Mobility Inventory (MI)
Chambless‚ Caputo‚ Jasin‚ Gracely‚ & Williams‚1985
Please indicate the degree to which you avoid the following places or situations because of discomfort or anxiety. Rate your amount of avoidance when you are with a trusted companion and when you are alone. Do this by using the following scale:
1- never avoid ‚ 2- rarely avoid‚ 3- avoid about half of the time‚ 4- avoid most of the time‚ 5- always avoid
Circle the number for each situation or place under both conditions: when accompanied and when alone.
Leave blank situations that do not apply to you.
PLACES | WHEN ACCOMPANIED | WHEN ALONE |
Theaters | 1 2 3 4 5 | 1 2 3 4 5 |
Supermarkets | 1 2 3 4 5 | 1 2 3 4 5 |
Shopping malls | 1 2 3 4 5 | 1 2 3 4 5 |
Classrooms | 1 2 3 4 5 | 1 2 3 4 5 |
Department stores | 1 2 3 4 5 | 1 2 3 4 5 |
Restaurants | 1 2 3 4 5 | 1 2 3 4 5 |
Museums | 1 2 3 4 5 | 1 2 3 4 5 |
Elevators | 1 2 3 4 5 | 1 2 3 4 5 |
Auditoriums/stadiums | 1 2 3 4 5 | 1 2 3 4 5 |
Garages | 1 2 3 4 5 | 1 2 3 4 5 |
High Places | 1 2 3 4 5 | 1 2 3 4 5 |
Please tell how high | ||
Enclosed spaces | 1 2 3 4 5 | 1 2 3 4 5 |
OPEN SPACES | WHEN ACCOMPANIED | WHEN ALONE |
Outside (for example: fields‚ wide streets‚ courtyards) | 1 2 3 4 5 | 1 2 3 4 5 |
Inside (for example‚ large rooms‚ lobbies) | 1 2 3 4 5 | 1 2 3 4 5 |
RIDING IN | WHEN ACCOMPANIED | WHEN ALONE |
Buses | 1 2 3 4 5 | 1 2 3 4 5 |
Trains | 1 2 3 4 5 | 1 2 3 4 5 |
Subways | 1 2 3 4 5 | 1 2 3 4 5 |
Airplanes | 1 2 3 4 5 | 1 2 3 4 5 |
Boats | 1 2 3 4 5 | 1 2 3 4 5 |
DRIVING OR RIDING IN A CAR | WHEN ACCOMPANIED | WHEN ALONE |
At anytime | 1 2 3 4 5 | 1 2 3 4 5 |
On expressways | 1 2 3 4 5 | 1 2 3 4 5 |
SITUATIONS | WHEN ACCOMPANIED | WHEN ALONE |
Standing in lines | 1 2 3 4 5 | 1 2 3 4 5 |
Crossing bridges | 1 2 3 4 5 | 1 2 3 4 5 |
Parties or social gatherings | 1 2 3 4 5 | 1 2 3 4 5 |
Walking on the street | 1 2 3 4 5 | 1 2 3 4 5 |
Staying home alone | 1 2 3 4 5 | 1 2 3 4 5 |
Being far away from home | 1 2 3 4 5 | 1 2 3 4 5 |
Other (specify): | 1 2 3 4 5 | 1 2 3 4 5 |
2. After completing the first step‚ circle the 5 items with which you are most concerned. Of the items listed‚ these are the five situations or places where avoidance/anxiety most affects your life in a negative way.
PANIC ATTACKS
3. We define a panic attack as:
1. A high level of anxiety accompanied by………
2. strong body reactions (heart palpitations‚ sweating‚ muscle tremors‚ dizziness‚ nausea) with…….
3. the temporary loss of the ability to plan‚ think‚ or reason and……….
4. the intense desire to escape or flee the situation (Note: this is different from high anxiety or fear alone).
Please indicate the number of panic attacks you have had in the past 7 days:___________
How severe or intense have the panic attacks been? (Place an X on the line below):
1- Very mild‚ 2- mild‚ 3- moderately‚ 4- very‚ 5- extremely
Safety Zone
4. Many people are able to travel alone freely in the area (usually around their home) called their safety zone.
Do you have such a zone? If yes‚ please describe:
a. Its location:
b. Its size (e.g. radius from home):
Chambless‚ Dianne L.‚ Caputo‚G.Craig.‚ Jasin‚ Susan E.‚ Gracely‚ Edward J.‚ Williams‚ Christine. (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy. 23(1); 35–44
Chambless‚ D. L.‚ & Gracely‚ E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research‚ 13‚ 9-20.
Chambless‚ Dianne L.‚ Sharpless‚ Brian A.‚ Rodriguez‚ Dianeth.‚ McCarthy‚ Kevin S.‚ Milrod‚ Barbara L.‚ Khalsa‚ Shabad-Ratan.‚ and Barber‚ Jacques P. (2011). Psychometric Properties of the Mobility Inventory for Agoraphobia: Convergent‚ Discriminant‚ and Criterion-Related Validity. Behav Ther‚ 42(4); 689-599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519241/