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Comprehensive Anxiety Assessment Form GAD 7 + TRA

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Introduction

The GAD-7 (Generalized Anxiety Disorder 7-item scale) is commonly used to assess the severity of anxiety symptoms, while the TRA (Trauma Response Assessment) is helpful for understanding trauma-based anxiety. Together, these forms provide a clear picture of how anxiety and trauma may be impacting your clients.

By completing this form, we will be able to better understand any traumatic experiences that may be affecting your mental and emotional well-being and standing in the way of your happiness. This assessment is not a diagnosis but rather a guide that provides valuable insights to help refine our therapeutic approach and create a customized plan tailored to your most important needs and goals.

Please take your time with each question and answer as honestly and openly as you can. There are no right or wrong answers—just your experience, which is valuable and important.

I look forward to our time together.

Warmly,

Monika

Monika Grace, CCTP-II
Integrative Somatic Psychotherapist, Trauma Specialist, EMDR, IFS, SE, PSYCH-K
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What is your full name?

What is your email?

What is your location?

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Instructions

For each question below, please indicate how often you have been bothered by the following symptoms over the past two weeks. Please read each statement carefully and choose the number that best reflects your experience. Rating Scale:
1 = Never
2 = Rarely
3 = Sometimes
4 = Often
5 = Very Often

Section 1: Generalized Anxiety Disorder (GAD-7) Questions:

1. Feeling nervous, anxious, or on edge.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

2. Not being able to stop or control worrying.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

3. Worrying too much about different things.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

4. Trouble relaxing.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

5. Being so restless that it is hard to sit still.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

6. Becoming easily annoyed or irritable.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

7. Feeling afraid as if something awful might happen.

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

Section 2: Trauma and Childhood Anxiety Exploration (TRA)

8. Do you often feel overwhelmed by past memories or experiences?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

9. Do you find yourself avoiding places, people, or situations that remind you of past trauma?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

10. Have you noticed changes in your sleep patterns (difficulty falling asleep, staying asleep, or nightmares)?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

11. Do you experience physical symptoms when feeling anxious (heart racing, sweating, dizziness)?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

12. Do you struggle with self-blame or guilt related to past events?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

13. Are there moments when you feel detached from your surroundings or your own body?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

14. Do you find it difficult to form or maintain close relationships?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

15. Do you experience mood swings or intense emotions when triggered?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

16. Do you often feel a sense of helplessness or hopelessness?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

17. Do you engage in negative self-talk or self-criticism, when anxious?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often

18. Do you engage in self-destructive behaviors when anxious?

1 Never
2 Rarely
3 Sometimes
4 Often
5 Very often
Substance Abuse: Alcohol, drugs, or tobacco
Self-Harm: Cutting, burning, or scratching the skin
Compulsive hair or eyelash pulling
Eating disorders: Anorexia, bulimia, binge eating, extreme dieting or purging
Reckless driving
Risky Behaviors: Unsafe sexual practices
Ignoring medical needs
Refusing self-care
Overworking or Extreme Perfectionism
Social Isolation: Withdrawing from relationships or support
Self-sabotaging relationships: avoiding intimacy, infidelity
Impulsive Spending
Gambling
Avoiding emotions
Constant self-judgment

Please share more details here:

19. How often do you feel that your anxiety is taking control of your life?

In the past month, how often have you had repeated, disturbing, and unwanted memories of a traumatic event?
NeverVery often
Thank you for completing this questionnaire. Your responses will be discussed during your next session to identify areas for support and healing.
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