Stress Survey
Posted by docapc at 1:49 am
Stress Survey
1) I tend to overwork and do most things myself
Yes—–No——-
2) I have difficulty falling or staying asleep
Yes——No——
3) My nutrition is generally poor to fair
Yes——No—–
1) Have you experienced the death of a spouse in the last six months?
Yes———No——-
5) Have you experienced the death of a close friend in the last six months?
Yes——N0—–
6) Have you been divorced or seeking divorce in the last six months?
Yes———-No——–
7) Do you have a son or daughter who is experiencing serious emotional difficulties in the last year?
Yes———-No———
Has your health deteriorated significantly in the last year?
Yes———-No——–
9) Have you had difficulties in the sexual arena in the last year?
Yes——-No——–
10) Have you or your significant other lost your job in the last year?
Yes———–No——–
11) Do you or your significant other have trouble with a boss?
Yes——No—–
12) Do you often feel guilty for reasons you know are irrational?
Yes——–No———–
13) Do you frequently feel impatient when you have to wait at the supermarket, other stores?
Yes———-No———
14) Have you been fighting more often with your partner?
Yes———No——–
15) Do you feel like you are racing through each day, seldom able to slow down?
Yes———No
16) Do you have few supportive relationships?
Yes——–No——–
17) Do you tend to make more of the normal stressors in life than others you know?
Yes————-No——–
18) Do you wake each day feeling like you won’t be able to cope effectively?
Yes————-No——–
19) Do you have few calm moments during the day?
Yes———-No———
20) Do you often think you have little time for exercise, relaxation, letting go?
Yes———No———
| 1312) |
Scores of 1-6 Low Stress
Scores of 7-12 Moderate Stress
Scores of 13-17 Significant Stress
Scores of 18+ Extreme Stress
Your Score is ———————
Taken from then book The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience
