Please download and fill in the stress assessment questionnaire
Stress Management Training S1.c
Session One
Stress Assessment Questionnaire
Name………………………………………………………………………………………………………………………….
How would you describe the problem?
How long have you had the problem?
How did the problem first start?
What does your Doctor say about the problem?
Have you had any treatment in the past?
Have you tried to overcome the problem in the past?
Have you had any success in overcoming the problem?
Do you suffer from any of the following?:
|
Headaches Blushing Dizziness Heartburn Weak knees Chest pains Itching Blurred vision Light-headedness Missed heartbeat Sleep disturbance Breathlessness Difficulty swallowing Anxiety Facial tics Nausea Frightening thoughts Worrying Loneliness Disorganisation Poor memory |
Diarrhoea Allergies Tiredness Faintness Nightmares Palpitations Rash Uncontrollable eye movement Unreal feelings Muscular tension Excessive sweating Sexual difficulties ‘Lump in the throat’ Panic attacks Sensitivity to light and sound Shaking Hating yourself Talking too fast Boredom Poor concentration Irritability |
Do you fear any of the following?:
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Future events Collapsing Panic attacks Losing control Crowded places Driving Being on a train Supermarkets Talking to people People looking at you Bridges Being alone Social occasions Waiting rooms Dogs |
Choking Fainting Being embarrassed Madness Standing in queues Being on a bus Being in shops Leaving the house Eating in front of people Writing in front of people Tunnels Going to work Cinemas, theatres Medical examinations Birds |
Do you suffer from unpleasant thoughts that you feel are beyond your control?
Do you feel compelled to do certain actions to control these thoughts?
Do you work outside the home?
Do you live alone or with family or friends?
Have your parents or brothers/sisters ever suffered from any psychological problems?
What are your hobbies/Social life?
Do you smoke? (and how many a day, for how many years, and in what circumstances)?
Do you drink alcohol? (and how much a week, for how many years and in what circumstances)?
Are you taking any medication?
How is your physical health?
What are your most serious symptoms? How do they affect your life at the present time?
Optional : Return your completed form to your coach for review: Email: [email protected]
