Stress Reactivity Name of the patient *Name of the referring DoctorContact Number of Individual / Referring Doctor *Email AddressDate of Birth of Patient *Gender & Marital Status *1. When tasks and duties build up to the extent that they are hard to manage *I am generally untroubledI usually feel a little uneasyI normally get quite nervous2. When I want to relax after a hard day at work . . . *This is usually quite difficult for meI usually succeedI generally have no problem at all3. When I have conflicts with others that may not be immediately resolved . . . *I generally shrug it offIt usually affects me a littleIt usually affects me a lot4. When I make a mistake . . . *In general, I remain confidentI sometimes feel unsure about my abilitiesoften have doubts about my abilities5. When I’m wrongly criticized by others . . . *I am normally annoyed for a long timeI am annoyed for just a short timeIn general, I am hardly annoyed at all6. When I argue with other people . . . *I usually calm down quicklyI usually stay upset for some timeIt usually takes me a long time until I calm down7. When I have little time for a job to be done . . . *I usually stay calmI usually feel uneasyI usually get quite agitated8. When I make a mistake . . . *I am normally annoyed for a long timeI am normally annoyed for a whileI generally get over it easily9. When I am unsure what to do or say in a social situation . . . *I generally stay coolI often feel warmI often begin to sweat10. When I have spare time after working hard . . . *It often is difficult for me to unwind and relaxI usually need some time to unwind properlyI am usually able to unwind effectively and forget about the problems of the day11. When I am criticized by others . . . *Important arguments usually come to my mind when it is too late to still make my pointI often have difficulty finding a good replyI usually think of a reply to defend myself12. When something does not go the way I expected . . . *I usually stay calmI often get uneasyI usually get very agitated13. When I do not attain a goal . . . *I usually remain annoyed for a long timeI am usually disappointed, but recover soonIn general, I am hardly concerned at all14. When others criticize me . . . *I generally don’t lose confidence at allI generally lose a little confidenceI generally feel very unconfident15 When I fail at something . . . *I usually find it hard to acceptI usually accept it to some degreeIn general, I hardly think about it16 When there are too many demands on me at the same time . . . *I generally stay calm and do one thing after the otherI usually get uneasyUsually, even minor interruptions irritate me17 When others say something incorrect about me . . . *I usually get quite upsetI normally get a little bit upsetIn general, I shrug it off (dismiss as unimportant).18 When I fail at a task . . . *I usually feel very uncomfortableI usually feel somewhat uncomfortableIn general, I don’t mind19 When I argue with others . . . *I usually get very upsetI usually get a little bit upsetI usually don’t get upset20 When I am under stress . . . *I usually can’t enjoy my leisure time at allI usually have difficulty enjoying my leisure timeI usually enjoy my leisure time21 When tasks and duties accumulate to the extent that they are hard to cope with . . . *My sleep is unaffectedMy sleep is slightly disturbedMy sleep is very disturbed22 When I have to speak in front of other people . . . *I often get very nervousI often get somewhat nervousIn general, I stay calm23 When I have many tasks and duties to fulfill . . . *In general, I stay calmI usually get impatientI often get irritablePerceived Stress Reactivity Scale - Prolonged Reactivity (PrR) (Out of 8)Perceived Stress Reactivity Scale - Reactivity to Work Overload (RWO) (Out of 10)Perceived Stress Reactivity Scale - Reactivity to Social Conflict (RSC) (Out of 10)Perceived Stress Reactivity Scale - Reactivity to Failure (RFa) (Out of 8)Perceived Stress Reactivity Scale - Reactivity to Social Evaluation (RSE) (Out of 8)SUBMITPlease do not fill in this field.
