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On a scale of 1 to 10, where 1 is low/easy/not at all and 10 is high/difficult/frequently[1]

Question Day One Day Twenty Day Forty
How much do you worry about what other people think of you?
How important is it for you to please others?
How would you rate your level of worry?
How would you rate your current level of exhaustion?
How much would you say you worry at night when you are falling asleep?
How hard is it to fall asleep at night?

[1] From The Intuitive Dance by Atherton Drenth. © 2016 by Atherton Drenth. Used by permission from Llewellyn Worldwide, Ltd., www.Llewellyn.com