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The following Stress Assessment is designed to help you quickly evaluate five important aspects of your stress. The 211 questions cover:
A. Stressors at Work and in your Personal Life.
B. Close Relationships
C. Health Conditions
D. Your Signs and Symptoms of Stress.
E. The Effectiveness of your current Coping skills and Resources.

You can complete the Assessment and use the information to help guide you in your objective to reduce the stress in your life. Then, you will be given the option to request Stress Less to provide you with a custom designed program based on your scores and personal background information.

A. STRESSORS

The following is a list of situations that many people find stressful. Please note those situations that apply to you over the last six months or that you anticipate will apply to you in the coming year. For each item that applies to you, press the button next to the level of stress coping that you believe most accurately describes how effectively you are coping with each stressor.

Definition of Coping Levels

- Stressed Out/Burned Out
Severe difficulties in coping, incapacitating feelings of anxiety, dread, depression, helplessness and/or anger, impaired functioning on the job or in personal life, extreme distress, presence of physical symptoms such as sleep and/or appetite disturbance, lowered immunity, physical tension, or depleted energy.

- Strained
Frequent difficulty in coping, a sense of overwhelm or feeling drained, persistent feelings of anxiety, anger, irritability, helplessness, worry, gloom, some impairment in functioning at work or personal life.

- Balanced
Effective and relatively stable functioning at work and/or personal life. Occasional distressing feelings which are appropriate and minimally disturbing or disruptive.

- Highly Effective
Highly effective and creative problem solving and performance, feeling challenged, energized, motivated, anticipating successful resolution.

Work Changes and Pressures

1. Too many responsibilities:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

2. Demanding or Unreasonable Deadlines:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

3. Conflicts with, or conflicting demands, unclear expectations from superiors, or management:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

4. Demanding or difficult customers:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

5. Difficult co-workers:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

6. Lack of control over my workload and/or decisions affecting my job:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

7. Office politics:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

8. Job insecurity due to cutbacks, layoffs,downsizing, reorganization:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

9. Limited opportunity for advancement and/or inadequate pay:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

10. Too much/too little contact with people:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

11. Too many hassles and interruptions:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

12. Other Work Stressor
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

Personal and Homelife

13. Death of significant person i.e., a spouse, friend, relative, or family member:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

14. Separation or divorce:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

15. Serious illness or injury:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

16. Not enough money and/or heavy debt:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

17. Conflicts with mate, inlaws, family or friend(s):
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

18. Sexual conflicts and/or frustration:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

19. Problems with child care:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

20. Conflict with spiritual, moral or ethical values:
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

21. Other Personal Stressors
Does not apply to me
Stressed out
Strained
Balanced
Highly Effective

B. Close Relationship

Use the scale given below to answer the following questions according to your relationship with your significant other (e.g. spouse, boyfriend/girlfriend). Please answer all items.
1 = Very dissatisfied
2 = Somewhat dissatisfied
3 = Somewhat satisfied
4 = Very satisfied

22. Degree of communication
1

2

3

4

23. Ability to resolve conflicts
1

2

3

4

24. Handling of money
1

2

3

4

25. Sexual relationship
1

2

3

4

26. Sharing duties and household chores
1

2

3

4

27. Degree of affection
1

2

3

4

28. How well I get along with my partner's friends and relatives
1

2

3

4

29. How well my partner gets along with my friends and relatives
1

2

3

4

30. Degree of closeness
1

2

3

4

31. My role in the relationship
1

2

3

4

32. My partner's role in the relationship
1

2

3

4

33. Raising children (If you don't have any children, please put your overall satisfaction with your relationship for this question.)
1

2

3

4

34. Leisure activities with my partner
1

2

3

4

C. MEDICAL AND MENTAL HEALTH CONDITIONS

Please answer the following questions by selecting a single response.

