Stress Questionnaire

Everyone needs to take a stress questionnaire at various times throughout your life journey.

I suggest that because of this example…

Think about when you are your car listening to the radio as you drive. Every so often, you start thinking about something and because your thoughts are elsewhere, you no longer “hear” the song that is playing.

Most people have become so habituated to stress that, just like with the music in the car, it has become hard to notice the impact stress is having on your life.

Being used to coping with stress doesn't mean that you are managing slowly begins to take its toll on you.

stress questionnaire

Give yourself the gift of “insight”

There is a BEST of you that flourishes when not stressed, or when you are in balance more time throughout the day. Because of the stress in most lives, it becomes harder and harder to “see” how stress is impacting ALL of who you are.

It is when stress becomes chronic that you may start to notice its impact on you physically, emotionally, spiritually, or with your thoughts of uncertainty.

You can’t fix something you can’t see.

If you give yourself an opportunity to “see” how stress might be impacting you then you also give yourself the gift of choice.

Cognitive stress
It is the thoughts of uncertainty, or your fears and worries, that are triggering the stress response so often. What are your thoughts of uncertainty?

Will I be laid off?
Will I be able to find a job?
Will I have enough money to pay my bills?
Will I be able to pay the rent, take care of my family?
Are my children safe?
Will I be healthy again?
Will I ever feel like my old self again?
When will the next “thing” happen to me?

Physical stress
Taking care of your physical body is like taking care of your car. If you do not keep up with regular maintenance, keeping fuels at a functional range, keeping tires in alignment etc. you risk damaging or shortening the life of the car.

There is some simple physiology to stress that is important to understand.

Some warning signs that your stress has become chronic stress is when you begin to notice getting headaches more often, not being able to sleep, or having more pain from muscle tension.

Taking 2 minutes to fill out the stress questionnaire will give you more information to take care of your body.

Emotional stress
In my experience, I have learned that the emotional part of who you are is one of the most important indicators of stress that we have. It IS within your emotions that the quality of your life is experienced.

Your benchmark for being in emotional balance, or not stressed, is when you feel peaceful and calm.

With chronic stress people often experience a sense of loss of control with their emotions.

Give yourself the gift of “insight” by taking the stress questionnaire . Without any blame, shame, or judgment…just allow yourself to notice how stress may be impacting your life emotionally.

Spiritual stress
In talking about stress, I refer to spirituality as the congruency between your actions and behaviors and who you believe you are as a person.

When you are not stressed and are in balance, your actions and behaviors are very congruent with your personal belief system of who you are.

With chronic stress , the relationships with yourself and others will suffer.

Stress Questionnaire Contact Banner - Click Here

Take a stress questionnaire

Becoming aware of something doesn’t mean you have to change anything.

There are some simple ways to begin to reduce your stress .

When you give yourself an opportunity to become aware of how stress is impacting ALL of who you are, you are giving yourself the gift of choice.

You CAN fix anything once you become aware of it.

Having choices is where your power resides.

When you have choices, you have control over your life. That is what is important.

Give yourself that gift of seeing the impact that stress is having on your life.

Stress Questionnaire - Self Awareness Survey

First Name*
E-mail Address*
Over the past 6 months, place a check next to ALL the ways stress has impacted you - Physically?
High blood pressure
More muscle aches and pains
Poor eating habits
Stomach problems
Trouble sleeping
Tired all the time
Sick more often
Over the past 6 months, place a check next to ALL the ways stress has impacted you - Emotionally?
I am more moody
I am more irritable
I am more anxious
I am more depressed
I get angry more often
I cry more often
I can't control my emotions
I'm withdrawing from others
I'm less tolerant of others
Over the past 6 months, place a check next to ALL they ways stress has impacted you - Spiritually?
I judge others more often
I gossip about others more
I belittle others more often
I yell at others more often
I am more critical of others
There is more shame in my voice
I let arguments get out of control
Over the past 6 months, place a check next to ALL the ways stress has impacted - What you think about?
I think about worst case scenarios
I worry about providing for my family
I worry about being laid off
I'm more pessimistic about life
I worry I won't find a job
I have trouble concentrating
I have more negative self-talk
Would you like me to contact you to talk about your results?*

Please enter the word that you see below.


For more information, please see:

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Pay it forward!

