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Anxiety rating scale
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VOLUME XII • NUMBER 6 NOVEMBER·DECEMBER 1971
PSYCHOSOMATICSOFFICIAL JOURNAL OF THE ACADEMY OF PSYCHOSOMATIC MEDICINE
A R.ating Instrument For Anxiety DisordersWILLIAM WK. ZUNG, M.D.
• Diagnosis and diagnostic criteria enableclinicians and researchers alike to com
municate with one another about their patients and make comparisons of cases anddata meaningful. The fact there is a need forassessing anxiety, whether as an affect, asymptom, or a disorder is obvious by thenumerous rating scales available and in use.However, the need for a standardized methodof evaluating and recording the presence ofanxiety as a clinical disorder has not beenmet by most scales today. We were interestedin having a rating instrument which wouldfulfill the following: it should be inclusive withrespect to symptoms of anxiety as a psychiatric disorder, it should quantitate the symptoms, it should be short and simple, and itshould be available in two formats so that, 1)the patient can indicate his own responses ona self-administered scale, and 2) the observercan indicate his clinical evaluation of the patient's status on the same set of criteria. Thisreport summarizes our efforts at devising arating instrument for anxiety disorders whichwe felt fulfilled our needs and purposes.
METHOD
In the construction of the present ratinginstrument the symptoms of the illness weredelineated by using the descriptive approach,since the basis of definition and classificationin psychiatric nosology continues to be basedupon presenting symptomatologyl.
Anxiety as a disorder is defined in the
Dr. Zung is Associate Professor of Psychiatry,Duke University Medical Center, and VeteransAdministration Hospital, Durham, N.C.
November-December 1971
Diagnostic and Statistical Manual, SecondEdition or DSM-II as a neurosis characterizedby anxious overconcern extending to panicand frequently associated with somatic symptoms2• More detailed definitions and descriptions of anxiety and its characteristic symptoms are described by the following authorsand summarized in Table I: Kolb in Noyes'Modern Clinical Psychiatry3, Lief in Comprehensive Textbook of Psychiatry" Portnoyin the American Handbook of Psychiatryl, anda report on anxiety neurosis by Wheeler,White, Reed and Cohen5
•
In devising our rating instrument, diagnostic criteria used were comprised of the mostcommonly found characteristics of an anxietydisorder, such as those listed in Table I. Fromthis list of criteria, an observer rated AnxietyStatus Inventory (ASI) and a patient Selfrating Anxiety Scale (SAS) were constructed.
Anxiety Status Inventory (ASI)
Table II is the form of the ASI which isthe clinician rated instrument. It contains thediagnostic criteria for anxiety as a psychiatric disorder (5 affective and 15 somatic symptoms) and the interview guide for elicitingeach of the symptoms. The data upon whichthe judgments are based come from the interview with the patient. The items in the scaleare to be quantified by using all of the information available to the rater. This includesboth clinical observations and the materialreported by the patient.
Use of the Interview Guide assures coverage of all of the areas in which judgments arerequired. However, the rater has the flexibility
371
PSYCHOSOMATICS
of interposing other questions or probing fordetails which allow for a smooth interviewwithout sounding like a question-answer examination. In rating the patient's currentstatus, an arbitrary period of one week priorto the evaluation is adopted in order to standardize the data.
In making the judgment, the following
rules are used:1. Each item should be independently
rated as a unit by itself in order to eliminateany "halo" effect.
2. Each score should be the average ofthe full range of responses observed or elicited,and not necessarily the extreme in severity.
3. The items are judged on a four-point
TABLE I - A comparison of symptoms found in anxiety as reported by various authors.
(*Percentage of each symptom present in patients with anxiety disorder)---- ----------
icOLIl (3)
AFFECTIVE SHlPTOHSApprehension, worried,
inexpressible dread,painful uneasinessof mind
SO~IATIC SY:IPTOMS
Musculoskeletal $vstemTremor,
Tension headache.
h'~akness,
k",stlessgess
I'!!.d.!o~'!.s cUl-,!,--S ys t eml'alpitation,
rapid heartbeat
B-e_,~p.iJ-,,-ton' Sys temHyperv",ntilation:dizziness,fainting,shortne::;s of breatil,f",eling of choking,pressure on tilorax,parestllesias
LIEF (4)
Apprehension, fearful,feeling of impendingdeath, helplessness,mental disintegration
~uscle tightness,tremors, spasms,painful movements,ileadaches, neck andback pains
h'eakness,Restlessness
Palpitation, throbbingpain in chest
Dizziness,
:::;lll.)rtness of ureath)Lvnstriction in chest,
pORno, (1)
Apprehensiol', utlcasincss,anticipation of danger,ilelplessness
Increased tension,tremors, stiffn"ss
Palpitation, rapid pulse,increased Bp
Rapid or irr~gu13r
breathing
\';HEELER eta1.
