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Frequency: (occurrence of issue) How often in a week/day/hour do you? Longest, shortest, typical, last?
Intensity: 0-10 Scale, How far would you go before needing to use safety behaviour?
Number: (occurrence of behaviour in relation to issue)
Duration: How long does …. last for?
Impact On Life (needs to be specific and in relation to the issue)
Work: Are you still working, if so in what area? Has the issue effected your work or aspirations?
Social Activities: Has your social life changed as a result of the issue?
Activities Of Daily Living: Has the way you manage your home changed as a result of the issue? What do you do around the house?
Leisure/Hobbies: Have you stopped doing activities that you once enjoyed? Have you started any activities as a result of the issue?
Relationships: Are you in a current relationship? Has the issue effected your relationships or your ability to form relationships?
Distress: What’s the worst thing about being this way/having this issue? If no distress – why is this a problem for you?
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