There a lot of people who have become overwhelmed by stress and how to get rid of it. I can understand this feeling. But it does not mean that good information is NOT out there. It is.

Please help a friend or loved one by sharing this information with them. Email this link to them or submit this page to your Tweet account, or Facebook or your favorite social bookmarking or networking site. Use the links below to pay it forward.

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“Ms. Churchill is the unique health care worker everyone hopes to encounter, but rarely does. She has an extraordinary gift that allows her to do much more than diagnose and treat.”
Abbie K. – Minneapolis

K., age 45, is a long term chronically PTSD disabled patient. She has had daily headaches for 20 years. Two weeks ago she reported that she had had 4 days of pain free time, and was having the exceedingly odd sensation of "smiling all the time". She and Cathi have made extraordinary fast progress together.
Dr. Cole

I referred C.L., age mid-forties, to see Cathi after a life of suffering the post traumatic stress disorder of parental sexual abuse over many years of her childhood, with major dysfunctions of alcohol and drug abuse, and with the disabling symptoms of migraine that have for more than twenty years become chronic.

She has lived with daily headaches that have not responded to any of the several drugs which have benefited many such suffering patients. She has needed chronic opiate treatment of her chronic pain syndrome.

In the few weeks that Cathi has worked with her, C.L. has begun to experience days without pain, periods of happiness, and a reduction in her opiate dosage requirements that represent a breakthrough in her stalled-out life as a single mom raising a teen-age daughter with only social security income resources.
Dr. Racer

“I first met Cathi Churchill eight years ago when she effectively helped my work unit through the stress of a hospital-wide layoff. I was impressed with her clear-minded approach and willingness to listen.”
Andy R.

N., age 60, is a hard driving attorney twenty year patient of mine who hit the wall with chronic fatigue four years ago, and began to realize she had to learn to rest. She recovered enough to return to her workaholic lifestyle when she was stopped by a herniated cervical disc and resumption of her chronic colitis.

Working with Cathi, she is discovering "the way she does life" and learning to make choices about it. She came in last week, having "danced until dawn". She is learning to dialogue with her body in effective ways.
Dr. Cole

“I stumbled upon Cathi after my recent heart attack that was brought on by stress. I was scared of having another one, and didn’t know what to do. I had lost hope. Working with her has changed my life. I’m so grateful."
Debbie – Canada

M.S., a woman in her late forties with progressively more and more disabling rheumatoid arthritis since childhood, whose most recent problems have arisen over the last two to three years as complications of immunosuppressive therapy for her disease. The complications have been associated with the severely disabling chronic pain of recurrent herpes neuralgia for more than three years, and for the past 15 months, recurrent osteomyelitis in her right lower mandible.

The second, more alarming (even life-threatening) problem has caused months of diagnostic and therapy confusion among her many consultants, three successive resections of the bone over the last six to eight months, and the still ongoing threat of more relapses of the smoldering bone infection and chronic pain only made bearable by chronic, massive doses of opiates.

In the few months since M. began to work with Cathi with several modalities: stress management, therapeutic touch, guided imaging, and others, her life has become more livable, as she has become able to bear the pain and the discouragement of unresolved disease.

She has relied on many of the methods for maintaining hope and getting through overwhelming discouragement by using the inner resources she has learned with Cathi.

My hope as her primary physician, is that Cathi and M. will be able to continue to work together to maintain that inner strength and hope as she faces yet more months of pain, and further repeated surgery.

Thank you for the healing guidance you've been able to give her thus far.
Dr. Racer

“I sought out the help of Cathi during my divorce, and found her to be an insightful and compassionate coach. Her ability to see deep into the heart of an emotionally stressful problem is, I believe, unique and I would highly recommend her service to anyone.”
P.R. – Brooklyn Center

S., age 48, is a Laotian patient of mine with 15 years of chronic abdominal pain. She has had an extensive medical worked up, and nothing ever worked. Cathi saw her over several months.

S. has improved! Cathi established a trusting relationship with her, and helped her to effectively break through her wall of silence and grief about her son's mental illness, and taught her how to "change her thinking".

S. now comes in smiling, notes some unusual continued symptoms, but no longer has chronic abdominal disabling pain.
Dr. Cole

“Control My Stress is so amazing. I want to thank you, again, for such a valuable resource.”

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