ApprehensionFear of death>h.-> rvousness
Trel:lblingShakiness
HeadacheTires easil~..WeaknessFatigued all
the time
Palpitation
DizzinessFaintnessllreathlessnessBreathunsatisfactpry
Paresthesias
(5)
60.7*41. 887.6
53.546.5
58.395.056.0
45.1
96.7
78.370.090.0
52.758.2
~~.~_r_l~-_i_~~s_ti na~ _S.Ls_~_\.~~~uus~a and vonlitill~ ~uusea, vonliting,
diarrheu,dllllrt'xia
Xausea, vomiling,diarrhea
\'omiting anddiarrhea
Anorexia14.012.3
~L:n_i_t.9-u_~~.!!...a_~~t ~~~.
Incre3sed desire tourinate
Skinrac,", f 1uSiled,
perspiration
_C_C.!1.t_ r..?_!. __~e [V_OUS S~i.-~
~lind in constant daz~,
:lbsent "'inded
Di fficulty infalling asleep,f":lrful dre:lms
rrillary frequellcy,urgcIH':y
flushing of f:lce,Sensation of heat
1.3ck 0f concentration,J~cr~ased memory,p0rc~ptu:ll defects,irritabilitv
Difficulty in falling:l~l"eJl, fitful sle"p,ul1pl~asant dreams
Urinary frequenc~'
Flushing or ~3llor,
cold, wet extremities
Sleep Jisturhililces
Frequency
FlushingSweating
Insomnia
~ightmares
18.6
36.244.9
52.7
If!. 3
372 Volume XII
RATING INSTRUMENT-ZUNG
system, taking into account Severity in termsof: intensity, duration, and frequency. Theseare defined as follows:
1 = none or insignificant in intensity orduration, present none or a little ofthe time in frequency
2 - mild in intensity or duration, presentsome of the time in frequency
3 - of moderate severity, present a good
part of the time in frequency4 severe in intensity or duration, pre
sent most or all of the time in frequency.
To help establish severity, the followingquestions may be necessary: Intensity ''How bad was it?" Duration - "How longdid it last?" Frequency - ''How much of thetime did you feel that way?"
TABLE II - The Anxiety Status Inventory (ASI) containing the diagnostic
criteria of an anxiety disorder and their respective interview guide items
AFFECTIVE £:< INTERVIEW GUIDE SEVERITY OF OBSERVEDSDrl<\TIC SYNPTONS FOR OR
OF ANXIETY ANXIETY STATUS INVENTORY (AS!) NONE MILD HOD SEV
I. Anxiousness Do you ever feel nervous and anxious: I 2 J .',
2. Fear Have you ever fe I t afraid? I 2 J .',
J. PanicHow easily do you get upset?
I 2 J .',Ever have panic spe lls or feel likc> it:
.', . Mental disintegratior 00 you ever fee I I ike you1re falling apart? I 2 J .',Going to pieces:
5. Apprehension H~lvc you ever felt uneasy? or that something 1 2 J .',terrible was going to happen?
6. Tremors Have hOU had times when you felt yourself 1 2 J .',trem ling? shaking?
7. Body aches '-. pains Do you have headaches? neck or back pains? I 2 3 .',
8. Easy fatiguability, How easily do you get tired? I 2 J .',weakness Ever have spells of weakness?
9. Rest lessness Do you find yourse If restless and can't I 2 J .',sit still?
10. Palpitation Have you ever felt that your heart 1 2 J .',was running away?
II. Dizziness Do you have dizzy spells? 1 2 J 4
12. Faintness Do you have fainting spells? or feel like it? 1 2 3 4
13. Dyspnea Ever have trouble with your breathing? 1 2 J 4
I.',. ParesthesiasEver have feelings of numbness and t ing ling
I 2 J .',in your fingertips? or around your mouth?
IS. Nausea & vomiting Do you ever feel sick to your stomach or I 2 3 .',
feel like vomiting?
