0 1 2 Never Once Two or three times 3 Four or five times 4 Nightly or almost nightly 0 None 1 Mild, minimal distress, did not awaken 2 Moderate, woke in distress, but went back to sleep 3 Severe, considerable distress, difficulty in returning to sleep 4 Extreme, overwhelming or incapacitating distress, could not return to sleep C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma) (5) efforts to avoid thoughts or feelings associated with the trauma Frequency In the past week, have you tried to avoid thinking about the event? Have you tried to avoid feelings related to the event? How often? Intensity How much effort did you make to avoid thoughts or feelings related to the event? (rate all attempts at cognitive avoidance, suppression, and reducing awareness with alcohol or drugs) 0 1 2 Never Once Two or three times 0 1 2 3 Four or five times 3 4 Daily or almost every day 4 None Mild, minimal effort Moderate, some effort, avoidance definitely present Severe, considerable effort, marked avoidance Extreme, drastic efforts at avoidance (6) efforts to avoid activities that arouse recollections of the trauma Frequency In the past week, have you tried to stay away from situations or activities related to the event? How often? Intensity How much effort did you make to avoid activities or situations that remind you of the event? (rate all attempts at behavioural avoidance) 0 Never 1 Once 2 Two or three times 0 1 2 3 Four or five times 4 Daily or almost every day 3 4 None Mild, minimal effort Moderate, some effort, avoidance definitely present Severe,considerable effort, marked avoidance Extreme, drastic efforts at avoidance