1=I have never had this condition and have no family history of it
2=I have never had this condition, but have a family history of it
3=I had this condition in the past, but it has been treated
4=I currently have this condition

Medical Conditions

35. High Cholesterol
1

2

3

4

36. Diabetes
1

2

3

4

37. Cancer
1

2

3

4

38. High Blood Pressure
1

2

3

4

39. Heart Disease
1

2

3

4

40. Anemia
1

2

3

4

41. Stroke
1

2

3

4

42. Seizures
1

2

3

4

43. Asthma
1

2

3

4

44. Arthritis
1

2

3

4

45. Heart Attack
1

2

3

4

Mental Health Conditions

46. Mood Disorder (Depression, BiPolar, Manic)
1

2

3

4

47. Anxiety Disorder (Generalized Anxiety, Panic, Phobia, PTSD, Obessive Compulsive)
1

2

3

4

48. Schizophrenia
1

2

3

4

49. Substance Related Disorders (Alcohol, Cannabus)
1

2

3

4

50. Eating Disorder (Anorexia, Bulimia)
1

2

3

4

51. Sleep Disorder
1

2

3

4

Physical Health Conditions

52. Do you exercise?
No

Yes

53. How often do you exercise?

54. What is the total number of times you exercise each day or week or month? (use the term from your answer to the previous question)

55. Each time you exercise, how long do you typically exercise for?

56. Do you smoke?
No

Yes

57. How often do you smoke? (please only choose one answer)

58. What is the total number of cigarettes you smoke each day or week or month? (use the term from your answer to the previous question)

59. Do you drink alcohol?
No

Yes

60. How often do you drink alcohol? (please only choose one answer)

61. What is the total number of drinks you consume each day or week or month? (use the term from your answer to the previous question)

62. Do you use recreational drugs (marijuana, cocaine, ecstasy)?
No

Yes

63. If yes, how frequently do you use these drugs? (please only choose one answer)


The next two questions will ask you about your height. The first question will ask for the "feet portion" of your height, and the second question will ask for the "inches portion" of your height. For example: If a person was 5 feet & 7 inches tall, that person would answer 5 feet for the first question and 7 inches for the second question.

64. How many feet tall are you?

65. How many additional inches tall are you?

66. Please type your weight (in pounds) in the box to the right.

D. SIGNS AND SYMPTOMS OF STRESS

The following is a list of Physical, Mental, Emotional and Behavioral symptoms of Stress. If a symptom applies to you over the past 6 months or you anticipate the symptom occuring in the coming year, please rate the severity of the symptom you have experienced or anticipate experiencing on the 4 point scale next to the item. Please rate every item.