16. Urinary frequency How often do you need to empty your bladder? I 2 3 4
17. Sweating Do you ever get wet, clammy hands? I 2 3 4
18, Face flushing Do you ever feel your face getting hot and 1 2 3 4blushing?
19. Insomnia How have you been sleeping? 1 2 3 4
20. Nightmares 00 you have dreams that scare you? 1 2 3 4
November-December 1971 373
PSYCHOSOMATICS
4. An items is scored positive and presentwhen:
A. Behavior is observedB. Behavior was described by the patient
as having occurred
c. Patient admits that symptom is still aproblem
5. An item is scored negative and not present when:
A. Symptom has not occurred and not a
TABLE III - The Self-rating Anxiety Scale (SAS)
NAME, AGE, _ SEX: M F
NO. _ DATE _
None OR :A little Some Good part Most OR AlII
of the time of the time of the time of the time
1- I feel more nervous andanxious than usual
2. I fee 1 afraid for no reason at all
3. I get upset easily or feel panicky
4. I feel like I'm falling apart andgoing to pieces
5. I feel that everything is all rightand nothing bad will happen
6. My arms and legs shake and tremble
7. I am bothered by he~daches,neck and ba~k pains
8. I feel weak and get tired easily
9. I feel calm and can sit sti 11 easily
10. I can feel my heart beating fast
ll. I am bothered by diZZy spells
12. I have fainting spe lls or feellike it
13. I can breathe in and out easily
14. I get fee lings of numbness andtingling in my fingers, toes
15. I ~m bothered by stomachachesor indigestion
16. I have to empty my bl~dder often
17. Hy hilnds are usuilily dry and Harm
18. Hy filce gets hot and blushes
19. I filiI asleep easily and get agood night's rest
20. I have nightmares
374 Volume XII
RATING INSTRUMENT-ZUNG
problem or presentB. Patient gives no information relevant
to an itemC. Response is ambiguous even after suit
able probingA total raw score is obtained by a sum
mation of the rated responses obtained foreach of the 20 items.Self-rating Anxiety Scale (SAS)
For the purpose of constructing the SAS,
illustrative verbatim records were made frompatient interview and examples were selectedfor inclusion which were most representativefor the particular symptom. Table III is theactual form of the SAS as it is used and to bescored by the patient. The SAS is based onthe same 20 diagnostic criteria as the observerrated Anxiety Status Inventory.
So that the patient is less able to discerna trend in his answers, the scale was devised
TABLE IV - Key for Scoring Self-rating Anxiety Scale (SAS)
None ORA little Some Good part Most OR All
of the time of the time of the time of the time
1- I feel more nervous andanxious than usual I 2 3 :.
2. I feel afr,1id for no reason at all 1 2 J :.
J. I i!et upset e3si Iy or fee 1 pnnicky 1 2 J .:.
4. I fee 1 like I'm fctllin~ apart and 1 :2 J -,going to pieces
5. I fee 1 that everythi ng is all right~ 3 :2 1
and nothing bad wi 11 happen
6. My arms and legs shake and tremble I :2 J .:.
7. I am bothered by headaches, 1 2 3 .:.neck 3nd bilck pilins
8. I feel weak and get tired easily I 2 3 .:.
9. I fee 1 calm 3nd can sit sti 11 easily .:. 3 2 I
10. I C.:10 feel my heart be3ting fast 1 2 3
II. I am bothered by dizzy spe lls I :2 3 .:.
1:2. I have faintin~ spells or feel1 2 3 "like it
13. I can breathe in '1nd out easily .:. 3 2 I
14. I get feelings of numbness and I 2 3 :.tingling in my fingers, toes
IS. I 3m bothered by stom3chaches 1 2 3 :.or indigestion
16. I h3ve to empty my bladder often 1 2 3 .:.
17. My hands are usu31ly dry and warm - J 2 1
18. Ky face gets hot :",d blushes 1 2 3 ~
19. I fall asleep easily "nd get a J 2 1'+good night's rest
20. I have nightm3res 1 2 3 4
November-December 1971 375
PSYCHOSOMATICS
so that of the 20 items used, some of the itemswere worded symptomatically positive, andothers symptomatically negative, dependingupon their suitability and usage. In addition,an even-number of columns were used toeliminate the possibility of a patient checkingmiddle and extreme columns.
