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              My Monthly Stress Self Assessment

 

          To be completed monthly - the same day/date each month,

then compare THIS month’s total with your PREVIOUS month’s total

 

 

Score your answers:      Never 0         Occasionally 1        Often 2            Almost daily 3

 

 

During the last month have you experienced                                During the last month have you experienced

these mental  & emotional symptoms of stress?            these physical symptoms of stress?

 

 

 

 


1.          Inability to concentrate                                          1.          Headaches

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2.          Difficulty making simple decisions                            2.          Difficulty in sleeping

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3.          Absent-mindedness                                                3.          Fatigue without exertion

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4.          Loss of self confidence                                          4.          Loss of appetite

 

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5.          Irritability with others                                             5.          Overeating  binges

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6.          Loss of interest in life                                             6.          Indigestion/heartburn

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7.          Extreme mood swings                                             7.          Constipation or diarrhoea

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8.          Feelings of failure & inferiority                             8.          Nausea

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9.          Uncalled-for aggression                                         9.          High blood pressure

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10.        Anxiety about imaginary misfortunes                          10.        Colds or flu

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11.        Irrational fears or panics                                         11.        Skin rashes

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12.        Feeling helpless & unable to cope                              12.        Aching neck/shoulder muscles

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                                        TOTAL                                        13.        Cramps and muscle spasms

                                                                                                 ----------------------------------------------------------------------

                                                                                                 14.        Heart palpitations

                                                                                                 ----------------------------------------------------------------------

                                                                                                 15.        Rapid breathing/breathlessness without exertion

                                                                                                 ----------------------------------------------------------------------

                                                                                                 16.        Fainting spells

                                                                                                 ----------------------------------------------------------------------

                                                                                                 17.        Sexual impotency/frigidity     

                                                                                                 ----------------------------------------------------------------------

                                                                                                 18.        Fidgety/nervous mannerisms  

                                                                                                 ----------------------------------------------------------------------

                                                                                                 19.        Sweating without reason

                                                                                                 ----------------------------------------------------------------------

                                                                                                 20.        Minor accidents                        

                                                                                                 ----------------------------------------------------------------------

                                                                                                                                                       TOTAL

 

Add up your scores for this month’s stress rating: 

 

 0 - 24 low           25 – 48 med          49 - 72 high          73 - 96 very high

 

 

 

MY JOINT TOTAL (both columns added together)  =

       

         

If it’s 49+  WHAT ARE YOU GOING TO DO ABOUT IT??

 

 

 

 

 


Should you wish to use any of the techniques or procedures described on these pages,  you

accept full responsibility for your own emotional, psychological, mental, physical and spiritual

wellbeing and health. 

 

© Christina Elvin Consultancy, tel: +44(0)1604 768343    fax: +44(0)1604 706609    mob: 07799 390022   

email: christina@emofree.biz   www.emofree.biz   www.create-the-reality.com   www.C2T2.co.uk   

If any of this information is used by you, please acknowledge the source – thank you

 

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