STRESS QUESTIONNAIRE

Please consider the following conditions and answer the questionnaire in an honest manner.
Remember denial refers to an adv anced stage of non-coping. Mak e a cross through the
number, which shows how regularly y ou hav e experienced the sy mptom during the last six
months. A dd all the numbers y ou hav e made a cross through to find y our total score, then refer
to the table at the end.

Go o d Luck

Heart pounding or racing

Trembling/shaking
Grinding of teeth (even in your sleep)
Do not sleep well
Susceptible to illness
Stomach pains
Headaches
Migraine headaches
Feeling tired constantly
Constipation
Hollow stomach
Lowered self-confidence
Loss of appetite
Excessive sweating (e.g. hands, face, arm
pits, etc.)
Sweaty palms
Listlessness dont feel like doing stuff
Forget things
Absentminded
Feeling irritated
Nauseous
Considered suicide
Pessimistic
Jealous/Envious
Moody
Pain in the lower back
Feelings of depression
Anxiety
Loss of interest in things
Sensitive and/or Touchy
Muscle pain
Indecisive
Unnecessary/excessive checking of work
Difficulty with breathing
Struggle to overcome minor sicknesses (e.g.
a cold)
Suspicious
Hair loss
Throat irritations
Lost sense of humour
Impaired concentration
Struggle to loose/gain weight even when
following a diet
Heartburn
Skin disorders
Dont take initiative as you used to

OFTEN

REGULAR

1
1
1
1
1
1
1
1
1
1
1
1
1
1

SOMETIM
E
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4
4
4
4
4
4

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4

0
0
0
0
0
0

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

4
4
4
4
4
4

0
0
0

1
1
1

2
2
2

3
3
3

4
4
4

NEVER

SELDOM

0
0
0
0
0
0
0
0
0
0
0
0
0
0

Nightmares
Dry mouth
Consume tonics (bioplus, liviton, lucozade,
pharmaton, etc.)
Diarrhoea
Nervous twitches in face or scalp
Feelings of inadequacy
Easily startled/jumpy
Increased appetite
Impaired co-ordination
Uncertainty
Become frustrated quickly
Less involvement with others
Biting of fingernails
Reduced motivation
Increased caffeine intake (coffee, tea, coke,
coke light, red bull, etc.)
Restlessness
Poor judgment
Increased smoking
Feeling out of control
Confused thoughts
Increased time sleeping
Use tranquilisers, sleeping pills
Waking up tired
Feeling overwhelmed by demands
Excessive blinking
Daydreaming
Procrastination
Feeling panicky
Reduced productivity
Wasting time on irrelevant activities
Cannot discuss my problems with others
Difficult to identify causes of nonperformance

0
0
0

1
1
1

2
2
2

3
3
3

4
4
4

0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4
4
4
4

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4

STRESS LEVEL
Your score:
00 - 20
21 - 45
46 - 70
71 - 90

91 plus

It is unlikely that your stress is so low.

Perhaps you interpreted the questionnaire incorrectly.
You cope effectively with stress. Your level of stress is below
average.
You do not experience more or less stress than the average
person.
You exhibit an above average level of stress and should learn to
manage your stress more effectively. You might find it difficult
to cope in specific circumstances. You can benefit from active
coping strategies.
You exhibit high stress levels. It is recommended that you learn
to identify causes of stress as well as active ways in dealing
with these causes. You might think youre coping, but youre not.