Part One: Your Environmental/ Pressures and Satisfactions
Scale 1: Work Changes
Think about... the past year. For each of the changes listed below, indicate how much or how little each has been a source of stress to you.
Scale 2: Work Pressures
Think about... the past month. For each of the pressures listed below, indicate how much each has been a source of stress to you.
Scale 3: Work Satisfactions
Think about... the past month. For each of the satisfactions listed below, indicate how true each is for you.
NOTE: The term family is used generally to mean those people closest to you, your inner circle, and not necessarily a traditional family. The word, mate is generically used to mean spouse, significant other or life partner.
Scale 4: Personal Changes
Think about... the past year. For each of the changes listed below, indicate how much each has been a source of stress to you.
Scale 5: Personal Pressures
Think about... the past month. For each of the pressures listed below, indicate how much each has been a source of stress to you.
Scale 6: Personal Satisfactions
Think about... the people closest to you, and your experiences with them in the past month. To what degree is each of the following statements true of these relationships.
Part Two: Coping Responses/ Assests and Liabilities
Scale 7: Self Care
Think about... the past month. For each self-care practice, indicate how often each is true for you, or practiced by you.
Scale 8: Direct Action
Think about... the past month. For each statement, indicate to what degree it describes your behavior or intentions.
Scale 9: Support Seeking
Think about... the past month. For each statement, indicate to what degree it describes your behavior or intentions.
Scale 10: Situation Mastery
Think about... the past month. For each statement, indicate to what degree it describes your behavior or intentions.
Scale 11: Adaptability
Think about... the past month. For each statement, indicate to what degree it describes your behavior or intentions.
Scale 12: Time Management
Think about... the past month. For each statement, indicate to what degree it describes your behavior or intentions.
Part Three: Inner World/ Thoughts and Feelings
Scale 13: Self-Esteen
Think about... the past month. For each statement, indicate how much each represents the way you think or feel about yourself.
Scale 14: Positive Outlook
Think about... the past month. For each statement, indicate how much each fits the way you think about the world.
Scale 15: Personal Power
Think about... the past month. For each statement, indicate how much each fits the way you think or feel about yourself
Scale 16: Connection
Think about... the past month. For each statement, indicate how much each is like the way you think or feel about.
Scale 17: Expression
Think about... the past month. For each statement, indicate how much each is like the way you think or feel about.
Scale 18: Compassion
Think about... the past month. For each statement, indicate how much each like the way you think or feel about.
Part Four: Signals of Distress
Scale 19: Physical Symptoms
Think about... the past month. For each of the symptoms listed, indicate how often it has occurred for you.
Scale 20: Behavioral Symptoms
Think about... the past month, Indicate how often you have done or experienced each of the items listed below.
Scale 21: Emotional Symptoms
Think about... the past month. For each of the symptoms listed, indicate how often it has occurred