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………
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/