In using the scale, the patient was askedto rate each of the 20 items as to how it applied to him within the past week, in thefollowing four quantitative terms: NoneOR A little of the time, Some of the time,Good part of the time, Most OR All of thetime. The SAS is constructed so that the lessanxious patient will have a low score on thescale, and the more anxious patient will have
TABLE V
a higher score. In scoring the SAS, a value of1, 2, 3 and 4 is assigned to a response depending upon whether the item was worded positively or negatively. A key for scoring thisscale can be simply made up, as shown inTable IV.
An index for the SAS (and for the observer rated Anxiety Status Inventory orASI) was derived by dividing the sum of thevalues (raw scores) obtained on the 20 itemsby the maximum possible score of 80, converted to a decimal and multiplied by 100(see Table V).
In order to prevent confusion between theASI and SAS results, the converted ASI scoreis called a Z score and the converted SAS
TABLE VI
A table for the conversion of raw scores toASI and SAS indices
Distribution of patients tested by their ase,sex, and psychiatric diallnoses at time of
discharse
RawScore
20
21
22
23
24
25
26
27
28
29..30
31
32
33
34
35
36
37
38
39
ASI&
SASIndex
25
26
28
29
30
31
33
34
35
36
38
39
40
41
43
44
45
46
48
49
RawScore
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
ASI&
SASIndex
50
51
53
54
55
56
58
59
60
61
63
64
65
66
68
69
70
71
73
74
Raw
Score
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
ASI&
SASllIdex
75
76
78
79
80
81
83
84
85
86
88
89
90
91
92
94
95
96
98
99
100
AGE
19 & under
20 - 3940 - 6465 & over
SEX
Males
Females
DIAGNOSES
Mental Retardation
Organic Brain Syndrome
Schizophrenia
Anxiety Disorder
Depressive Disorder
Obsessive Compulsive Disordel'
Personality Disorders
Psychophysiologic Disorders
Transient SituationalDisturbances
No Psychiatric Diagnosis
N
897
112
8
225
175
50
225
1
5
25
22
967
54
2
12
1
225
%
3.643.149.73.6
100.0
0.42.2
11.19.8
42.9
3.224.2
0.9
5.3
100.0
376 Volume XII'
RATING INSTRUMENT-ZUNG
score is called an index.
Taylor Manifest Anxiety Scale (TMAS)
The TMAS consists of 50 items drawnfrom the Minnesota Multiphasic PersonalityInventory (MMPI) judged to be indicativeof manifest anxiety.6 Since this is a commonlyused scale in anxiety studies, we included itin our investigation.
The self-rated forms were not looked at norscored until the completion of the study.
The SAS was given on randomly selecteddays to a normal control group of 100 individuals, who were at work at the hospital.They consisted of approximately an equalnumber of professional and non-professionalstaff members.
TABLE VIII
TABLE VII
Anxiety Status Inventory (ASI) Z Scores forthe various diagnostic groups tested
Self-rating Anxiety Scale (SAS) indices forthe various diagnostic groups tested
Subjects Tested
A total of 225 patients were tested duringthe period of study. The inpatient population(N=152) were all men, whose ages rangedfrom 22 to 75 years (m=45). The out-patient population (N=73) had 23 men and50 women, whose ages ranged from 14 to 72years old (m=32). The total mean age forall 225 subjects was 41 years old. Each patient was given a diagnosis at the time of discharge by his psychiatrist, and was donewithout any knowledge of the scale results.The distribution of all patients tested by theirage, sex and diagnoses are presented inTable VI.
A total of 100 normal adult subjects weretested. There were 57 men and 43 women.Their ages ranged from 18 to 62 years old(m=34).
RESULTS
Anxiety Status Inventory (ASI)
Results of the ASI for the five largest diagnostic groups which comprised 93% of thetotal patient population tested are presentedin Table VII. Statistical tests of significanceusing analysis of variance indicated that themean ASI Z score obtained by patients withdiagnoses of anxiety disorders was significantly higher than those of the other four diagnostic groups (P = < 0.05).
