Rare, Medium, or Well Done?
Stress, Burnout, and Adrenaline Addiction Assessment Questions
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In the last six months, have you:
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1. Experienced a significant change in your immediate family (yourself, spouse, brother, sister, parent,
child) — death, birth, marriage, or divorce?
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Yes
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No
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2. Had a significant falling-out with a family member, close friend, or co-worker?
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Yes
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No
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3. Experienced considerable, long-term (more than a week or two) uncertainty about your personal or
professional future — whether because of job difficulties, personal problems, health issues, or
any other reason?
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Yes
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No
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4. Had to deal with serious legal or financial issues?
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Yes
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No
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5. You or your spouse/partner taken a new job with a different organization?
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Yes
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No
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6. Changed jobs within your organization?
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Yes
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No
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7. Moved?
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Yes
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No
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8. Slept more - or less - than usual?
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Yes
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No
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9. Taken a vacation of at least a week?
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Yes
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No
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10. You or a family member had an illness or significant injury lasting longer than two weeks?
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Yes
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No
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11. Taken sleeping or anti-anxiety pills (prescription or over-the-counter) or an herbal sleeping aid
(other than chamomile tea)?
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Yes
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No
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12. Taken a long weekend?
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Yes
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No
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13. Read a book not related to work or your profession?
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Yes
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No
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14. Achieved a significant personal or family goal?
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Yes
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No
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15. Completed a significant project at work?
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Yes
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No
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16. Felt significantly less interested in or involved with work and your career?
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Yes
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No
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17. Noticed that other people's jokes just aren't funny?
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Yes
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No
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18. Had an auto accident, even if only a fender-bender?
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Yes
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No
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19. Had to slam on the brakes, or nearly made a left turn into traffic?
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Yes
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No
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20. Been in touch with friends and family on a consistent basis?
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Yes
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No
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21. Noticed that you have drifted away from people to whom you were once close?
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Yes
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No
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22. Taken a chance on something that was risky, either physically, emotionally, or financially?
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Yes
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No
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23. Broken a tooth or had a toothache?
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Yes
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No
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Do you consistently:
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24. Exercise three or more times per week?
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Yes
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No
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25. Feel tired much of the time?
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Yes
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No
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26. Have trouble falling or staying asleep?
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Yes
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No
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27. Average more than 50 hours’ work per week, week in and week out?
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Yes
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No
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28. Suffer from bad dreams?
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Yes
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No
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29. Wake up before your alarm clock?
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Yes
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No
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30. Feel slightly breathless for no good reason (i.e., other than during a workout or other strenuous
activity)?
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Yes
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No
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31. Feel overwhelmed?
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Yes
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No
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32. Take on projects or tasks that aren’t really yours to do — but who else will?
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Yes
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No
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33. Believe that the best way to get something done is to give it to a busy person?
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Yes
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No
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34. Run slightly (or significantly) late to meetings and appointments?
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Yes
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No
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35. Postpone doing things for no good reason, even when you have time to do them right away?
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Yes
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No
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36. Feel resentful of other people, especially if they appear successful in your chosen field or profession?
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Yes
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No
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37. Find yourself being disproportionately emotional — quick to anger, irritable, prone to tears,
depressed?
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Yes
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No
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38. Drink more than two caffeinated beverages per day?
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Yes
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No
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39. Eat or drink carbohydrates (especially bread, cookies and pastries, anything with processed sugar,
wine, beer, or other alcohol) to relax or fall asleep?
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Yes
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No
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40. Feel slightly irritable and/or frustrated?
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Yes
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No
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41. Check work email and/or voicemail during nonworking hours (including vacations and holidays!)?
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Yes
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No
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42. Add more to your “to do” list than you can possibly cross off in any given day?
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Yes
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No
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