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Stress Survey

Stress Survey

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———

8) 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

 

 

 

 

 

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