Physical Symptoms:
1= Low or none; 2 = Mild; 3 = Moderate; 4 = Severe;
NA = Not Applicable
67. Chest Pain 1    2    3    4    NA 
68. Headaches(Tension Migraine) 1    2    3    4    NA 
69. Back pain 1    2    3    4    NA 
70. Tense Neck and Jaw 1    2    3    4    NA 
71. Throat Constriction, difficulty swallowing 1    2    3    4    NA 
72. Muscle Cramps 1    2    3    4    NA 
73. Sleeplessness 1    2    3    4    NA 
74. Sexual Difficulties, Loss of Sexual Interest 1    2    3    4    NA 
75. Dizziness 1    2    3    4    NA 
76. Cold Hands/feet 1    2    3    4    NA 
77. Fatigue, Low Energy, tired 1    2    3    4    NA 
78. Bloating 1    2    3    4    NA 
79. Diarrhea 1    2    3    4    NA 
80. Nail Biting 1    2    3    4    NA 
81. Reduced Immunity
(Frequent Colds/Flu, Allergies or Infections)
 1    2    3    4    NA 
82. Heart Racing/rapid pulse 1    2    3    4    NA 
83. High Blood Pressure 1    2    3    4    NA 
84. Shortness of Breath 1    2    3    4    NA 
85. Over Eating 1    2    3    4    NA 
86. Loss of Appetite 1    2    3    4    NA 
87. Ulcers 1    2    3    4    NA 
88. Colon problems 1    2    3    4    NA 
89. Voice Shaky, Stuttering or Strained 1    2    3    4    NA 
90. Tight muscles or Muscle aches 1    2    3    4    NA 
91. Bruxism (grinding or teeth clenching) 1    2    3    4    NA 
92. Frowning, wrinkled forehead 1    2    3    4    NA 
93. Trembling or shaking 1    2    3    4    NA 
94. Gas pains or cramping 1    2    3    4    NA 
95. Acid Stomach, Heartburn 1    2    3    4    NA 
96. Constipation 1    2    3    4    NA 
97. Nausea 1    2    3    4    NA 
Mental Symptoms
1= Low or none; 2 = Mild; 3 = Moderate; 4 = Severe;
NA = Not Applicable
98. Forgetfulness 1    2    3    4    NA 
99. Negating own ideas 1    2    3    4    NA 
100. Disorganized thinking 1    2    3    4    NA 
101. Mental chatter 1    2    3    4    NA 
102. Mind racing 1    2    3    4    NA 
103. Lack concentration/attention 1    2    3    4    NA 
104. Obsessive thinking 1    2    3    4    NA 
105. Worry 1    2    3    4    NA 
106. Unable to prioritize 1    2    3    4    NA 
107. Decision making difficulties 1    2    3    4    NA 
108. Automatic thoughts/images 1    2    3    4    NA 
109. Irrational beliefs and self talk 1    2    3    4    NA 
110. Disturbing thoughts or daydreams 1    2    3    4    NA 
Emotional Symptoms
1= Low or none; 2 = Mild; 3 = Moderate; 4 = Severe;
NA = Not Applicable
111. Anger, Irritability 1    2    3    4    NA 
112. Anxiety, Panic, Fearful 1    2    3    4    NA 
113. Depressed, Sad, Downhearted, Blue 1    2    3    4    NA 
114. Feel strong dependency need 1    2    3    4    NA 
115. Helpless 1    2    3    4    NA 
116. Hopeless 1    2    3    4    NA 
117. Lonely 1    2    3    4    NA 
118. Pessimism 1    2    3    4    NA 
119. Unworthy 1    2    3    4    NA 
120. Flattened Affect (e.g. feelings are dulled) 1    2    3    4    NA 
121. Blaming 1    2    3    4    NA 
122. Guilt 1    2    3    4    NA 
123. Impatient 1    2    3    4    NA 
124. Frustrated 1    2    3    4    NA 
125. Feel inadequate 1    2    3    4    NA 
126. Feel suicidal 1    2    3    4    NA 
127. Sudden moments of panic 1    2    3    4    NA 
128. Tenseness or uptight 1    2    3    4    NA 
Personal Behavioral Signs
1= Low or none; 2 = Mild; 3 = Moderate; 4 = Severe;
NA = Not Applicable
129. Lack close relationships 1    2    3    4    NA 
130. Low trust 1    2    3    4    NA 
131. Non assertive 1    2    3    4    NA 
132. Won't take risks 1    2    3    4    NA 
133. Avoid challenges 1    2    3    4    NA 
134. Dull & Boring 1    2    3    4    NA 
135. Avoid change 1    2    3    4    NA 
136. Poor love relationships 1    2    3    4    NA 
137. Limit social life, Withdraw 1    2    3    4    NA 
138. Lack control over life 1    2    3    4    NA 
139. Poor self-esteem 1    2    3    4    NA 
140. Fear commitments 1    2    3    4    NA 
141. Lack self forgiveness 1    2    3    4    NA 
142. Indecisive 1    2    3    4    NA 
143. Make unrealistic demands 1    2    3    4    NA 
144. Coercive 1    2    3    4    NA 
145. Lack Drive, Unmotivated 1    2    3    4    NA 
146. Over reacting 1    2    3    4    NA 
147. Passive, Dependent, Controlled by others 1    2    3    4    NA 
148. Poor family harmony 1    2    3    4    NA 
149. Lack of interest in hobbies 1    2    3    4    NA 
150. Worry about health 1    2    3    4    NA 
151. Worry about physical appearance 1    2    3    4    NA 
152. Fear losing control 1    2    3    4    NA 
153. Fear dying or death 1    2    3    4    NA 
154. Fear social embarrassment 1    2    3    4    NA 
155. Worry about being criticized/disapproved by others 1    2    3    4    NA 
156. Fear you will pass out/faint 1    2    3    4    NA 
157. Domineering 1    2    3    4    NA 
158. Unable to reach out to others 1    2    3    4    NA 
159. Critical 1    2    3    4    NA 
160. Marital problems 1    2    3    4    NA 
161. Alienation 1    2    3    4    NA 
162. Poor communications 1    2    3    4    NA 
163. Molehills into mountains 1    2    3    4    NA 
164. Lack compassion 1    2    3    4    NA 
165. Jealousy 1    2    3    4    NA 
166. Can't relax 1    2    3    4    NA 
167. Unable to express true feelings 1    2    3    4    NA 
Work Behavior Signs
1= Low or none; 2 = Mild; 3 = Moderate; 4 = Severe;
NA = Not Applicable
168. Over eating 1    2    3    4    NA 
169. Lack response to Challenge 1    2    3    4    NA 
170. Choices related to self image
rather than reality
 1    2    3    4    NA 
171. Lose creativity 1    2    3    4    NA 
172. Oppositional/Hostile 1    2    3    4    NA 
173. Rigidity/By the book 1    2    3    4    NA 
174. Poor Performance 1    2    3    4    NA 
175. Low motivation 1    2    3    4    NA 
176. Lack self initiative 1    2    3    4    NA 
177. Absenteeism 1    2    3    4    NA 
178. Low aspirations 1    2    3    4    NA 
179. Accept low status 1    2    3    4    NA 
180. Trying to over please others 1    2    3    4    NA 
181. Avoid responsibility 1    2    3    4    NA 
182. Avoid risks 1    2    3    4    NA 
183. Inability to work well with others 1    2    3    4    NA 
184. Poor time management 1    2    3    4    NA 
185. Too Controlling 1    2    3    4    NA 
186. Create tension in others 1    2    3    4    NA 
187. Poor communications 1    2    3    4    NA 
188. Waste time/Procrastination 1    2    3    4    NA 
189. Poor skill development 1    2    3    4    NA 
190. Unable to complete tasks 1    2    3    4    NA 
191. Crisis oriented 1    2    3    4    NA 
192. Lack respect for others 1    2    3    4    NA 
193. Low delegation 1    2    3    4    NA 
194. Lack interpersonal skills 1    2    3    4    NA 
195. Overwork 1    2    3    4    NA 
196. Lose clarity of goals 1    2    3    4    NA 
197. Competitive 1    2    3    4    NA 