Self-rating Anxiety Scale (SAS)
Results of the SAS for the five largest diagnostic groups are presented in Table VIII.Analysis of variance indicated that the meanSAS index obtained by patients with diagnosis of anxiety disorders was significantlyhigher than those of the other four diagnosticgroups (P = < 0.05). In addition, the meanSAS index obtained from normal control sub-33.8 ± 5.9
209100Controls6
Data CoIIection
The data for this study were obtained asfollows: all new patients admitted to the psychiatric in-patient service of the hospital for15 consecutive months, and all new patientsseen at the out-patient clinic for 4 consecutivemonths were seen and tested. Patients werefirst given the self-rating form of the anxietyscales (SAS and TMAS), after which an interview was conducted to complete the interview-rating form of the anxiety scale (ASI).
ASI Z ScoreGroup Diagnosis N Mean & S.D.
1 Anxiety Disorder 22 62.0 ± 13.82 Schizophrenia 25 49.4 ± 15.93 Depressive Disorder 96 49.9 ± 12.54 Personality Disorder 54 52.6 ± 13.65 Transient Situational
Disturbances 12 42.0 + 8.1
SAS IndexGrou,p Diagnosis N Mean & S.D.
1 Anxiety Disorder 22 08.7 ± 13.52 Schizophrenia 25 46.4 ± 12.93 Depressive Disorder 96 50.7 ± 13.44 Personality Disorder 54 51.2 ± 13.25 Transient Situational
Disturbances 12 45.8 ± 11.9
November-December 1971 377
PSYCHOSOMATICS
TABLE IX
TABLE X
Severity of Symptoms of Patients withAnxiety Disorders
Taylor Manifest Anxiety Scale (TMAS)Scores for the various diagnostic groups tested
Volume XII
as being the worst (upper third) the following affective symptoms: feelings of mentaldisintegration, anxiousness and apprehension,and somatically: symptoms referable to themusculoskeletal and gastrointestinal systems.By comparison, Wheeler et al.5 noted in theirstudy that the most frequent complaints bypatients with anxiety neurosis as involvingthe cardiovascular and respiratory systems(see Table I).
Taylor Manifest Anxiety Scale (TMAS)
Results of the TMAS for the five largestdiagnostic groups are presented in Table X.Analysis of variance indicated the meanTMAS scores obtained for these diagnosticgroups were not significantly different fromeach other (P = > 0.05).
Correlation between ASI, SAS and T M AS
Pearson product-moment correlation forcalculation of the coefficient r on data obtained from all patients was performed. Allof the coefficients r calculated were statistically significant, with P = < 0.01 in all instances.
The correlation between the ASI and SASwas 0.66. Correlation between the ASI andTMAS, and SAS and TMAS were 0.33 and0.30, respectively. Correlation between theASI and SAS scores for patients with a diagnosis of anxiety disorder was 0.74.
Split half correlations for the ten evennumbered and the ten odd-numbered ASIitems, and similarly, for the even-odd SASitems were 0.83 and 0.71, respectively.
Correlations between items 1 through 20of the ASI with the ASI Z score were as follows: 0.50, 0.56, 0.65, 0.65, 0.64, 0.50, 0.52,0.34, 0.51, 0.65, 0.61, 0.65, 0.42, 0.63, 0.60,0.39, 0.54, 0.49, 0.58, and 0.47, respectively.
Correlations between items 1 through 20of the SAS with the SAS index were as follows: 0.39, 0.53, 0.57, 0.69, 0.50, 0.56, 0.58,0.40, 0.50, 0.64, 0.47, 0.51, 0.27, 0.55, 0.61,0.62,0.42, 0.47, and 0.49, respectively.
DISCUSSION
Anxiety scales available and in use todaycan be divided into those which are generaland measure anxiety as a personality trait or
MeanSAS Item Items: in Decreasing
Score No. Order of Severity
2.8 4 Mental disintegration2.8 6 Tremors
2.6 7 Body aches and pains2.5 1 Anxiousness2.5 5 Apprehension
2.5 15 Nausea and vomiting
2.4 2 Fear
2.4 3 Panic
2.4 10 Palpitation2.4 14 Paresthesias
2.4 16 Urinary frequency2.2 17 Sweating2.1 8 Fatigue
2.1 13 Dyspnea
2.1 20 Nightmares2.0 9 Restlessness2.0 11 Dizziness2.0 12 Faintness
2.0 18 Face Blushing2.0 19 Insomnia
TMASScoreGroup Diagnosis N Mean & S.D.
