Rate the degree of intensity of your stress symptoms using the scale below. This is for your awareness only. There are no right/wrong or ideal targets to achieve. Once you are honest with yourself about the levels of various stresses you are experiencing and what the effect is on you, it becomes easier to design a routine that takes care of your needs.
This checklist is set up for you to have a before and after look at your stress responses. This helps you have a clear picture of what is helping but also can give you a sense of accomplishment based on your self-care.
Slight Moderate Extreme
1 2 3 4 5 6 7 8 9 10
Stress symptom Present level of intensity Level after program
- Situational Anxiety (list):
- Relationship Anxiety (list):
- Generalized Anxiety
- Hopelessness
- Helplessness
- Sadness (Cry easily or inability to cry)
- Low Self-Esteem
- Irritability
- Anger
- Hostility
- Resentment
- Fears
- Phobias
- Inability to Concentrate
- Obsessive Thoughts
- Confusion
- Muscular Tension
- Muscle Spasms
- Headaches
- Backaches
- Stomach/Intestinal symptoms
- Fatigue
- Insomnia
- Sleep too much
- Weight
- Work Stress