Instructions: Please read each of the following statements and place a check in one of the two adjacent boxes next to each statement indicating your response of YES or NO. 

For the correct answers, click here.

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Yes   No

     1. Do you worry about the future?

     2. Do you sometimes have trouble falling asleep?

     3. Do you often reach for a cigarette, an alcoholic drink and/or a tranquilizer in order to reduce tension?

     4. Are you easily irritated over insignificant matters?

     5. Do you have less energy than you seem to need or would like to have?

     6. Do you have too many things to do and not enough time to do them?

     7. Do you have headaches or stomach problems?

     8. Do you feel pressure to get things done?

     9. Are you very concerned about being either well-liked or successful?

     10. Do you perform well enough in life to satisfy yourself?

     11. Do you get satisfaction from the small joys or simple pleasures of life?

     12. Are you able to really relax and have fun?

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                                                     For the correct answers, click here.