Stress Survey

Please read each statement and make a selection that best describes how your stress patterns are.
There is a reason for each question, but try not to spend too much time on each one, rather select your first reaction to each one.

1Section i)

2Section ii)

3Section iii)

4Section iv)

5Section v)

6Section vi)

When under stress for a week or longer, I...

	Never	Seldom	Often	Daily
Get wound up when I get tired and have trouble calming down:
Feel driven, appear energetic but feel ‘burned out’ and exhausted:
Feel restless, agitated, anxious and uneasy:
Feel easily overwhelmed by emotion:
Feel emotional – cry easily or laugh inappropriately:
Experience heart palpitations or a pounding in my chest:
Am short of breath:
Am constipated:
Feel warm, overheated and dry all over:
Get mouth sores or a sore tongue:
Get hot flashes:
Sleep less than seven hours a night:
Have trouble falling asleep and staying asleep:
Worry about high blood pressure, cholesterol and triglycerides:
Forget to eat and feel little hunger:

What is stress all about

Stress is a normal part of our everyday life. We are faced with deadlines, bills, uncertainties, hopes and fears on a daily basis. In the modern day, we often do not have enough time to relax and tend to push ourselves mentally for way more hours of the day than in previous generations. This, of course, affects our body and it is important to manage stress in order to diminish the possible negative effect that stress can have on our overall health. Continuous stress leads to a constant release of stress hormone, which may lead to symptoms of burnout, such as feelings of fatigue, weakened immune system, insomnia.

The stress questionnaire is an assessment tool we use to measure how much stress you are under, possible symptoms of burnout you may be suffering from and whether you are releasing excess stress hormone. This questionnaire will allow us to assess how you’re managing stress and whether it is affecting your overall health.

	Never	Seldom	Often	Daily
Find myself worrying about things big and small:
Feel like I can’t stop worrying, even though I want to:
Feel impulsive, pent up and ready to explode:
Get muscle spasms:
Feel aggressive, unyielding or inflexible when pressed for time:
See, hear and smell things that others do not:
Stay awake replaying the events of the day or planning for tomorrow:
Have upsetting thoughts or images enter my mind again and again:
Have a hard time stopping myself from doing things again and again, like checking on things or re-arranging objects over and over:
Worry a lot about terrible things that could happen if I am not careful:

	Never	Seldom	Often	Daily
I have had my adrenals tested and had an abnormal result:
Have muscle or joint pains:
Have muscle weakness:
Crave salt or salty things:
Have multiple points on my body that when touched are tender or painful:
Have dark circles under my eyes:
Feel a sudden sense of anxiety when I get hungry:
Use medications to manage pain:
Get dizzy when rising or standing up from a kneeling or sitting position:
Have diarrhoea or bouts of nausea with or without vomiting for no apparent reason:

	Never	Seldom	Often	Daily
Have headaches:
Have trouble organising my thoughts;
Get easily distracted and lose focus:
Have difficulty making decisions and mistrust my judgment:
Fell depressed and apathetic:
Lack the motivation and energy to stay on task and pay attention:
Am forgetful:
Feel unsettled, restless and anxious:
Wake up tired and unrefreshed:
Experience heartburn and indigestion:
Catch colds or infections easily:

	Never	Seldom	Often	Daily
Feel tired for no apparent reason:
Experience lingering mild fatigue after exertion or physical activity:
Find it difficult to concentrate and complete tasks:
Feel depressed and apathetic:
Feel cold or chilled – hands, feet or all over – for no apparent reason:
Have little or no interest in sex:
Constipated:
Feel puffy and retain fluids:
Sleep more than nine hours a nights:
Have poor muscle tone:
Have trouble losing weight:
Wake up tired even though I seem to get plenty of sleep:
Have no energy and feel physically weak:
Am susceptible to colds and the flu:
Feel dragged down by multiple symptoms such as poor digestion and body aches:

	Yes	No
Put on weight when stressed even though I eat the same:
Am resistant to infections even though everyone else goes down with them:
Tend to be warm and don’t feel the cold as much as every one else:
Tend to carry weight around my waist:
Can endure physical activity for much longer than most other people:
Can miss a meal and not feel fatigued:
Struggle to fall asleep:
Struggle to wake up in the morning: