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Telephone Counseling
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Have you experienced or witnessed a life-threatening event that caused intense fear, helplessness or horror?
Yes
No
Did you re-experience the event in at least one fo the following ways?
Repeated, distressing memories and/ or dreams?
Yes
No
Acting or feeling as if the event were happening again (flashbacks)
Yes
No
Intense physical and/ or emotional distress when you are exposed to things that remind you of the event?
Yes
No
Do you avoid reminders of the event and feel numb, compared to the way you felt before,
Avoiding thoughts, feelings, or conversations about it?
Yes
No
Avoiding activities, places, or people who remind you of it?
Yes
No
Blanking on important parts of it?
Yes
No
Losing interest in significant activities of your life?
Yes
No
Feeling detached from other people?
Yes
No
Feeling your range of emotions is restricted?
Yes
No
Sensing that your future has shrunk (for example, you don’t expect to have a career, marriage, children or a normal life span)?
Yes
No
Are you troubled by two or more of the following:
Problems sleeping?
Yes
No
Irritability or outbursts of anger?
Yes
No
Problems concentrating?
Yes
No
Feeling “on guard”?
Yes
No
An exaggerated startle response?
Yes
No
There is no scoring data. Print out the test and show your answers to your doctor or therapist.
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