of approximately equal intensity and/or severity.
For each level, check one or more terms that were most salient for your patient during the past week. If a different term of roughly equal intensity applies, write it in the blank field.
For the term(s) checked at the most intense/severe level, estimate how often your client expressed or experienced the negative affective state during the past week.
Note that ratings can be made on the basis of both verbal and nonverbal expressions of affect. Improvement may be evidenced by an initial increase, maintenance, or decrease in negative affect.
Complete your rating as soon as possible after the session ends.
Any indication that this individual is avoiding negative affect (e.g., denial)?
Mark the highest and lowest levels observed (0 = none, 5 = strongest imaginable distress).
For terms checked at the most intense/severe level, how often did the client express or experience this state during the past week?