Fear & Avoidance
Phobias can limit life in small or big ways. This form helps us understand how much fear or avoidance you experience around specific situations or objects.
It’s a gentle way to map the intensity of fear and how much it affects daily life. You can complete it on your own or during our session — whichever feels most comfortable.
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Would not avoid it | Slightly avoid it | Definitely avoid it | Markedly avoid it | Always avoid it |
| Choose a number from the scale above to show how much you would avoid each of the situations or objects listed | Your Score | |
| 1 | Social situations due to a fear of being embarrassed or making a fool of myself | |
| 2 | Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness) | |
| 3 | Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying). | |
