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Schlitz, M. Keynote Address. 15th Annual Healing 

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The Nature of Stress

25

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Although there is no definitive survey composed of 20 questions to determine if you are stressed or burnt out, 

or just exactly how stressed you really are, questionnaires do help increase awareness that, indeed, there may 

be a problem in one or more areas of your life. The following is an example of a simple stress inventory to 

help you determine the level of stress in your life. Read each statement, and then check the box next to Agree 

or Disagree. Then count the number of “Agree” points (one per question) and use the Stress Level Key to 

determine your personal stress level.

 

Statement

Agree

Disagree

1.  I have a hard time falling asleep at night.

F

F

AGREE



F

F

DISAGREE



2.  I tend to suffer from tension and/or migraine headaches.

F

F



AGREE

F

F



DISAGREE

3.  I find myself thinking about finances and making ends meet.

F

F

AGREE



F

F

DISAGREE



4.  I wish I could find more to laugh and smile about each day.

F

F



AGREE

F

F



DISAGREE

5.  More often than not, I skip breakfast or lunch to get things done.

F

F

AGREE



F

F

DISAGREE



6.  If I could change my job situation, I would.

F

F



AGREE

F

F



DISAGREE

7.  I wish I had more personal time for leisure pursuits.

F

F

AGREE



F

F

DISAGREE



8.  I have lost a good friend or family member recently.

F

F



AGREE

F

F



DISAGREE

9.  I am unhappy in my relationship or am recently divorced.

F

F

AGREE



F

F

DISAGREE



10.  I haven’t had a quality vacation in a long time.

F

F



AGREE

F

F



DISAGREE

11.  I wish that my life had a clear meaning and purpose.

F

F

AGREE



F

F

DISAGREE



12.  I tend to eat more than three meals a week outside the home.

F

F



AGREE

F

F



DISAGREE

13.  I tend to suffer from chronic pain.

F

F

AGREE



F

F

DISAGREE



14.  I don’t have a strong group of friends to whom I can turn.

F

F



AGREE

F

F



DISAGREE

15.  I don’t exercise regularly (more than three times per week).

F

F

AGREE



F

F

DISAGREE



16.  I am on prescribed medication for depression.

F

F



AGREE

F

F



DISAGREE

17.  My sex life is not very satisfying.

F

F

AGREE



F

F

DISAGREE



18.  My family relationships are less than desirable.

F

F



AGREE

F

F



DISAGREE

19.  Overall, my self-esteem can be rather low.

F

F

AGREE



F

F

DISAGREE



20.  I spend no time each day dedicated to meditation or centering.

F

F



AGREE

F

F



DISAGREE

Stress Level Key

Less than 5 points 

You have a low level of stress and maintain good coping skills.

More than 5 points 

You have a moderate level of personal stress.

More than 10 points 

You have a high level of personal stress.

More than 15 points 

You have an exceptionally high level of stress.

© Paramount Wellness Institute. Reprinted with permission. All rights reserved.



EXERCISE 1.1: Are You Stressed?

Chapter 1

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