1 Anxiety Disorder 22 31.0 ± 15.32 Schizophrenia 25 23.0 ± 13.53 Depressive Disorder 96 25.1 ± 13.54 Personality Disorder 54 31.7 ± 10.85 Transient Situational
Disturbances 12 29.3 ± 7.0
378
7
5
6
4
2
3
1
RankOrder
jects was significantly lower than all five ofthe patient diagnostic groups (P = < 0.01).
Table IX rank orders the 20 items of theSAS as quantitated by the patients with anxiety disorders, listed in decreasing order ofseverity, and arbitrarily divided into thirds. Itcan be seen that these patients complained
RATING INSTRUMENT-ZUNG
feeling state, and those which are specific andmeasure anxiety as a clinical entity. They mayalso be grouped as those which are self-administered and those which are given by atrained interviewer. General instruments include those by Costello and Comrey;, whoseanxiety scale was designed to measure a predisposition to develop anxious states; Cattell'sanxiety scale" which is used to measure fluctuations in level of anxiety over short periodsof time; and Taylor's manifest anxiety scaler,.Use of a general scale for the measurement ofanxiety as a clinical entity may tend to obscureresults more than it would reveal. Thus, in astudy of the TMAS, O'Connor et aP did afactor analysis of their results and showedthat as many as five different dimensions wereinvolved in the items comprising the scale.Aggregate scores of such a scale may confoundby blurring, and analysis by sub-groups ofitems may fail to indicate differences whichmay be present. Examples of specific anxietyscales include those by Hamilton10 and Kellner and Sheffield ll
• These are both interviewer-rated scales and require a trained clinicianto complete them.
In developing the presently reported rating instrument for measuring anxiety as aclinical entity, we felt that it would fullfill thepreviously mentioned criteria and that itwould be a useful tool for our purpose. Fromthe results obtained, it did appear to us thatthe two-part instrument, consisting of the selfrated SAS, and the clinician-rated ASI wasuseful in quantitating anxiety as an operationally defined disorder.
SYNOPSIS
A rating instrument for the measurementof anxiety as a clinical entity was devised asan attempt to quantitate the symptoms of thisdisorder, using the most commonly agreedupon diagnostic criteria. As a two-part instrument, it can be used as an interviewer-ratedinventory (Anxiety Status Inventory or ASI),
November-December 1971
or as a self-rated scale (Self-rating AnxietyScale or SAS). Data was collected from apopulation of psychiatric patients using thenew instrument and the Taylor ManifestAnxiety Scale (TMAS). Statistical analysesof the results indicated that the new instrument was able to differentiate significantlyanxiety patients from patients with other diagnoses, whereas the TMAS did not. Correlation between the ASI and SAS, and betweenthe individual items of the two-part instrument with their respective total scores wereall significant.
REFERENCES
1. Portnoy, I.: The Anxiety States, in Arieti, S.(Editor): American Handbook of Psychiatry,Vol. I: Basic Books, New York, 1959, p. 308.
2. Diagnostic and Statistical Manual of MentalDisorders, Second Edition, American Psychiatric Association, Washington, D.C., 1968,p.39.
3. Kolb, L.: Noyes' Modern Clinical Psychiatry,Seventh Edition, Saunders, Philadelphia, 1968,pp. 464-466.
4. Lief,. H.: Anxiety React;on, in Freedman, A.and Kaplan, H. (Editors): CcmLIJrehensiveTextbook of Psychiatry, Williams and Wilkins, Baltimore, 1967, pp. 865-866.
5. Wheeler, E., White, P., Reed, E., and Cohen,M.: Neurocirculatory Asthenia (Anxiety Neurosis, effort syndrome, neurasthenia), JAMA,142: 878-888, 1950.
6. Taylor, J.: A personality scale of manifestanxiety, J. Abn. & Soc. Psychol. 48:285-290,1953.
7. Costello, C. and Comrey, A.: Scales for measuring depression and anxiety, J. Psychol.66 :303-313, 1967.
8. Cattell, R.: Handbook for the IPAT AnxietyScale. Institute for Personality and AbilityTesting, Champaign, Illinois, 1957.
9. O'Connor, J., Lorr, M. and Stafford, J.: Somepatterns of manifest anxiety, J. Clin. Psychol.12: 160-163, 1956.
10. Hamilton, M.: The assessment of anxietystates by rating, Brit. J. M ed. Psychol. 32:50-55, 1959.
11. Kellner, R. and Sheffield, B.F.: Symptom Rating Test scores in neurotics and normals,Brit. J. Psychiat. 113 :525-526, ]967.
37~