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MoonDragon's Alternative Health Information
WELL-BEING QUESTIONNAIRE - Page 2
"For Informational Use Only"
For more detailed information contact your health care provider
about options that may be available for your specific situation.
MIND
LIFE EVENTS
A = No
B = Sometimes
C = Frequently
In the last year has your life been affected by:
1. The death of an important friend or relative? A B C 2. Changes in close relationships (including marriage and the birth of a baby)? A B C 3. Moving to a new home? A B C 4. A change of job? A B C 5. A lay-off or retirement? A B C 6. Major financial changes? A B C 7. Legal problems? A B C 8. Serious health problems (yours or those of someone close)? A B C 9. Marital or family problems? A B C 10. Problems with friends or neighbors? A B C 11. Ongoing daily hassles that wear you out? A B C 12. Do you think these events have affected you? A B C TOTAL A_______ B_______ C_______
GENERAL GUIDANCE
Remember that the degree to which pressure affects you depends on how you perceive stress, how much you feel in control, and how effective your coping strategies are - whether you exercise, follow a healthy diet, and allow time for relaxation.
YOUR SCORE
- A - A high A score indicates that you are fortunate to be free of major life stressors. You might consider whether your present strategies for dealing with stress could sustain you through unexpected challenges.
- B - If you have a majority of B's, you may be more affected by life than you realized and should be alert to any possible symptoms of stress.
- C - A high C score shows you need to use stress management techniques and pay attention to other aspects of well-being, such as nutrition, fitness, and emotional support. The following therapies may be helpful for stress: Relaxation & Breathing, Psychotherapy & Counseling, Autogenic Training, Visualization.
VALUES & CREATIVITY
A = Yes
B = Sometimes
C = Never
1. Do you stay aware of political and social issues? A B C 2. Is your work consistent with your values? A B C 3. Are your leisure activities consistent with your values? A B C 4. Are you able to accept people with different values and lifestyles? A B C 5. Does your spiritual life sustain you? A B C 6. Do you feel your life has a sense of purpose? A B C 7. Do you feel you have a place in the scheme of things? A B C 8. Do you feel there is enough creativity and stimulation in your life? A B C 9. Do you welcome new possibilities? A B C 10. Do you feel you can handle uncertainties? A B C 11. Do you feel you can handle boredom or lack of stimulation? A B C TOTAL A_______ B_______ C_______
GENERAL GUIDANCE
A contradiction between our beliefs and our way of life creates uneasiness and dissatisfaction that can affect our emotional and ultimately physical well-being. Similarly, everyone has the capacity to be creative, whether growing flowers, cooking supper, or writing music, and the inability to fulfill our creative urges causes frustration and low self-esteem. If you feel comfortable with yourself and where you are going in life, you are less likely to be threatened by unexpected challenges and will have a flexible attitude that enables you to adapt to circumstances.
YOUR SCORE
- A - If you scored high in A's, you should feel a sense of commitment, coherence, and control that will enhance your ability to cope with stress.
- B - See C.
- C - High B and C scores may indicate a sense of self-doubt and unhappiness and a low resistance to stress and even infection. Make a list of the things you value and enjoy and examine how they fit in with the way you are living. Also look at areas of conflict, and what changes you could make.
COPING WITH STRESS
A = Never
B = Sometimes
C = Usually
1. Do you compulsively work, eat, smoke or drink? A B C 2. Do you feel that your life is really out of control? A B C 3. Do you experience physical symptoms when stressed (for example, nausea or vomiting, diarrhea, pain, palpitations, exhaustion, breathlessness, indigestion? A B C 4. When you are under pressure, is your mental or emotional life affected, for example, by lost interest in life, fear of disease, sleep disturbance, poor concentration, indecisiveness? A B C 5. Do people who know you think of you as being "stressed"? A B C 6. Do you find it difficult to relax and enjoy moments of pleasure? A B C 7. Is it hard to maintain good relationships with others, even (or especially) those closest to you? A B C WHEN YOU ARE UNDER PRESSURE, DO YOU BEHAVE IN A "HOT" WAY... 8. Do you blame other people or feel angry? A B C 9. Do you become aggressive? A B C 10. Do you fume inwardly? A B C OR IN A "COLD" WAY... 11. Do you become withdrawn or deny that there is a problem? A B C 12. Do you become panicky? A B C 13. Do you blame yourself or feel guilty? A B C TOTAL A_______ B_______ C_______
GENERAL GUIDANCE
How you react to pressure may be influenced by your personality. Some people behave in a "hot" or hostile way, fuming and blaming others, making themselves prone to coronary heart disease. "Cold" reactors may use up energy in trying to ignore the problems or in blaming themselves, and thus deplete their immune system and become vulnerable to infection. Other indications that you are not coping include compulsive or obsessive behavior, emotional problems such as insomnia, or physical conditions such as indigestion.
YOUR SCORE
- A - If you scored a majority of A's, you are one of those hardy characters who respond well to challenge.
- B - If you scored a majority of B's, this indicates that you may deal well in some situations but not others, and would be well advised to learn some coping strategies.
- C - If you scored high in C's, you have a coping style that is particularly vulnerable to stress. The good news is that you can learn to cope but you need to monitor yourself and make a real effort to practice stress management techniques.
WELL-BEING QUESTIONNAIRE: CONTINUED...PAGE 3
MoonDragon's Alternative Health Index
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