Make your own free website on Tripod.com

FASS-S

 

The items in this questionnaire refer to things and experiences that may cause fear or other unpleasant feelings.

 

1. Please imagine yourself in each situation below and rate how much the object or situation DISTURBS you using the scale below (CIRCLE the number that applies):

 

Not at all A little A fair amount Much Very much

1------------------2------------------3------------------4------------------5

 

"I am disturbed by ________."

 

 

 

Item #

"I am disturbed by ________."

Rating (Circle)

1

Witnessing Surgery

2

Rodents

3

Taking part or speaking in a meeting or class

4

Birds

1---2---3---4---5

5

Injections

1---2---3---4---5

6

Writing while someone watches

1---2---3---4---5

7

Acting on a stage

1---2---3---4---5

8

Snakes

1---2---3---4---5

9

Open wounds

1---2---3---4---5

10

Eating or drinking where someone could watch you

1---2---3---4---5

11

Going to a party or other social outing

1---2---3---4---5

12

Dogs

1---2---3---4---5

13

Blood

1---2---3---4---5

14

Dead People

1---2---3---4---5

15

Insects

1---2---3---4---5

 

-------------------------------------------------------------------------


>>>PLEASE NOTE<<<

 

 

The next two questionnaires have items that are similar to those on the previous questionnaire. However, they are different in an important way: they ask about “WHY” you are fearful of the object or situation. It is very important that you read the directions and answer the questions accordingly!

 

 

One questionnaire asks you to imagine yourself in each situation below and rate how much the object or situation disturbs you BECAUSE of a fear or concern that something dangerous could happen that would cause harm (like a building collapsing, a fire, being attacked, car accident, etc.).

 

For example, “I am disturbed by __elevators__ BECAUSE of a fear or concern that something dangerous could happen that would cause harm (like the elevator falling).”

 

The other questionnaire asks you to imagine yourself in each situation and rate how much the object or situation disturbs you BECAUSE of a fear that you might not be able to get help or get away quickly if you experience intense fear, dizziness, nausea, or panic.

 

For example, "I am disturbed by __elevators__ BECAUSE I might not be able to get help or get away quickly if I experience intense fear, dizziness, nausea, or panic."

 

 

Please keep the differences in these instructions in mind as you answer the questions.

 

-------------------------------------------------------------------------


Please imagine yourself in each situation below and rate how much the object or situation DISTURBS you BECAUSE of a fear that you might not be able to get help or get away quickly if you experience intense fear, dizziness, nausea, or panic using the scale below (CIRCLE the number that applies):

 

Not at all A little A fair amount Much Very much

1------------------2------------------3------------------4------------------5

 

"I am disturbed by _________ BECAUSE I might not be able to get help or get away quickly if I experience intense fear, dizziness, nausea, or panic."

 

Item # Rating (Circle)

16 Storms 1---2---3---4---5

17 Traveling in a bus 1---2---3---4---5

18 Being in enclosed places 1---2---3---4---5

19 Tunnels 1---2---3---4---5

20 Large open spaces 1---2---3---4---5

21 Thunder or lightning 1---2---3---4---5

22 Traveling in an automobile 1---2---3---4---5

23 Being outside the home alone 1---2---3---4---5

24 Heights 1---2---3---4---5

25 Standing in a line 1---2---3---4---5

26 Being in still water like a swimming pool 1---2---3---4---5

27 Elevators 1---2---3---4---5

28 Being on a bridge 1---2---3---4---5

29 Being in a crowd 1---2---3---4---5

30 Traveling in a train 1---2---3---4---5

31 Dirt 1---2---3---4---5

 

-------------------------------------------------------------------------


Please imagine yourself in each situation below and rate how much the object or situation DISTURBS you BECAUSE of a fear or concern that something dangerous could happen that would cause harm (like a building collapsing, a fire, being attacked, car accident, etc.) using the scale below (CIRCLE the number that applies):

Not at all A little A fair amount Much Very much

1------------------2------------------3------------------4------------------5

 

"I am disturbed by _________ BECAUSE of a fear or concern that something dangerous could happen that would cause harm (like a building collapsing, a fire, being attacked, car accident, etc.).”

 

Item # Rating (Circle)

32 Storms 1---2---3---4---5

33 Traveling in a bus 1---2---3---4---5

34 Being in enclosed places 1---2---3---4---5

35 Tunnels 1---2---3---4---5

36 Large open spaces 1---2---3---4---5

37 Thunder or lightning 1---2---3---4---5

38 Traveling in an automobile 1---2---3---4---5

39 Being outside the home alone 1---2---3---4---5

40 Heights 1---2---3---4---5

41 Standing in a line 1---2---3---4---5

42 Being in still water like a swimming pool 1---2---3---4---5

43 Elevators 1---2---3---4---5

44 Being on a bridge 1---2---3---4---5

45 Being in a crowd 1---2---3---4---5

46 Traveling in a train 1---2---3---4---5

47 Dirt 1---2---3---4---5

 

 

Thanks for helping out!!!

 

A description of the theory behind the development of this questionnaire will be made available at http://hanshananigan.tripod.com/fearstudydebriefing.html, as well as the results of the pilot data, when available.