Name
*
First Name
Last Name
Email
*
SYMPTOMS OF STRESS
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Using the table below, assess the frequency that you experience these common symptoms of stress.
Strongly Disagree (never)
Disagree (1-2 x a month)
Neutral (1 x a week)
Agree (2-3 x a week)
Strongly Agree (daily)
Headaches
Tense Muscles
Sore Neck and Back
Fatigue
Anxiety/ Worry/ Phobias
Difficulty Falling Asleep
Irritability
Insomnia
Bouts of Anger/Hostility
Boredom
Depression
Eating Too Much or Too Little
Diarrhea
Cramps/ Gas
Constipation
Restlessness
Itching/ Scratching/ Pulling hair/ Biting Nails
PERCEIVED STRESS SCALE
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The questions in this scale ask about your feelings and thoughts during the last MONTH.
In each case, you will be asked to indicate how much you agree or disagree that you have felt or thought a certain way. Although some of the questions are similar, there are differences between them and you should treat each one as a separate question. The best approach is to answer fairly quickly.
IN THE LAST MONTH HAVE YOU.......
1. Been upset from something unexpected that happened?
2. Felt unable to manage the important pieces of your life?
3. Felt nervous and stressed?
4. Felt insecure about your ability to handle problems?
5. Felt that things were NOT going your way?
6. Found that you could not cope with everything going on?
7. Not been able to control irritations in your life?
8. Felt that you were NOT on top of things?
9. Been angered from things you couldn't control?
10. Felt difficulties were piling up too much for you to manage?
THE ARDELL WELLNESS STRESS TEST
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Are you HAPPY with your decisions, abilities, or success in the following categories?
1. Choice of career
2. Present job/ business/ school
3. Marital status
4. Primary relationships
5. Capacity to have fun
6. Amount of fun experienced in last month
7. Financial prospects
8. Current income level
9. Spirituality
10. Level of self-esteem
11. Your ability to have a positive impact on others close to you.
12. Sex life
13. Body, how it looks and performs
14. Home life
15. Life skills and knowledge of issues about the world.
16. Learned stress management capacities
17. Nutritional knowledge, attitudes, and choices
18. Ability to recover from hurts, setbacks, and tragedies
19. Confidence in who you are and your purpose.
20. Achievement of a rounded or balanced quality in your life
21. Sense that you are moving forward in life with hope.
22. Level of participation in regards to your passions.
23. Current or future family.
24. Role in some kind of network of people you care for.
25. Emotional acceptance of the inescapable reality of aging
STRESS COPING RESOURCES INVENTORY
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1. How frequently do you moderately exercise (at least 20 minutes of exercise)?
2. How often do you get a full, restful night of sleep?
3. To what extent is your energy sufficient for our work and daily activities?
4. How closely does your weight approach the ideal level?
5. To what extent do you eat a nutritious diet?
6. Which of the following best describes your use of tobacco?
7. Which of the following best describes your use of alcohol?
8. To what extent do you believe that you have a history of coping well with highly stressful
situations?
9. How confident are you of being able to control your emotions in stressful situations?
10. When things are not going well, how likely are you to view the situation as being temporary rather than permanent?
11. When something bad happens to you, how likely are you to exaggerate its importance?
12. When stressed by a complex situation, how likely are you to focus your attention on those aspects of the situation that you can manage?
13. When highly stressed, how capable are you of changing your thinking to calm down?
14. When confronted with a stressful situation, how likely are you to wait passively for events to develop rather than to take charge?
15. Which of the following courses of action are you most likely to take when you have become thoroughly frustrated?
16. If you had worn an article of clothing one day and then found it to be flawed, how likely would you be to return it and ask for a refund?
17. When an unexpected, negative event happens to you, how likely are you to actively seek information about the event and how to cope with it?
18. How much decision-making power do you have in your family?
19. How much decision-making power do you have in your working environment? (if not working
outside the home at present, use your last job as a basis for answering this question.)
20. To what extent do you believe that events in your life are merely the result of luck, fate, or
chance?
21. What is your best guess as to the extent and quality of contact you had with your parent(s)
shortly after birth?
22. During your early childhood, to what extent was your mother both calm and generally
permissive?
23. How easily do you make friends in a strange situation?
24. When highly stressed, how likely are you to ask friends or relatives for help?
25. In comparison with other people, how likely are you to see others as threatening,
uncooperative, or exploitative?
26. How often are you confused about the intentions of others toward you?
27. To what extent are you aware of practical, healthy ways of relaxing?
28. How frequently do you pursue some highly relaxing practice?
29. How often do you engage in a spiritual practice such as prayer, mediation, or inspirational
reading to enrich your interior life?
30. How connected do you feel to God?
31. To what extent do you believe your life has purpose?
32. How much contact do you have with what you would consider a spiritual community?