E. STRESS COPING SKILLS AND PERSONAL RESOURCES

The following is a list Coping Skills, Habits and Personal Resources that are effective for combating and preventing Stress.

Please rate on the four point scale the level of your ability to apply each skill to reduce your stress:

Rating Scale:
1 = Strongly Disagree
2 = Somewhat Disagree
3 = Somewhat Agree
4 = Strongly Agree

198.Diet and Nutrition
I have good nutritional habits that include eating a balanced diet, taking appropriate nutritional supplements and limiting caffeine, sugar and fat intake. 1    2    3    4 
199. Relaxation
I am aware when stress builds up in my body and use relaxation techniques to reduce body tension. 1    2    3    4 
200. Physical Exercise
I am physically fit and use regular exercise to combat and prevent stress. 1    2    3    4 
201. Social Support
I am able to ask for and receive support from friends, family members or professionals as a buffer against stress. 1    2    3    4 
202. Communication
I am able to effectively listen to others and comfortably express my own thoughts, feelings and opinions. 1    2    3    4 
203. Assertiveness
In conflict situations, I am able to speak up on my own behalf, honestly express my opinions, feelings, and wishes, give constructive criticism, and refuse unrealistic requests.  1    2    3    4 
204. Financial
I am good at managing money, do not needlessly worry about financial matters, and have enough money to meet most of my needs and use in the service of reducing stress. 1    2    3    4 
205. Time Management
I am able to efficiently manage my time.  1    2    3    4 
206. Taking Action
I am able to establish priorities, take action on my plans, goals and set limits, schedule effectively, avoid procrastination and pace my efforts. 1    2    3    4 
207. Problem Solving
I am skilled at defining problems, approaching them in a timely and logical way, obtaining information, finding workable solutions, considering alternatives, seeing potential consequences and evaluating the results of my actions. 1    2    3    4 
208. Challenging Stressful Thinking
I am able to reduce stress by consciously monitoring, challenging and changing negative thought patterns, placing problems into proper perspective, practicing relaxation techniques, mentally rehearsing coping behaviors and using positive self-talk and visual images. 1    2    3    4 
209. Functional Beliefs
I am able to change rigid and absolute stress inducing beliefs into more functional beliefs such as "I can be happy even if others disapprove of me", "the world doesn't have to meet my wishes all the time", and "I don't have to be perfect to be worthwhile." 1    2    3    4 
210.Humor
I do not take myself too seriously and use humor to balance life's frustrations 1    2    3    4 
211. Spiritual
I believe in a higher power and spiritual connectiveness to life. 1    2    3    4 




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